>The simple answer is that better care costs more.
>
>OK. Does costing more mean quality must be better or do you have some other comparison in mind? Example: does care cost more in California or Ohio? I ask because Ohio did better in the most recent Commonwealth study than California.

It was a "simple answer". No further basis than the concept of "you get what you pay for".

>Some specific factors include higher per capita income, burdensome overhead from both private and public insurance due to rising legal costs and malpractice costs, fewer health care workers entering the profession and of course governmental regulation and intervention, mainly through mandated employer-provided care.
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>Care to predict a % additional cost caused by each? For interest, what proportion of the working day do you suppose physicians say they must dedicate to defensive activity/administration?

The latest I read was from this : http://industry.bnet.com/healthcare/1000666/how-much-health-plan-requirements-cost-physicians/
physicians spend about three hours a week interacting with insurers; clinical and administrative staff devote much more time to it. Nurses bestow an average of 3.8 hours per physician per day on health plan work, and clerical staff invest 7.2 hours per physician per day, or 35.9 hours per week. I'm not sure what percentage that amounts to, but it surely amounts to quite a chunk of time and money.

>Contrary to popular opinion, I'd suggest that per capita spending on health care is far too low around the world and I'd cite rationing of care as primary evidence.
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>Everybody rations care though there are many drivers. It used to be parsimonious physicians ("waste is unethical") but the lawyers soon fixed that. Now it's the insurance companies with their caps and the HMOs with their policies, though I have no doubt that the lawyers will figure out ways to fix them too once they've forced the entire medical workforce to behave defensively at whatever cost.

I do not follow the logic of everyone else does it so we should too. Nor would I suggest a solution of imposing a bureaucratic institution which is subject to political whim over another which is subject to penny pinching accountants. I have and always will advocate for a return to a personal doctor-patient transactions to cover one's day-to-day health care with a catastrophic insurance plan as the safety net. If we as a people insist on universal coverage, it should follow mandatory auto insurance models rather than single payor. I physically cringe at the idea of some bureaucrat being in charge of my family's care in a life or death situation. Any plan that removes my ability to care for my family's health is a non-starter for me. Hence my aversion to any government-run plan and for that matter, my aversion to HMOs.