I might put up with the government's inevitable restrictions on doctors' options and rationing of medical care -- which happens everywhere; it's just done covertly by way of delays and inefficiency rather than overtly by policy -- _if_ the malpractice industry were taken away from lawyers.

But we'll probably end up with the worst of both worlds -- all the governmental regulation of European/Canadian-style socialism and all the litigation trial lawyers can drum up (see Edwards, J.).

What options, currently available to private doctors and patients, would be unavailable if the government paid for healthcare?

Oh, at first, none. Then, as the program becomes more and more bankrupt, "quality-of-life" treatments (knee and hip replacements, say) will become harder and hard to get.

See, e.g., Journal of Evaluation in Clinical Practice, 10(1), "'Equity and need when waiting for total hip replacement surgery" (/doi/abs/10.1111/j.1365-2753.­2004.00485.x). Here's the conclusion from the abstract:

"A large proportion of patients had long waiting times both for an outpatient appointment and while on a surgical waiting list. There were significant differences in waiting time according to social, geographical and health care system factors. Patients with a worse pain and disability at surgery waited longer for an outpatient appointment. The longer patient waited, the worse was their pain and disability, suggesting that patients were not prioritized by these criteria. Benefits of prioritizing should be tested"

And, of course, the government will clamp down even harder on pain medication. See John Tierney's series of articles in the NY Times and on his blog: tierneylab.blogs.nytimes.com/

Then MRIs will be restricted to save money; instead of every hospital having one, only one hospital per region will. Etc. All perfectly justifiable on economic grounds, but tending to increase pain and suffering.

well thats certainly a plausible worst-case scenario, but it's also a certainty that thats where we're headed unless we change things dramatically.

I don't see how if "There were significant differences in waiting time according to social, geographical and health care system factors" that it follows that it was the government's fault. That sounds to me like those people who had better insurance policies (better jobs\richer) got attended to first.

Pain medication is its own, controversial issue. There are plenty of good arguements for restricting its abuse as well as liberalizing its distribution.

This is rather a dystopian view, but something to be concerned about, if current events elsewhere didn't refute it handily.

Forgive me for not footnoting--never my specialty--but I recall a National Geographic article some years ago pointing out that Japan (a socialized medicine state) has more MRIs per capita than the U.S., leading to a higher density of "high tech" medicine, rather than a lower one.

But we are wrong to assume that improved access to technology = improved health. It may offer additional treatment options, but people fly around the world for treatment as needed already. If such flights were paid for as part of a health plan, fewer dollars would need to be spent on keeping every region updated and more could be spent on other more mundane tasks such as vaccinations and preventative care.

I do agree, however, that trying to "economize" healthcare is a bad idea, at least as it is currently done (I recall a Slate article a month or three back on this topic) but I don't believe that less money necessarily translates to an increase in pain and suffering.

To summarize my point, I agree that long wait times and bureaucracy are anathema to good health care. I think we all do. But I don't see how a private system (and especially our system today) ameliorates that. A huge proportion of the money spent on health care costs goes to the administrative overhead of insurance companies and other middlemen today, so I'm not going to buy the arguement that a bureaucracy would waste more money. We have a bureaucracy today - and I can't think of a country that doesn't have a huge medical care bureacracy.

To me, its a case of not rejecting the good for the perfect.

I agree. Even HHS's bureacracy can't match the medical insurance's we currently have.

But as for seeing patients, new techniques and technologies are rapidly being deployed to allow doctors and patients to get together faster and more often without overburdening the system. I believe this is a nonissue, or will be within a few years.

"I might put up with the government's inevitable restrictions on doctors' options and rationing of medical care -- which happens everywhere;"

Soooo....who exactly do you think controls doctor's options and the rationing of medical care NOW? Insurance companies, thats who. Who do you think has more incentive to limit your treatment, an insurance company who profits from every dollar not spent on patient care or the government?

Yes.....its always the fault of the trial lawyers. Have you ever even seen the things that happened to the clients of J. Edwards?

What you all seem to miss is the fact that is excellent health system is only excellent for the percentage of the population that have it. the 47 million of us without it, and the large portion with sub standard coverage dont have the same rosey view of the system.