By the way, the profit motive is of course a huge issue. But we on the left have to pay more attention to complexity. One of the problems with all privatized systems is complexity. With a multi-payer system, there are multiple companies, each offering their own plans. That means that healthcare providers and companies have to set aside money just to manage the complexity. More administrative staff to manage paperwork, more time on the phone talking with insurance companies, more time spent by consumers going over this or that plan, more time by accountants managing the complexity, more money spent on lawyers to make sense of the system. Single payer simplifies the system. Governments can lessen some of that with price controls, but that is difficult in a system like ours, especially with a legal system stacked with right wing lunatics. So, regardless of the government’s role in price controls, complexity means money has to be set aside to manage the complexity. In our system, as much as a third of all expenditures deal with managing the complexity of the system, which is a big reason why this system is so inefficient.
An example of this was given by the recent governor of Illinois, Rauner, a right wing billionaire asshole. He was talking about Medicaid in the state, which is actually a privatized managed care thing more than single payer. He said that one of the problems was the large number of plans, and he recommended lessening the options. Less options meant less complexity, and less system-wide inefficiencies. This was a right winger, mind you, and he didn’t say that with single payer in mind. But the point stands. More complexity at the system level equals more inefficiencies, and there are inefficiencies at the institutional level as well that make the system inefficient (profits, marketing and lobbying costs, high executive pay, high administrative overhead, etc.). A 2010 WHO study showed that the administrative overhead in private healthcare systems was, worldwide, three times higher than in public systems, for these reasons. It is why the privatized Chilean pension system is far more inefficient than our own Social Security administration.