It's easier to write an op-ed than fix healthcare

An op-ed in today's New York Times argues for a public option in healthcare using Haiti as an example:

The sudden availability in Haiti of free high-quality care from foreign doctors put enormous competitive pressure on the private local doctors, who had already been working under difficult conditions. Watching this situation unfold, I found myself wondering if the same would happen to private medical services back in the United States were our government to suddenly provide high-quality, low-cost health care.

The writer does realize that there's a potential problem with this solution: if public healthcare were to charge prices below the market rates, then competition from it would drive private providers out of business. To prevent that, the author proposes a public-private partnership: the government provides good quality, low-cost healthcare and also subsidizes private providers so that they can remain profitable.

This idea has some huge problems. First and foremost, it's too vague to even be a start of a productive discussion. It may work or it may not; the devil is in the details and those are lacking. Second, using Haiti as an example in a discussion about US healthcare is completely ridiculous. It may be fairly easy for the government to "suddenly provide high-quality, low-cost healthcare" in a country of 9 million people with a GDP per capita of $1,300. What on Earth makes you think it would be possible in a country of 300 million people and with the GDP per capita of $47,000? Returns to investment are diminishing with its size, and investments in healthcare in the US are currently gigantic. There is simply no room in the US to lower the cost of healthcare to patients without making it more expensive to providers. Another thing is that Haiti is receiving huge amounts of foreign aid that can be used to pay for healthcare; the US can't really count on those. The funding for healthcare in the US has to be found within its own economy.

But the main problem is that of huge differences in scale; whoever wrote the op-ed seems to believe that returns on investment increase linearly with the investment's size. Take this quote, for example:

It is clear that the American health care system functions at a much higher level than its Haitian counterpart does, but that’s mostly a matter of national wealth.

In other words, while it may be true that the US spends a bit more on healthcare than Haiti does, it's only because the US is a tiny bit richer. So clueless it's actually funny.