Mark, you are getting close to understanding why single payer cannot work. But I fundamentally disagree with the idea that we could ever just "know" costs well enough to make it work. Hayek was right about this. The relevant knowledge is too dispersed, too local, and too dynamic to ever be gathered and priced correctly by central planners.
Take basketball.
Imagine single payer basketball. The government is the only purchaser of basketball entertainment in all its forms.
Fans are not allowed to just buy a ticket to the Mavs game. Instead, a central office decides who gets to attend and hands out tickets based on "need." The central planners also handle the TV deals, merchandising, concessions, and every other revenue stream. Everything goes through the government, with no out of pocket cost to any consumer.
Now teams no longer compete for fans on price, experience, convenience, or innovation. They submit cost reports to Washington explaining what it allegedly costs to run a game.
But here is the problem. If there is no market price for tickets, media rights, parking, merchandise, or concessions, how exactly do you decide what the game is worth? How do you decide what players should be paid? How do you know whether a courtside seat is underpriced, overpriced, or priced just right? You do not. You are guessing.
So bureaucrats step in and decide the approved reimbursement for a regular season game, a playoff game, courtside access, halftime entertainment, parking, and concessions.
What happens next?
If the approved rates are too low, teams do not magically become leaner and more innovative. They cut where fans can feel it. Fewer games. Worse arenas. Less staff. Delayed upgrades. Lower quality. Longer waits. Less access. Maybe smaller market teams shut down altogether.
If the approved rates are too high, you do not get efficiency either. You get lobbying. Every team hires consultants to prove that its fan base is poorer, sicker, more rural, more complex, or otherwise deserving of special payment adjustments. Soon the league is no longer about basketball. It is about coding, compliance, modifiers, subsidies, carveouts, and political influence. Teams make money not by pleasing fans, but by persuading Washington that their costs are uniquely deserving of reimbursement.
And once government is the only buyer, there is no real price discovery left. There is only political bargaining disguised as pricing. The Knicks get one deal. Rural teams get another. Old arenas get subsidies. Favored constituencies get carveouts. Every interest group insists that without one more special adjustment the whole sport will collapse.
Fans are told this is fair because nobody has to pay at the gate.
But of course they still pay. They pay through taxes. They pay through rationing. They pay through fewer choices. They pay in lower quality. They pay by being told which arena they can use, which game they qualify for, and how long they have to wait.
That is the key point. Knowing the accounting cost of hosting a basketball game does not tell you the right price of a ticket. Price is not cost. Price emerges from supply, demand, scarcity, quality, preference, and competition.
A central planner can know what it "costs" to turn on the lights, pay security, and clean the arena. That still tells him nothing about what a seat is worth to fans, what kind of experience teams should offer, which franchises are efficient, or where new arenas should be built.
Healthcare is even less suited to central planning than basketball. It is more heterogeneous, more personal, more local, and far more dependent on dispersed knowledge. The fantasy is always the same: if only the people at the top had better data, they could set the right prices. No, they could not. They would still be guessing, just with nicer spreadsheets.
Traveler at Newark Airport welcomes ICE's help: They're here to help. They're not bothering nobody. As long as they can get me on my flight, I'm good to go.
Most peoples lives are the exact same way
They get near the end and look back on how interesting it could have been or how much opportunity there really was had they actually been present throughout it.
Then they wish they had more time
Randoms online will project their opinions on to you as if that's what you must do w/ your life (Including me), IRL none of our opinions are relevant to you.
Should is the most oppressive word in the english language.
The only time "should" is beneficial is once you develop the wisdom in knowing when it "should" be implemented or disregarded.