In other words its lack of political will than anything else. Pretty strong words for true liberal policy from someone who makes certain proggers cry.

He lays out very important talking points for single payer. I can only think of one person who I'd rather have on the side of single payer, but the current president's spokesman already ruled out single payer as inherently a bad idea, if not in those words exactly. Too bad we have to hate Bill Clinton and adore everything Obama says and does.

CLINTON: I -- I don't want us to wind up getting universal coverage, which is morally imperative and necessary, and not do enough preventative and primary and cost control changes about the way the system is organized to bring our costs in line with our competitors. Because if we are 5 points of our GDP more on health care than any of our competitors and we're getting no better results, now we get worse results. But if we get no better results, then it will weaken our economy over the long run and we won't be able to afford the system.

[...]

CLINTON: Well, I think it's more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.

GUPTA: Sure.

CLINTON: And Medicare is quite popular.

The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers' administrative costs and employers' administrative costs in health care that we would not waste if we had any other country's system.

On the other hand, if you look at the experience of Germany, France, Japan -- that don't have pure single payer systems, they have more mixed systems -- their costs are actually slightly lower overall than Canada's. So there's something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it's not all up to the political bodies.

[...]

GUPTA: Do you think there is a degradation quality of care with a single payer system?

Is that a concern?

Should that be a concern?

CLINTON: Well there's no evidence of that in Canada that I'm aware of, except for excessive delays, which they always try to come to grips with.

excessive delays in canada?

that's a fraser institute talking point. fraser is one those free market think tanks, and they distort this for all it's worth. canada's waiting times problems largely mirror our own, there are areas of the country without enough doctors and hospitals -- generally the remote rural areas and some inner city areas. add on to that that we have unmeasured, and unmeasureable, waiting times due to lack of ability to pay or denial by insurance companies.

the mixed systems are cheaper than canada's single payer?

it's true, in recent years at least, canada pays slightly more per capita than germany and france, but as percent of gdp, both france and germany pay more than canada. if he's going to compare our costs to other countries in terms of gdp, then he's being disingenuous to compare canada, france, and germany to each other on per capita spending instead of spending as % of gdp.

competition is controlling prices?

i don't know enough about germany, but in france and japan, it's not competition that's keeping the costs down, it's that the government, in negotiation with doctors and hospitals, sets the rates that they can charge. also in france, the government tells the insurance companies what benefits they have to include in their coverage and how much they can charge for it. the companies are allowed to set their own rates for supplemental insurance and compete there, but not on the social [non-profit] insurance. and the social insurance in both germany and france is better than most of our gold-plated cadillac for-profit plans here.

competition does work in france to some extent. the doctors aren't required to follow the govt rates, and can charge more, and you can pay out of pocket or buy supplemental [for-profit] insurance to cover the extra, but most doctors in france elect to follow the standard rates. because the patient/consumer/customer is guaranteed to be able to pay for necessary care, through their publicly-funded social insurance, they can freely elect which doctor and hospital they want to patronize, and can freely elect to pay higher rates, which makes theirs a functioning market.

it's worth noting that supplemental for-profit insurance in europe covers about 5% of all healthcare spending. for all that bill clinton speaks of the insurance industry's professed willingness to play ball this time around, i don't see anybody asking them to cut back to that level and become largely non-profits.

so yeah, he's right in that there's more than one to pay for and deliver good health care.