[netcan]

A competitive free market is more likely to develop better medicine.

Well, yes & no. A free market does develop good medicine in much the same way as it develops good everything else. But what you are usually measuring something essentially different when evaluating medicine.

You could say that a free market system should produce more medicine. But (as free markets do) this is distributed unevenly among the population. that's OK when you are talking about shoes. Your free market will produce more shoes then a nationalised shoe industry. But a lot of those will end up in the closets with 20+ pairs or in the form of $500 shoes. Same with medicine.

The US is a good place to go if you want $10m surgery. But if you are measuring public health: life expectancy, infant mortality, death from preventable diseases, & such a $1 at the bottom goes a lot further then $1 at the top. The gains made from flattening the system, generally outweigh the lost effeciency.

[SapphireSun]

Hmm I've thought about this a bit, and it strikes me that while yes, it does seem to make sense that we should have medicine for everyone, we should also have an area where there is pressure to perform. Essentially what I am positing is that the US should remain a nonsocialist area so that we innovate and provide the necessary advances because eventually they will filter down and become affordable by the average person. In the meantime we could make it easier for people to leave the country if they prefer to live under a socialist system. This would be counterbalanced by most of the rest of the world having that flat system you referred to. It's a compromise. On the other hand, let's assume that my dear reader has no soul and will thus not vituperate me for the following idea: Modern medicine has been around for like 60-80 years which is essentially no time at all. In the space of that time, major advances have been made that have not yet filtered down to the bottom. If you take the long view, in 100 years the stuff we thought was a $10M miracle today might be a trip to the doctor's office with a 20 dollar copay then (think robots). So what's really important is not curing every poor person today, but advancing the field to cure the poor people of the future. The trick to surviving is to try not to be poor and/or get insurance.

Essentially, this is a highly tangled problem and a simple solution won't do.

[davidw]

> Essentially, this is a highly tangled problem and a simple solution won't do.

Bingo. There's a nice discussion of just a bit of the economics involved in health care in "The Undercover Economist". It's really a very complicated subject because it is not your typical market for something like shoes, to use someone else's example. Pure capitalist systems will leave at least a few unfortunate individuals to die or suffer from easily/cheaply curable diseases. Pure state run systems throw out all the useful information that a market provides and introduce inefficiencies of their own.

[netcan]

a few unfortunate individuals What percentage of Americans do not have access to adequate health care?

You guys keep thinking about this as if the economy existed in a world where buzzwords & their associated connotations are absolute. You are not choosing between US 2008 & 1963 Soviet Russia. The most radical model likely to ever be proposed in the US is something like the UK's.

The system tries to provide internal pressure to reform (just like big companies do). There will probably be a decline in mean medical care from an economic utility standpoint (to the extent that term has any meaning - I think very little) There will be a dramatic improvement in health to the bottom 25% -30% resulting in huge gains to life expectancy & similar indicators.

As a bonus that the fear Americans have of being left without health cover will lift.

Capitalist evangelists of various sorts are always quick to point out there are no good example of command economies performing well. That's fair. But there are plenty of examples of 'socialist' health care systems that work. They perform well on any meaningful scales at a cost lower then the US's. From Cuba (an outlier but a very interesting one) to the UK to Japan. Pick one.

[davidw]

Read the book. It's highly recommended, and makes all the points you do and then some, and even points out an interesting compromise model that attempts to cover everyone, but still maintain some of the good effects of having a free market.