My question would be that if the well to do are certain to get the highest quality of care, why would it matter for them which system we follow?

Unfortunately the uninsured children born everyday will never have the ability in a private system to make even the most basic of care a realistic possibility.

And if the care given to those of a higher status will remain at a higher level of quality than that of the less fortunate, why would we continue to pay a far greater rate per service provided than the other countries you mentioned?

You see sir, it is not the private system that we use. It is in fact the profit system that we use. In any system the goal should be treatment while maintaining costs. Instead, ours is profits while debating treatments.

I hope you have an idea on how to improve our private system. Because even the worst care for the less fortunate is preferred over no care at all.

Thanks for sharing your thoughts.

We must remember that, other than size and power, there is no significant difference between corporate (HMO/MCO) and national socialized (NHS/MCO) controlled health services. The formal cartel arrangements between a NHS and government abroad are far bigger and more powerful than the formal cartels in the US between many corporate health services and public sector Medicaid HMO progams (with fixed government fee schedules) and the informal CMS HMO-Medicare Advantage programs with, for the moment, massive subsidies and serious cost over-runs.

All cartel systems say the same thing: “give us your money and we’ll take care of you”. The music of “coverage means care” stopped for some Medicaid patients long ago and predictably will stop for Medicare Advantage patients, when the “payer” partner hands out a bag of care money that’s half empty. ObamaCare has ramped up the “coverage means care” music volume to include both public and private sector markets. The potential insurance corporate cartel partners are at this moment spending advertising millions to “play”. [Some would argue that the AMA is a play-thing haplessly spending its future].

ObamaCare is a means to create a US cartel system with power to franchise insurance-providers (HMOs and agent ACOs) and fix prices of services and insurance (both HMO premiums-benefits and agent ACO capitation rates). Cartel systems are an old discredited and defunct capitalist plot to enlist government in market control “for stability” (code: monopoly). These centralized command market controls were avidly adopted, always for some “greater good”, by every modern socialist government (Soviet or Fascist) or mixed socialist government (Western democracies). Too bad that the single goal of national socialization, i,e., total mobilization, to win a war of survival (WWII) does not work when there are millions of individual goals in peacetime microeconomic sectors. All those socialized microeconomic systems (mixed or not) failed in the last century–after 1980 in the West and after 1991 in the Soviet Bloc. This makes it curious that a command and control system that no economist would recommend for any other microeconomic sector today, is now the favored policy maker “cure” for whatever ails our own US medical microeconomic sector.

The question is why don’t socialized microeconomic systems work? What is the common factor by which all command and control systems failed? Goodman has said it well, but here is my favorite paraphrase of what the liberal economist John Cassidy wrote: no central authority, however brilliant the managers, can accomplish the functions of freely determined prices for the allocation of labor, capital, and human ingenuity (Cassidy J. The price prophet. The New Yorker. February 7, 2000:44-51.)

The other historical and economic references for what happens in planned microeconomic sectors and the fate of nations unable to deregulate (the old Soviet Bloc instead imploded) are: Yergin, D, and Stanislaw J. Chapter 5, Crisis of Confidence. In: The Commanding Heights. New York, NY: A Touchstone Book. Simon and Schuster; 1998:128-129, 137. Landes DS. Chap. 28. Losers. In: The wealth and poverty of nations. W.W. Norton & Company, New York, 1999: 495-499. McNeill WH. Part II. The human condition: an ecological and historical view. In: The global condition: conquerors, catastrophes, and community. ‘Princeton , New Jersey; Princeton University Press, 1992:127-131.

So when next we hear about health care nirvanas abroad dominated by government controlled health services and budgets, they nonetheless are cartels having serious cost problems (inflation hidden by global budgets, queues, and infrastructure erosion) and diminished quality of care. The rhetoric of “equity and fairness” becomes Orwellian sophistry where not true.

We have the same problems in the US dominated by less powerful insurance corporation controlled health service delivery and budgets. Classic cartel formation, capitalist for profit or socialist for “equality” and “fairness”, even if run by good willed authorities, will not “cure” medicine’s cost and quality problems or in the US mean that a government cartel “partner” might not be co-opted by the corporate. But more important, complex regulated command and control microeconomic systems don’t work–something that applies in equal measure to the medical microeconomic sector.

Goods and services can be distributed with money or by political agents. One method works and the other does not. A complex “coverage” system is neither money nor care. In contrast, it ought to be relatively simple to make sure that everyone has money for health care whether from a job, savings, or a safety-net subsidy. This just might work, since we have tried everything that does not.

Once, when buying a home, it was one problem after another, and I finally said, if we were meant to get this home, it wouldn’t be this hard. I’m sure we’ve all bought something, with multiple problems, then looked back and said – there were plenty of signs we shouldn’t have followed thru with the purchase.

Reminded me of this health care bill. If it is the right thing to do, why are they having so much trouble getting it passed? It seems to be one problem after another – 15 months worth so far. An more to come if it becomes law – legal challenges, etc.

We’re all more impressed with the person who will admit it’s not working, accept they are wrong/defeat and start over than the person who won’t admit they are wrong, won’t accept defeat, and just keeps pushing so they won’t be wrong or lose. Too big of an ego to admit their idea’s aren’t popular.

People dislkied Bush’s stubornness on issues like security, terrorists, etc. When will someone publisize Obama and Pelosi’s stubbornness in not listening to the 72% of the public that says stop or start over on healthcare.

Like the decision to buy a home, just not this home, we need to reduce the cost of healthcare, just not this ‘reform’.

How do we get this message to the people?

My son is 6’7”, and went to school in Canada. In the 9th grade, he missed basketball tryouts. In the 10th grade he was told that anyone who was not on the team last year would not be on the team this year. In the 11th grade he was told they were not looking for tall kids because they had to give the short kids a break. In the 12th grade he was told they did not have enough jerseys. SO he never played basketball in high school.

He suffered a head trauma in Canada, and waited 3 hours to get an x-ray and was discharged with no CT or MRI.

He ended up getting a full free ride to UT Dallas in pre-med and business, but transferred to California after a year, and has just been accepted into George Mason for graduate studies in economics.

Further, you buttress my old argument that economics is best understood as a subset of evolutionary biology (or behavioral ecology).

I think you know I’ve been thinking and writing about this for years, i.e., “…who gets what under socialism.”.