The idea that government-run or government-financed healthcare is less efficient, more restrictive, or less responsive to the patient is a widespread belief – and there is not a shred of evidence for it.
Take a look at this YouTube clip from a "Town Hall" meeting that features John McCain addressing a question about healthcare, and you'll get a keener sense of the political vulnerability of real healthcare reform. Amidst the rhetoric, McCain mentioned two actual ideas about reform: a federally-backed insurance pool for the uninsured, and payment in some way tied to outcomes, or at least to packages of care, rather than to whatever processes the doctor might come up with and get reimbursed for. Both of these, in themselves, are good things.
But only one specific line garnered whole-hearted applause from the audience. The line was, "I don't believe that government-run healthcare is more efficient."
This is a widespread belief without a shred of evidence for it, and many counter-examples, both in the United States and in other countries.
The percentage of money in the door paid out in medical claims by private health insurance is far lower than is paid by Medicare and Medicaid – and this low "medical loss ratio" is closely followed and highly applauded by Wall Street analysts, since that's where the profit comes from. At the same time, all providers know that, on average, Medicare and Medicaid are far more abstemious in reimbursements than private insurance – even though, unlike much private insurance, they actually pay reliably.
The most widely praised insurance programs are government-run, including the military TriCare program and the Federal Employee Health Benefits Program and, of course, Medicare. Outside of its politically inspired troubles at Bethesda, and some problems of underfunding in caring for the wounded of the Iraq War, the Veterans Administration is widely considered to be on the forefront of both efficiency and effectiveness.
People occasionally ask me, amidst talk of healthcare reform, "But wouldn't this lead to 'socialized medicine?'" "Socialized medicine" is a curious locution, the tocsin of the American Medical Association during their fight in the 1960s against Medicare – a battle cry the physicians promptly dropped when they saw their incomes rise 11% in the first year that Medicare was implemented. We have, in this country, a number of government-run and government-owned systems, including schools, airports, libraries, national parks – all kinds of things. I have never heard of anyone complain about "socialized airports" or "socialized national parks." Most people seem to think that owning and running these things is a normal duty of government.
Yet even the purest form of government intervention in the healthcare market suggested in the U.S. debates, the single-payer model, does not contemplate a government-run and government-owned system, but merely a government-paid system, an extension of Medicare to all ages. Calling such a plan "socialism" or "socialized medicine" is pure nonsense, a chimera, a political scare word with no solid meaning, yet one that many voters seem to have bought without really thinking through its meaning.
The specter behind the term "socialized medicine" is a Soviet-style scenario in which faceless bureaucrats following efficiency mandates would decide what course of treatment you are allowed, what specialists you could see, and when to cut off treatment. The irony is we already have that scenario in place for many Americans, we have just outsourced it to private insurance companies.