> Here, the cost is foisted disproportionately on employers and their employees

There is no such thing as a free lunch. Employers and employees still pay when the money is run thru a government payor instead of a non-government heath plan. There is no magic money that appears by changing who cuts the checks to providers.

This assumes a zero-sum economy, which is not how the healthcare economy works at a national scale.

Hypothetically, competing insurance companies would push prices down. In practice, the market isn't a fair market (even before you get into issues like "People need medicine to live, so a market is a bad tool to parcel out medicine because price the patient is willing to pay is unbounded"), so insurance companies tend to add cost through paperwork, managerial overhead, accounting overhead, and cases becoming more expensive to treat as delays in preventative and early-intervention care cause issues to become chronic and urgent-care issues.

When the payer is the government, the government can say "The price of insulin is 2% above cost of materials" ... and it is. And when the money is flowing from taxes to government to healthcare, instead of employees to employers to insurance to healthcare, a company isn't asking itself "Can we afford to take on more employees right now if it's going to cause our healthcare insurance costs and employment taxes to go up," because the decision of how many people to employ is decoupled from the question of how much in taxes the company will pay.

That’s a rosy hypothetical in which people get lower costs and better service through a change in payors.

That doesn’t change the fact that the costs of healthcare will still be “foisted disproportionately on employers and their employees” because those are the revenue generating population.

Government is already the largest payor in healthcare through Medicare and Medicaid [0] (funded by taxes “disproportionately on employers and their employees”). You’d think that they would already have the market power to do whatever they’d like with prices.

0. https://www.cms.gov/research-statistics-data-and-systems/sta...

The government has quite a bit of power to set cost, but not as much as in other countries because in the United States private health insurance is a huge industry and makes up a huge alternate payer. This includes health insurance coupled directly to hospital networks, which is almost certainly double dealing itself in a way that makes the numbers meaningless.

Is your claim that the rosy picture of low transaction costs and price controls is only achievable when government payouts control 17% more of healthcare spending? The 49% already performed by federal and state govt isn’t enough? From the above link:

The private business share of health spending accounted for 17 percent of total health care spending,

That plus the private spending. So you'll be looking at a number closer to like 90, 95% of the entire market. Because in terms of how many employees companies can afford to hire, it also matters when employees are getting sick all the time because they don't have a basic standard of health care due to either the company not offering insurance or the employee being unwilling to pay the premiums; people who pay their own way for medical costs tend to defer spending on preventative therapy and wind up costing a lot more because they end up in the emergency intervention train.

Wait, the private spending number is stuff people pay out of pocket for, like OTC, deductible, co-ins, and copay, right? Those are the mechanisms intended to balance availability with discretion to not over-consume.

For additional clarity, I probably need to find the data source for what CMS describes on that link.