We pay much more per capita, for a system that does not cover everyone, than countries pay for a system that does cover everyone. A more efficient system would cover everyone in the US at no additional cost.

Ah, but Steve - you know from all your years of fulminating against JC's that "a more efficient system" means that someone's taking it in the shorts.

You have a "more efficient system" by cutting reimbursement rates to providers. The savings from administrative costs aren't enough. You have to cut what the providers get. And then they end up being against your system, making it politically intolerable, and it meets the same fate as the "doc fix" did every year.

If people don't like the premiums for private coverage, they can move to the national health program. The VAT is stepped up accordingly. while the "JC" sees his cost for employee insurance fall.

I thought under Plan Steve, eligibility for the national health program was based on birth year? If everyone can choose to move into the national health program, rather than it being fixed by birth year, then you don't have this issue. But you pick up all the massive problems of adverse selection.

Again, the impact of the VAT will be mitigated by the fact that the providers of goods and services retirees buy, are no longer adding the cost of employee insurance into their products.

It won't even come close to mitigating the impact of the VAT. The VAT will have to be enormous to cover the cost of all healthcare in the US. Unless there's also a whopping big payroll tax and a smaller VAT - but then you don't get the lower cost of goods and services.

There's no escaping it, Steve. Changing the way health care is paid for inevitably involves major changes in who pays what. There have to be distributional effects. You can't replicate the current distribution of costs using payroll, VAT, or income taxes. You can set the taxes high enough to replicate the total amount of money, but not the distribution. Unless you have big big savings through slashing provider compensation, you can't make sure that there aren't a large number of people who are made worse off by the change. Not just insurance companies - ordinary regular people, retirees and union members and so on. And that's fatal to the plan's political prospects.

Again, that's what killed single-payer in Vermont. The fact that more than a third of workers would be worse off with the switch. That's different than what killed single-payer in New York, which is the union opposition - and that's a whole different distribution issue on the beneficiary side, since you can't possibly give everyone the solid platinum plans that the union members enjoy. But either is enough to be fatal to a single-payer system coming from the left, regardless of the insurance companies.