Reply #126: You are correct, Sir

[Nederland]

I failed to include those objections and will dispense with them immediately. Your arguments, sentence by sentence:

1) Compactness, uniformity of condition, degree of control and personal quality of supervision down to smallest detail, benefit any program.

2) In a country which has both a high per capita income and a reasonably flat income distribution, with the upper tenth enjoying only a fifth of the income and the lower tenth still possessed of a twentieth of the whole, health outcomes will be better whatever the system employed.

3) By comparison, in the United States, the lower tenth commands little more than one percent of the national income, while the upper fifth enjoys half the income total."


1) I'm not sure what you mean by "compactness". If this is a restatement of the size issue, I have already dispensed with that argument effectively. With regard to "uniformity of condition", I disagree. Certainly there is a greater diversity of employment in the US, and that may result in a slightly different cross section of diseases, but I fail to see why that would have a crippling effect. Degree of control is completely dependant on the legislation you pass. If you need a certain degree of control, you write it into the legislation. The only limit is the Constitution, and I fail to see how my proposal would violate that. Personal quality of supervision assumes that their is a significant difference between the abilities of Singapore citizens and US citizens. I have not seen any evidence of that, but am open to hearing of it.

2 & 3) You seem to assert that the difference in distribution of wealth between the US and Singapore makes the application of the Singapore model in the US impossible or at the very least unwise. I would have to point out that this exact same argument could be made of single payer. If the differences in wealth distribution are significant, how can you argue that the differences between the US and Singapore are relevant, but the differences between the US and Canada are not? Regardless, you have not explained why differences in wealth distribution matter. I fail to see why they are. Certainly one result of that difference is that in the US a larger percentage of the population would require subsidies to their medical savings accounts. Why this would make things impossible I am at a loss to explain. It seems akin to arguing that a income tax of 25% will work, but one of 35% will not. It is simply not true. If you need more money, just raise the rate. Whatever amount of money you need will be similar regardless of how you achieve universal coverage, so if you have a logistical or economic problem here you will have it with single payer too.

Finally, you seem intent on pursuing the lost cause of size making a difference. I cannot fathom why you continue to press this. I have already conclusively demonstrated that there are certain advantages to having more people in the system such as reduced per unit administrative costs. Your example of Rhode Island being unable to teach Texas about transportation fails to apply. Rhode Island has a vastly different population density than Texas, and it is obvious why that makes a difference when building roads. While I do not deny that the US and Singapore are also different in terms of population density and other factors, it is not obvious why that affects the operation of medical savings accounts. You cite the differences, but do not explain why they matter. To prove your point, you must do so.