Reply #26: Interesting. Still, a single-payer scenario has its own feedback facilities...

[phantom power]

For example, Canadians still do pay for their health-care, they just do it via taxes. So, Canadian voters are exposed to those increasing costs, and they have the opportunity for input into what gets done about it. Or, the Candian govt can directly influence what it chooses to pay for, and how much.

One thing about the "individualized, market-based" scenario that is a real problem: spending decisions about health care deeply violate the "ideal-consumer" model, in at least three very important ways:

1) In many cases, there is not time to make a rational cost/benefit decision. For example, suppose I've got a racing heartbeat and a left arm that feels funny. Do I (a) call the ambulance (a huge expense) (b) drive myself to emergency room, or (c) do nothing? How much time do I have to carefully think about it? BTW, this actually happened to me one time. It turned out to be dehydration and a fever, so technically (c) was the answer: lying down with a few glasses of water would have fixed my problem. However, I went to the emergency room. Why? Because it was presenting like a potential M.I.

2) Making rational cost/benefit decisions requires medical expertise.

3) Even in the situations where there is proper time and information for a rational decision, the fundamental cost/benefit relations in matters of health are deeply skewed. What amount of money will I pay to preserve my health? Or the health of my wife, or child? It's not the same as saying something like "well, I'll drive this old car for a few more years because that's the fiscally sound decision. Or ride the bus, or walk." There is no competitive alternative to being healthy, or remaining alive period.