According to Gawande, switching to a single-payer system won't in itself control medical costs. He gives examples of communities where Medicare is the prime payer but where overall health care costs are extremely high. He also gives examples of US communities where health care costs are low. The difference is that in the expensive communities the model of medicine as a for-profit business predominates -- which leads to unnecessary tests, procedures and medication. In the low costs communities (such as where the Mayo Clinic is) physicians have banded together and created organizations in which patient care, not profit, is the primary driving force.
Lots of interesting facts and analysis, like:
"Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later?"
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande
Now, I do favor single-payer, because I think that it's the best way to remove the profit motive from the system and to standardize and reduce the bureaucratic overheads. But Gawande makes a strong case that single-payer is not enough to fix the problem.
