YOU CAN RATION HEALTH CARE BY PRICE, OR RATION IT BY POLITICS.

Tyler Cowen at Marginal Revolution builds a post off a lengthy comment on some other post.

Single payer’s magic has historically worked via just a few channels:

1. Some amount of monopsony allows the government to bid down medical services below market rates.
2. Political imperatives lead to lower training burdens, lower staffing ratios, and lower certainty in diagnosis and treatment.
3. Obfuscation of possible alternatives diminishes demand for costlier care.

There's a great deal of elaboration in the comment, go over to the post and read it.

I remain amused that public monopsonies such as a government health agency or a state liquor store get commendations for bargaining down the prices they pay for supplies, whilst private monopsonies such as a company town get slagged upon for bargaining down the prices they pay for supplies.  But I digress.

Professor Cowen concludes the post with a few observations on those single payer systems coming to grief.

There is a natural tendency on the internet to think that all universal coverage systems are single payer, but they are not. There is also a natural tendency to contrast single payer systems with freer market alternatives, but that is also an option not a necessity. You also can contrast single payer systems with mixed systems where both the government and the private sector have a major role, such as in Switzerland.

I’ll say it again: single payer systems just don’t have the resources or the capitalization to do well in the future, or for that matter the present. Populations are aging, Covid-related costs (including burdens on labor supply) have been a problem, income inequality pulls away medical personnel from government jobs, and health care costs have been rising around the world. Citizens will tolerate only so much taxation, plus mobility issues may bite. So the single payer systems just don’t have enough money to get the job done. That stance is conceptually distinct from thinking health care should be put on a much bigger market footing. But at the very least it will require a larger private sector role for the financing.

It's not possible, however, for Our Intelllectual Betters to develop humility.

There is, however, ample evidence that court intellectuals for Democrats design policies from a mind-set of Omniscient Expertise, whether For Your Own Good (voters are ignorant) or as Efficient Division of Labor (voters are boundedly rational and experts have objectively better information sets), that court intellectuals for Democrats often come across as snobbish and condescending (I watch MSNBC so you don't have to), and that Democrats enact policies that oft run afoul of the Law of Unintended Consequences.

Fortunately, the court intellectuals are mostly on defense these days.