A bad doctor is (largely) better than no doctor, and that would be the difference for a lot of people. Being represented by a public defender isn't the best, generally, but it's a hell of a lot better than not being represented at all; moving to a purely paid legal system would not be an improvement.

The doctor chooses. In Canada, doctors can accept whoever they want and they'll only accept patients with good 'fit'. Everybody else is stuck going to a walk in clinic or the ER. How does it work in US? Do Doctors charge different rates for a checkup? I thought it was fairly opaque between the doctor and the insurance company?

> The doctor chooses.

Then there'll be a non-monetary "currency" of favors, who you know, black market, strings, etc. Such systems inevitably appear in any system of "free" scarce goods.

I'm a Canadian physician, and this is not a correct statement. Nowhere in Canada are you allowed to cherry-pick patients.

"Canadians pick their own doctors, just like Americans do. And not only that: since it all pays the same, poor Canadians have exactly the same access to the country’s top specialists that rich ones do."

https://ourfuture.org/20080204/mythbusting-canadian-health-c...

When the good doctors are in demand, and the not-so-good ones are not, how is the allocation done?

Funny thing about markets: they work even if you don't "believe" in them. So the more you try to tightly control a market, the more alternatives show up.

In this case the alternatives being the usual power networks of the socialist states: friends and relatives in government and administration. Who you know becomes more important than what you know. Who you do becomes more important than what you do. A small favor done once gets returned. Informal networks of favors, relations and power turn rapidly into an impenetrable mafia.

Imagine your DMV visits applied to life-and-death situations. And it's not only doctors. It's also access to latest medicine, newest medical devices, best hospital beds and sections and especially doctor attention.

Source: I lived in these god-forsaken systems, unlike most of the down voters here...

>Imagine your DMV visits applied to life-and-death situations.

Kinda funny, but my DMV visits have been extremely smooth. If you get there with everything they ask for (you did read the FAQ, didn't you?), there's no reason why you can't have a similar experience.

Now my experiences trying to get a doctors appointment otoh...

My DMV experience was long lines and waiting around for an employee to manually grade multiple choice tests. That was in CA. On the other hand things were a lot better, way more efficiently run in PA. Why can't California give me a similar experience as Pennsylvania?

> Imagine your DMV visits applied to life-and-death situations.

I don't have a lot of trouble at the DMV; maybe we could use an example where I've consistently had terrible experiences, like UPS?

Where have you lived?

>If health care was free, a problem arises. Everyone will think they're entitled to the best doctor. Who gets the best doctor?

Oversimplifying here, but how about setting a base line for free health care. And then if someone wants to get the 'best' doctor they can pay extra?

Same reason why not having net neutrality is a problem. Eventually health care gets terrible for the people who aren't paying, or are paying less, and you've institutionalized a two or more tier public service based on wealth.

What if somebody could pay extra to have the best firemen, or the best police?

WalterBright has posed a real problem here, but I honestly think that the solution is just that patients pick their doctors, and if they can't get the doctor they want, they can get on a waiting list for that doctor while seeing another. Additionally, that waiting list would not involve any administrator latitude or patronage, just list seniority.

On the other hand, most health care is routine, and one doctor is as good as another. The best doctors are needed for the hard cases. A strict waiting list does not allocate doctors to where they would be most effective.

It's similar to the inherent misallocations of rationing - goods & services are not allocated to where they are most needed.

Because then the people who only get the baseline become a political force for how unfair that is. (We see this in the newspaper essentially every day regarding the public school system.)

Yet the doctors who charge outrageous sums may not actually be as good as the doctors everyone has access to at the county hospital. Indeed, teaching hospitals are known to have better outcomes, and serve the underserved.

You have to look at reality and not just a some simplified model. Does this happen in countries with universal health care? I don't think so.

> I don't think so.

I asked that question of a Canadian doctor further in this thread.

As far as I know Canadians don't all rush to some superstar doctors. This is also not happening in Germany either. This is the same simplistic thinking when people say that if health care is for free they will consume more. This is simply not happening in countries where health care is free.

When a scarce resource is free in terms of dollars, other factors come into play that act as costs. Common methods are rationing, waiting times, social status, favors, donations, etc. Something has to happen to match up supply with demand.

People who can go to a doctor freely go sooner and don't (have to) wait until things get really bad - at which point treatment also gets far more complicated, lengthy and expensive, and that relationship is not linear. I don't need to wait until the tooth is truly rotten and now the jaw and bones holding it are impacted, because I have no incentive to delay and safe the expense, which is even worse for the many uninsured and under-insured.

I grew up in the GDR (East Germany) for the first 17 years of my life. While I turned out well, I had years and years of close contact with a large variety of doctors, for my eyes, sleep EEG, LOTS of small problems. I was a regular visitor of a pretty sizable variety of doctors in various places, not just the hometown.

The fears expressed hear from Americans about that kind of health care, to me, are simply ridiculous. The system worked darn well. I got soooo much, and I wasn't even all that sick, and that in a really poor country (compared to Wet Germany).

By the way, we did have a "top layer" of doctors (in East Germany) where you needed more (don't know if it was money or favors or if they selected you), who were far better than the normal ones. Still, nothing any more outrageous than now - the best are few, everywhere. Getting to them wasn't a matter of being rich though (I know because I got to see one or two of such top doctors).

Interestingly, a friend of mine found that getting the "top doctors" even now does not have to be a question of money. His wife got cancer and the standard treatment would have given her 6 months. He had money and brain, he checked the literature and did his research to find the best doctors relevant for his wife's case - and all it needed to get them to treat his wife was a few phone calls. Not a single additional Euro was spent, they didn't want any. They were cancer researchers at German university clinics, but he also checked with experts in the US. the experimental treatments she got and that gave her a few more years (instead of 6 months) were all paid for by the "Krankenkasse" (the common public insurance vs. private insurance, which exists too). They paid the huge sums without question but refused paying tiny amounts for small stuff...

For each medical condition, there exists a wide range of treatment options, all varying in efficacy, convenience, pain, risk, and cost. If cost were no consideration, why should anyone not get the most costly treatment available, even if it is only a minor improvement?

Most people don't behave that way. You seem to be assuming that people always want to squeeze everything they can out of a system but that's simply not the case in real life.

> Most people don't behave that way.

They don't? How many patients in a "free" health care system ever ask what the cost is for any of the options?

If coach / first class were offered to you, free of charge, which would you pick?

Is it a coincidence that electric cars are suddenly taking off in the UK when their TCO (Total Cost of Ownership) dropped below that of gas cars?

Building a mass market system that relies on the bulk of people behaving altruistically is not likely to work.

Maybe people go to a doctor only when they need it? I don't want more medical treatments when they are free.

There are a lot of people who will only go when they need it, mostly men. For instance I have not been to a GP in probably 6 or 7 years. But I can see lots of people with chronic conditions (most of which could be prevented or reversed with lifestyle changes) going all the time. And it seems like the kind of thing where once you have a couple prescriptions, you're going in frequently to check in, and each time possibly adding new ones for different ailments you develop.

My Doctor-couple friends said it this way: There are three ranks of hospital: childrens' hospitals are the best. Next are womens' hospitals (maternity etc). Finally hospitals catering mostly to men are the worst, mostly because men are so indifferent to treatment.

Canadians who can afford it go to other countries to get prompt care

:s/willing/able

> Under a market system, [a problem arises.] The best doctor goes to the patient [capable of paying] the most.

Exactly. Add that to the long list of reasons for working hard to earn more money. It's not just about the bigger house and the faster car -- it's also to get treated by the best doctor.

The alternative mechanism amounts to "the best doctor goes to the person who has the most connections and somehow subjugated the most people." That's why elected officials in Congress get to the front of the line.

> That's why elected officials in Congress get to the front of the line

There are more doctors than members of congress, so it's a global improvement on the status quo, unless doctors not treating Congress critters just sit around twiddling their thumbs.

It's only an improvement on the status quo if you assume that the status quo is that there are fewer doctors for some reason, or that Congresspeople create an excess of doctors than are needed to treat Congresspeople?

What is the "status quo" in this comment?

> entitled to the best doctor

The problem is "the best doctor" is essentially a lie. Modern medicine is mostly a huge fraud. Non of this hi tech crap even works when measured on the basis of lifespan.

Disease is overwhelmingly rooted in nutrition and lifestyle. This idea that doctors and their treatments matter is a big lie.

The USA blows a fifth of GDP on health care and it is obviously completely useless. Americans in practice live no longer than Mexicans or Cubans, who spend a tiny sum in comparison.

The most immediate political problem we face is starving the American medical racket out of existence. These crooks are bankrupting the country. The hospitals and doctors and "researchers" and pharma companies must be cut down to size. Starve them of a cent of federal revenue. Or prosecute them for their pervasive anti-trust violations. I don't care. Crushing the medical complex by any means available is literally the most important problem facing America. These crooks are literally stealing over a thousand dollars from every American household every month. It's unbelievable.