Okay, let's talk Germany.

“The system is funded by contributions from employers and employees, who pay just under 14 percent of their salaries into it. Still, next year, there will be an expected shortfall of 7 billion euros($9 billion). ” 14%. Wow. Someone earning 10k per month has to pay 1400/mo for health care. Depending on your income level, you pay half and your employer pays half. If you make enough, you can opt out and purchase private insurance.

Long term care costs you another 1.7% of your income.

Germany is also considering tacking on an additiona .5% increase in costs, plus adding another bureaucracy to deal with their new health fund, which will add additional costs and could cost up to 25,000 jobs in the country.

In a deeply unpopular reform, members of the statutory insurance plan have had to pay 10 euros per quarter to see a general practitioner since 1 January 2004.8 Members of the statutory health care plan must contribute towards the cost of prescription drugs, wound dressings and bandages; 15% of the cost of other items; 20% of the cost of supports, insoles, etc; a share in the cost of in-patient preventive treatment and rehabilitation, out-patient rehabilitation, and in-patient hospital care (9 euros a day); the cost of dentures (as well as up to 50% of the accompanying treatment); and 13 euros towards the cost of travel. Some people are exempt from these contributions, including children under 18 and people receiving social assistance, war victims’ benefits, unemployment or education assistance, or assistance for the disabled.9 General practitioners are paid on a fee-for-service basis, with the fees negotiated centrally.

47.7% of Germans reported being somewhat or mostly unhappy with their health care. The German health ministry concluded in May 2003 that their health care system suffered from a lack of competition; superfluous, insufficient or inappropriate care; shrinking revenue and an aging population.12 Long waits for care are a particular problem in Germany; in a 1990 poll, 19.4% of Germans reported waiting more than 12 weeks between being seen by a specialist and receiving surgery. To fix these issues, the ministry suggested, among other measures, that they provide incentives to promote cost-effective care; perform a therapeutic benefits/cost analysis of prescription drugs by the Centre for Quality in Medicine; and finance benefits not covered by health insurance by increasing the taxes on cigarettes.

So, what exactly are the reasons of the crisis our German SHI system suffers from? Basically it is about an imbalance between expenses and revenues. Let’s have a look at the revenues of the system:

Our biggest problem is the system’s high dependence on economic performance and unemployment in particular:

:: In times of recession and high unemployment, contributions decrease immediately.

:: Also, the wages reflect the low economic performance. As contributions directly depend on salaries, they are kept down as well.

Another important reason for decreasing revenues is the demographic change, which I have already mentioned. Due to a higher life expectancy and a trend towards childlessness, the share of aged people in society is growing. This is not without consequences for the SHI:

:: An ever growing share of pensioners within the system contribute less to the SHI than active employees. Additionally, pensions do not rise as quick as wages.

:: At the same time, there are less and less active earners who are the backbone of the system.

On the part of the expenses, it is the demographic change again which is a major cause of concern:

:: A higher life expectancy results in a growing share of elderly people in our society, who naturally have higher medical needs.

:: Furthermore, the medical progress offers an ever growing range of opportunities for treatment.

:: And finally, more and more people practice a very health-conscious and quality-demanding life style.

All these factors result in an increasing demand in healthcare services and consequently higher expenses, particularly of the SHI.But is it really fair to talk about a “cost explosion” which threatens the system?

According to the renowned German Institute of Economic Research (DIW), it is not the “explosion” of costs and expenses that really threatens the German SHI system. Over the last three decades, these experts say, health expenses have shown an increase not very much higher than the average economic growth. What is more bothering is the stagnation and possibly the future meltdown of the financial foundations of the system, namely its income in terms of contributions. Over the same period of time, contribution rates have risen by almost six percentage points.

So, what do the experts recommend? They say: “In order to avoid a further increase of the contribution rates (which would be poison for the economy), it is absolutely necessary to find additional financial resources for the SHI.”

Now, I'm not defending the status quo. There are a large number of issues with our current healthcare system. But putting the government in charge is not the answer. It's bad enough having to deal with the insurance company over denied treatments and payments. But I have options there. When the government denies treatments because of costs, and they absolutely will, I will have no recourse.

So while some things in Germany, at least in certain aspects appear to be better, other aspects in the US are better, while costs appear to be comparable, and in some cases, much lower here.

Now, if you want to talk about removing employers from the equation, and simply letting people buy their own personal health insurance with pre-tax dollars, and selecting the coverages they want, I'm all for that. I'd prefer to get the employer out of the way. If they want to provide a portion of money as a benefit towards my personal health care, that's fine too. After all, most people are more judicious about spending their own dollars than someone else's dollars. That's no less true when you have employer sponsored health care than government sponsored health care. But it would certainly drive down costs, and by increasing competition, larger risk pools, and eliminating mandatory government coverage and letting people choose the coverages they want, we can have an even better system.

In the end, you can claim all the “wins” you want if that makes you feel better. Doesn't make them true of course, except in your own mind.

As to your last point, you really don't understand conservatives then. Just because Bush increased the deficit doesn't mean conservatives were happy about it. Far from it. Don't confuse the GOP in congress with most conservatives. You'll find a lot of disagreement between those two camps. And whether waste in health careand other areas dwards any stimulus plan spending is a red herring. Just because one thing is bad doesn't mean you should accept another thing that is bad.

But anyway, back to my point about underrepresentation. States with high urban concentrations get stiffed by the feds so it follows that the cities that are in these states are getting stiffed as well. So even though you think the Feds have poured money into the cities, I would wager a substantial amount that on a per capita basis you are very wrong. Cities have received less per person than rural areas. I know that the same thing happens in state government, with much more money per person flowing to out state Minnesota. I just think this should be factored in before people start talking about how much cities have been neglected by bad liberal government. It's simply much more challenging to govern a city that is underfunded and attracts a higher proportion of the poor and uneducated. You can blame the liberals. I blame the underfunding and the additional complexity. Maybe it's a little of both. I certainly don't want to defend Detroit's choice of politicians.

I enjoyed the back and forth. Sorry for starting out on the wrong note.

And of course you were able to compare us to Canada which happens in every discussion I have with a conservative online about healthcare. You guys always pick Canada as if that's the only choice. Why not compare us to Germany which has shorter wait times and spends about 60% of what we do on healthcare while insuring everyone? And Canada spends about 60% of what we spend as well so it shouldn't be surprising if they do some things less well.

I guess the larger point is that for a 40% markup on our healthcare costs, the burden is on those defending the status quo to explain why the hell we are spending so much more and if you are generous, getting similar results, while not even insuring everyone. You want to move further away from the European models that have proven to be much more efficient than our more market based model. That's ludicrous. That's anti-empirical. That's not reality based.

So you can spend all day telling me what's wrong with studies but until you find a study that actually shows that we are getting better value on our health care dollars, you lose the argument, at least on economic grounds.

And this is what drives me mad about conservatives arguing against wasteful spending. I don't really believe they care about waste and these are my two main data points to go along with the fact that the deficit increased quite considerably under Bush and his Republican Congress. They don't seem to care about out of control defense spending, in fact, they want more. And they don't seem to comprehend that our health care system, the most market driven in the world, spends spectacularly more than everyone else in the world. The waste in these two areas dwarfs the waste we'll see in any stimulus plan that will get passed.

Local governments, not the Federal government, build schools. Federal tax cuts give taxpayers the means to pay their local governments to build schools, if that's what they want.

http://heroesofcapitalism.blogspot.com/2009/01/…

There's a guy with an undergrad degree in economics. I'm sure if you comb the site you can find more. If you're looking for a high-profile tenured academic economist who's started up a business…well, I imagine they're not common. That's because time is scarce and academics gain prestige by writing, researching, teaching, etc., rather than starting up businesses.

As for changing a public agency for the better, try Alfred Kahn.
http://en.wikipedia.org/wiki/Alfred_E._Kahn

http://online.wsj.com/article/SB123275512887811…

“And what is more inefficient than investment in an enterprise that fails? Nothing.”

How about an enterprise that should have failed but is perpetuated by government (See: Amtrak). How about an investment in something with a very low upper bound in terms of utility (See: Bridge to Nowhere).

Yes, businesses fail and bad investments are made. This is part of creative destruction. This is how society figures out where we should be allocating resources. It's a discovery process. The problem with government investment is that too often there is neither creation (at least of something that people actually want) nor destruction (government projects tend to stick around).