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This is not really an answer, because I just read all the answers and most replies and comments, and wanted to provide an observation from my detached perspective, being a Canadian but a follower of American politics and policy.Right off the bat I have to say that I’ve seen nothing happen since 2016 that has made the healthcare situation better, and indeed, purposeful neglect and pro 1% policies have made it much worse. The trillions of dollars that are and will be going to the very wealthy individuals and corporations will obviously come out of healthcare spending, and other social safety net programs. And many of you think that’s just fine. Law of the jungle sort of thing. Well folks, those laws of the jungle don’t exist and never have. Most animals in the wild have developed social instincts to survive and flourish. Being responsible for others and sharing resources is how most survive. Yes at a certain point they leave the sick, old and unproductive to the jackals and vultures that will pick their bones clean. But hey, can we not perhaps see the human race as just a little better than that, perhaps slightly more evolved to realize that officially pooled resources can do so much more so much cheaper than any individual act or even collective act of charity can even begin to dream about.The ACA appears to me to have failed by a lack of courage by the Democrats to put in place a system that went much much farther than the tepid first steps they chose. This combined with a shifting balance of power and a mean spirited and racist obstructionist campaign by the Republicans to hamstring the ACA at every turn, express mock ill-informed concern about costs and deficits, practically guaranteed the answers and comments associated with this question.My only worries about healthcare are that I might need it, not in any way, shape or form is it about paying for it. And after a lifetime of accessing the system twice, once when I was born 64 years ago and once when I was five and had my tonsils out, I needed it in a big way in my early 50’s.My parents had the misfortune of having a premature baby with a defective heart born in 1952, a few years before Canada brought in universal healthcare. And I can go back and read many of the same objections I’ve read here. My father’s annual salary was about $5000 and after 5 years and about 25 hospital stays followed by open heart surgery, our family was in debt up to close to 6 digits. This random act of life completely drove my family’s life until the late ‘60’s when after 15 years it was finally paid off. My parents were scraping pennies and making health payments for a good decade while all around them healthcare was no longer a cost concern for anyone else. But life isn’t fair and I don’t bring this up to garner sympathy for my family, I bring it up because even with that initial imbalance, the net gains to my family and to our community, province and country were so huge having universal healthcare, that it was all worth it. And you would not find even the most far right political candidate (yes we do have them) even whisper that they would dismantle Medicare, as that would be the end of their nascent political career. Does that tell you anything?Does America think it is so different from almost 100% of the developed world (indeed most of the “undeveloped” world) who have implemented universal health care, that it really would not work in their country? You don’t think that’s taking “American Exceptionalism” a little far? It can work, and it will be cheaper, and it doesn’t have to cover everything. Canadian healthcare for the average person (not poor, not a senior, average income) does not cover dental, prescriptions, private hospital rooms, alternative or additional healthcare (massage therapy, some mental health services, chiropractors) that other countries do. What we have in Canada is a bit of a mixed system which encourages employers, pension plans, public service work groups, employer and/or employee associations to offer extended health care (EHC) packages that are considered taxable benefits and are often cost shared or paid wholly by the employer. The cost of these plans vary depending on the size of the Group enrolled. To buy it completely out of pocket as an individual is anywhere from $150 to $400, an employer and employer can split the cost 50/50 60/40 whatever is agreed and most of these extended plans will cover 80–100% of dental, prescriptions, 100% with annual limits for alternative medicines, and with an annual deductible of $0–100 for all services. Oh the grumbling when I pickup that first prescription in January and have to pay over $100 for that medicine I bought in December for only the dispensing fee of $4.56. (and will pay only $4.56 again February to next December)No human created system is perfect, yes there are wait times for non life threatening but needed for quality of life surgeries such as joint replacements, hernias and such. They seem to be getting better, my sister got on the list for a knee replacement at the end of summer and has a confirmed date at the end of October. I had spinal surgery in 2008 and from the middle of February I had 3 kinds of xrays, saw a neurosurgeon, had an MRI, 2 CT scans, was scheduled and had surgery by the end of May that year. One of the world’s best neurosurgeons led a surgical team, private hospital room, total cost for everything for me ….$0.As I wrote earlier, my only worry about healthcare is that I might need it, it’s not ever been, how can I afford it, and I believe that piece of mind transcends or should transcend politics, rampant individualism, and concerns about you paying for some fat guy’s gastric bypass. (Fun fact, in the US you’d only be paying 1/275,000,000 the cost for that bypass)Cheaper than a stick of gum. What a deal.

This is a long reply. I prefer to support my answers rather than giving my opinion in the form of: “Yes/No because I say so,” or “Yes/No because other people do it and I believe it works well/poorly.” Hopefully, someone interested in the concept of sustainability has a sustainable attention span.Any discussion of healthcare sustainability needs to examine systematic weakness. There is no perfect system. All systems have compromises. All systems can improve different metrics. Since this is all true, no healthcare system on the planet is sustainable in its current form.Many other answers support their point of view by saying that it is sustainable elsewhere. But is it?The first things to disappear in a “single-payer” government run system are competition and price transparency. Almost every economist agrees that competition has been shown to reduce costs by increasing efficiency. Competition disappears when government has a monopoly on healthcare delivery.The Inefficiency of Monopolyhttps://courses.lumenlearning.com/wmopen-microeconomics/chapter/the-inefficiency-of-monopoly/Most people criticize monopolies because they charge too high a price, but what economists object to is that monopolies do not supply enough output to be allocatively efficient. To understand why a monopoly is inefficient, it is helpful to compare it with the benchmark model of perfect competition.Markets and Priceshttps://www.econlib.org/library/Topics/HighSchool/MarketsandPrices.htmlSupply and Demand: Prices play a central role in the efficiency story. Producers and consumers rely on prices as signals of the cost of making substitution decisions at the margin. How are prices determined?A work that still holds today is this one showing that economic calculation (price transparency) is impossible under government run systems. Price transparency disappears in a government run system because true prices (for both goods and services) cannot be determined despite claims purporting to know how much is spent:Economic Calculation in the Socialist Commonwealthhttps://www.goodreads.com/book/show/1714576.Economic_Calculation_in_the_Socialist_CommonwealthMises argued that no prices for capital goods could be obtained in a socialist economy if the government owned the means of production, since all exchanges would merely be internal transfers rather than "objects of exchange", setting the price mechanism out of order.Socialized Medicine: An Accounting Perspectivehttps://mises.org/wire/socialized-medicine-accounting-perspectiveJust like any language, financial accounting is not perfect. One limit of accounting must be stressed repeatedly in the debate over socialized medicine: financial accounting cannot exist without money prices. Financial accounting is impossible if buyers do not pay money prices for goods and services. In a socialized healthcare system, consumers (or patients) do not exchange money for their medical services. Therefore, there are no money prices for medical treatment in a socialized healthcare system. This means financial accounting is impossible under socialized medicine. …… However, socializing medicine makes financial accounting impossible in the healthcare system. This means socialized medicine has no language, no system to verify whether the most urgent needs of the patients are being satisfied in the best possible way. It impossible for the directors of the system to determine whether scarce medical resources are satisfying the most urgent needs of the patients, or whether those precious resources are being wasted. Without financial accounting, production decisions in socialized healthcare systems are always irrational. Consequently, a socialized healthcare system will be arbitrary, chaotic, and inefficient.Sometimes there is a difference between “universal” healthcare (government mandates that everyone has healthcare insurance) and “single-payer” healthcare (government is the one source for healthcare payments). Many other countries have mixed public/private systems:The new public/ private mix in health: exploring the changing landscapehttps://www.who.int/alliance-hpsr/resources/New_Public_Private_Mix_FULL_English.pdf?ua=1Universal Health Coverage Around the Worldhttps://axenehp.com/international-healthcare-systems-us-versus-world/So if most other countries don’t have single payer or socialized medicine, what do they have? Other systems fall in one of two broad categories:1. Insurance Mandates – Government mandates that all citizens purchase health insurance from private or public health insurers. Often includes a requirement for a standard minimum coverage across all insurers, subsidies for low income individuals, and forbids underwriting and for-profit insurance. Some countries with insurance mandates include Germany, Japan, the Netherlands, and Switzerland.2. Hybrid systems – Combines elements of single payer systems with private insurance mandates. Government provides a standard set of care for all citizens, with options to supplement with private insurance. Some countries with hybrid systems include Australia, France, Singapore, Sweden, and the UK.The Commonwealth Fund regularly publishes an excellent resource that summarizes the health care systems of many countries. The most recent report in May 2017 examined the systems in 19 countries. The following draws heavily from that report, and I highly recommend reading it if you would like more detail on the systems that I touch on here.Perspectives on the European Health Care Systems: Some Lessons for AmericaAmericans will probably be surprised to learn from the remarks that follow that Switzerland's health care system relies almost entirely on a system of private insurance. They might be surprised to learn that there is a growing reliance on the private sector in the financing and delivery of health care in Europe, particularly in the Netherlands, Germany, and Sweden. Even the Labor government in Britain has entered into an agreement with representatives of the private health care industry to improve health care delivery in certain vital areas…GermanyGermany's system is the prototype of the European sickness fund health care system. The most interesting aspect of the German system, however, is that Germany allows people whose income is above a certain level to opt out of that system. They are no longer obliged to pay a percentage of their wages to the sickness fund; however, they must use that money to buy private health insurance.The NetherlandsLike the Germans, the Dutch also can leave the sickness fund system once they earn more than a certain income. The financial threshold is lower in the Netherlands than in Germany, and as a result, one-third of the population is privately insured.SwitzerlandSwitzerland has the least paternalistic health care system in Europe. It is the only country in Europe with a health care system that is based totally on private insurance.Government run systems rely on price controls. Government sets the price of services and prescription drugs. That is why prescription drug prices are cheaper in most government run systems. Almost every economist agrees that price controls have been shown to reduce innovation. The sustainability of any system is determined by adaptation and innovation. The sustainability of most government run systems depends on the innovation provided by the U.S. system. Although not free market, it is more so than most other systems. Do supporters of government run systems consider lack of innovation as a condition for sustainability?Price-Control Failures, Then and Nowhttps://mises.org/wire/price-control-failures-then-and-nowPrice Controlshttps://www.econlib.org/library/Enc/PriceControls.htmlDespite the frequent use of price controls, however, and despite their appeal, economists are generally opposed to them, except perhaps for very brief periods during emergencies. In a survey published in 1992, 76.3 percent of the economists surveyed agreed with the statement: “A ceiling on rents reduces the quality and quantity of housing available.” A further 16.6 percent agreed with qualifications, and only 6.5 percent disagreed. The results were similar when the economists were asked about general controls: only 8.4 percent agreed with the statement: “Wage-price controls are a useful policy option in the control of inflation.” An additional 17.7 percent agreed with qualifications, but a sizable majority, 73.9 percent, disagreed (Alston et al. 1992, p. 204).Though The U.S. Is Healthcare's World Leader, Its Innovative Culture Is Threatenedhttps://www.forbes.com/sites/gracemarieturner/2012/05/23/though-the-u-s-is-healthcares-world-leader-its-innovative-culture-is-threatened/#38151a5c77ebThe United States remains the world leader in medical innovation, having produced more than half of the world’s new medicines over the last decade. But our edge is slipping away because of crippling domestic regulatory and tax policies.U.S. Medical Research Spending Drops While Asia Makes Gainshttps://www.usnews.com/news/articles/2014/01/02/us-medical-research-spending-drops-while-asia-makes-gainsALTHOUGH THE UNITED States once accounted for more than three-quarters of the world's research spending, its share has continued to drop in recent years, while countries in Asia saw a dramatic increase.In a study published Wednesday in the New England Journal of Medicine, researchers found the United States comprised 51 percent of global research spending, at $131 billion in 2007. But by 2012, that number dropped to $119 billion, or 45 percent of the world's biomedical research spending. By comparison, Japan and China increased their spending by $9 billion and $6.4 billion, respectively, during the same time. In 2012, Japan and China accounted for 13.8 percent and 3.1 percent of the world's total research spending.List of Nobel laureates in Physiology or Medicinehttps://en.wikipedia.org/wiki/List_of_Nobel_laureates_in_Physiology_or_Medicine7 Countries that Produce the Best Doctors in the Worldhttps://forum.facmedicine.com/threads/7-countries-that-produce-the-best-doctors-in-the-world.24520/1. U.S.A.Our 7 countries that produce the best doctors in the world list has come to an end with truly the greatest source of exceptional minds in the field of medicine. American doctors made the most lifesaving discoveries and groundbreaking treatments than any other country in the world.International comparison of health care systems using resource profileshttp://www.who.int/bulletin/archives/78(6)770.pdf… On the other hand, access to advanced medical technology was far greater in the USA than WHO 00198 Fig. 1a–f. Spider-web diagrams for the six study countries showing selected health care expenditures and resource measures for 1986, 1991, and 1996, normalized by the group maximum (% GDP = % gross domestic product; Exp/cap = expenditures per capita; Drugs/cap = drug expenditures per capita; MRIs = MRI units per capita; CT Scanners = CT scanners per capita; Beds/cap = no. of hospital beds per capita; Emp/cap = health care employment per capita; Phys/cap = No. of physicians per capita; Nurses/cap = no. of nurses pers capita; % Emp = health care employment as % of total employment) International comparison of health care systems Bulletin of the World Health Organization, 2000, 78 (6) 775 in the other countries, and this gap appears to be increasing in absolute terms. It would appear that relative differences in staff wages and access to medical technology may explain a substantial part of the difference between US and European expenditures.Government run systems are also susceptible to rising costs. Economics 101 tells us, in order to keep the system afloat, this means either raising taxes, increasing efficiencies and/or reducing services. Efficiency will account for a small percentage since efficiency can only be improved to a point. Taxes in most countries with government run systems are already much higher than in the U.S. Do supporters of government run systems consider the sustainability of rising tax burdens and reductions in services?A Comparison of the Tax Burden on Labor in the OECD, 2019https://taxfoundation.org/tax-burden-on-labor-in-the-oecd-2019/OECD Better Life Index- United Stateshttp://www.oecdbetterlifeindex.org/countries/united-states/The United States performs very well in many measures of well-being relative to most other countries in the Better Life Index. The United States ranks at the top in housing . and ranks above the average in income and wealth, health status, jobs and earnings, education and skills, personal security, subjective well-being, environmental quality, social connections, and civic engagement. It ranks below average in work-life balance . These rankings are based on available selected data.Money, while it cannot buy happiness, is an important means to achieving higher living standards. In the United States, the average household net-adjusted disposable income per capita is USD 45 284 a year, much higher than the OECD average of USD 33 604 a year, and the highest figure in the OECD.Reductions in services are already happening:Is U.S. Health Care Less Efficient than Other Countries’ Systems?https://object.cato.org/sites/cato.org/files/serials/files/regulation/2012/8/v35n2-8.pdf… Hidden costsIn most other developed countries, health care prices are controlled below the level necessary to clear the markets. This is especially common in single-payer systems like those of Canada and Japan. The result is a great deal of nonprice rationing. Some of the nonprice rationing is based on professional judgment, roughly similar to that occurring in competing managed care plans in the United States. It is probably reasonably efficient. But much of the rationing is accomplished by consumers waiting for services, which leads to large hidden costs of health care…… Unlike Medicaid, the nonprice rationing problem is system-wide in some other counties. Atlas shows that for many different diagnoses, Americans obtain appropriate care more often than those in many other countries. The delay and poor access to care resulting from rationing by waiting harms health outcomes, but delay and poor access tend to be concentrated on issues that are not life threatening; therefore, they do not…Perspectives on the European Health Care Systems: Some Lessons for Americahttp://www.heritage.org/health-care-reform/report/perspectives-the-european-health-care-systems-some-lessons-america… If you insist, with a straight face, that in a government-run health care system, all of your fellow citizens will be treated equally -- regardless of their class, station in life, or disease condition -- you are not merely enthusiastic or well intentioned. You are lying…… A British PerspectiveDavid G. Green, Ph.D... Lesson #1: Aim to make the market serve everyone, whether they are self-supporting through work or not. Governments should confine themselves to what they can do best and leave the rest to civil society. This implies that:-- Governments should not try to be the single payer, because this will result in rationing; and-- Governments should not impose a single provider, because this would mean that consumers could not escape bad service and incentives to raise standards would be diminished……A Belgian ViewPaul Belien… Denial or Restriction of TreatmentAnother method currently used to cut costs is to restrict the access of patients to costly health care services. Sometimes these services are denied to all patients; sometimes, only to certain categories -- for example, the elderly.I have experienced the impact of this policy in my own family when, several years ago, my grandfather needed an operation. Because he was over 80 years old, my grandfather was given an old antibiotic that has drastic side effects: It causes deafness. Though there were other, but costlier, treatments available, the hospital gave the old drug to my grandfather because of his age. They knew about the side effects, but it did not strike them as unreasonable or unjust to reserve the modern treatments for people of a younger age group and to give old rubbish to the elderly.A recent study shows that while over 50 percent of patients in the United States receive the latest, most effective pharmaceuticals for arthritis, they are available to only 15 percent of patients in Germany and the United Kingdom. The same trend is revealed with regard to cardiovascular medicine. In Italy and Belgium, the threshold condition for receiving the most innovative and effective therapy is having a cholesterol level of about 290 as well as proof of a family history of heart trouble, even though established medical opinion holds that a cholesterol level of 190 is the appropriate threshold for treatment.New medications are a critical component of health care, yet patients in many European Union countries have to wait years before they become available. In most European countries, pharmaceutical companies must not only get approval from the national departments of health, but must also obtain pricing and reimbursement approvals before they can introduce a new drug into the market. Because this can result in delays averaging 18 months, many breakthrough medications are simply unavailable for extended periods of time. A study conducted by Europe Economics revealed that, from 1995 to 1997, more than half of the new medications surveyed were unavailable through pharmacies in Portugal, Italy, and Greece. More than one-third were unavailable in Belgium, France, and the Netherlands.The delays serve an economic purpose: Because the new products are more expensive than the old ones, by delaying access to the new drugs, the governments save money. Though European politicians try to save money by cutting services across the health care sector, pharmaceuticals are frequently targeted because cutting drug expenditures is relatively easy.Access to healthcare in Europe in times of crisis and rising xenophobiahttps://www.uems.eu/__data/assets/pdf_file/0009/1530/MdM_Report_access_healthcare_in_times_of_crisis_and_rising_xenophobia.pdf… In its 2012 report Health policy responses to the financial crisis in Europe, the WHO classified the global financial crisis that began in 2007 as a health system shock or “an unexpected occurrence originating outside the health system that has a large negative effect on the availability of health system resources or a large positive effect on the demand for health services”. The WHO further warned that “cuts to public spending on health made in response to an economic shock typically come at a time when health systems may require more, not fewer, resources – for example, to address the adverse health effects of unemployment”. Measures such as reducing the scope of essential services covered, reducing population coverage, increasing user charges for services and reducing the number of health providers were specifically identified as policy tools that undermine health system goals.Here is what is being proposed in the U.S.:Considering “Single Payer” Proposals in the U.S.: Lessons from Abroadhttps://www.commonwealthfund.org/publications/2019/apr/considering-single-payer-proposals-lessons-from-abroad… Policy ImplicationsCurrently, single-payer bills in the U.S. tend to share the same key goals: centralizing the financial and regulatory structure of the system, expanding the public benefits package, and eliminating private health insurance entirely. However, these three features are not the norm across countries that have achieved universal coverage for health care.In contrast to single-payer proposals in the U.S., many universal health systems delegate significant financial and operational responsibilities to regional authorities, as long as they comply with federal regulations. In addition, the comprehensiveness of the universal public benefits package varies greatly by country. Finally, virtually every country with universal health coverage offers complementary, supplementary, or substitute private health insurance, which is purchased to ease the burden of cost-sharing, expand access to hospitals and providers, and cover benefits excluded under the public insurance scheme.Although all “single-payer” systems are “universal” healthcare systems, not all “universal healthcare” systems are “single payer.” Here is a list of countries considered to have “single-payer” systems:Single-payer healthcarehttps://en.wikipedia.org/wiki/Single-payer_healthcareCanada, Taiwan, South Korea, Nordic countries, United KingdomIt's Surprising How Few Countries Have National, Single Payer, Health Care Systemshttps://www.forbes.com/sites/timworstall/2017/03/26/its-surprising-how-few-countries-have-national-single-payer-health-care-systems/#3090cc5c5a65There are indeed national and single payer systems out there, most notably the National Health Service in Britain. That's very fair, very equitable, but performs horribly on "mortality amenable to health care" which is otherwise known as curing people of what ails them. That's not a recommendation.Let’s look at some sustainability issues in Canada:Cost of public health care for Canadian families soared by 70% over two decades: reporthttps://globalnews.ca/news/4364344/cost-health-care-canadian-families/Canadians' health-care costs have skyrocketed: Studyhttps://torontosun.com/2017/08/01/canadians-health-care-costs-have-skyrocketed-study/wcm/495190a8-ff3e-4016-aea2-43c61b4e6d3dDrug costs rising fast in Canadian health-care spending, report findshttps://www.cbc.ca/news/health/cihi-health-costs-canada-report-prescriptions-pharmacare-1.4390945Universal Health Care in Canada: A Colossal Government Failurehttps://mises.org/wire/universal-health-care-canada-colossal-government-failureTom Kent was the senior government policy person in Canada when the Medical Care Act was passed in 1966The aim of public policy was quite clearly and simply ... to make sure that people could get care when it was needed without regard to other considerations.After half a century, the government has still not honoured its commitment, and its performance declines with each passing year, despite increased spending. Furthermore, the government made it illegal for citizens to pay private parties for the health care which the government fails to provide.Waiting, Waiting, Waiting for a DoctorAccording to a Fraser Institute survey, for medically necessary treatment, the median waiting time for patients in Canada from referral by a general practitioner to consultation with a specialist, and then to the date of actual treatment, was 21.2 weeks in 2017.This year’s [2017] wait time — the longest ever recorded in this survey’s history — is 128% longer than in 1993, when it was just 9.3 weeks.Research has repeatedly indicated that wait times for medically necessary treatment are not benign inconveniences. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish. In certain instances, they can also result in poorer medical outcomes — transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities.Or even death! From a 2014 study by the Fraser Institute:The Ugly Truth About Canadian Health Carehttps://www.city-journal.org/html/ugly-truth-about-canadian-health-care-13032.htmlI was once a believer in socialized medicine. I don’t want to overstate my case: growing up in Canada, I didn’t spend much time contemplating the nuances of health economics. I wanted to get into medical school—my mind brimmed with statistics on MCAT scores and admissions rates, not health spending. But as a Canadian, I had soaked up three things from my environment: a love of ice hockey; an ability to convert Celsius into Fahrenheit in my head; and the belief that government-run health care was truly compassionate. What I knew about American health care was unappealing: high expenses and lots of uninsured people. When HillaryCare shook Washington, I remember thinking that the Clintonistas were right.My health-care prejudices crumbled not in the classroom but on the way to one. On a subzero Winnipeg morning in 1997, I cut across the hospital emergency room to shave a few minutes off my frigid commute. Swinging open the door, I stepped into a nightmare: the ER overflowed with elderly people on stretchers, waiting for admission. Some, it turned out, had waited five days. The air stank with sweat and urine. Right then, I began to reconsider everything that I thought I knew about Canadian health care. I soon discovered that the problems went well beyond overcrowded ERs. Patients had to wait for practically any diagnostic test or procedure, such as the man with persistent pain from a hernia operation whom we referred to a pain clinic—with a three-year wait list; or the woman needing a sleep study to diagnose what seemed like sleep apnea, who faced a two-year delay; or the woman with breast cancer who needed to wait four months for radiation therapy, when the standard of care was four weeks…… My book’s thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada’s population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays. The only solution, I concluded, was to move away from government command-and-control structures and toward a more market-oriented system. To capture Canadian health care’s growing crisis, I called my book Code Blue, the term used when a patient’s heart stops and hospital staff must leap into action to save him. Though I had a hard time finding a Canadian publisher, the book eventually came out in 1999 from a small imprint; it struck a nerve, going through five printings.Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity— 15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren’t available. And so on.Let’s look at sustainability issues in Taiwan:Health Care for All: The Good & Not-So-Great of Taiwan's Universal Coveragehttps://international.thenewslens.com/article/108032… Is NHI sustainable?However, the system is far from perfect.A budget deficit, an aging population, a rise in chronic diseases, questionable quality of care, disgruntled doctors and incessant public demand on Taiwan’s medical services are just some of the challenges detailed by Princeton University Health Policy Research Analyst Cheng Tsung-mei’s (鄭宗美) report on the country’s health care system…… NHI’s annual expenditure currently grows by 4.83 percent while funding grows by 4.35 percent annually. “Fortunately, we have NT$200 billion (US$6.48 billion) in safety reserves,” says NHIA Director General Lee. “But the 2016 decrease in premium has resulted in a NT$10 billion (US$323.9 million) deficit and possibly the deficit could double this year to NT$24 billion (US$777 million).”…… But instead of blaming the public on wasting resources, the system itself is designed to be open to abuse, Lin Chao-yin (林昭吟), an associate professor at National Taipei University Department of Social Work and an adviser to the Taiwan Health Care Reform Foundation (THRF, 台灣醫療改革基金會), points out.“Sometimes a patient is required by the doctor or hospital to return for follow-up visits or repeat medical exams. What should the patient do?” says Lin. An NGO that protects patients’ welfare, THRF also acts as a watchdog for the country’s health care system.“We have to look at the issues from different perspectives,” says Lin, “and work together to figure out how to educate the public and make the system more effective.”Aging populationAs of March 2018, Taiwan has officially crossed the “aged society” threshold – which World Health Organization (WHO) guidelines define as a society in which over 14 percent of the population is aged 65 or older.Taiwan is currently on track to become a “super-aged society” in 2026, or a society in which one out of five people is 65 or older.Overworked, underpaidSo how does Taiwan continue to lift its health care standards despite the tight purse strings?“At the huge expense of health professionals,” argues Chiang Kuan-yu (姜冠宇) of the Taiwan Medical Alliance for Labor Justice and Patient Safety (TMAL; 醫勞盟). Founded in 2012 by a group of physicians and nurses across Taiwan, TMAL has been plugging for all physicians to be covered under the Labor Standards Act (LSA, 勞動基準法) since its early years.“We are tired and burnt out,” says Chiang.In 2016, resident doctors clocked an average of 80 to 100 hours a week. Neurosurgery residents’ duty hours topped the chart at an average of 90.9 hours, followed by doctors in orthopedics, surgery, obstetrics, neurology and internal medicine.Doctors are falling ill or suffering from exhaustion due to occupational hazards, Chiang added. One high profile case in 2009 involved a former resident doctor who suffered a stroke and subsequent brain damage after working 84 hours a week for six months. After a lengthy three-year legal battle, his family was able to claim a retirement pension and compensation. However, the doctor’s mental capacity has regressed to that of a six-year-old…… “We don’t have statistics for the number of doctors who have left the country, but the situation is bad enough that MOHW [Ministry of Health and Welfare], at one point, considered banning young doctors from practicing overseas,” says Chiang.Taiwan’s health care system: The next 20 yearshttps://www.brookings.edu/opinions/taiwans-health-care-system-the-next-20-years/… Except for the first three years since implementation (1995-1998), annual growth in expenditures in Taiwan’s NHI had typically outstripped revenues. In the period 1996-2008, for example, NHI revenues increased at an annual rate of 4.43 percent while expenditures increased at an annual rate of 5.33 percent…… A main reason for NHI’s high performance is the ability of the government, as the single payer, to set and regulate fees, and impose a global budget system that caps total NHI expenditure. For 2015, for example, NHI expenditure is budgeted to increase 3 percent from its 2014 levels. The NHI Administration (NHIA), the government agency that administers the NHI under the Ministry of Health and Welfare (MOHW), wields near monopsonistic power as the single buyer of and payer for health care services including drugs vis a vis health care providers. This power enables the NHIA to control costs and provide Taiwan’s public with affordable health care services, in sharp contrast to the United States where private health insurers often have limited power to set fees, especially in markets dominated by large provider organizations…… While it is important to remove financial barriers to needed medical care, in the longer term the question of sustainability of the current generous copayment exemption policy must be raisedLet’s look at some sustainability issues in South Korea:First, we look at WHO rankings. Many people who discuss healthcare cite the WHO data without knowing where the information comes from or how it is generated. WHO methodology is biased toward “universal” healthcare systems.The Worst Study Ever?Exposing the scandalous methods behind an extraordinarily influential ‘World Heath Report'https://www.commentarymagazine.com/articles/the-worst-study-ever/… At its most egregious, the report abandoned the very pretense of assessing health care. WHO ranked the U.S. 42nd in life expectancy. In their book, The Business of Health, Robert L. Ohsfeldt and John E. Schneider of the University of Iowa demonstrated that this finding was a gross misrepresentation. WHO actually included immediate deaths from murder or fatal high-speed motor-vehicle accidents in their assessment, as if an ideal health-care system could turn back time to undo car crashes and prevent homicides. Ohsfeldt and Schneider did their own life-expectancy calculations using nations of the Organisation for Economic Co-operation and Development (OECD). With fatal car crashes and murders included, the U.S. ranked 19 out of 29 in life expectancy; with both removed, the U.S. had the world’s best life-expectancy numbers (see table above)…… What we have here is a prime example of the misuse of social science and the conversion of statistics from pseudo-data into propaganda. The basic principle, casually referred to as “garbage in, garbage out,” is widely accepted by all researchers as a cautionary dictum. To the authors of World Health Report 2000, it functioned as its opposite—a method to justify a preconceived agenda. The shame is that so many people, including leaders in whom we must repose our trust and whom we expect to make informed decisions based on the best and most complete data, made such blatant use of its patently false and overtly politicized claims.Scott W. Atlas is a senior fellow at the Hoover Institution and professor of radiology and chief of neuro-radiology at the Stanford University Medical Center.If we are to use a study that is biased towards “universal” healthcare systems, it would be important that a country’s “universal” healthcare system be ranked higher than the U.S. South Korea is ranked 21 spots lower than the U.S. Yikes! That does not instill confidence for sustainability.World Health Organization’s Ranking of the World’s Health Systemshttp://thepatientfactor.com/canadian-health-care-information/world-health-organizations-ranking-of-the-worlds-health-systems/Health Care Reform in South Korea: Success or Failure?https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447690/… Everything went smoothly in both administration and financing in the first half of the 1990s. However, with the advent of the economic crisis of 1997 throughout southeast Asia, Korean NHI began to run a financial deficit. At the end of 1997, despite some Korean resistance, the International Monetary Fund (IMF) intervened in Korean financial affairs, causing a dramatic increase in the NHI’s deficit, which then grew each year until 2002….… THE FINANCIAL CRISIS IN KOREAN HEALTH CAREAfter 1996, Korean NHI began to develop significant deficits (Figure 1). From 1996 to the present, total health expenditures have exceeded total income. During the economic crisis of 1997, when the Korean economy was controlled by the IMF, NHI’s financial deficit grew worse. In addition, the financial structure of Korean NHI was disrupted by the separation of reimbursement for medical care and reimbursement for pharmaceutical services in July 2000. Although government continually raised the mandatory insurance premiums to make up for the deficit, many health policy experts predicted that increased governmental funding would not solve the problem.Let’s look at some sustainability issues in Nordic countries:‘Socialist’ Nordic Countries Are Actually Moving Toward Private Health Carehttps://www.dailysignal.com/2019/06/13/socialist-nordic-countries-are-actually-moving-toward-private-health-care/Never mind that these are not true socialist countries, but highly taxed market economies with large welfare states. That aside, they do offer a government-guaranteed health service that many in America wish to emulate.FinlandWhy is Finland’s healthcare system failing my family?https://www.theguardian.com/society/2016/feb/23/finland-health-system-failing-welfare-state-high-taxesImagine going to your nearest doctors’ surgery at 9am on a weekday with your sick six-year-old daughter because you cannot make an appointment over the phone. After your drive to another part of the city, you can’t simply book a time with the receptionist. There isn’t one. Instead, you must swipe your daughter’s national insurance card through a machine, which gives you a number. Then you and your feverish child simply sit and wait. Or rather, you stand, because the room is so crowded that people are sitting on the floor, on steps, or leaning against walls. The numbers come up on a screen every 10 minutes or so, in no particular order so you’ve no idea how long your wait will be as your daughter complains of feeling cold then hot and then cold again.By 10.45, another patient’s dad exclaims he’s been there since 8.15, he’s had enough, and he’s going to go to a private GP. “You used to just be able to make an appointment with a doctor!” he says angrily.You see, you are not even waiting to see a GP. You’re waiting to a see a nurse in order to justify to her how quickly your child needs to see a GP or whether she needs to see one at all. At 11.30, you give up and take your daughter to see a private doctor as well, forking out £50 for the privilege.This isn’t some nightmare vision of the NHS after 10 years of Tory cuts. This happened to me recently in a country I have moved to from Britain that is normally lauded as the shining example of a successful welfare state.Finland receives such a positive press in Britain. Its schools consistently have the best international student assessment results in the western world; there’s high social equality; all its teachers have master’s degrees. But it has one of the worst health services in Europe.Finland’s health service has been in a parlous state for decades and it is getting worse.According to an OECD report published in 2013, the Finnish health system is chronically underfunded. The Nordic nation of five million people spent only 7% of GDP on its public health system in 2012, compared with 8% in the UK. In 2012, the report found, 80% of the Finnish population had to wait more than two weeks to see a GP. Finland’s high taxes go on education and daycare…… In Helsinki there are reports of huge queues at health centres (GP surgeries), waits for appointments of many weeks, and greater and greater demands with less and less funding. In south-eastern Finland it takes about a month to see a GP. Back in December 2013, it was reported that Finns were increasingly using private doctors in neighbouring Estonia to save time and money.I live in Oulu, Finland’s northern technology hub, famed for its annual Air Guitar Festival. Jani Saarinen (not his real name), an Oulu doctor in his 30s, who has worked in both the state and private sectors in different parts of the country, explained to me that the municipal health system was plagued by “cost pressures” and “long waiting times”.“There used to be an outsourced health centre in Oulu, so it was private, but it was the public service that the city offered,” says Saarinen. “Using a different system from the municipality, they managed to get waiting times down to two weeks and see emergency appointments on the same day. Outsourcing was a much more efficient way of working, but it was closed down.”Saarinen explains that the system essentially forces people to go private or rely on friends who are doctors.Finland's cabinet quits over failure to deliver healthcare reformhttps://www.reuters.com/article/us-finland-government/finlands-cabinet-quits-over-failure-to-deliver-healthcare-reform-idUSKCN1QP0R6.. Healthcare systems across much of the developed world have come under increasing stress in recent years as treatment costs soar and people live longer, meaning fewer workers are supporting more pensioners.Nordic countries, where comprehensive welfare is the cornerstone of the social model, have been among the most affected. But reform has been controversial and, in Finland, plans to cut costs and boost efficiency have stalled for years.The 'dark side' of Finland's famous free health carehttps://www.cnn.com/2019/08/15/world/finland-health-care-intl/index.html… Of course, it's not all rosy. In March, the Finnish government resigned because it failed to get its health care reform through Parliament -- becoming the second government in a row to fail to do so.Finnish's decentralized health care system is often managed by local municipalities with populations ranging from hundreds of thousands of people to fewer than 100. And that decentralized nature is not only very expensive to maintain but also can produce vast disparities in the quality of care.Municipalities receive funding for health care services based on the size of the taxable population, which can make it more difficult to provide services in remote and larger areas -- where those services are also more expensive to begin with.In March, just after Juha Sipila's government resigned, the governor of the bank of Finland, Ollie Rehn, warned that reform remained urgent "from the point of view of fiscal sustainability."As the country's population ages and birth rates fall, the number of taxpayers paying into the system is diminishing—while the overall population is living longer and putting greater strain on resources. In 2018, the average single Finn faced a net average tax rate of 30%, compared to 23.8% in the United States….…"So if you think of sustainability, either we get more people to Finland or we have to cut the cost," he adds.To make Finland's health care system financially sustainable, one of the aims of the last government's reform proposal was to cut costs by centralizing services and introducing more private options. But centralization is proving tricky in a country that is sparsely populated in some areas, and where the health care system was designed to serve even the most remote parts of a country that stretches all the way up to the Arctic Circle…… "People outside of Finland tend to see only the good sides of the system," says Hiilamo."Normally, we show people the sunny side of the street, but there is a dark side of the street. And health care is on the dark side, and for many years we have had a problem."NorwayNorway: health system review.https://www.ncbi.nlm.nih.gov/pubmed/24434287Public sources account for over 85% of total health expenditure; the majority of private health financing comes from households out-of-pocket payments. The number of practitioners in most health personnel groups, including physicians and nurses, has been increasing in the last few decades and the number of health care personnel per 100 000 inhabitants is high compared to other EU countries. However, long waiting times for elective care continue to be a problem and are cause of dissatisfaction among the patients. The focus of health care reforms has seen shifts over the past four decades. During the 1970s the focus was on equality and increasing geographical access to health care services; during the 1980s reforms aimed at achieving cost containment and decentralizing health care services; during the 1990s the focus was on efficiency. Since the beginning of the millennium the emphasis has been given to structural changes in the delivery and organization of health care and to policies intended to empower patients and users. The past few years have seen efforts to improve coordination between health care providers, as well as an increased attention towards quality of care and patient safety issues.Illusions of Paradise? Health Inequalities in Norwayhttps://www.europenowjournal.org/2016/10/31/illusions-of-paradise-health-inequalities-in-norway/How can inequalities in health possibly exist in such a society? For many years, it was believed that health inequalities could not exist in the most egalitarian societies. At least, that is what we thought in Norway. We did not even bother to collect information on educational attainment in our health surveys. When the Black Report became available to us, revealing substantial health inequalities in the United Kingdom, which shared many of our principles related to the national health system (actually, we copied and pasted this system), we started to question whether health inequalities could exist in our society as well. But the real shock would come later: Health inequalities really emerged as a topic in the Norwegian public debate in the aftermath of a cross-country study published in The Lancet in 1997. The study documented the existence of considerable socio-economic health inequalities, above all in Norway and other Scandinavian countries.Health Care Around the World: Norwayhttps://www.healthcare-economist.com/2008/04/18/health-care-around-the-world-norway/… Waiting Times. There are significant waiting times for many procedures. Many Norwegians go abroad for medical treatments. The average weight for a hip replacement is more than 4 months. “Approximately 23 percent of all patients referred for hospital admission have to wait longer than three months for admission.” Also, care can be denied if it is not deemed to be cost-effective.Let’s look at some sustainability issues in SwedenPerspectives on the European Health Care Systems: Some Lessons for America… A View from SwedenJohan Hjertqvist… Changing Mindsets in EuropeAll of the above factors will influence the future of health care in Sweden and many other countries in Europe. It can safely be said that the old welfare state is on the run. There is word from all sides that confusion reigns. Conflicts have emerged with trade unions as signs of future changes and present realities confront old thinking about pensions, health care, and the labor market. A new brand of welfare society is emerging, leaving the traditional European welfare state behind. In Sweden, the Social Democrat government is beginning to accept this development as a tool to engender public efficiency, improve the quality of services, and meet the expectations of the middle class -- if not officially in party manifestos, in reality in its response to changes.Last year, the Swedish Parliament passed a bill welcoming private providers in primary care and nearly all other kinds of health care services with the exception of emergency care.What's most important is for Europe to change its perspective regarding the economics of health care. Traditionally, European politicians frown on any move toward the free market and declare that health care must be strictly rationed. They are afraid of over-consumption. They're afraid of new expensive drug therapies.From the perspective of most European governments, a successful year is one in which there was a zero increase in health care costs. Very seldom do these politicians relate costs with outcome, as any business would.The service-delivery market reform in Stockholm builds on a purchaser-provider relationship. All 2,200 producers in the system -- public and privately owned -- are paid by the same mechanism, which rewards productivity. (Even if Sweden officially denounces every American influence, many of the technical aspects of this system, such as the payment structure, have been imported from the United States.)As a result of this competition and the number of private service providers, services have increased dramatically in the Stockholm area while long waiting lists continue to plague health care in most other parts of Sweden. In fact, there is a direct correlation between a monopoly of old-style health care and long waiting lists. Outside the metropolitan region, patients must wait for up to one year for cataract surgery and two years for hip surgery.The Truth About SwedenCarehttps://mises.org/library/truth-about-swedencare… It is impossible to put a number on it, but it is obvious that the level of energy in the medical professions in Sweden is low compared to America. It can be seen on several levels, from doctors and even down to students. An American medical student and friend of mine spent a year at a major Swedish hospital. He was shocked when he realized that students never spent any of their spare time in the operating room; there was no drive to become the best. There are of course enthusiasts who love their work regardless, and do a fantastic job, but the system is not conducive to this attitude.Planning always fails. The planners come to realize that the market is superior but they will not back off. Rather they will try to mimic a market, using trendy techniques such as “New Public Management,” voucher systems, or healthcare exchanges. The results of these solutions are usually even more disastrous than outright planning. In order to work, they will have to reduce every medical condition to a code, every patient to an ID number, and every procedure to planned (arbitrary) cost and income numbers.It was recently revealed in one of the major newspapers that doctors were told to prioritize patients based on their value as future taxpayers. Old people naturally have a low future-taxpayer-value, so they naturally became low priority in the machine and less likely to receive proper treatment. In a private healthcare system you can make your own priorities, you can for example sell your house and spend the proceeds on becoming well. In a socialized system somebody else sets the priorities. …… When I moved to the U.S., our family health insurance took three months to kick in. One of my family members broke a leg in this period. We found a “five-minute clinic” half an hour away, had the leg X-rayed, straightened and casted, with no waiting time — all for $200 cash. That kind of service is non-existent in Sweden. It is an example of how a market, not yet totally destroyed by the state, can create affordable and high quality services.The reason American insurance-based healthcare is so expensive is that it is heavily regulated and legally connected to the equally-regulated insurance industry. Both are well protected from competition by regulation. Obamacare will make them even more expensive, bureaucratic, and inaccessible. The way to fix U.S. healthcare is by excising the central planners and regulators from it, not by implanting droves more of them.I have seen (and lived in) the future of American health care, and it does not work.Crisis situation at Swedish hospitalshttps://www.eurotopics.net/en/178879/crisis-situation-at-swedish-hospitalsSo Long, Swedish Welfare State?https://foreignpolicy.com/2018/09/05/so-long-swedish-welfare-state/… Sweden’s welfare problems affect people’s daily lives. Average earners in Sweden pay half their income in direct and indirect taxes. Yet, the famous Swedish welfare state is plagued by difficulties in accessing health care. Some individuals and companies are therefore turning toward private health insurance. At the end of 2017, 643,000 individuals in Sweden were fully covered by private health insurance. This is an increase of over half a million users compared to 2000.Swedes enjoy world-class healthcare—when they get ithttps://medicalxpress.com/news/2018-09-swedes-world-class-healthcarewhen.htmlAsia Nader didn't know whether to worry more about being diagnosed with a hole in her heart at the age of 21, or having to wait a year for Swedish doctors to fix it. …… Swedish law stipulates patients should wait no more than 90 days to undergo surgery or see a specialist. Yet every third patient waits longer, according to government figures.Patients must also see a general practitioner within seven days, the second-longest deadline in Europe after Portugal (15 days).Yet waiting times vary dramatically across Sweden's 21 counties responsible for financing hospitals.One dental patient in central Dalarna county told AFP six months passed before his check-up, while emergency room queues at Stockholm's largest hospitals average four hours.The 2016 nationwide median wait for prostate cancer surgery was 120 days, but 271 days in the northern county of Vasterbotten, official figures show.Let’s look at some sustainability issues in DenmarkFree Healthcare in Denmark: My First-Hand Experiencehttp://www.sageandsimple.com/2016/02/free-healthcare-in-denmark/First, let’s get one thing straight. Free healthcare in Denmark is not free. Danish healthcare is an 8% line item deduction of gross pay. Free healthcare in Denmark does not cover physicals, vision or dental care, and mental health services are only partially covered and only in certain situations. Prescriptions are full price until a personal annual threshold is reached, then they are progressively discounted as the spend increases. My first asthma prescription this year cost me around $200, and I paid $35 just yesterday for prescription strength B-12 tablets. In nearly six years, I’ve never had my total yearly prescription cost in Denmark come in below that of my $10 – $20 US co-pay.I pay roughly six times as much for my free healthcare in Denmark as I did for my employer-sponsored plan in the US, and it covers far less. But that’s not the point of this post. The point of this post is to tell you what it’s like to live with free healthcare in Denmark.A DANISH STUDENT’S PERSPECTIVES ON HEALTHCAREhttps://prospectjournal.org/2013/12/02/a-students-perspectives-on-danish-healthcare/.. Peter then described some of the issues that have plagued the healthcare system in Denmark for the past couple of years, and what the government has done to combat these problems. Peter argued that the worst part of having a centralized healthcare system is that treatment is often inaccessible in rural parts of Denmark, as all hospitals and most outpatient clinics are located in cities or suburban areas. People often have to drive up to 50 miles for a weekly checkup, or even further for access to surgical treatments. To counteract this problem, the Danish government has been focusing on developing more outpatient clinics and on increasing the number of emergency care centers in rural areas. While not all treatment types are available for patients at these outpatient clinics, patients don’t have to encounter long ambulance lines and waits at the emergency rooms.One of the unsolved issues that still remains for Danish citizens’ concerns the quality of care at these mega-hospitals. One major issue is overcrowding at hospitals, creating long waits for procedures in cases that are not immediately life threatening. Hospitals are usually fully booked, with patients sharing rooms and being rushed out as soon as possible. Additionally, there are long waiting lines for surgeries, often more than a month, and patients are forced to cope with their problems while they wait. However, Peter claims that this trend is increasingly accepted as the norm, as people understand that it is impossible to have excellent, individualized care for every single citizen. No matter the socio-economic status of the patients, the facility and doctors that treat them are the same. This equality is what drives the system effectively and allows it to work with minimal issues.Why Denmark isn't the utopian fantasy it is made out to behttps://www.independent.co.uk/news/world/europe/why-denmark-isnt-the-utopian-fantasy-it-is-made-out-to-be-a6720701.html… Politicians in the U.S. like Bernie Sanders praise Denmark for its relative income equality, its free universities, parental leave, subsidized childcare, and national health system. That all sounds pretty good, right?It is fantastic in theory, except that, in Denmark, the quality of the free education and health care is substandard: They are way down on the PISA [Programme for International Student Assessment] educational rankings, have the lowest life expectancy in the region, and the highest rates of death from cancer. And there is broad consensus that the economic model of a public sector and welfare state on this scale is unsustainable. The Danes’ dirty secret is that its public sector has been propped up by — now dwindling — oil revenues. In Norway’s case, of course, it’s no secret. …… One thing that’s often glossed over among outsiders is the extraordinarily high tax level, which is high for the middle class as well as the wealthy. Do Danes think that they get their money’s worth in social services? Do you?Denmark has the highest direct and indirect taxes in the world, and you don’t need to be a high earner to make it into the top tax bracket of 56% (to which you must add 25% value-added tax, the highest energy taxes in the world, car import duty of 180%, and so on). How the money is spent is kept deliberately opaque by the authorities. Danes do tend to feel that they get value for money, but we should not overlook the fact that the majority of Danes either work for, or receive benefits from, the welfare state. …The Danish Health Care System: An Analysis of Strengths, Weaknesses, Opportunities and Threats (SWOT analysis)The three major challenges are interrelated: 1. Demography (aging, more chronically ill), 2. The manpower situation (a declining workforce), and 3. Fiscal sustainability in view of not only the demographic development but also the welfare effect of a steadily increasing income level: When gross domestic product, GDP, increases by one percent, health expenditures increase by 1.2 - 1.3%, hence gradually capturing a greater share of GDP. …… Be careful with the interpretation of the cost‐benefit ratios – they are tricky compared to the QALY-ratios commonly used in health economics. They cannot be equated to savings‘ in the health care system. Consider, for example, Solution 2 in the table below.The cost‐benefit ratio is 1:26. This means that individual willingness to pay for an additional life year leads to this result (in accordance with the thinking behind cost‐benefit analysis). However, viewed from the health care system‘s perspective, the solution is cost neutral‘ according to a health economic evaluation of the experiment. For practical purposes it is this result that is of interest. However, if one wants to put a monetary value on the added life time, this can be done by applying an estimate of the individual‘s willingness to pay for (a fraction of) an extra life year. It should be obvious that this cannot be interpreted as savings, but rather is the monetary value of additional life time. It should be noted that the individual willingness to pay may differ from the political willingness to pay for an added life year – and resource allocation in health care essentially is political. …… Within the next two decades publicly financed health expenditures will increase with between an (unlikely) 20% and a more likely 35% in real terms. To this should be added an increase in social expenditures of app. 13% under the assumption of 0.3% additional growth. …… Slow introduction of new treatments?In many areas Denmark have not been on the forefront of implementing new technologies and treatments. The slow adoption of new technologies and drugs may be due to the before mentioned successful cost containment but this is not the only reason. The awareness and capability to implement new technologies is another reason as in general what determines diffusion of new treatments where economics is only part of the explanatory variables.Let’s look at some sustainability issues in the United Kingdom:The NHS - Britain's national religion - doesn’t have a prayerhttp://www.telegraph.co.uk/news/nhs/10959391/The-NHS-Britains-national-religion-doesnt-have-a-prayer.html10 charts that show why the NHS is in troublehttp://www.bbc.com/news/health-38887694Rationing of NHS services ‘leaving patients in pain and distress’, says new reporthttps://www.independent.co.uk/news/uk/politics/nhs-rationing-the-kings-fund-report-patients-pain-distress-cuts-district-nurses-sexual-health-a7628101.htmlN.H.S. Overwhelmed in Britain, Leaving Patients to Waithttps://www.nytimes.com/2018/01/03/world/europe/uk-national-health-service.html?mtrref=search.myway.com&gwh=C0C462EEA64AA2936BD246A5900E0756&gwt=payUS vs UK: Allied Healthcare at Home and Abroadhttps://www.aimseducation.edu/blog/us-vs-uk-allied-healthcare/Availability of CareGetting care when you need it is universally important. Speedy care in the emergency room is essential. The UK healthcare system target is to have a patient wait time of four hours or less for 95% of its patients.Currently, they’ve achieved this wait time for approximately 85% of emergency care patients. By comparison, 95% of visitors to the ER are seen within three hours of arrival. The average wait time for emergency and accident care in a US emergency room is 58 minutes.Patients Are “Dying in Corridors" of Britain’s Socialised Health Systemhttps://mises.org/wire/patients-are-%E2%80%9Cdying-corridors-britain%E2%80%99s-socialised-health-systemHealth Check: The NHS and Market Reformshttps://iea.org.uk/publications/research/health-check-the-nhs-and-market-reformsThe recent Commonwealth Fund study, which ranked the NHS well, has its merits, but it is structurally designed to favour an NHS style model of healthcare. The study’s limitations are perhaps best, albeit unintentionally, captured by The Guardian’s coverage of the report which stated: ‘The only serious black mark against the NHS was its poor record on keeping people alive.’Does Britain Have the World’s Best Health System? Only If You Ignore Outcomeshttps://mises.org/wire/does-britain-have-world%E2%80%99s-best-health-system-only-if-you-ignore-outcomes… How is it possible, then, that the NHS should have ranked so highly in this recent study by the influential Commonwealth Fund health think tank, despite all these major problems? The answer is in the study’s careful selection of the criteria used as metrics of success, in order to give the most weight to the few areas in which the NHS actually does succeed.The fraying edges of universal health carehttps://www.washingtontimes.com/news/2019/apr/10/universal-health-system-in-britain-collapsing-a-ha/If you’re wondering what Democrats have in mind when they tout “Medicare For All,” look no further than England. There are more reports of the U.K.’s National Health System’s collapse, this time featuring horror stories of rationing care for the elderly. Doctors are now sounding alarms bells that seniors with cataracts are going blind as they wait for surgical approval.Cancer waiting timeshttps://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/access-to-treatment/waiting-times-after-diagnosisBeing diagnosed with cancer can sometimes take a while. At times, just about everyone will have to wait to have tests or to get the results. Sometimes people have to wait for appointments to begin their treatment. This can be frustrating and difficult to cope with.Within the UK, there are targets for maximum waiting times to start treatment. The different UK nations have their own targets around referral for suspected cancer and waiting times to a diagnosis.Urgent referral for suspected cancerYour GP might arrange for you to see a hospital doctor (specialist) urgently because you have symptoms that could be due to cancer. This can be very worrying, but it’s important to know that 9 in every 10 people (90%) referred this way will not be diagnosed with cancer.In England, an urgent referral means that you should see a specialist within 2 weeks. In Northern Ireland, the 2 week wait ONLY applies if you are referred for suspected breast cancer.This 2 week time limit does not exist in Scotland and Wales. But wherever you live, you are seen as quickly as possible.These examples are what happens within “single-payer” healthcare systems:Who is Charlie Gard, what is the disease he suffered from and what happened in the court case?The story of Charlie GardNHS doctors determined that Charlie Gard had a rare and incurable disease. The problem with that diagnosis is that medicine has not advanced to the point of absolute surety.List of Brain Dead Patients Who've RecoveredHospital Doctors Misdiagnose Woman as Brain DeadMan Diagnosed as Brain Dead RecoversOne-in-five ‘vegetative’ patients is misdiagnosed: StudyDoctors Diagnose Comatose Patient As Brain Dead And Refuse To Treat Her — They Were WrongMother's joy as her 'brain dead' son makes a miracle recoveryMrs Reid, married to David, was told by doctors his brain had 'completely died' and he spent a further nine months on the hospital's Paul ward.Signs of LifeEven if we concede that the doctors were 99.99% sure of their diagnosis, what happened next was a Kafkaesque, totalitarian nightmare. Bureaucrats within the EU refused to let the Gard family use THEIR OWN MONEY to do everything they could to save their child. “Single-payer” healthcare systems refuse funding for cases they deem economically unfeasible. This is no different from private insurance doing the same. But to deny a citizen the right to use their own money is dictatorial.The case of Alfie Evans followed with the same results. What may have saved Oliver Cameron were those two previous cases. Because there was now a loud enough outcry from the populace to at least let the family try to save their child. The problem was that doctors within the NHS lacked the innovative technical expertise to perform the surgery. Oliver was allowed travel to the U.S. NHS doctors accompanied him so that they could learn the procedure from U.S. doctors:Baby Oliver saved in U.S. after UK doctors said his heart couldn't be fixedNHS to fund baby's US heart operationThe NHS said it was also discussing whether a UK surgeon might accompany Oliver to Boston to learn from the surgeons in the US so the innovative surgery could "potentially be offered in the UK in future".The UK Finally Allowed a Sick Baby to Seek Treatment in the US — Now the Baby Is Tumor-FreeHealthcare systems in Europe are not the panacea many supporters of government run systems claim:Health Care Reform: The European Experiencehttps://www.ncbi.nlm.nih.gov/books/NBK231468/The fear of liability for malpractice and related defensive medicine did not significantly contribute to the introduction of quality assurance mechanisms in Europe, but partly explains the substantial lag in implementation of quality monitoring and improvement compared with that in the United States. Attitudes regarding advances in medicine in particular and science in general are ambivalent, notably when human dignity is at stake. Admiration and zero-risk expectations are mixed with accusations of pointless therapeutic assault. This in turn explains the reluctance of health professionals to expose their decision-making to peer review and scrutiny by members of the public…… Europe's human resources for health care are plagued with a series of problems. An unbalanced supply of various categories of health care workers is compounded by geographic and functional maldistributions. There is a marked oversupply of physicians, dentists, and pharmacists in most countries. Graduates compete for limited employment opportunities in health facilities and programs in the public and private sectors. Increasing numbers of young doctors join the ranks of Europeans who receive unemployment benefits. Others engage in various forms of “alternative medicine,” which are often questionable practices. Growing numbers enlist in international aid organizations and disaster areas, either natural or those caused by people, which span the globe…… Nursing in Europe is slipping into a deep crisis. A severe and growing shortage of nurses is starting to have a negative impact on patient care. Because of the demographic “degreening” of the population, there are fewer potential candidates for nursing and allied health professions. Cost containment and related shifts of inpatient care to alternate sites for care have contributed to a greater dependency on nurses to care for sicker patients. “Burnout” among health care workers has reached unheard-of proportions. Financial compensation is gradually being perceived as grossly unfair and insulting.Strikes and “work-by-rule” actions are frequent and, in turn, contribute to alarming declines in recruitment. During the last 4 years, Belgium, France, The Netherlands, and the United Kingdom have repeatedly been confronted with outbursts of anger from demoralized nurses, ambulance drivers, and even junior doctors.In the U.S, Medicare is an example of a “single-payer” system:$1.1T: CMS Sets Record for Annual Spending by a Federal AgencyThe Centers for Medicare and Medicaid Services (CMS) spent over $1.113 trillion in fiscal year 2013 — setting a record for the most money spent by a federal agency or department in a single year.Social Security and Medicare Funds Face Insolvency, Report FindsAn annual government report on the status of the programs painted a dire portrait of their solvency that will saddle the United States with more debt at a time when the economy is starting to cool and taxes have just been cut.According to the report, the cost of Social Security, the federal retirement program, will exceed its income in 2020 for the first time since 1982. The program’s reserve fund is projected to be depleted in 16 years, at which time recipients will get smaller payments than they are scheduled to receive if Congress does not act.Meanwhile, Medicare’s hospital insurance fund is expected to be depleted in 2026 — the same date that was projected a year ago. At that point, doctors, hospitals and nursing homes would not receive their full compensation from the program and patients could face more of the financial burden.Controlling costs through raising taxes:Reductions in a family’s ability to purchase goods and services, and accumulate savings, has many ripple effects for quality of life, as mentioned in the OECD “Better Life Index.” What is compassionate about reducing a family’s ability to provide costly education for children who do not have grades that allow eligibility for scholarships or government financed education? Because most of the “free education” systems of Europe are only free to those whose grades are high enough. What is compassionate about reducing a family’s ability to provide their children educational experiences through travel? What is compassionate about reducing a family’s ability to provide their children with better housing choices? What is compassionate about reducing a family’s ability to provide their children with better nutritional choices? What is compassionate about reducing an individual’s ability for a retirement that provides more choices?Controlling costs through reduction in services (rationing):Despite false claims to the contrary, medical rationing is a part of reducing costs in government run systems. Quality care is simply denied to the elderly and people whose illness has been deemed too costly by government bureaucrats.Controlling costs through innovation reduction:As has been shown, the U.S., having more vestiges of a free market than most countries, supplies the lion’s share of medical research and innovation from which the rest of the world benefits. As has also been shown, that percentage has decreased dramatically since the inception of the AHCA. Further government control of the U.S. healthcare system will reduce the ability of the U.S. to provide medical innovation. This is a Luddite approach. I find it bizarre that people demand rapid technological innovation for their phones but think nothing of slowing or stagnating technological innovation for healthcare.Europe’s health systems on life supportFacts About European HealthcareAs the population is increasing in Europe, the health care costs are also increasing, but the quality of the service is degrading day by day. The challenge in front of the government is how to strike a balance between increasing population and facilities providing health care. To add to the agony, Europe has a majority of aging population, which definitely needs good health care services and benefits. Health care industry in Europe faces major criticism. It is constantly compared to other developed countries.Why single payer health care is a terrible option… Massive waiting lists and dangerous delays for medical appointments… Life-threatening delays for treatment, even for patients requiring urgent cancer treatment or critical brain surgery… Delayed availability of life-saving drugs… Worse availability of screening tests… Significantly worse outcomes from serious diseasesIt might be said that the bottom line about a health care system is the data on outcomes from treatable illnesses. To no one's surprise, the consequences of delayed access to medications, diagnosis and treatment are significantly worse outcomes from virtually all serious diseases, including cancer, heart disease, stroke, high blood pressure and diabetes compared to Americans.And while some studies have noted that Canadians and Germans, for example, have longer life expectancies and lower infant mortality rates than Americans do, they are misleading. Those statistics are extremely coarse and depend on a wide array of complex inputs having little to do with health care, including differences in lifestyle (smoking, obesity, hygiene, safe sex), population heterogeneity, environmental conditions, incidence of suicide and homicide and even differences in what counts as a live birth.

Would both gun control proponents and opponents be interested in further investigation and possibly altering their opinions if it could be shown, possibly repeatedly, that their political affiliates have been lying or being dishonest on the subject?Probably not. The best evidence of the hardening of people’s position on gun control is probably the lack of outrage among gun activists over the rampant financial mismanagement in the NRA. Despite overwhelming evidence that the NRA’s leadership, lawyers, consultants, and board members have been self dealing and mulcting the organization for decades, there has been very little change in anyone’s positions. Now, you could argue that NRA leaders have been lying and being dishonest about their own self-dealing, but not lying or being dishonest about the issue; but there has been little outrage or self examination about a boatload of money that was collected from well-meaning people and wasted in extravagant spending.Here is a pretty good take on the scandal in the NYT, which most pro-gun folks will just ignore. Inside Wayne LaPierre’s Battle for the N.R.A. Despite the source, the article is based upon court filings of the NRA itself, audits, and financial records. Nobody from the NRA is really disputing the facts, and they cooperated with the NYT reporters. You’ve seen a little bit of pushback from some notable gun enthusiasts. Hickok45: We're Not Working With the NRA Any More - The Truth About Guns and a single tough interview from Fox News Swamp Watch: The lavish elitist lifestyle of Wayne LaPierre Despite the fact that the facts are basically uncontroverted, no minds have been changed.While the pro-gun side, at the top, have basically become nothing more than grifting TV evangelists, the gun control side has simply used the issue as a political fund raising device. The truth is that crime has rapidly and definitively declined since the late 1960s, and we are living in one of the safest eras in US history—from a crime standpoint. The relationship between crime and guns is certainly not linear, and it’s relationship to other social ills is poorly defined. The biggest social problem associated with gun ownership is never really addressed, which is suicide.And, from a gun industry perspective, it would not be an incredible leap to believe that they fund both sides to gin up business. Barack Obama was great for gun sales. Proposed gun control legislation is great for gun sales. School shootings actually increase gun sales.The truth is that the past fifteen years have seen incredible legislative and judicial wins for the pro gun side. Despite those wins, the pro gun folks act like there is a squad of Lesbian Transgendered Shock Troops, commanded by Nancy Pelosi and Eric Holder, standing at the ready with pink dildo shaped billy clubs ready to raid everybody’s gun cabinet. And despite those gun control wins, crime has decreased so its unclear what outcome that pro gun control folks believe they would achieve with additional regulation or restrictions. Aside from the incredibly rare mass shootings and a few select locations and neighborhood, the real threat from gun violence is incredibly low.Bait and SwitchAnd perhaps the real reason why no minds are never changed is because the gun issue is really just virtue signalling—on both sides. The biggest real issues in this country, from an economic standpoint, is that while wages have remained relatively flat for decades—despite historically low unemployment— the costs of health care and higher education have decreased real purchasing power for most working Americans. http://files.kff.org/attachment/Report-Employer-Health-Benefits-Annual-Survey-2018 In real terms, health care costs have risen significantly for the typical working family:For the bottom 50 percent of workers, employers’ health insurance contributions averaged 30 to 35 percent of companies’ total compensation packages. Companies also increased the premiums that workers themselves must pay to get coverage. From 1999 to 2015, worker premiums for a family plan more than doubled in inflation-adjusted dollars, from about $2,000 annually to almost $5,000.As this shows, higher health-care costs fall heaviest on lower-paid workers. The reason: Insurance coverage is a bigger part of their total compensation. (In the example, the $5,000 is 10 percent of income for a worker making $50,000 but only 5 percent for a worker making $100,000.)In addition to health care costs, higher education costs, which is now mandatory for higher paying jobs, has risen significantly faster than inflation for decades. So, if you are a typical working family, any raise you get, or have gotten, is instantly wiped out by higher tuition and health care, which in turn means that families have little to save for their own retirement. it’s basically why people are so strapped and feel economically uncertain—despite a fairly strong economy. The problem for most working people is not higher taxes, it’s not unemployment, its not even low wages—the problem is disposable income. People are working harder, making more, but they have less to spend—due to health care costs and educational costs. From a breadwinner, real man issue, nothing can make you feel more impotent as a man than not being able to pay your family’s medical bills, your kid’s tuition (and having little to save for retirement).I am not going to delve too much into the actual cause for these issues, other than to say that during much of the post WWII period, we saw the high point of “stakeholder capitalism.” Corporations served the interests of their stakeholders, which included not only their shareholder, but also their employees, surrounding communities, and the country’s national interests. Perhaps the most famous expression of this sentiment was:“ For years I thought that what was good for our country was good for General Motors, and vice versa. The difference did not exist. Our company is too big. It goes with the welfare of the country. Our contribution to the nation is considerable. “Charles E. Wilson (1952), CEO of GM on his appointment as Defense Secretary.What this meant was that high paying jobs created a strong consumer class who would buy the products that these companies sold with their wages. The companies and their workers, in turn, paid taxes that funded the education and infrastructure necessary to train those workers. The companies also provided generous health care and retirement benefits to these workers, which helped make strong families and communities, and reduce dependency on the government. It all worked in a nice symbiotic way.Cities and towns were defined by what they made. And men defined themselves mostly by their ties to their employer and surrounding community. During the 1950s, a high percentage of men had served directly in the armed forces, or served indirectly in war related industries, they had stable jobs that provided for their families in a complete way. The local schools were good because their was a healthy tax base, medical care was provided. the company provided generous scholarship and retirement benefits. Stakeholder capitalism, followed by a significant period of self sacrifice for the interests of the nation, builds very strong communities. Families feel secure.Outside of the Cities, a vast percentage of rural folks, in addition to having cultural institutions in their town based upon their employers, local schools, churches, and civic organizations, also had a sportsmen culture where guns played a major part. In most areas of PA, the first day of Buck season was a school holiday. Families would go out and hunt, but this was followed by weeks of scouting out the deer trails, zeroing your old deer rifle, and generally getting ready for the season. And during the rest of the year, there were Turkey shoots target shooting events, and other gun related community events.After the 1970s, we saw the rise of “Shareholder Capitalism,” which means that the only interest was eking out the last nickel of profit for short term quarterly returns to the owners and shareholders, and management who made the bulk of their money in quarterly bonuses. Sure, closing the factory and moving production overseas would mean less consumers, but you wouldn’t see those results for decades. Suddenly, Dad, as provider and breadwinner, is completely replaceable and fungible. Instead of a skilled and valued worker, the stuff made by Dad can be made overseas and shipped cheaply back over to the US. The country was reassured, the US economy is becoming a service economy. Forget about stakeholder capitalism, people would work in high paying industries that required higher or skilled education; and finance, health care, higher education, information, all would be the new cleaner industries that would provide high paying jobs, which would provide a strong tax base to continue to provide the benefits formerly paid for by Stakeholder Capitalists. And, don’t worry, since these jobs are largely service orientated, and society is rapidly becoming more gender equal, family income can be supplemented simply by having women enter the workplace. First it was Japan, but now it’s China, but over the past forty years, the high paying jobs formerly done by male high school graduates have gone overseas, and with those jobs have gone the generous health care and retirement benefits, and the taxes that flowed into those communities to make them strong, fund the schools, etc.But more importantly, in a society where men were unquestionably men, as defined by being breadwinners, veterans, and community leaders, what defined men in this new Shareholder Economy? In that type of economy, value is measured in your IRA, 401k, stock portfolio, quarterly bonus, and the toys you own. So, what is it that can possibly can continue some of that culture?On the other side, the death of Stakeholder Capitalism, and its migration from the Cities to more suburban locations (along with most of their tax base), created rising crime, social unrest, and family disruption, which also unnerved a significant percentage of the population who had no real ties to traditional gun culture. In other words, the triple whammy of de industrialization, tax flight from the cities, and the mass concentration of social ills in select urban neighborhoods fueled an incredible increase in crime and gun violence from 1968 to 1991. Despite the fact that this tide has turned, for many urban dwellers who lived through this ear, or moved from urban areas in response, there is an intrinsic link between guns and crime.2. The New Gun MessageIn the mid-1970s, there was a political dispute within the NRA from a Sportsmen organization, which it had always been, into a political guns rights advocacy organization, which it is right now. Without boring you with the actual details, the more important question is why the pro-gun message resonated then, when it was largely irrelevant during most of the 20th Century. In fact, the NRA was largely supportive of the gun control legislation passed in 1968 following years of rising crime and assignations.At the same time, City governments plagued by crime, often gun related violence, from three decades of social unrest, needed somebody or something to blame. While their tax base was decimated by the movement of manufacturing from the inner core, and aging infrastructure, they certainly had no interest in spending their money wisely. And they really did not have much to offer to attract new business or taxpayers, so it was either focus on attracting government money to solve social ills, or trying to bring back companies who were not only interested in leaving the old cities, but were more interested in moving operations overseas.The truth is that most of the politically power were heavily invested in Shareholder Capitalism, which meant that their priorities were lower taxes and less regulation. They could give two craps about anything related to the folks being affected by the rapid changes in the economy, and the societal changes that were emanating from it. The message, “From the same folks who closed your mill, take a look at our tax package” would have zero appeal.And the politically connected in the Cities could care less about the residents who were there after the office buildings emptied out at 6:00 every day. During this time, most of the older US cities were incredibly dysfunctional and dependent largely on government programs rather than businesses. What businesses they could attract were done largely with massive tax abatement.So, the real question is what message would appeal to rural voters, and not cost the Shareholder Capitalists anything? And conversely, what message would appeal to City dwellers harassed by rising crime, that would not cost those Shareholder Capitalists who had kept their headquarters in the City, albiet with generous tax abatements, anything?3. Guns As Virtue SignallingGiven that guns as a political issue inspire strong passions, but cost politicians nothing from a budgetary issue, it is a perfect virtue signal device; and perfect to raise money. If you are for any type of gun control, then you are a gun grabbing socialist who wants to defecate all over the US Constitution. If you are against gun control, then you must be in favor of dead school kids. In a country whose real problems are health care, higher education, and de-industrialization, what could be a better issue than guns.On the pro gun side, the first task is to convince people that the real measure of a man (and thinking person) is not whether you actually served in the armed forces, or provide adequately for your family—because the folks who manipulate that side have no interest in making sure that we do send troops to war for only the best reasons, or provide jobs where folks can support their families—is gun ownership. Gun owners are not just random organized folks who happen to own a particular tool, they are the militia, the defenders of our Constitution. Wow, so I am not just a middle age guy worried about whether I can afford my mortgage and living expenses, $6,000 in health insurance premiums, and $25,000 for my kid’s college tuition on a 60k annual salary, I am actually a bona fide defender of the Constitution as long as I own a gun, pay an annual fee to the NRA, and support only politicians who are with me on the gun issue—even if they work actively to screw me on the health care and education issues. Oh, and by the way, the people actually working on health care and education issues, are actively trying to take your guns away and keep you from performing your Constitutional duties.Again, I apologize if this seems insulting. But at 53, I can still pass the US Marine Corps physical fitness test, and probably even get a perfect score, if I spent more quality time working on my pull ups. I can also easily qualify as Expert on the Marine Corp marksmanship test (as it existed before the recent change). But I am not a Marine; nor am I in any way fit to serve in the Marine Infantry. To suggest that I possess the qualifications of a Marine, or a member of the National Guard simply because I can pass certain tests is insulting to every member who has put on, or puts on those uniforms. To the 1954 Teamster who had served in the Pacific during WWII or Korea—in any branch, claiming that I was a member of the militia because I owned a firearm would seem hysterical. The skill necessary to achieve Expert level proficiency level with an incredibly user friendly and accurate rifle like a AR 15, is less than the skill required to be a very good corn hole player. So, I am sorry to report to you, that regardless of what you’ve read, including the text of the US Constitution, in the 21st Century, being a functional member of any military unit, including a militia, requires more than just owning a firearm. Disagree with me, run with me for two miles at 6:00 minute pace, and we will go fire 20 rounds down the range with our heart rates going, and you can tell me how functional you’d beAnd the militia stuff is unnecessary, thanks to our old friend Antoin Scalia and a majority of SCOTUS. He said that under the Constitution, the militia clause is prefatory and not an operative clause. Friendly tip from an attorney, when you win an issue totally and completely, you pack your stuff up and leave the courtroom as quickly as you can. You don’t spend a lot of time arguing about an issue that the Court didn’t even really find worth reaching, which is who or what is the militia. SCOTUS ruled that the individual right to self defense contained in the Second Amendment was not dependent upon collective service in any militia. In plain English, the Second Amendment protects your individual right to keep a a handgun in your night stand to protect your home—you don’t have to claim that its really all about being mustered in the middle of the night to repel Canadians who snuck over the border!And more importantly, nobody takes your militia talk seriously. Our founding fathers took up muskets against the most powerful empire in the world because they didn’t want to pay taxes on tea. You folks will not take up arms regardless of the injustice wreaked upon you. The Shareholder Capitalists closed the factory in your town. You didn’t take up arms. Instead, you packed the equipment up to send it to China (or Japan), just like the real power in this country expected you to do. When the Shareholder Capitalists told you to pay 10% of your salary as medical premiums while lobbying for corporate tax cuts, you said, “thank you sir, may I have another.” When state colleges suddenly started charging 50% of your annual income in tuition and plunging your kids in decades of debt, you didn’t take up arms; instead, you complained that the colleges were too liberal. You still bought the TVs made in China and South Korea, and angrily protest China while wearing clothes made in China and typing on a computer made in China. None of your kids have the skills to even work in these high tech factories because you didn’t want the government to invest in any of the educational or technical programs to develop these skills. When the test scores in this country showed that our kids were learning less math after graduating high school, then some fifth grader in Singapore already learned, you didn’t take up arms, you just complained about the liberal elite in our schools. When you walk into your area hospitals, and none of the doctors and specialists graduated from the local schools your paid for, and are all from overseas, you don’t take up arms and challenge the government for failing to educate your kids well enough to go to professional school and come back and serve your community, you elect politicians who make it happen. When the drug companies gave opiates to any member of your community who so much as complained of a little pain and they became addicted, you didn’t take up arms. More of you have killed yourself by stuffing your guns in their mouth the past decade than died in the Vietnam war. Did any of you take up arms against the system that does nothing for mental health in your community? Did any of you take up arms when the food industry peddled lies to you and more than 33% are obese, with 50% of your kids likely to be obese in a decade. Aside from removing Confederate monuments, or Starbucks removing Christmas from its paper cups, I am having a hard time even imagining an issue that would cause this group to finally take up arms.The truth is that when the powers that be finally come for your guns, many of these communities will have nothing left to take beside the guns. Main Street is a Dollar Store, Pain Clinic, and Pawn Shop. It won’t come by government seizure, it will come by pawn shop when that’s all you've got left to pay medical bills and tuition. The truth is that the only thing I can see the pro- gun folks actually fight for is if someone tries to take your guns, which is both meta and ironic. The purpose of keeping your guns is to prevent the bad guys and government from taking all that other stuff, and destroying your way of life. You’re not supposed to sit idly by while they take it all, so that your left with nothing more than your guns.On the Anti-gun side, crime is not a big mystery to reduce. We’ve seen NYC and many other cities dramatically reduce crime. Social contagion is real. You can’t create pockets of anarchy where the only government instrument is a bad guy with a gun, and his willingness to use it. Taking Bubba’s AR 15 isn’t going to make the South Side of Chicago any safer. It took us several decades to figure out urban crime, most of it spent with misguided programs and solutions. It’s going to take us some time to figure out school shootings. Would we have them if we had gun laws like Great Britain or Japan, probably not. But, there is certainly low hanging fruit to collect with hardening security at our schools, and addressing the warning signs definitively. And then maybe you will get some cooperation from the gun crowd. Maybe they will even be willing to accept that there is a toxic element in the gun culture that includes white supremacists and misguided folks who believe that just because well adjusted people can generally handle guns safely, it makes sense to put guns in the hands of your Adam Lanzas, Nikolas Cruz, Dylan Roof, Steven Paddock and Eddie Routh. In other words, all the normally benign macho man talk is pretty toxic if fed to the wrong person; and if a person is struggling with a mental illness, take them bowling not shooting. Maybe instead of railing against liberals, they wouldn’t mind cleaning their own house because while the Chicago South Side is one side’s mess, the solo gun loving lunatic going on a spree is the other side’s mess.4. The Real LiePro gun folks, people are making money off of your gullibility. Not since Tammy Fay and Jimmy Swaggert have fundamentally decent people been so badly fleeced and played. Wayne La Pierre and most of the other gun loving “patriots” are about making money for themselves directly off of the public who has watching most of their culture get dismantled by greed. And these are secondary to the Shareholder Capitalists who are running up the score on tax cuts to send your jobs overseas and your money in complex financial instruments that they control. Owning a gun doesn’t make you a freedom fighter, a militia member, or a man. It’s just a tool to protect something valuable, which is why we protect it under our Constitution. If you give away everything valuable just because somebody plays lip service to that tool, you are being played. Tax cuts and bail outs cost money. Hugging the flag and waving around a gun doesn’t cost a politician anything in many parts of the country. Stop being so focused on the tool that you stop asking him to protect the stuff worth protecting with a gun. When everything else is gone, your more likely to use your gun to end your life than protect your hill of dirt.Anti gun folks, the law abiding gun owner is not the cause of your problems. In fact, your real problems are identical to his. Wages are flat, health care is expensive, tuition is expensive, and our educational system is not preparing kids for the future global employment market. Oh, and both you and your kids could stand to lose some weight—it’s not just a rural problem. For whatever reason, the kids in the South Side are not shooting up their schools—heck, they are barely attending them without guns! But its tough to lecture our political adversaries about virtue without getting our own house in order.Both sides need to return to sanity on the gun issue. For most of our recorded history, a gun was a useful tool to function in a rural environment; or it was an unnecessary extravagance to those who lived away from dangerous critters or criminals. The country was safe due to two large oceans, a physically capable population, massive industrial capacity, and things worth fighting for. We weren’t a great country because we had lots of guns. We were a great people because we had people, communities, and stuff worth protecting with guns, and we could make a whole bunch very quickly if we needed them. After most folks returned from service in WWII and Korea, they never picked up another gun, except to go hunting or win a turkey. There was no rabid gun culture who worshiped flawed heroes like the Bundy’s Weavers, or Branch Davidians. There were no multi millionaires who conducted massive politically charged rallies about real and imagined domestic enemies that would have been a better fit in Nuremberg than the USA. I get it. Rural culture has been affected harder than most in the US over the past 40 years, but gun rights have actually never been stronger.From a data driven perspective, more guns in our country or a need for less restrictive gun laws, barely registers on any scale that could measure meaningful progress for the group trained to care the most about this issue. From the anti gun data perspective, I imagine that you could seize every person’s guns who attended a gun show, NRA meeting, or purchased a gun legally, and all you’d see would be a reduction in suicides, and a slight decrease in accidents. Gun control only works if the entire society is invested in a low or no gun society, and its very restrictive—see Britain or Japan—and we are not going to see that kind of society here any time soon. In fact, SCOTUS, in its current composition seems poised to remove restrictions from gun ownership in an unprecedented fashion. The fact that the NRA or any gun rights organization can raise even a nickel with the current Supreme Court stands as a testament to the gullibility of the typical pro-gun activist. And guess what, even as those gun rights expand, your health care premiums will continue to rise. tuition will continue to rise, wages will remain flat. and your downtown will continue to be anchored with the pain clinic and dollar store. Enjoy your gun—but your health care is really going to suck over the next few decades. The Mar-a-lago crowd appears to be doing well. Maybe they will add a gun range and Steve Mnuchin will take you shooting as he works to make it easier for his hedge fund buddies to take away the remainder of your bare boned benefits.