I hate to harp on one speech by Mitt Romney, but it was quite illustrative on another count. This unintentionally revealing statement is getting a lot of scrutiny today:

“Do you realize what health care spending is as a percentage of the G.D.P. in Israel? Eight percent,” [Romney] said. “You spend eight percent of G.D.P. on health care. You’re a pretty healthy nation. We spend 18 percent of our G.D.P. on health care, 10 percentage points more. That gap, that 10 percent cost, compare that with the size of our military — our military which is 4 percent, 4 percent. Our gap with Israel is 10 points of G.D.P. We have to find ways — not just to provide health care to more people, but to find ways to fund and manage our health care costs.

And why would that be? I just cannot imagine. How does Israel’s health care system differ with the United States, in a way that enables them to spend so much less on health care? Whatever could be the reason?

Well, it turns out that Israel has what amounts to a single payer health care system.

Israel created a national health care system in 1995, largely funded through payroll and general tax revenue. The government provides all citizens with health insurance: They get to pick from one of four competing, nonprofit plans. Those insurance plans have to accept all customers—including people with pre-existing conditions—and provide residents with a broad set of government-mandated benefits. Health insurance does not, however, cover every medical service. Dental and vision care, for example, fall outside of the standard government set of benefits. The majority of Israelis—81 percent —purchase a supplemental health insurance plan to “use the private health care system for services that may not be available in through the public system,” according to a paper by Health Affairs.

This isn’t the most direct single payer system in the world, but citizens pay into a fund and get a menu of health coverage options as a result. They can then layer on private coverage on top of that for additional services. The cost to the government is kept down because they bargain for the services of the competing non-profits and pay for it out of a centralized budget. The country sets the rates for the health care plans, caps hospital revenue, and uses its influence to bargain for cheaper prices. Taxes fund the system and create the budget. Oh by the way, Israel has a higher life expectancy than the United States, so quality of care is not sacrificed, and the public has a high degree of satisfaction with the system.

I don’t want to pick on Mitt Romney. It’s not like single payer was featured as part of any Democratic debate on health care. In fact, several areas where the government could have bargained down prices were given up in the Affordable Care Act. And for all the talk of an individual mandate, the system does not guarantee affordable coverage, given all the exemptions and hardship controls.

This kind of a debate, informed by evidence, about the best possible health care system in terms of both quality and cost is completely off the table in the United States. And even when a Presidential candidate inadvertently praises what amounts to a single-payer system, that debate is sure to not get kick-started, because the major parties here simply don’t agree with that approach.