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If the market is sufficiently competitive, yes, I trust corporations more than governments. I firmly believe giving more power to governments results in more monopolies, generally speaking, because it creates an opportunity for the larger players to lobby for ways to create barriers to competition.
That's a pretty broad statement though, and there are certainly cases where I would prefer the government to step in.
I don't think that's true. I think you're making an assumption that the payer has an incentive to reduce costs, but I really don't think that's the case. What they do have is a lot of power over pricing, and while that could be used to force producers to reduce costs, it can also be used to shift costs onto taxpayers in exchange for favors from the companies providing the services.
That's quite similar to the current military industrial complex, the military is the only purchaser of these goods, so the suppliers can largely set their prices. A monopsony means the value of making a deal is massive for a company because they get access to a massive market, which also means the value of lobbying to get that deal is also high.
So I really don't trust that a single payer system would actually work in the US to reduce total healthcare costs, it'll just hide it. If we want to actually cut healthcare costs, we need to fix a number of things, such as:
The problems are vast and I think single payer would likely just sweep them under the rug. We either need socialized healthcare or maximum transparency, single payer would just be a disappointment.
Competition naturally degrades over time as companies go out of business and consolidate. And capital interests fight tooth and nail against large monopolies being split back up. Its more or less a miracle that it's ever happened at all and it would be naive to think it'll ever happen again.
Do you think a more direct "medical patient union" would work? Skipping a government intermediary?
I mean, I'd prefer socialized healthcare over single payer. Single payer for me is merely an acceptable middle ground. As would having a proper public option next to private care (though admittedly that would slowly erode from lobbying).
And it naturally improves over time as companies challenge established players and "distupt" the market. As long as the barrier to entry remains sufficiently low, there's no reason for a net degradation in competition.
Large companies tend to become less efficient. Yes, they have economies of scale, but they tend to scare away innovators, so they switch to lobbying to maintain their edge.
The correct approach IMO is to counter the lobbying efforts of large orgs, and that means stripping governments of a lot of their power. Regulations tend to result in more monopolies, requiring antitrust to fix, and as you noted, that's extremely rare.
Yeah, that can work. I'm thinking of having your primary care orovider offer your "insurance" policy, and they'd be on the hook to fund any procedures you need. So they have an incentive to keep you healthy, and that agreement could be a legal obligation that the doctor is doing their best to keep you healthy.
I do think we should socialize emergency services though. If a paramedic determines you need an ambulance ride, that should be free.
I prefer privatized care with transparency in pricing across the board, shortened patent durations, and some government assistance for the poor. But failing that, socialized care is probably the next best. Anything in the middle just breeds corruption.