Paul Krugman and Robin Wells review three books on health care and provide a thorough discussion of the issues we currently face on this topic. In the opening summary, they remark:

The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There’s now a large body of evidence on what works and what doesn’t work in health care, and it’s not hard to see how to make dramatic improvements in US practice. As we’ll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation’s health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from “integrated” systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.

Two points in this paragraph seem worthy of emphasis. First, that “the government pays directly or indirectly for more than half of the nation’s halth care.” And second, that the many players who have a hand in delivering this care “add cost without adding value.” Hospitals, both for-profit and non-profit, have a stake in perpetuating their own existence, and with the government reimbursing them for so much of their care, they pass the increases in costs for medical labor and technology on to the government. So in this sense, we already have a system which is largely dependent on a single payer. It’s just that there are lots of middle men — hospital insurance and billing and quality review departments, and insurance care management teams and billing departments, that eat up funds.

The article has seven sections which question how health care spending has gotten to be such a huge part of our economy, how the system for employer-based health care was created and is now unraveling, what Medicare and Medicaid have to do with the problems and solutions, how the Bush plan for “consumer-directed” care is largely a diversion and a misdiagnosis of the problem, what kind of single-payer system might be possible, and the fear of rationing being a result of single-payer. Finally, the authors conclude that, because of the immense pressures of lobbying and free-market ideology, the health care system in America is probably destined to get worse before it gets better.

I highly recommend reading the whole thing.