by Smitty
Maybe he’s explained a way around Pournelle somewhere. I should like to see such an explanation in the context of this:
Ultimately we must either ration health care (death panels and all) or restructure it top to bottom so that it is able to deliver the same or, preferably, much higher levels of care much less expensively. Proponents of a single payer health care system (basically, the kind many European countries and Canada have where the government collects premiums for everyone, sets prices, and pays bills) argue that it is cheaper than our current hybrid (and grossly inefficient and excessively) pricey system.
I agree with the single payer crowd there, but a single payer system only really makes sense under two conditions. The first, as the Spanish are discovering in a very unpleasant way, is that single payer only works if the single payer has plenty of money. If you count on the government to cover your health care, and the cost of health care bankrupts your government so that the health care system goes down as well, it’s hard to call that a success.
The second problem is related to it: single payer would be more feasible if the technology of health care has frozen. That is, if we already knew the best way to treat all diseases, manage hospitals, divide up responsibilities between different types of health care professionals and so on, a single payer approach might make sense.
The Iron Law of Bureaucracy, just to rephrase it for fun, says that homo bureaucratus lacks predators. That is, for all these metrosexual creeps may do nothing useful to add to the population of the country, they sure now how to make an org chart ‘splode.
One huge question here, pertaining to health care and everything else, is: ‘How in the world are we offering feedback to stabilize the size of the bureaucracy and trim it?’ Our first task on the path to sanity is to disabuse ourselves of the notion that the federal government should manage individual health. Yes, some in our society continue to want to make that mistake, but that doesn’t make it any less bloody-minded.

