It effectively works the same as the fast/cheap/good model that freelancers know so well. When you stop looking at "should" and start looking at "possible," you realize that medical treatment is neither a privilege nor a right. It is a commodity. It is a resource.
And most important of all, it is finite.
The US (and I'm speaking in very broad strokes here) chose a model where you get what you pay for, but everything is available for a price. With multiple payers, multiple options open up
The bulk of what I've seen of industrialized countries with some form of NHS or single-payer system turns that on it's end. Cost is lower for everything, but quantity is based on availability, quality likewise. you might be able to afford procedure X or treatment Y, but you'll be in for a long wait, or a specialist for it can't be found. With no other payers (read: customers), there's no space for a market outside the system.
Back to the US. You can get anything you want for a price, but who pays? Nobody wants to (and several can't, whether it's a broke individual or a program budgetary limit).
Which is where the argument always boils down one way or another: who pays? And for what? A lot of what we're seeing from hospitals closing to doctors retiring early to clinics refusing to accept aid payments is that a huge swath of the payment programs (everything from commercial insurance to medicaid and medicare) simply will not pay for what it costs. Which means the providers (doctors/hospitals/clinics) raise prices elsewhere.
This is why economics of medicine sounds batshit insane. It's not that a motrin and a tongue depressor costs pennies on one end and over a hundred dollars on the other, it's the huge fucking tail of hidden costs desperate for a revenue stream to come from somewhere.
Add in the three big money sinks in American medicine: malpractice, EMTALA, and the FDA.
Malpractice suits are big business. Everyone knows doctors are rich, and juries love to soak 'em when they fuck up. All well and good, but that drives up malpractice insurance premiums for everybody, especially in fields that are needed right now, like GP, pediatrics, and trauma. When it costs too much to go into the business, people don't go. This affects not only how many and what type of skilled labor you're going to find in a given market, but what procedures they're willing to perform.
EMTALA operates as an unfunded mandate. Hospitals have to provide initial care to anyone who arrives regardless of whether they can pay if said hospital wants to get Medicare/medicaid funds, but EMTALA provides no additional funding to cover it. So every time someone who can't pay for it rides the ambulance to a facility, your cost for an aspirin at that hospital goes up a tenth of a percent. Because the money for that service always comes from somewhere.
Third is the FDA. Research into new drugs and therapies cost out the ass, in prices that are Hollywood-level insane. The West Wing said it best: "the second pill cost 'em four cents. The first pill cost 'em four hundred million dollars."
And yet, the US leads the world in biomedical research. Grabbing a few-years-old Forbes article, the U.S. publishes 40% of the world's biomedical research. That's way beyond every other industrialized country in the world. Our closest competitor is the UK, with somewhere around 6%.
When you look at who's making new drugs, miracle drugs, new prosthetics, new therapies, new treatments, more effective treatments, every single measurable leap, stride, and step forward in saving lives and bettering lives, there the US is at the top of the pile.
Money. Filthy lucre.
There's gold in them thar sick people!
That's why drug companies fucking despise generic equivalents. They're trying to make the Harry Potter of painkillers: make 'em for $200 million, make $Billions on them. Then some fucking asshole from Canada or Shanghai or wherever makes bootlegs off of their work.
So yeah, we're dragging the planet's medical industry kicking and screaming into the future. And everyone else is using what we build (we also collaborate research more than any other country, too).
And that, honestly, is what scares the fuck out of me about the possibility of single payer in the US.
Not the fact that single payer is single controller.
Not that I don't have sympathy for people too scared or in pain to tell whether the boot on their fucking neck is an insurance executive's or some bureaucrat's.
It's that without that profit motive, without that chance to work your ass off, be smarter and tougher than the competition, and make fucking bank in the process, our advances in medical technology grind to a halt alongside the rest of the world.
It all ends there. Not just for us. Worldwide.
Then we're in for another long, dark time of stasis. Maybe not as long as the stretch between oh, Galen and Da Vinci, or even from Da Vinci to Pasteur. But it's gonna be there.
Is there corruption and greed in our hospital admins, drug companies, insurance companies and related industries? Oh hell yeah.
Is there corruption and greed in our bureaucracy? Yep, there too.
But they're both also forced to do what they can with what we have.
And we're back to those three tiers again.
Our costs will go down.
But our quality and quantity will go down with it.