Re: Hugo Shortlist 2008 (Sawyer)

If I may chip about nationalized medicine (sorry, I can't stand
socialism myself), there are some additional aspects to it besides
laudable concern for one's fellow woman.

a) In a purely elective privately-funded system, there is a pretty
strong incentive for the not-so-rich, young, and relatively healthy
not to opt in for coverage, especially if that coverage is expensive.
Conversely, the self-selecting customers might tend to be the not-so-
healthy, older folks, who _need_ the coverage.

The result, for health insurers, is pretty disastrous - you only get
bad risk customers.  So you  ramp the fees up and get more opt-outs by
the folks who consider themselves to be least at risk.

Morality:  once agreed on, universal coverage is best if compulsory,
not elective.


b) The US actually spends more money than most countries with
universal coverage.  For about equivalent life expectancy that's not a
bargain, but does sustain lawyers.

www.oecd.org/dataoecd/1/44/39616601.pdf

c) Why should big companies have to shoulder the health care costs of
their employees?  And, is it efficient for the economy at large that
an employee might want to stay in a dead end job just to hang out to a
better medical package?


The Canadian model, despite what Sawyer, sorry - his character, says,
is not perfect by any means.  There are at least 2 flaws.  The first
is that the providers are usually unionized + state sector, with
corresponding productivity, political wrangling and lack of
innovation.  That might be a good thing for Sawyer, it ain't to me.

The second is that it is prohibited to pay for care covered by the
system, regardless of waiting list duration.  For example, some guy
wanted hip surgery but the budget was out for that year.  So he offers
to pay its cost, of $2500 CAD or 3000 USD ;-).  Refused.  Now he can
go to the US, but that would have cost him more than he could afford
by far.  And the state will have to cough up the dough later on
instead of having him pay.

Strangely enough the Canadian police, military, politicians and sundry
civil servants have their own options to jump past the general queues.

France has a better, though even more costly model, where the state
pays the costs, but the providers include a sizable pro****tion of
specialized private companies.  For a while you had to be a salaried
worker, but that has changed to cover pretty much everyone.

Though I am against big government, I see public health funding (not
delivery) as one area where the state has a valid role to play.
Partly for moral reasons, partly for the economic reasons listed
above.

In any case, as populations get older its going to be more and more
difficult to find the funding, whether on a US or European/Canadian
model.

If it is such anathema for Americans to have publicly funded
healthcare, when are y'all gonna ditch Medicare?  Good policy proposal
to win an election with, that.