What Startups Need To Know About Health Insurance in 2013

"Since the US acts as a safety valve for Canada (look at the number of Canadians getting treatment in the US)..."

While I don't doubt that there ARE Canadians who travel to the United States for medical treatment, I'd be curious as to the percentage of the population.

Growing up in both countries, I can say with certainty I had less hesitations in the Canadian system. In America, I worry all the time about switching jobs and figuring out healthplans. In Canada, I always assumed that I'd be covered in some form.

> My premiums go up by double digit percentages every year because "costs" keep increasing

Because of government regulation.

> The more private companies run our lives (especially something like healthcare), the more they will be able to dictate our choices (what we eat, risky behavior etc).

Not violently, under the threat of fees or imprisonment.

> The only difference between corporate control and government control is that we actually have some say in how the government controls us because at the end of the day we control the government.

That's not true. The principal difference is that government uses violence to maintain control, while companies almost universally do not (except when they do so by lobbying government). Businesses go out of business all the time, which is a prime example of society exercising control over unpopular businesses, but unpopular governments very rarely cease to exist. I'm not sure how you can justify the claim that society has more control over government, with its vast military and police system and its nationwide campaign of mandatory taxation, than over businesses, which (with very few counterexamples, most of which involve employing government violence) only make money through voluntary transactions where both parties believe they are benefiting.

When you list the downsides of public and private health care, you leave out the primary distinction, which is that with private health care each person gets to choose which (if any) provider and plan to pay for, while with public health care there is no (or less) individual choice.

Now, I won't deny that a "perfect public health care system" sounds ideal, but the problem is that the definition of "perfect" varies from individual to individual. This is not a particularly profound or original idea: any dictatorial control is great for the people who enjoy the choices the dictatorship makes. You can easily apply this to some industry that is mostly privatized, like automobiles. If the perfect vehicle for Bob is a 4 door sedan with great gas mileage because Bob commutes and drives his family around a lot, then a "perfect" system for Bob would probably be one where 4 door sedans were the only automobile produced, and every household paid a set fee and was issued one of these sedans. Bob's costs would almost certainly go down, both from the economy of scale from only manufacturing a single type of car, and from the distributed fees. But that system is really bad for Joe, a farmer who really needs a large pickup truck and will probably have to buy one himself while his government-issued sedan goes to waste. Joe could argue (and I would agree) that even though switching to a privatized automobile industry might cause higher prices for a lot of people (like Bob), the individual choice is the important factor.

There is a big difference between single-payer and a nationalized healthcare system. In the latter, doctors are government employees. The UK and Canada work that way, and choose to spend very little money on healthcare. But most peer nations have single-payer non-nationalized healthcare systems and choose to spend more than Canada and the UK, but much much less than the US.

With a single payer, the commercial service objective is warped: patients and doctors are motivated to make care decisions that are inefficient or even harmful, and customer service or premium care for people who want it is eliminated.

See, this is not true at all. Consider the French system. Basic care is provided by a government plan, but doctors don't work for the state and everyone can supplement with private coverage if they want to pay extra.

The old joke in Grand Forks, ND was that "Friendly Manitoba" license plates outnumber ND license plates. It was a big enough issue that in 2009, Canadian health agencies were contracting with hospitals in border cities[1]. Plus, the US has a lower cancer mortality rate than Canada.

One driving factor is waiting lists in Canada are much longer than in the US (well, except at IHS). This drives Canadians to seek treatment in the US. There are several studies done on this.

The only real advantage to the Canadian system is that it isn't tied to your employer. In pretty much all other respects[2] it is not as good in either time taken or results.

[1] http://www.freep.com/article/20090820/BUSINESS06/908200420/1...

[2] Costs are debatable, but do remember the government costs money and is not free

But the existence of the French or Japanese or Dutch healthcare systems do. At some point, empty theorizing has to give way to observation of how these systems actually work in practice. In practice, all of these systems provide care that is much much cheaper than the US system with very high levels of public satisfaction.

Also, I think you're wrong in claiming that the Republican party rejects single payer for those reasons. The Republican party loves single-payer healthcare for old people. They expanded the single-payer program for old people massively and they make political hay out of any efforts to reduce its spending.