[lotsofpulp]

I would predict rest of the world will move to an American model, based on lowering fertility rates and demand from people who cannot afford to pay for healthcare exceeding supply of healthcare.

Managed care organizations (MCOs, aka health insurance companies) are the mechanism by which you can provide different groups of people with different levels of healthcare, while still having plausible deniability that you provided healthcare for political purposes.

Example: Medicare and Medicaid are both subsidized healthcare programs in the US. But the people who receive Medicare are more valuable to leaders, so Medicare pays more, and hence Medicare recipients get better healthcare. Medicaid recipients are less valuable to leaders, and so it pays less, so Medicaid recipients have to travel farther and wait longer for healthcare.

MCOs can even be used to implement different levels of healthcare for different groups of employees based on how well the coverage for that group of employees pays providers. You can delineate all the way from President and staff, to legislators, to military, to civilian employees, and private businesses can delineate between employees of low profit margin, low pay businesses, and high profit margin, high pay businesses.

On the provider side, poorer people will get seen by NP/PA, while richer people can be seen by MDs. Or richer people can skip the line or get access to MDs via concierge medicine or direct primary care.

[messe]

> I would predict rest of the world will move to an American model, based on lowering fertility rates and demand from people who cannot afford to pay for healthcare exceeding supply of healthcare.

The US pays more per capita for healthcare than most of europe. Why do you believe that lowering fertility rates—leading presumably to an increase in the proportion of the population needing access to healthcare due to age, and a similar decrease in the amount of tax payers—would lead to a shift towards a US-model that costs more overall?