Asymmetrical Information

I think it's quite clear that these polls actually reflect how things are being portrayed in the media right now. We had very similar polls when we were first starting to come out of the post-9/11 recession: most people felt very secure in their own economic prospects while simultaneously being very worried about the overall state of the economy.

Numbers like that don't reflect anything at all about the current state of our economy, or in this case our current opinions about health care. They just reflect the fact that Americans, as a whole, are very compassionate people who worry about how their fellow Americans are doing. When the media shouts at us all day that everybody else has it horribly, we start to think it must be true, and we want to help them.

We just don't want to give up all the greatness of our own lives to do it.

I think that the real issue here is that the American public understands that there is no free lunch. It has been my experience that supporters of both a single payer system and universal health care have not done the sums. They want "affordable" health insurance, but one that has no restrictions on pre-exsisting conditions, which negates the insurance aspect of the plan, and without some sort of rationing negates the affordability. There is usually an anecdote about personal experience, meaning "I need someone else to pay for this".

I've been following the future President Romney's "Get Health Insurance OR ELSE" legislation in the Commonwealth of Massachusetts very carefully. His premise is pretty simple:

#1) The Commonwealth kicks in $1,000,000,000 of tax payer money, per year, to private hospitals to reimburse them their expenses on treating uninsured individuals.

#2) The Hospitals are forced to do that becaue they are required by law to treat everyone, to stabilize everyone in the Emergency Room, regardless of whether or not they have insurance.

#3) So in reality, (according to Romney) everyone in this country HAS Health Insurance.

#4) Why not take that $1,000,000,000 that the Commonwealth is already spending, and offer some subsidized health insurance (or subsidies to buy a decent private health plan) to some of the 500,000 Massachusetts residents who aren't already covered?

Governor Romney's "anger" (much that it is) is that he sees 100,000 of his 500,000 uninsured, as 20-something-year-old kids, who are recent college graduates who went looking for work. In this economic recovery, finding high paying jobs for college grads is still a little tricky, but finding high paying temp and consulting jobs is a piece of cake. Much of those kids are making big bucks, doing temp work on a Help Desk, writing code, configuring workstations, and the like.

Oh, and they have lots of expendable income to go skiing, mountain biking, mountian climbing, paint-balling, and motorcycling on the weekends.

And if they get hurt while they are having fun, their temp jobs offer no health insurance protections.

So the Commonwealth winds up paying for these kids' emergency room bills, and these kids gross $1200-$1500/week as temps. They can afford health insurance, but can't be bothered. Romney can't stand that, so he had the legislature create a law that forces them to get health insurance from the private sector. I can certainly understand this reasoning (even if I don't totally agree with the outcome.)

Romney has my vote (and I think he wins the election in a ROUT), but I really wish he would have pushed harder for making "Catestrophic Health Coverage" the law of the land, not just heavily regulated health insurance. If Romney wants these kids covered so his government isn't footing the emergency room bill, and he wants to make it compulsory, at least force them to get a Catestropic Plan. That might have passed the Heavily Democratic State legislature as easily as regular health insurance. Why make the kids pay $250/month for health insurance, when the real Emergency Room coverage only costs $300-$400 a year on a Catestropic plan?

Paul, I'm going to sidestep the meat of your comment, and ask why you give the responsibility of the bill to Romney? I understood the bill was an initative from the legislature, both houses of which had their own plans that were difficult to reconcile. And that key players outside the legislature, including HMOs (which lean Republican in Mass.) and private industry, worked with the state government on the bill to help create a workable compromise. Harvard Pilgrim Health Care was given particular credit.

Romney has no clout with the legislature and spends most of his time in South Carolina and Michigan these days. He did fly back to veto the assessment on companies that don't provide insurance.

Unlike New Coke, we won't be able to ignore socialized medicine once we get it.

The left is doing a pretty good job of equating 'federal goverment as single payer' with 'unlimited free health care for everyone'. If they can keep this idea alive, we are likely to get 'single payer' eventually.

I have insurance and I am not at all happy with the current system. Costs are too high, getting higher, and it doesn't look like there are any effective checks to keep them from continuing to climb. I recommend Arnold Kling here--his commentary is the most sensible discussion of health care I've seen.

The attribution to Richard Epstein seems to be in error.

"When push comes to shove, insured Americans will take the devil they know over government promises."

I wouldn't bet on it. Even insured people will worry about what happens if they get fired tomorrow. But unless costs are controlled, fewer and fewer people will be able to afford insurance-of-the-kind-Americans-want anyway.

It was Romney's idea. You could ask any of the State Legislators (and State Rep) and they will all say the same thing: this was Romney's baby, and he will parlay this right into the White House. He decided he wanted to do this when he saw that $1,000,000,000 line item in the state budget.

Romney has no power in Massachusetts State Politics, absolutely none. The Massachusetts Democratic Party runs that state. And since there are 120+ Democrats in the Statehouse (to the 20 some odd Republicans) the Democrats have a Super Majority. They can (and have) voting uniformly in over-riding every one of Romney's vetos.

That's a good mark for Romney, then. Thank you for following up.

Oh, and they have lots of expendable income to go skiing, mountain biking, mountian climbing, paint-balling, and motorcycling on the weekends.

And if they get hurt while they are having fun, their temp jobs offer no health insurance protections.

No, but their motorcycle or auto policies often do go a long way toward defraying the costs. In any case, as a whole, this group you describe -- high-paid men in their 20s -- consume a vanishingly small portion both of the cost of health-care generally, and the cost of emergency care specifically. We're talking less than 1% of overall costs, which is how so many of them can get away with going bare on coverage.

And many of them undoubtedly WOULD take-up private insurance, if private insurers actually were permitted to charge them rates that reflected the actuarial reality of how tiny their risk is. Massachusetts' guaranteed issue and community rating laws make that impossible. The Romney bill allows for a small discount to the youngest policyholders, but still nothing like actual risk-based "insurance."

It's a tax on young workers. Faced with the reality that consumers will rationally opt not to purchase coverage that costs more than it's worthy, Massachusetts has decided to hold a gun to their head and make them a health care offer they can't refuse. You know, for "their" own good.

The Romney bill allows for a small discount to the youngest policyholders, but still nothing like actual risk-based "insurance."

This is why I was so rooting for Catestrophic Health Coverage to fulfill the legislative obligation to the Commonwealth. Apparently it doesn't.

I'm not so sure about that 1% figure (of uninsured 20-somethings) at the Emergency rooms. You might be right. I have no counter evidence, to dispute you.

The 1% figure is for total health care costs. I don't have specifics on the EMTALA-related costs attributable to uninsured, well-paid men in their 20s. But there are some reasonable guestimates you can make around some of the national ambulatory care statistics, like:

1. Nearly a third of all emergency visits are related to respiratory arrest, cardiac arrest, or cardiopulmonary arrest, most of which are concentrated in the 65 and over age group.

2. Another quarter or so are related to obstetric deliveries or complications -- which we've yet to see strike a man

and

3. To the extent that the third major ambulatory care category for ED patients, accidents & poisonings, could involve significant numbers of young men, it is nonetheless skewed by disproportionate numbers of VERY young men (under 15 -- especially the poisonings part) and minorities (blacks are 86% more likely to utilize emergency room services than whites). Which is not to say that some of those blacks couldn't be high-income males, but probably not enough to account for the disparity in utilization.

Adding that all up, while young high-paid males may account for more than 1% of EMTALA costs, they're still a pretty darned small piece of the pie, and an almost invisible piece of the larger pie.

Romney has painted his plan as if their decision to go uninsured was THE problem of our health care system, when in reality, young men consume virtually no health care at all. He's just found a unique way to fund his plan by passing a tax that falls wholely on the demographic group least likely to earn public sympathy.

Apparently, people said they want universal coverage, guaranteed by the federal government.

In other news, a majority of persons polled also favor free candy and ice cream, assuming "free" means that it operates well and other persons bear all costs.

The most sensible suggestion I've ever heard is to to scrap medicare, medicaid, the VA, and every other form of government healthcare available in the US, and reconstitute the entire system as a series of public clinics that offer basic-care physicians and emergency services, to everyone. The private market could still provide these services to those willing to pay, and all specialist-type care and elective surgeries would have to come from a person's own pocket, or private insurance.

It would guarantee that everyone has access to basic and preventive-type care, and if executed with some intelligence (*cough*), it could not possibly cost the US taxper any more than what we presently have.

When the mass media is busy telling people how rotten the healthcare system is, strongly implying (while never actually saying) that poor working folks are dying en masse outside of hospitals because they couldn't afford treatment, it surprises me very little that people think the health care system is in trouble. After all, if a person listens to the media, they'd have difficulty avoiding the conclusion that they're among a very very rare breed of Americans who have the option of going to a doctor when they're sick.

Thus conditioned to believe that the poor are dying by the hundreds of thousands for lack of affordable medical care, their charitable instincts kick in and prompt them to say "yes, we should definitely do something about this horrible situation". Voila...instant groundswell of public opinion favoring drastic cures for a problem that doesn't actually exist.

But then, if they believe the mass media, they probably also think the Rosenbergs were innocent and we're losing the war in Iraq, too. Unless you're predicting the outcome of an election, the opinions of the majority are pretty irrelevant to the facts on the ground.

Anony-mouse is right on target. Of course people want health care to be cheaper. For most people in this country the increases in their compensation goes mostly into health care and has for a long time now. But, as the Mouse noted, that can't happen without basic reforms in health care delivery.

No, the poor aren't dying by the hundreds of thousands because of a lack of health care. That's because of Medicaid and laws compelling emergency rooms to accept any patient that presents him/herself.

But the number and percent of people uncovered by either Medicaid or health insurance is rising and unless there's some kind of reform the pressure for fully socialized medicine in this country will become irresistible for one simple reason: the people with health insurance can get tuberculosis and other communicable diseases from their nannies, maids, handymen, security guards, and other folks without health insurance.

The original post seems oddly theoretical to me. We have government run health plans today and we have private ones. We can actually see which people like better.

The polls I have seen report higher satisfaction rates with Medicare and the VA health system than with private plans. For example:http://www.cmwf.org/publications/publications_show.htm?doc_id=221504

Likewise on costs, my understanding is that private plans have to be subsidized to get them to compete with Medicare.

I could be wrong about both of the above, but we don't need to treat the issues as theoretical.

Tom

I recall a summary of a consultants report that said that care was 4-5 times more expensive than private sector. The VA is, to some extent, a University setting and, at higher rank, you see fewer patients and contribute in research or clinical supervision. The VA expanded in 1957, during the presidency of former General Eisenhower, to cover non service connected illnesses the administrative determination of which can be arbitrary and, as in the case of W/C in Texas, prejudiced against the patient.

Maybe in this topic area, you might cover travel for medical care such as Coronary Artery Bypass Grafts in India; it is much cheaper there. Also we tend to think of a government sytem as the NHS in the UK and Ireland where the government is pretty much it. Is there a mixed system in France and Spain?

Tom G --

Isn't there bound to be more happiness with the public system because you are paying far less for it and likely getting more? (As opposed to saying "I've paid for this and I'm not getting my share back" as we are used to with private insurance.)

Klug,

Fair enough. Although I expect most people on employer plans are unaware of what they pay for health insurance.

The survey results I linked to had responses to variety of different questions, most of which did not relate to cost.

Tom

Up here we've had single payer for 35 years and for a long time it seemed to be great. You simply went about your life and never gave it a thought. Up until the 90s, waiting lists for surgery were not an issue. As costs exploded in the 80s, goverments constrained by the need to control taxes and spending at the same time chose to limit supply, in a price managed monopoly environment, which naturally and inevitably caused the current specialist and hardware shortage that is the basic problem in Canada today (and in some areas, GP shortages too).

In the news last week was that 9000 patients in Montreal had their surgeries cancelled and delayed in 2005. Today, if you get sent to the ER, or need to go to the doctor for something, no worries generally. But if you are diagnosed with cancer or heart disease, you can't be sure you'll be treated in time any more. The alternative is to go to Vermont.

The basic reality has sunk into Canadians finally; if the single payer does a good job, it's great, but if the single payer messes up, it stinks, and the worst part is there is no recourse.

There isn't much pressure to abandon the system totally, but I think most people would like to see private care alternatives. Governments have resisted this mainly for ideological reasons, but since a recent Supreme Court decision against government bans on private care, the changes are starting.

John in Montreal - it is interesting that single payer is preferred by people unless they get sick. I don't say that as a mere slam to the Canadians and Europeans. We spend most of our time not-sick. The comfort of knowing you have a floor under you is powerful.

Once you've been accurately diagnosed and had proper treatment (or prescribed for chronic conditions) , who wouldn't want single payer health care? The problem is getting through those first two conditions.

I agree with Matt C, check out Arnold Kling http://www.tcsdaily.com/article.aspx?id=060106C for good articles on Universal vs US health care on an overall basis.

No one has really mentioned the cost side and/or the rationing of care. As an American living the past 10 years in Belgium, my marginal tax rate is about 60%. For my company, another 25-30% of my gross salary.

On top of this is a co-pay every time for a doctor visit, operations, giving birth (3 kids delivered here). 4 patients in a room unless you have a private insurance supplement.

The basic care has been good, but the hospital infrastructure is not on the same level as in the US. And treatment for seniors, operations get postponed (problems with my father-in-law getting an operation).

I agree with those who have already suggested the castostrophic coverage is the best way to go, and then people can add on if they want.

WJ-

I agree with those who have already suggested the castostrophic coverage is the best way to go, and then people can add on if they want.

In 1992, I was working for a 'computer services' company... the guy working along side me(who I trained into his job) was completely pathetic- yet he got an effective $10,000.00 raise over me(on the same $30K/yr salary I was earning at the time) simply because he got married (company-provided health insurance for 'spouses'/'children' and the tax benefits for marriage/dependents)...

I was a single male, late 20's at the time. I soon quit that job-- I have only had a privately purchased "catastrophic care" plan since...(5K deductible- started at $260/yr as a 29 yr old smoker in 1993- currently about $900/yr).

My total "out-of-pocket" health-care costs over the last 12 years have been less than $7,000.-- and over $3K of that was for a "lasik" operation in 1997--(Notice my "voluntary" free-market payment in the "early adoption" of this technology!)
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Oops! Did I forget to mention I also bought a new $150,000.00 condo-- I paid cash!- simply by investing the other $6,000.00/yr I would have been paying for the 'typical' "health insurance coverage" every year for the last 12 years?
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But, I'm almost old now--- (42- same age as when my father died...)-

When I'm 50 or 55, it will then be time for 'universal health care'!

(paid for by people younger/healthier than I...)

Boy, does this remind me of the loaded "surveys" that I participated in when my county was trying to justify a massive campaign for a sales-tax increase. The questions were all apple-pie stuff like should we keep firehouses open, improve transportation, etc. There was no part of the survey that talked about whether you thought you were taxed enough, whether you thought the county had too many useless and overpaid bureaucrats, etc.

There was a "free comment" part of the survey where I ripped into the tax, but that was doubtless ignored by those who need to quantify things. After over $1M on propaganda spent by the civil service unions and various government parasites pushing the tax increase, it went down in flames, thank God.

Another reason we may eventually get single-payer healthcare system is that now large companies have begun seriously looking at the amounts they pay for employee health insurance, including health insurance for retirees, realized that they can push these costs onto taxpayers, and are starting to push for single-payer. I think GM's CEO has made at least one statement in favor of single-payer. I predict more will follow. That will add these companies' lobbyists to the push for single-payer. I don't know whether this additional support will push it over the line, but I'm not optimistic.

Larry,

Don't be deceived, companies like GM calling for single payer health care don't represent the norm, their just like anyone else who wants to consume more than they produce. GM, and several other unfortunately union riddled companies made some bad expensive chooses about locking in high health care costs. They are now seeking to transfer those costs to others.

Most businesses, while not happy with their current health care bills, are bright enough to understand that they will pay much more to go the single payer route, either through direct taxation, or overtaxing of their customers.

The only businesses calling for single payers are the ones who figure that they can come out ahead because their cost of health care is so much higher than the level that by spreading it out to everyone else. Most businesses aren't in the position. It's basically another variation on government bailing out pension plans and other overpromises companies made to their union employees.

From first-hand experience, I would choose the UK's National Health Service over private U.S. healthcare.

I've just returned from more than five years in London. My two children were born in National Health Service birthcentres and my daughter's life may have been saved by fast work of physicians who treated her for meningitis.

I paid more in taxes, both nothing for insurance. It's difficult to compare the costs, but I suspect the UK single payer system might be very similar in costs out of my pocket.

I have plenty to grumble about with the UK system. We had to clean our own room when my son was born, got better treatment only because we demanded it of the staff and often were frustrated by lost test results.

But doctor's made house calls, there was system-wide support for my wife's desire for natural, drug-free childbirth and we enjoyed same-day appointments for sick kids.

Didn't Clinton's plan fail in part because HMOs argued they could contain costs better than the government regulators? Few people would buy that argument now.

I wonder if some politicians can make a convincing argument for nationalizing healthcare by focusing on added security for U.S. workers. With lower healthcare costs, U.S. manufacturing looks a lot more competitive.

GM isn't alone. Plenty of companies are fighting to reverse the collective bargaining agreements struck in the 1980s and 1970s that offered free healthcare and final salary pensions to retirees.

I was watching some talking heads TV show the other day making the point that people basically agree with the Democrats. They had polling data on all the various issues (education, health care, the economy, etc...) and people sided with the Democrats on almost every issue. The one exception was national security.

The pattern is not that people agree with the Democrats. The pattern is that people support whichever has the largest government involvement. I sometimes think our victory over communism was pyrrhic. Their ideas have won even though they don't actually work.

We are number one at healtcare......spending, that is! But when it comes to results....we are 48th(life expectency). I cant believe all those socialists who spend half as much as us and live longer dont see the wisdom of our free market!!! They must just be jealous.

I cant believe all those socialists who spend half as much as us and live longer dont see the wisdom of our free market!

I can't, either. Go look into how they count infant mortality, and adjust that "48" accordingly.

Then go figure how much of life expectancy is a product of individual lifestyle choices, rather than general quality/availability of healthcare, and adjust your reckoning again.

Then go look into how many life extending pharmaceuticals and procedures were developed in the US, versus how many were developed in socialist healthcare systems, and create yet another weighting factor.

Then, and only then, does your snark have any hope of finding a target. I'm not saying you won't win that argument; only that you definitely don't have an argument now.

A small question. In single-payer or nationalized healthcare how do you figure in quality-of-care? All I see is questions on quantity. I am a military retired officer. I use the miltary healthcare called Tricare (I have access to the VA medical establishment). Guess what, when I moved dwon here to Texas and asked all my neighbors who were the best doctors for the family, not one would take the government insurance. The ones who would even talk to me said that they lose money on Tricare patients. I got the same results in NoVA just outside the Pentagon during both stints there. Only in Shreveport,LA did the 'good' doctors take the military healthcare.

Bottom line, unless you force ALL Dr.s into the system the best will form alternative systems that will effectively ration the best care. Since why would best Pediatricians take the same pay as some Dr. Schmoe at the county hospital? (Paraphrasing from my retired Dr. neighbor).

And I know no one who is going to cover my kids orthodontist bills (est $5K/kid over the next 3-5 years).

Then go look into how many life extending pharmaceuticals and procedures were developed in the US, versus how many were developed in socialist healthcare systems, and create yet another weighting factor.

The FDA essentially waits for Europe to finish the drug approval process before the FDA concludes their process. It causes a several years delay to use Europe as a testing lab. There have been assertions that the delay costs far more lives than it saves and the wait is motivated more by CYA. But I don't know enough to review that critically.

Go look into how they count infant mortality Okay, I'll bite. How is their counting of infant mortality different from in the states?

Personally, I just don't care too much for conventional medicine except if it's a crisis. But it's hard to get conventional doctors to do the tests I'd like. God forbid the government comes in and makes them even more set in their ways. At least now I can take my cash to a private clinic if I want.

What we need more than anything, I think, is better QC of doctors.

But that's just my 2 cents.

Okay, I'll bite. How is their counting of infant mortality different from in the states?

In the States (and Canada), stillbirths are normally incoporated into infant mortality counts, and concomitantly, are more commonly treated with heroic lifesaving measures first. The same is NOT typically the case elsewhere, which skews comparisons of infant mortality significantly, and average lifespan somewhat. This aspect is rarely appreciated by persons who wave either of these two figures around as evidence against the US healthcare system.

My uncle (on a friday)in the UK was told to come in on monday after calling in having symptoms of a stroke. In the US they educate us on the symptoms so we can get in within 3 hours and receive the meds to counteract the stroke.

I can't, either. Go look into how they count infant mortality, and adjust that "48" accordingly.

The US, Canada, and the Nordic countries all report infant mortality similarly, yet the US has worse infant mortality than those countries. In addition, when you look at statistics that combine infant mortality and stillbirth rates, the US still does worse.

Then go figure how much of life expectancy is a product of individual lifestyle choices, rather than general quality/availability of healthcare, and adjust your reckoning again.

You just made an own-goal. If the health care system isn't the deciding factor, then why don't we switch to socialized medicine if it is cheaper?

Then go look into how many life extending pharmaceuticals and procedures were developed in the US

And we could look at how many fewer of these there would be if the government did not socialize the costs of the basic research used as a foundation for the development of these things.

Here's what we know: a well-designed socialized health care system in the US would, almost certainly, cost less than the current mess, either improve health or leave it no worse off, and lead to increased satisfaction with health care. Opposition to it seems to be mostly ideological rather than outcome-based. I'd like to see us use markets where they work best and try other solutions when markets don't work best, but that isn't possible when some people have a religious faith that markets always work best.

There are issues with medical care expenditures in the US that may or may not have similar parallels in other countries- that 50% of the US population is responsible for something like 20-30% of health care expenditures, while 1% of the population is responsible for ~25% of the health care costs in this country. How do you fix that sort of thing?

A small data point comparing the US and UK for health care. I have sleep apnea. Current studies show it increases the risk of diabetes, obesity, heart disease, stroke, senility, and liver disease (everytime they turn around they are finding it contributes to something new).

Fortunately, it's highly treatable with a CPAP (continuous positive airway pressure). It's basically a little machine that slightly ups the pressure in your airway while you sleep.

The problem is, many people can't tolerate CPAP treatment without a humidifier. In the US, physicians generally prescribe, and insurance companies generally pay for, the humidifier with your CPAP machine. From what I've seen on CPAP support boards, in the UK this is not true. Now the studies are and have been there for years now showing MUCH better results for sleep apnea patients with humififiers. This is why they are broadly prescribed in the US. In the UK, no humidifiers.

Just a small data point.

You just made an own-goal. If the health care system isn't the deciding factor, then why don't we switch to socialized medicine if it is cheaper?

That was not an exclusive-or statement, therefore the above logic is fallacious.

And we could look at how many fewer of these there would be if the government did not socialize the costs of the basic research used as a foundation for the development of these things.

We certainly could, and it might well show that not-insignificant proportion "x" of all drug research begins with government funding. How would it modify our understanding of what happens to the R&D process thereafter, particularly in the comparison to the socialized healthcare economies?

Here's what we know: a well-designed socialized health care system in the US would, almost certainly, cost less than the current mess, either improve health or leave it no worse off, and lead to increased satisfaction with health care. Opposition to it seems to be mostly ideological rather than outcome-based.

If you get to invent and conform your expected outcomes to a best-case scenario and crown them with a just-so argument, then you cannot fault your opponents for leaning on ideology in theirs (if indeed they are).

I'd like to see us use markets where they work best and try other solutions when markets don't work best, but that isn't possible when some people have a religious faith that markets always work best.

This line of criticism applies equally well to persons who have a religious faith that markets cannot adequately serve healthcare needs, and that social healthcare systems can and must. Clearly, social healthcare systems can go both directions, as illustrated by a comparison of the doddering Canadian and UK systems to the more robust systems found elsewhere (many of which, though social in their organization, use market-principle pricing mechanisms to constrain moral hazard).

Considering that the US has never actually tested a national healthcare system, and that the various social healthcare offerings it does have are commonly plagued with the metaphorical death-by-a-thousand-cuts, what assurance do you have that a social healthcare system would not follow the same route, ultimately making matters worse for all in spite of the good intentions?

How would it modify our understanding of what happens to the R&D process thereafter, particularly in the comparison to the socialized healthcare economies?

Who is suggesting socializing drug research? I would suggest fully privatizing it. I don't see any reason for drug companies to continue sucking at the public teat.

If you get to invent and conform your expected outcomes to a best-case scenario

That was best case? I can come up with cases a lot better than that. That was a reasonable prediction given the experience of other countries.

This line of criticism applies equally well to persons who have a religious faith that markets cannot adequately serve healthcare needs

Should you ever find such a creature, feel free to point it out. I prefer market solutions, when they work.

Clearly, social healthcare systems can go both directions, as illustrated by a comparison of the doddering Canadian and UK systems to the more robust systems found elsewhere

Yet even doddering systems, apparently, can deliver better results than the US system. All the more reason to scrap the system we have in favor of socialism, isn't it? After all, we can model our system after the most successful socialist system rather than the least, can't we?

what assurance do you have that a social healthcare system would not follow the same route, ultimately making matters worse for all in spite of the good intentions?

There are already socialist health care systems in the US, and as pointed out above, the satisfaction of the users of these systems is higher than the satisfaction of other alternatives. This should be a clue to the less than clueful.

'Apparently, people said they want universal coverage, guaranteed by the federal government.'

What they want is private health care paid for by someone else.

"Then go figure how much of life expectancy [in other countries] is a product of individual lifestyle choices"

And of non-choices: Walking miles a day because you can't afford a car to get to work and the public transport only comes so close to your house and to your job. Eating less because food is expensive.

That was best case? I can come up with cases a lot better than that. That was a reasonable prediction given the experience of other countries.

Actually, it's an optimistic prediction that ignores the elephant in the room: other countries administer their systems over a far smaller population base. In Europe, for example, the largest population operating under one government is Germany, I think (82m). France and the UK come in second (about 60m each). The others are smaller yet.

Should you ever find such a creature, feel free to point it out. I prefer market solutions, when they work.

I'm pointing at it now. Neither the assumption that the healthcare market has failed in the US, nor the assumption that a social system would work better, are shown conclusively by objective evidence. Your evidence, as cited thus far, is heavily cherry-picked. Yet you appear quite willing to run with both of those premises and chide those who don't accept their bases without question, so what else am I supposed to think?

Yet even doddering systems, apparently, can deliver better results than the US system.

...until they explode. Canada is clearly running in that direction as we speak. Nice artful, dodge, though.

Oddly, I was conversing with a UK acquaintance the other day, and spinning off from the fact that my younger sister had just completed dental hygiene school, I happened to ask how dental care was structured under the UK NHS. He said that in recent years, because of the way NHS payments are currently structured to compensate dental hygiene practitioners, many dentists have dropped out of the NHS entirely and gone into fully-private practice. You can pay out of pocket for dental care, but it is exceedingly difficult to get an appointment under the NHS.

Which sounded to me suspiciously like what has happened with many US doctors in regard to Medicaid/Medicare: the compensation bureacracy is so onerous in its structure, many doctors simply refuse to deal with it.

All the more reason to scrap the system we have in favor of socialism, isn't it? After all, we can model our system after the most successful socialist system rather than the least, can't we?

My, are you optimistic. The last serious attempt at that was nothing of the sort (HillaryCare), and the one state that attempted to adopt the model anyway (Tennessee's TennCare) saw the good intentions ride merrily away in a handbasket.

There are already socialist health care systems in the US, and as pointed out above, the satisfaction of the users of these systems is higher than the satisfaction of other alternatives.

And as I am attempting to point out now, this ignores a lot of peripheral evidence about how well these systems operate from a more objective perspective.

Generally speaking, unless you really screw things up, most people are moderately happy to take free handouts. That doesn't really tell us much about whether the system is efficient and sustainable, especially if its scope were vastly expanded.

This should be a clue to the less than clueful.

Ah, there we go! Kind of like burping an infant: you know by the crying that they need to let one out, but sometimes a little time is required.

Universal healthcare provided by the government would not lower U.S. private pharmaceutical research. Price controls on drugs are what does that. But how in the world can you get Universal healthcare without price controls on drugs? Universal free health care would lead to *much* higher government expenditure on pharmaceuticals, so politicians would find it expedient to push for price controls to lesson that cost.

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