let's say we can reach agreement that Medicare needs to grossly simplify things in order to do a better job. Providers that sign up with them must agree to a simple annual salary. They must put in a minimum amount of hours to get full pay. In a complete national health care system providing care for all ages, that annual compensation will be high enough to be that doctor's entire salary.

This piece discusses the salaries of doctors. How much will that be cut? What about the huge education costs? A doctor can accumulate from $120,000 to $160,000 in student loan debt. Just have the government pick all that up for them? Who decides who gets to be a doctor under those circumstances? Or are you ready to switch the current system for one where we import doctors from places where education is cheaper?

They can dump those 5 office billing specialists.

I can't seem to get the simple idea across to anyone that a government system is going to be at least as byzantine as the private insurance system, and probably more so. Every experience with government programs has this outcome, including Medicare (for my own part, I had to deal with NASA paperwork). No medical system is going to pay for everything sight unseen, and there will always be gatekeepers. Always.

Every time this comes up, you and others just keep plowing forward with the idea that when the government runs things, the paperwork is going to be greatly reduced. This is a weird blind spot, and I don't understand it.

If the government's backing all their business, they can probably cut way back on malpractice insurance.

Really? Does that mean that huge malpractice suits will be outlawed or severely limited, or does it mean that million-dollar awards will be paid by the government? Either way, it won't turn out well. Except for malpractice attorneys in the latter case. Talk about deep pockets.

They can choose to work out of a national health facility and not have to be in charge of maintaining drugs and equipment.

I don't understand this one. either. Somebody will be in charge of such things, and they need to get paid, too.

I'm not averse to a test system but I'm not sure you'll see the real savings until the entire system is nationalized and of course my opinion is that it must be a complete single-payer system with annual salaries as the model for compensation. That's a tough thing to run as a hybrid. In many ways, despite the obvious chaos, it might just be best to bite the bullet and take the plunge.

Translation: Even if Medicare operates at a huge loss now, we'll make up the costs in volume.