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July 29, 2009



A comparison of US and Canadian health systems:

A single-payer system has already been tried in parts of the world to great success. Why is there so much fear and stubbornness in this country?

Nathan Smith

It is not really at all clear that health care in all those other countries is better than health care in the United States. That they spend less proves nothing since they may get worse service, and in fact, in some respects they certainly do: wait times for key operations are much longer in Canada, for example. Often people point out that life expectancies are no shorter and sometimes longer in other countries that spend less than the US does, but to use life expectancy as an indicator of the quality of a health care system is very invalid. Longevity depends on many factors other than the quality of health care, including diet, exercise, stress, accidents, homicides and suicides, and perhaps race and genetics. The US has more obesity than most other countries, which is correlated with health, and that is just one anecdote suggesting that American medicine has an uphill battle. Also, other countries are to some extent parasitic on US health care, because drug companies often make their profits here and (are forced to) sell at marginal cost abroad. These extra monies spent on drugs are not wasted; they finance pharmaceutical R&D, which benefits not only America but the whole world.

And just because a single-payer system has worked with some success-- "great success" understates the problems-- elsewhere does not mean it would work well here. Americans are accustomed to a lot of what Arnold Kling calls "premium medicine," high-cost diagnostics and treatments with arguably little value-added, and which are often not supplied elsewhere. We might continue to demand them under a single-payer system. In that case US health care would become still more expensive, while losing some efficiencies and flexibilities that the market encourages.

Medicare may serve as a "natural experiment" in how single-payer health care would work in the US. If single-payer were more efficient, we should expect Medicare to provide lower-cost service for over-65s than private health care does for younger people. This does not happen. Health care for elderly Americans, financed by Medicare, is just as much more expensive, proportionally, than health care in other countries, as health care provided by private insurance is.

All of this provides strong grounds for skepticism that a single-payer system would provide better health care in the United States, and for fears that it might make things worse. Certainly it appears that Obamacare will *exacerbate,* not mitigate, the deficit.

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Health-care Reform, Particularly a Public Option, Do the "Sky is Falling" Scenarios Have Much Merit?

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We might continue to demand them under a single-payer system. In that case US health care would become still more expensive, while losing some efficiencies and flexibilities that the market encourages.

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Where can I read the new US health care act?
You know - the actual document itself.

Or maybe a non-partisan (if that's possible) overview of it. Both would be good


hi...i just came across your post, so thought I'd comment anyway, even if its over a year after the original post!.... the right to healthcare does not materialize unless there is "perfect obligation"...you might agree with the moral force of an act (here, provision of free medicines), but this is not enforceable - not an actual "right" - unless you find someone willing/forced into funding for the same.
Incidentally, all the steps you enumerate for making this right possible are all supportive of a larger role for the private sector; if you view it in another way, the cutting down of health care costs could also be furthered by, say, country-based suspension of patent rights, and generic medicines.

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i an entire lifetime, what %age will suffer from some form of ill health at some point.

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