Consider also that government, being a monopoly, has no incentive to offer different services to different people with different needs. Looking at the big social safety nets in the US, Medicare, Medicaid, and Social Security, shows us that letting the government take this out of the hands of individuals produces one-size-fits-all solutions that in reality fit none.

More over, determining needs from the top down ensures inefficiency because top down decisions will affect almost all situations in an inefficient manner. It is fundamentally impossible for a central authority to efficiently make economic decisions for a large population because they cannot comprehend enough about the situation of that population to do so. Letting people choose options based on what they know of their own needs from the bottom up is always far more efficient.

This information problem is part of our limitations as human beings, and cannot be circumvented in a central control or monopolistic situation. So, when you say this:

Once you obtain an efficient government it is fundamentally the best way to obtain health care. Or let me say the health care normally provided by a good insurance company. The main reason for the advantage is government is not bound by the onerous burden of making a profit. In some cases 10-15% profit. That is 10-15% savings. Which means the government could be 10% less efficient and still be cheaper. Of course choice will be limited just as a good insurance company limits choice.

Please realize you’re saying something fundamentally unachievable by humans. The information problem of a monopolistic situation such as this simply cannot be overcome. As an example, you say that choice will be limited in this monopolistic situation. What happens if the choice that is inefficient for most but is the only efficient choice for a particular patient is eliminated? That patient is forced to live with inefficiency just because he dared to be different. If this happens a few times, it wouldn’t be enough to wipe out the efficiency gain you think would occur. But in a sector so massive and diverse as health care it would occur so many times as to significantly increase inefficiency.

Contrast this with a market situation where a patient can choose between many types of insurance as well as paying his doctor directly. Not all insurance companies limit the same choices, making a much wider array of services available and increasing the odds of people making efficient decisions for themselves.

I would say, categorically, that government has structural incentives that do not encourage efficiency, while the market has structural incentives which encourage efficiency.

Does this mean that government can not do things efficiently? No. But it means that — on balance — government should be expected to be less efficient more often than you’d find in the market.

While you’re right that barriers to entry (usually government-enforced) remove some structural incentive of corporations to be efficient, and frankly I’d state that those corporations become inefficient bloated failures over time, just like government.

I would say that in the case of any industry, competition and profit are the most reliable ways to generate an efficient outcome. I think this is especially true in democracy, because the incentives of politicians are skewed towards electoral results, not outcomes.

In theory, the lack of a profit motive can lead to better efficiency. But the theory doesn’t hold when actual people start running things.

If you opt not to do business with a company, they cannot send officers to place you in jail for refusing to buy their product.

However, a government run company or institution can be efficient. It is fundamentally the same thing. The real question is whether it is a public priority. So for those of us that inherently distrust government, we will not gamble as to whether it can be efficient and instead pay a premium for the RELATIVE choice provided by private insurance.

Once you obtain an efficient government it is fundamentally the best way to obtain health care. Or let me say the health care normally provided by a good insurance company. The main reason for the advantage is government is not bound by the onerous burden of making a profit. In some cases 10-15% profit. That is 10-15% savings. Which means the government could be 10% less efficient and still be cheaper. Of course choice will be limited just as a good insurance company limits choice.

So really the fundamental argument is can government be trusted. In China this may give someone pause. However, in a democratic countries the real question is can democracies be trusted to manage the public good. Or should they be limited to things which private corporations can not do, which by the way is not much.