It's hard to be absolutely certain that a national single-payer healthcare system would be successful, but it seems to have some basic logic on its side. The principle of insurance pooling is to spread costs over the largest population possible, and it seems like a uniform national system that tries to cover everyone would have the ultimate buying power advantage. Still, a lot depends on whether this hypothetical agency has the will to play hardball with the suppliers. It could be another case in which business has a motive and an opportunity to corrupt government. There's room for optimism, though, in looking at analogous entities like FNMA and how they've instituted controls. Fannie Mae's been on the hot seat for bad management decisions, but I know of no case in which a participating lender has managed to bribe FNMA or otherwise gotten an unfair advantage. Rectitude and fiduciary responsibility are not out of the question.
I think it would end up saving money for business. They're caught between using health insurance benefits as an enticement, tending toward increasing costs; and the drive to keep the costs down. Companies also generally understand that they need to provide uniform health benefits to all employees to avoid serious morale problems. But applying a fixed cost burden to a range of pay scales distorts their labor economics--lower-paid workers become disproportionately expensive. If employees could be assured that their basic health needs will be taken care of by an independent entity, employers could dangle gold-plated extra benefits in front of more valued employees with less risk of offending the lower ranks.
Another incentive for business, I think, is in a sense moral. We've become so accustomed to this system of employer-provided healthcare that we feel that it's a moral obligation on business to continue to do so. Which is misplaced, I think--this may surprise you, but I don't think business is particularly obligated to take care of social needs, nor do I think it's the best sector of society to deal with those things. Let business do what it does best, and let government take care of unversial societal concerns. I just get my dander up when Conservatives push for the former but want to block the latter. Balance! I say. Let us have a national healthcare system and we can lighten up on the subject of business's moral bankruptcy for failing to take care of it. Which they shouldn't have to in the first place.
I agree that such a program should be funded by business taxes, at least for a long interim period. You give good reasons why the transition has to first put the tax burden on business, but in light of my views of the last paragraph, I think long-term this is a general obligation on all citizens, because it's one of those universal societal concerns and not one just of interest to business. I'd want to take some time to make the transition from business to general tax funding, but I think that would be the right place to end up.
The numbers for healthcare spending that I use come from the UN Human Development Programme's annual reports. Just tracked down the latest one--here's a huge PDF for you to read: http://hdr.undp.org/reports/global/2005/pdf/HDR05_HDI.pdf.
Page 236 is "Commitment to health: resources, access and services". The US ranks 10th in the overall UNHDP quality-of-life rankings and so all the tables list countries in the same order, with numbers in individual columns not necessarily reflecting that same ranking. It shows the US, with per-capita healthcare expenditures of $5,274, 6.6% of GDP. The nine countries above us (overall) are spending in the same percentage range--5.3-8.3%--but the dollar amounts are a little above half our per-capita expenditure.
An interesting numbers is physicians/capita. We're #1 at 549 in the top ten, the other guys range in the high 200s to mid 300s. For some reason Italy (#18 overall) has more doctors per-capita than any other country: 606. Must be trauma specialists dealing with traffic accidents.
The bottom line is what we get for the money. Scanning some tables on page 249, the US numbers stand out from the trend lines in the immediate vicinity, always in the wrong way. We rank lower than countries above and below us in the overall rankings in terms of life expectency (77.3 years for us at #10, #9 Belgium is 79.8, #11 Japan 81.9 years, etc.). US infant and child mortality is higher. Maternity death rate is disturbingly high: 17/1000 for us, 0 to single digits for most others, though Luxembourg is looking bad at 28/1000.
That's where the perception comes from that countries with some sort of national health strategy provide better care at lower costs than America does with no strategy.
As one example, does the billions in R & D from our pharmacy companies get added to our health care costs? Other nations just get to buy the drug off the shelf.
Are you talking about R&D tax credits? The UN stats don't break down the source, but given their focus on governments, I'm guessing they're talking about direct expenditures and not tax subsidies.
From your grumblings on the subject it's easy to tell you're opposed to any solution to the health care crisis that isn't perfect. Which is to say, it must reduce the size of government, cut taxes, win the GWOT, put God back into our lives and ensure a permanent Republican majority. Such a plan doesn't exist, and holding out for it means not addressing the problem.
What stats like those from UNHDP show is that other countries are getting better results from whatever they're doing, however flawed it may be. Better to get started than to never start at all. There's always a tomorrow--we can fix the flaws we discover and improve the system. But we'll never get the chance to see the flaws and do better if we don't try. We're stuck in the worst of all possible worlds where we are now.