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Curious to see +Fareed Zakaria's full report on this. And amused with the many negative responses to this prelude (zero of them arguing with facts), from the typical people with blind faith in a radical free-market ideology.

Now capitalism is mostly great (or less bad than all alternatives attempted so far), but there's no need to proof that healthcare is one area where pure capitalism has been a failure. The core problem is that the free market always produces an economy of scarcity. This is fundamental to maximize profit. Prices for all services and products will be artificially higher, and their offer artificially limited, compared to their demand by potential customers. It's hard to reconcile this with the primary purpose of healthcare. I am confortable with the fact that I can afford a better car than my neighbor, because I've studied and worked harder. But I'm not comfortable with the fact that my son can have a liver transplant if he needs it, but maybe my neighbor's son cannot have that, because his family didn't "deserve" it. Health should not be one of the prizes awarded for economic success.

One thing I always guessed nobody would dispute, is that universal insurance of some sort--a system where everybody pays for healthcare, no mater how--is necessary. But even this is disputed in the US. Health can be an unfair aspect of life; many conditions cannot be prevented, and some conditions are expensive enough (or can occur at young age--before one can save enough money), so most people simply wouldn't afford the cost. There is no way to reconcile this with with the conservative ideas I see here (well, in the extent that the current debate of GOP primaries represents American conservative values.. I hope this lunacy is just a grotesque caricature of what half of the country really thinks). Bad genes, virii and accidents apparently failed Liberalism 101, and they strike largely at random.

Having said that, I strongly believe that personal responsibility should have a major impact in the costs and quality of healthcare. I just don't believe that economic success should be the criteria for that. No; the fair criteria is the obvious things that everybody, rich or poor, can and should do for their own health. A good diet, some exercise, and abstinence of drugs (remarkably nicotine), will keep the doctor away. I don't consider fair to pay higher insurance or taxes, to subsidize people who enjoy Big Macs or cigarettes regularly... or practice high-risk sports. Yes, at some point it's difficult to draw the line; but there is a significant number of objective, scientifically undisputed factors that are also basically personal choice. I for one, would happily provide to my insurer a yearly, limited health checkup to assert some basic factors, from my status of non-smoker/drug user to my body-mass index. (The idea seems fraught with abuse risks, but only in a private and unregulated health system.) Now the people who want to have the freedom to smoke or eat bacon all day long, they can go on, but freedom and responsibility means paying up for your choices.
Stefan Haustein's profile photoJim Douglas's profile photoOsvaldo Doederlein's profile photoJoel Webber's profile photo
I'd like to see this too. Hope they put it online sometime soon.

As for the question of fairness (i.e. that car vs. healthcare analogy), I agree but tend to look at it from a more utilitarian standpoint: Society has an interest in providing services where failure to do so would create a negative externality for the group, and where markets won't sort out on their own.

In the car example, society doesn't have any interest in providing nice cars to everyone, because it doesn't hurt you (or anyone else) if your neighbor drives an old junker. It does harm society as a whole when its citizens are in bad health, even in cases where it's their own fault (e.g., subsisting on cheetos and cigarettes). It's less a question of fairness than of doing what's best for society. Sick people have shorter working lives. They have a harder time caring for their own children (leaving the rest of us to deal with the aftermath). They often can't work as effectively (needing more sick days, or being less effective when on the job). When uninsured, they must often fall back on indigent emergency-room care (the most expensive way to treat anything, often by several orders of magnitude -- witness the relative cost of managing diabetes vs the cost of someone going to the emergency room in a diabetic coma). Give everyone access to basic healthcare, however, and we all benefit, for the opposite reasons of those given above.

But, rhetoric aside, it's sort of glaringly obvious that the market can't provide this service (even ignoring Zakaria's point about efficiency). You've pointed this out above -- how can the market provide insurance to everyone when it's strictly necessary to get rid of the sickest people in order to maximize profit? Even stranger to me is the idea that people even believe we have free-market insurance in the US now. If we did, then your insurance company would drop a sick person like a hot potato when he or she changed jobs or plans. They don't do this because there are some regulations in place, but they're a bloody random patchwork that people fall through all the time.

Put another way: If private insurance were "enough", then my epileptic brother (who's not remotely in the Medicaid income range) would be able to get insurance for some price. But he can't. No one will insure him. And if they did, they'd have to charge a hopelessly unaffordable price for it. His only "mistake" was being uninsured for a brief period in his 20s when he happened to get diagnosed.
As a Canadian, it never occurred to me when I was growing up that health care was something that could be driven by the profit motives of private insurance companies. I've listened to the US debate, and the almost fundamentalist opposition to any sort of change to the US system leaves me baffled. There doesn't seem to be any dispute about the basic facts: The US spends two to three times as much as other rich democracies on health care, and by almost all measures it gets inferior outcomes. From any rational perspective, you'd think that anyone, of any political persuasion, would see this as a problem to be fixed.

The arguments seem to boil down to "the US is a free-market capitalist country, unlike socialist Canada." Or something along those lines; it's often difficult to get to a coherent argument. The reality, of course, is that the US and Canada, and all western democracies, blend "free market" and "socialized" approaches. I tend to think that Canada generally gets the mix better. I'd argue that the 2008 market meltdown was largely triggered by an excessive willingness to trust the unregulated free market. The more regulated (conservative with a lower-case 'c') Canadian banking system came through the meltdown relatively unscathed.

Canadian health care is a single-payer insurance system that everyone pays into (I send the province of B.C. a cheque for $64/month), and doctors -- private business people -- bill the government-run insurance system. Everyone is covered; if you can't afford the premiums, the government (taxpayers) pick up the tab. Three basic categories aren't covered -- optometrist, dentist, and prescription drugs, all of which I pay out of pocket (but, I understand, less than I'd pay if I lived 25 miles south of here, in Washington State).

CBC Marketplace, a consumer-affairs show, aired an episode recently ( that touches on what happens when the free market profit motive is injected into the health care system. Canadians traveling outside Canada have to purchase a private policy that covers them for any medical emergency that might occur. For a retired couple spending months in a Florida vacation home, this is obviously a big thing; people in their 60s and 70s tend to need medical attention more than younger people. So private insurance companies require that older people fill out detailed and confusing questionnaires about their medical history. Not to establish eligibility, but to be mined for an excuse for the insurance company to deny coverage in the event of a claim (example:

I'm a free-market capitalist. I've started (and sold, to my business partner) a software business. And the goal was absolutely to make a buck. But some things are not well served by the profit motive. If my house burns down, there's a good chance it will take my neighbours' houses down at the same time. So the fire department puts out all fires. Police protection is available to every citizen; we have a common interest in safe cities (but see for what happens when cities fire cops to balance their budgets). And -- I would argue -- health care falls into this same category. At some level, everyone has to believe in his gut that he's a full member of society, entitled to basic protections, not just from fire and crime, but from illness and injury, which can randomly hit any of us. If you don't have basic medical coverage, you don't show up at the hospital until a situation becomes an emergency, when dealing with it is exponentially more expensive. For example, if a pregnant woman doesn't have health care, then the first time a doctor sees her may be the day she gives birth, having had no prenatal care whatsoever.

BTW, GPS has posted several blog posts and videos in advance of tonight's show, in addition to the one referenced above:
I don't think the state needs to provide the whole system to make it work (as in the UK) -- the state "just" needs to set up the right framework. In Switzerland, every health insurance company must provide a standardized basic coverage package where customers cannot be cherry-picked. Insurers are still able to differentiate using add-ons and discounts. And the costs for the cherry-picking process and litigation over pre-existing conditions alone are probably a significant contributor to the inefficiency of the US system as a whole.

Other markets -- such as buying and selling physical goods -- already have a set of rules set up, and nobody complains that it's communism if you can't prevent re-sale of a car in some kind of EULA (btw: I'd like to see this simplified for software, too).
+Jim Douglas I pretty much agree, as you can guess, though +Stefan Haustein's right that single-payer isn't the only viable solution. Unfortunately our attempt to move vaguely toward the Swiss model has half the country screaming shrilly that the government can't force people to buy things! Nevermind the fact that there's not a hell of a lot of difference between a "requirement to purchase" and "bought for you with tax money", especially if the purchase price in the former case is at least partially scaled to income...
+Joel Webber It was pretty interesting; did you get a chance to watch it? I hadn't realized that Singapore introduced a completely new system in the 1990s, following the same basic model that we use here (universal single-payer government insurance, but private doctors and hospitals). And they've got an awesome computer system that tracks everything in realtime. Yeah, the thing about any sort of insurance system is that it only works if everyone pays into it one way or another, through taxes or mandatory insurance. Seems pretty obvious, but maybe I've been indoctrinated by Canadian socialism.
Many good ideas here... One thing I was trying to do is reconciling a good, universal healthcare system with a people's ideology. Full egalitarianism is not likely to fly, even in fundamental rights like health and education. Some nonessential things can be left as extras for those who can pay, e.g. a private room in inpatient care, or using a brand-name drug instead of the generic drug that's 3X cheaper and just as effective. But we will be in a good place when the discussion reaches that level, instead of, calamitous abuses like a person being simply denied coverage due to an expensive, preexisting condition. The flipside is that we don't want to allow the younger-and-healthier to feel safe to not pay for healthcare until they need it, which totally breaks the insurance model. So the only solution is making insurance mandatory, there's no way around it. As +Joel Webber commented, everybody pays with taxes in indirect ways. Not to mention that hospitals often gouge the insured with massive bills when they have to make up for people who cannot pay. The number o Americans (often even having some insurance) who go bankrupt due to healthcare debt, is insane, see

To put another way: three of the major economic factors of 90% of all American families -- housing, healthcare, and college education -- are evident, abject failures of the free market's capacity to regulate itself. In all cases, most people who are not lucky (i.e. being very wealthy, very healthy, or winning scholarships), are doomed to massive loans, which means the system is ultimately designed to suck wealth into the financial system.
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