@woiyo,
I believe you may be ignoring important elements of the operation of an effective efficient health care system that is truly attentive to the needs and wants of those who use it.
The Medicare system is hardly the unvarnished good that you appear to imply. It certainly appears to be efficient with lower administrative overhead than private insurers require. However, that is merely a result of the differences in government accounting compared to the private sector. A private health insurer pays its own legal & enforcement costs, the retirement costs for its employees and the cost of the physical facilities and offices it occupies. Together, these are about half its overhead cost. Few of these costs are included in the Budgets for the agencies administering the Medicare Program: these costs exist, and are generally higher than those for the private sector, but they reside in the budgets of other government agencies.
In addition there are other often unseen costs associated with the "simplicity" of Medicare. The cost associated with fraudulent claims for Medicare services vastly exceed those associated with comparable private sector operations - that's why most people love to hate them. The consequences to a government bureaucrat of uncorrected fraud and waste are generally far less than for a comparable manager in a private insurer. In addition, there can be political incentives for wasteful management of government systems - as illustrated by the enormous growth of Social Security disability costs and Food Stamp costs under the current Administration.
It is also getting much harder to find doctors and other health providers who will accept Medicare patients. This is apparently a result of the low rates and the administrative chicken **** the government demands. What is the solution to this growing problem?? Shall we give more power to the government agencies that created the problem and give them exclusive control of the practice of medicine and all its providers ? That is the core flaw of authoritarian socialism. To function and resolve the adverse side effects of its own operations, it requires ever more control of those associated with them, ending with control of the whole economy it seeks to regulate. The result of course is the mediocrity and stagnation that pervaded the former Soviet system (remember "We pretend to work and they pretend to pay us"?)
People acting in their own self interest generally do a much better job than to those who inhabit bureaucracies. In the unending battle between tax cheats and the IRS, I would always put my money on the tax cheats: they are better motivated, more agile and work harder than the bureaucrats trying to chase them down. Moreover as the IRS has amply shown us, it is not immune to politically motivated corruption (and coverups) itself.
We will always have tax cheats and we will always need the IRS, however the lesson here is that if something can be done in the private sector it is generally far better to do it there than through the bureaucratic mechanisms of government. Too often we find ourselves dealing with comparisons between the reality of a private sector operation and some highly abstract vision of an idealized government system that functions with perfect efficiency and integrity. Such things simply don't exist, anymore than do Plato's philosopher kings. The unfolding reality of the ACA has amply demonstrated the reality and accuracy of these observations. I believe you are making such a comparison here.
Finally there is the question of scale. Some government systems that ride on the back of functioning private sector marketplaces can appear to work very well. However if they were expanded to fully replace the market systems on which they ride, they would fail completely. Both depend on the creativity and innovation of profit-motivated entrepreneurs for the development of new techniques and services. In the case of health care it is the development of new diagnostic and treatment systems, devices and drugs. If we were left to the devices of the Department of Health and Human Services for this, we (and the world which depends on our innivation and creativity) would quickly fall back to archaic mediocrity. Can you imagine the organization that designs your income tax forms or managed the ACA rollout running Google, Apple or Amazon ???
