That's one of those heads I win tails you lose issues. I also don't have answers just questions , so let me turn it around somewhat:

If markets are the most efficient distributor of resources (in this case, health care), why does the American public periodically turn to the government for assistance with markets that don't work for them?
Health care is an issue that the American public has repeatedly turned toward the government for help.

Clearly there is something about health care issues that markets don't handle well. Unless one accepts that only those who can afford it deserve health care, the market isn't much help. Basic health care for all may not be a 'right', but it's a pretty good idea in a civilized society, part of the social contract.

Not so...you have it exactly backwards.

"U.S. hospital administrative costs rose from 23.5 percent of total hospital costs ($97.8 billion) in 2000 to 25.3 percent ($215.4 billion) in 2011. During that period, the hospital administration share of national gross domestic product (GDP) rose from 0.98 percent to 1.43 percent"

"Administrative costs accounted for 25 percent of hospital spending in the United States, more than twice the proportion seen in Canada and Scotland, which spent the least on administration. Administrative costs were notably higher in the Netherlands (20%) than in other European nation."

"In countries where hospitals receive global, lump-sum budgets, garnering operating funds requires little administrative work. Per-patient billing, on the other hand, requires additional clerical and management staff and special information technology systems. In countries where there are multiple payers, as in the United States, billing is even more complex, since each hospital must negotiate payment rates separately with each payer and conform with a variety of requirements and billing procedures. Also factoring into administrative costs is how hospitals obtain their capital funds. The combination of direct government capital grants and separate global operating budgets—the approach taken in Canada and Scotland—was associated with the lowest administrative costs."

http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs



Results

"In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for 31.0 percent of health care expenditures in the United States and 16.7 percent of health care expenditures in Canada. Canada's national health insurance program had overhead of 1.3 percent; the overhead among Canada's private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers' administrative costs were far lower in Canada.

Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations' figures exclude insurance-industry personnel.)

Full Text of Results...
Conclusions

The gap between U.S. and Canadian spending on health care administration has grown to $752 per capita. A large sum might be saved in the United States if administrative costs could be trimmed by implementing a Canadian-style health care system."

http://www.nejm.org/doi/full/10.1056/NEJMsa022033

I used the NEJM article because it is pre- ACA, just in case some think it's relevant.

Archie (I think we're familiar enough for 1st names...I can be stiff if you like)

It's not that I'm arguing the ACA is good, or even defensible, though I think it is. There are serious questions about American health care policy and it seems that every so often the issue bubbles to the top of the political ladder because of some issues the public is not happy about. There are certain things we can check on. For example, the assertion that government cannot efficiently administer a health program. Studies show that assertion is not accurate. It could be true that the American system of governance doesn't lend itself to efficiency (those built in checks and balances, 1000 yesses needed to get anything done, one no to kill that anything).

I know next to nothing about medicare and medicaid, who qualifies, under what terms.

As to the transfer of wealth and resources....at some point the American people must have agreed to it, under the umbrella of general welfare. Whether the government has the right to tax and for what purposes is a much larger discussion, of which the ACA would be just a part. Now, in general, I agree that folks should take care of themselves and that government assistance can have strings attached....working for welfare, e.g. I certainly don't want to subsidize anyone's free ride. But I also don't want to subsidize a system that generates double the administrative costs so that pencil pushers get to sleep at their desks.

I understand you feel the same...no free ride. We just have to figure a way to do that, and have a working health care system.

Most countries having single payer is a great exageration, but those who do have it, and the means to do as they want, have always come to the USA for their medical attention, because what their country provides is inferior medical care with long waits, and those that come to the USA for their medical care get superior medical care almost immediately, and they especially includes the rulers of those countries.

The Canadians, and those in the UK, especially come to the USA, or Malaysia, anywhere there is a free market medical system, whose competition makes the medical care superior to whatever the socialized medicine has to offer.

People in the USA can get medical care almost immediately, while those in Canada and the UK have to wait on average 9 months, to get the operations they need, and many die before their schedule operation time arrives.

The way Obama has handled the VA, it shows a prime example of how government runs medial care, as so many of our vets have died waiting for medical care.

So you better hope and pray we don't get what you want us to have, because then, it may be one of your loved ones that dies waiting for medical care.