I grant that they are serious concerns, and as I said I do not want us to copy the NHS. At the same time it sounds like you are falling into the opposite trap of discarding a system that is superior to what we have just because it isn't perfect.

Here's my attitude on healthcare and why I address it like I do.  We should best address cost and access.  I don't have serious concerns about quality of care at all.  They may cite the studies that say American healthcare stinks, but I don't think American's have concerns over quality either. 

We should realize that Access, Price, and Quality are linked.  A smart blogger I sometimes read I thought put it best when he said, "Access, Price, Quality.  Choose any 2 of the 3."  Where our system fails is that we attempt to bring all 3 and fail to deliver on at least 1 and a half (I'll give us half on Access.  We do treat the elderly with expensive treatments more often.  We generally do provide for expensive treatments more.  These are tough decisions that the government sometimes makes for people in state-run systems.)

So those are the problems I see them, here's how I'd address them, in part.

The cost of healthcare is out of control precisely because there isn't a market mechanism working...and with government paying for 45% of the healthcare in this country, we already have a socialized system.  Additionally, I ridiculously high number of expenses are paid for by insurance.  Insurance isn't meant to pick up routine expenses.  Insurance is a necessary evil in my mind, but it is better attached to socialism rather than the free market (I suppose that by definition, it's collectivist.) Between government and insurance, only 15 cents out of every dollar is paid for out of our pocket today, but in 1960 it was at least 50 cents.

I think we have to get to a point where we're introducing markets back to healthcare, and I don't think this mix and match that we're currently doing that even approaches it.  It's not just a government problem though, employee sponsored health insurance has really screwed things up. The HMO Act of 1973 required that all but the smallest employers offer healthcare and that those costs would be tax deductible.  That tax deduction and the requirement that employers offered the insurance sealed the illogical coupling of a job and health insurance for the next 20+ years. 

These plans don't serve the interests of the consumer from a cost perspective.  They are often low deductible plans which do not give the employee any incentive to act responsibly in their healthcare purchases.  Additionally, the medical professional has an incentive to overprescribe boarderline procedures (think MRIs) or unnecessary drugs.  I would challenge you to find a healthcare professional who believes that those with access are underprescribed.

Naturally, inflated demand for healthcare gives rise to inflated prices for healthcare....so much so that consumers and doctors often don't know what basic procedures cost (if you're insured, when's the last time you looked for a better price?)  Unfortunately, the uninsured are left holding the bag from a cost perspective. 

 

What would I do?  First off, eliminate the favoratism to business in terms of the tax incentive to offer insurance.  I believe it should be achieved by giving private citizens the same tax break and removing the incentive for business altogether. 

Additionally, I think the Whole Foods model employed by John Mackey could work as an overhaul.  I would offer HSA's and high deductible plans at the Federal level instead of the current medicare system.  The HSA's would bring market economics back to healthcare at the low end, and I think I can say with confidence that you don't have the same sort of moral hazards for more serious medical matters. 

Finally, look at providing catastrophic coverage for "free" at the federal level.

Easily, the most important part of this plan would be to get insurance out of the picture routine procedures.  That's what will help keep a lid on costs, yet still provide incentives for the healthcare profession to continually become more efficient and better serve the consumer.

 

 Here's some background on what John Mackey has done at Whole Foods.

WHOLE FOODS EMPLOYEES GO BARGAIN HUNTING FOR HEALTH CARE

High-deductible insurance policies that require the insured to pay thousands of dollars before insurance covers their care may be the key to lowering costs and putting people in charge of their health care, says ABC News.

Five years ago, the grocery chain Whole Foods Market switched to a different kind of health insurance, a policy that puts patients more in control:

• Whole Foods has an insurance policy with a high deductible; that means an employee must pay about $1,000 before their insurance kicks in.
• If they get cancer or heart disease, their insurance covers it, but if they have a sore throat or a sprained ankle, they pay.
• To help workers pay, Whole Foods puts money into an account for them.
• Some employees got $1,500 this year; if they don't spend it on medical care this year, they keep it and the company adds more next year.

Most companies call these accounts Health Savings or Health Reimbursement Accounts. The company saved money, too. "Our costs went way down," says CEO John Mackey.

Still, some employees were angry about the plan. They said they wanted their full coverage back.

"When you go from a system where people are very dependent and now you're telling them, 'Hey, you have to take more responsibility for your own health.'  And that was frightening to them," Mackey said. "Because they were going to have to be responsible for themselves, they weren't going to be taken care of any longer."

Source: John Stossel, Gena Binkley and Patrick McMenamin, "Health Savings Accounts: Putting Patients in Control; Whole Foods Employees Go Bargain Hunting for Health Care," ABC News, September 14, 2007.

So my solution isn't to look at a Healthcare system and say "That's what I want."  It's to very specifically look at what gives rise to our problems and solve for the issue.  If I would choose by the "let's be more like country X", I'd probably select one of the medical tourism spots.

I don't mind subsidizing bad luck. I do mind subsidizing obviously bad decisions.

Hmmm. You would deny healthcare based on some set of "obviously bad decisions" yet I think you oppose vigorously someone denying other social payments (welfare, student loans, EIC, etc) based on what others might also classify as "obviously bad decisions" such as choosing the wrong major and not being able to find work, not pursuing the proper education or training, not taking available employment, being disinclined to move to where jobs are, having children that one cannot afford to raise, etc.

Good or bad health is a combination of luck, genes, and actions, perhaps moreso than any other "social attribute" one might name. A lifetime smoker may get cancer not from smoking, but from the emissions of the chemical plant next door. Yet it seems you would categorize and dismiss their needs as quickly as a Randian would dismiss the unproductive's.

I find that very interesting.