[falien]

Only 22 states have more than 5 million people. They have even fewer households. The whole idea of economies of scale is that they work better the bigger they are. Depending on the application there will usually be an equilibrium point, but your definition seems to be inverted. (And what serious politician was arguing for an immediate single payer system? Public option is just a government competitor to private companies)

[jerf]

"The whole idea of economies of scale is that they work better the bigger they are."

You just blipped over my point and did nothing to address it. Economies of scale aren't magical. They have diminishing returns. What economy of scale do you get at 100 million that you don't get at 10 million? That's a real question. If you can't answer it, or you answer it with something that just boils down to "Uh, something", you haven't countered my point.

But you know, even that's beside the point. People have completely lost the ability to understand freedom nowadays, which is why we're going to lose it. The alternative isn't "Federal plan or nothing", it's not even "Federal plan or 50 state plans", it's "Federal plan or States acting on their own". Believe it or not, and I realize this may be a cognitive shock which I recommend you actually think on for a moment, if poor little Rhode Island doesn't want to strike out on its own, it can actually form a partnership with, say, Delaware. Or nowadays for all geography matters, with California. If that doesn't work out, it can leave, it isn't stuck. Or it can choose to go on its own. Or it can leave it up to its counties. Or it can say "stuff it" and stick with a regulated private system. If the economies of scale are so all-important, than you shouldn't need to force people to take advantage of them at the point of a gun, they should choose it on their own!

(The real problem is that there almost certainly aren't any hidden economies of scale left. Where would they be hiding? Big Medicine is pretty Big already. "Economies of scale" is just an argument people make and hope you don't think about the argument too hard.)

It's never a choice between "the Feds do it" or "we sit on our hands", unless you've become so helpless that that really is your only choice. (And "you have to do everything on your own" isn't the other choice either. There's a ton of other options.)

And then we can find out what really works, because no plan survives contact with the enemy. Not even Federal plans.

[falien]

I didn't blip over your argument, I rejected your premise. Economies of scale mean it works better the bigger it gets (up to a certain point in most cases which I already said, whether that point in this case is greater than a state or less than a country I'm not going to make any sort of claim on). If I'm manufacturing a widget my fixed costs aggregate over all widgets produced. A prototype is extremely expensive. The first 10 million are much cheaper. The next 90 million are even cheaper than that. Yes the benefits get less drastic on a per unit basis, but the total savings for that last 90 million could still be extremely significant. Whether this actually applies to health care I'm not about to say because its incredibly complex, but the idea that it would work is not an outrageous one.

Now that I'm done defining what scaling means... I think it would be great if the states could actually get it done, but the lower the office the less scrutiny is placed on an elected official and the more influence insurance companies can exert on them.

>The alternative isn't "Federal plan or nothing"

I'm well aware that federal action is not the only possibility, but I and many other people think it is the best one which is why we support it.

>you shouldn't need to force people to take advantage of them at the point of a gun

Who is advocating this? I would support single payer despite being in the class with incredibly low health care costs, but I know thats not going to happen any time soon so I advocate a public option. As the name implies, it is an option, not mandatory (as opposed to the boondoggle that actually got passed which I'm only okay with because it does have redeeming qualities that make up for the corporate handout). I believe state governments simply don't have the resources to set a system like this up.

Other arguments for federal action on this issue:

- it is a fundamental human right that must be protected at the highest levels. States protecting free speech doesn't mean federal doesn't need to.

- a uniform minimal baseline is desirable, on top of which the states can build how they choose.

>Big Medicine is pretty Big already.

Its objective is not to provide health care. Its objective is to generate profit. It is extremely good at generating profit, but not as good at providing quality health care for anyone who needs it.

>It's never a choice between "the Feds do it" or "we sit on our hands"

Who has ever said that it was? It may be the best choice we can get done.