re: Well Kimmel dragged his son out tonight

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The cultural problem is the concept of "Choice".

That is what differentiates us from Europe and other socialist healthcare states, including the NHS in Britain.

America wants choice. With that, socialized medicine will never work and is never a possibility.

It was stressed when I met with the NHS last June. We had a frank discussion, with their KPMG consultants in the room, the point I made was what was lacking was consumer choice. That is why healthcare costs are higher in America. There is no central route of care. Without that, costs cannot and will never be managed effectively.

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More or less, yes. It's a little more complicated than that, but that's the general gist.

The NHS can effectively manage basic care for every single person in the country because they take a very cold econometric calculation (based off a rough system called a QALY, or quality-adjusted life year) in determining for what they will and will not pay.

Choice is a factor in all this, but it's really relatively minor. The growth in expenditure, both public and private, is because we spend an enormous amount of money on the intensive curve in healthcare. We are willing to spend every last marginal dollar we have on healthcare whereas the UK is not. It is not surprising - the US is a very, very rich country (even compared to the UK PPP-adjusted), and we tend to blow money on stupid shite. Healthcare is a normal good, afterall.

Choice is a piece of it, but not the only piece. Private payers are starting to limit choice again after an explosive growth in network access in the 1990's (which, of course, dramatically raised prices). American consumers are starting to become more comfortable with price discrimination in healthcare vis a vis limited networks than they used to be. The data on that is pretty clear.