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August 31, 2009


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Right now I'd agree. If, however, we end up with sweeping health care reform legislation that involves conversion to a NHS-style single payer system (highly unlikely) or some sort of explicit rationing (rather more likely), things may be different.

Peter! You can't leave a statement like that hanging. I don't understand --- explain!

Important nitpick: the NHS is not a single-payer system. In the U.S., Medicare is single-payer and the V.A. is an NHS-style centralized provider. These are two very different animals.

My mistake, I meant a NHS-style centralized provider. The point is that a truly sweeping sort of health care reform might be so hugely controversial that courts might try to strike it down, for example by holding that rationing would deprive people of their rights (to live).

That would be unusual. The death panels have played little role in determining Canadian health policy.

The problem areas of the Canadian health care system relate to the provision of adequate care rural areas and in chronic-care situations. Court challenges to medicare have come mainly from doctors, who are contesting the monopoly of medicare on doctors. Rationing has played only a marginal role if at all, judging by my experience and that of my family and intimates.

This is something of a tangent, but has anyone else here read Gregory Clark's "Was There Ever a Ruling Class?"

I ask because the argument made in that paper - that we have moved from a world of equal intergenerational opportunity to one of class rigidity, rather than the reverse - may, if it is at all accurate, have some bearing on the question at hand.

King-Walters, that paper is fascinating and provocative. What do you think its lessons are for the modern United States?

Well, if we really have moved in the direction of increased social immobility and class rigidity, that can't be good for American democracy. I'm not sure we have enough data yet to draw any actual lessons, but it seems to be the sort of thing we should keep in mind when talking about potential failure modes of the United States.

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