I'm not an economist or accountant. I'm a molecular physicist. As such, I do a sort of accounting as well: I do thermodynamics, which is basically the subject of how energy moves around.
The First Law of Thermodynamics states that energy can't be created or destroyed. So, if you have a box, or a planet, or a universe, the energy that goes into that system must equal the energy coming out of that system plus the energy that's accumulated within. So, you'd think the accounting is pretty easy, what goes in stays in or comes out. But is it always that simple?
And what does this all have to do with health care?
Well, the thing about thermodynamics is that while the basic rules are quite simple, it's not actually that simple to figure out what's going on in a particular situation. The system as a whole is simple, but figuring out the flows of energy between lots and lots of constituent parts can be extremely vexing. There are situations that make my head spin just trying to think about them. There are situations where people who are experts in the area confuse each other, because they might've defined a word just a bit differently, and as a result the numbers don't add up.
The same thing goes for accounting and economics. They study where the money is going. Like thermodynamical situations can at times, my head often spins when I try to think about things like macroeconomics and where, exactly, all the money is going. This is also why accounting standards exist - to avoid confusion and make it clear where money's coming from and where it's going. And it's also why accounting fraud exists - because by playing with definitions and obfuscating, you can easily make money seem to appear from nowhere, or make it 'disappear' to nowhere.
Physics isn't devoid of 'accounting fraud' either - only it usually takes the form of self-delusion. All the crackpots who manage to confuse themselves into believing they've created a 'free energy machine' or some other perpetuum mobile. There's thousands of them. (although most aren't actually trained scientists)
But the accounting fraud I'm talking about are the arguments so often being made in the whole debate about universal health-care; especially against single-payer systems. The usual objections here are:
"It'll require paying more taxes" and
"I don't want to have to pay for other people's health care" or some variants.
Now, the first hinges on the idea that your money is what you get from your employer before taxes. But for most, the employer is paying for their health care - which they would not in a single-payer system. It's ridiculous to assume that this cost doesn't affect your salary.
The second argument is flawed for similar reasons. You already are paying for other people's health care - through your taxes but also every time you buy an product made by a company with employee health benefits. Again, it's ridiculous to assume you'd be paying the same if the employer's expenses had been lower.
An overall increased cost of living is just a tax by a different name.
In other words, you simply cannot do the accounting of health-care in terms of your own economy, because it's not a simple transaction between you and the health-care provider. You have to account for your employer, and everyone else's, and essentially the whole national economy! By which time your head should be spinning.
Does that mean we can't say anything about health-care costs without an incredibly complicated analysis? Nope. Like in thermodynamics, the really big picture is often simpler. Heat is the motion of atoms and molecules, but I don't need to know the speed and trajectory of every molecule in a gas to know what its temperature is.
So what does that kind of big-picture analysis tell us about our health-care system? Well, most people in the US do have adequate health care. Who pays for that? The costs of that are being picked up by the workers, businesses and government. The usual suspects. Who pays in a single-payer system? The exact same parties.
Given that, we can't really say exactly who is paying how much and for what, in either case, at least not without getting very complicated. But we can still ask what are we paying, overall, for health-care - and what are we getting in return?
That analysis doesn't look so good for the USA. We pay almost twice as much overall, for our healthcare than anyone else. And yet we do not provide universal coverage, unlike everyone else. So we're not doing well in that respect.
Well, are we getting twice as much value for our money? The answer to that, by my own experience and that of so many others, is simply: No. Your average American has adequate health-care. So is that of the average citizen in other western nations. On balance, they're pretty satisfied with their health-care: Few other western nations are clamoring for an extensive overhaul of their entire system the way the USA is. (And to the extent they are, none of them view the US system as a solution. )
Hence the conclusion: We're paying more, a lot more, and receiving less for it. It's simple and pretty obvious, much like the aforementioned First Law.
If Europeans have higher taxes, it's not because they're paying more for health-care. We know it's not. It's appears that way, because a single payer system has 'honest' accounting. All costs are concentrated on one account, not distributed all over the economy, contributing to increased living costs and lower wages.
The perpetuum mobile builders all try to dazzle as well, building incredibly complicated machines until they reach they point where they've managed to confuse themselves into believing it somehow violates this very simple law. The opponents of health care reform are more malicious: Their obfuscation is intentional. It's accounting fraud. And like a physicist looking at an alleged perpetuum mobile, we should avoid being taken in by the details, but rather take a step back and look at the biggest picture. If it doesn't work there, it won't on the detailed level either.
(And if you read this far: Thanks for bearing with me on what turned out to be a lot more long-winded diary than I thought it would be)