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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.

Answered 5 March, 2020Yes, there is a genre of supervolcano fiction! It’s humourous the other answerer assumes the questioner betrayed her prejudices supposedly against volcanic potential, which wasn’t the case at all. Instead, he shows his unawareness of human commercial literary drive. Also, there is no way a large volcanic event at Yellowstone could happen next Tuesday as he said or next year. Yes, the Yellowstone supervolcano can wipe out humanity, but we'll have years of warningFear or perceived opportunity spawns art, some good and some bad. If spread by the internet, this is doubly so. Without going thorough the vetting of an established publishing house, much of the material out there is amateurish and poorly phrased, though well-intended.A Short History of the End of the WorldImagine your would-be famous author trying to find an unexploited niche, some theme to make their own by which to rise above the pack. Stephen King was ahead of the crowd when he wrote The Stand way back in 1978. Now there are scads of virus and pandemic fiction novels. Same with earthquakes, runaway AI, WWIII, the post apocalypse, psychic phenomenae, the paranormal, creepy humans and/or clowns, aliens, you name it. I’ve got it! The Yellowstone “Supervolcano!” I’m sorry to report, that has been mined, though mostly poorly. I count 36 fictional treatments, three of them movies of some sort. I will add more as I’m made aware of them. I bet I missed some; there’s a whole lot of self-publishing going on out there. Like the proliferation of poor Yellowstone tour guides, it’s easy to claim authorhood.Even if you write about a new challenge, it’s still necessary to have a good, believable story researched using the best knowledge regarding it, have compelling characters and to have been proofread well.To be fair, before the mid-teens, ash distribution models were inflated and before 2017 tomographic imaging had not yet revealed the 91% non-fluidic nature of the uppermost magma chamber. Jesse Lee O’Connor 李杰西's answer to What is going on with the Yellowstone volcano? Will it implode, explode or suddenly halt activity?But they should have known that was a crucial factor. No imminence equals no drama, which is where we are now, in the real world. In the 2005 teledrama “Supervolcano” magma chamber melt ratio was discussed but never measured when their supercomputer simulator VIRGIL could have done it easily. The hot spot cannot erupt to form a large caldera unless its upper chamber is more than 49% fluidic. Jesse Lee O’Connor 李杰西's answer to How much warning time would we likely have if the Yellowstone volcano was going to erupt? The least conservative, informed estimate is it will provide decades of warning; it cannot “go off tomorrow.” Yellowstone Supervolcano's Nasty Surprise: Only Decades To Prepare For An EruptionBefore the aughts, scientists knew Yellowstone had two calderas. Then, it was pieced together that its volcano created many, all across Idaho.A recurring error among writers is their having the Yellowstone hot spot going from quiescence to “super” eruption (VEI-8) in too short a time. Also, an almost prevalent confusion exists between slowly falling ash and sulphur dioxide gas in the stratosphere. Yes, ash can be an aerosol but the minute particles able to reduce temperature are different than what’s covering the cities and killing car engines.The biggest problem is authors making up their own Yellowstone by ignoring where locations are in relation to each other and even what landmarks are called. A gifted writer may gain readers by their craft but if they haven’t learned their subject they will lose an audience who does. To would-be future writers, please run your manuscript by an experienced local first? A lot of embarrassment might be avoided. If you don’t see the grading criteria below, I haven’t read it yet but will add a review after I read it.C- charactersG - geographyP - punctuationS - storyT - time from detection ‘till eruptionV - volcanic realism, reasonable/researched scienceBobby Akart 20 July, 2018 Yellowstone Hellfire 1 of 4.C - cliched, G -, P +, S-, T-2 years after drilling begun, V - confuses “seismic activity, ground uplift and subsidence and gas releases,” which are common to Yellowstone, with “telltale signs of a potential eruption.” Claims super eruption is “overdue.” There is a huge difference between magmatic and tectonic earthquakes that is missed here as in most offerings. Describes the “YVO” a new physical structure at West Thumb in 2018. “Gibbon’s River.” “Lake View Cafe,” “fly fishing along the shoreline across West Thumb,” “The largest most dangerous active volcano on the planet.” Dozens to hundreds of frogs in a marsh on Yellowstone Lake. Eruption caused by “Project Hydro” drilling and fluid injection. Passing Old Faithful on the way to elephant back mountain from West Thumb. Cabins at Grant Village. A 1,200 square foot ranger residence on the Firehole River near Sentinel Creek. A borehole 15 miles deep, in hot, plastic rock 3 12 miles deep. The entire mantle characterised as magma, cell coverage near Cave Falls. Old Faithful erupting every 30 minutes. ”Yellowstone’s three prior eruptions have been greater than or equal to Toba.” “A [any] Yellowstone eruption will be at least 1000 times more powerful than Mount St. Helens.“ I could go on…Likable characters with realistic sounding jargon but completely fantastic.Cora Buhlert Christmas After the End of the World 15 December, 2019. Pretty good little story. C+, G + there is no park in this story, P+, S+, T hard to say. Protagonist is 13 and was unaware of any advanced warning. V + except for only light ash near Billings. Story is so pleasant I have no complaints. The reason there’s no other people is they were ordered to to evacuate and the young characters didn’t know.Paul Curtain Gray Snow: A Post-Apocalyptic Thriller 6 February, 2019 Deeply psychological in painful detail yet believably so. C+, G+ played safe, no Yellowstone locations, P+, T- a day’s warning, V+ except for T complaint and ash in upper atmosphere instead of gas and fine particulate. Mostly quite enjoyable, except, as well-thought out and prepared as the story setup is, it feels very much like a typical disaster movie; these conflicting, baggage-laden principals are locked up in a small space to clash and to compromise in order to survive. The rawness and the finest of human spirit will be on display so that truth; good, bad and ugly, will be exposed and milked. Since I wrote that, all has turned much more realistically horrible. There is much to like here and much soap opera as well.Leonard J. DiSanza Seeds of Our Future 18 November, 2019 C+, G: bypassed by having no action in or near YNP, P+, S+, T?, V- relies upon humans inducing an eruption by nefarious yet undescribed methods. Claims climate change increases volcanism. Pleasant enough mystery though derivative and with likable characters. An enjoyable read.Jay J. Falconer and M. L. Banner Frozen World: Silo: Summers End 30 October, 2019 1 of 3 C+, G- could take place almost anywhere, nothing to do with YNP, P+, S+, T bypassed, never addressed, V-Yellowstone is never named but “The Event” 12 years previous include 91 volcanoes induced to erupt by humans - its hinted by nuclear devices. This is a fine action story with realistically complex characters and conflicts. Authors know their military hardware and culture well. However, the verbiage is tedious. Vocabulary is stilted to contrived. I would say no one talks like that but some do; highlights difficulty of writing realistic dialogue’s nuances that successful authors master. Multiple points of view and setups for future books drag out the fairly pedestrian post apocalyptic dystopian tale unnecessarily. Some continuity problems. If I enjoyed being inside the many characters’ minds more it would not seem so long and I’d eagerly read books 2 and 3 but I did not.John Fishwick and Lisa Wroble The Yellowstone Affair 10 April, 2017 C-trying far too hard, G-, P mostly + but could have been proofread better for stray unintended words, S-, T-(Projected, never occurs on page), V- “Ten thousand times Mt. St. Helens” would be VEI 9, which has never happened on Earth even though there are four more powerful eruptive sources on the planet. Stats from three most recent large eruptions are given with conclusion new one is “40,000 years overdue” with nothing to support that (2.1 MY/3=700,000 years, not 600,000.) Disagreement between Dr. Alvarez and YVO regarding multiple calderas? What’s to dispute about the patently obvious? (Volcanoes don’t erupt from calderas, they create them.) “70 feet of ash” on the closest cities? But from only 330 cu km ejected? Orion is a star? Arcturus is in Ursa Major? Comets influence volcanoes? “Geologist” says it can happen next year or in five years. This is a cloak and dagger on the lam tale which takes time to provide travelogue and cheerful geoscience education a la John McPhee along the way. All is put in motion by the proposal of the idea of overlapping calderas making an imminent catastrophic eruption. Though I’m sure they meant to say magma chambers, this is a commonly held and frequently broadcast fallacy completely unworthy of government cover up and murder. I can’t say if this book’s amateurishness or pretension is more offputting.Jean M. Grant Will Rise From Ashes 7 April, 2019 Author knows more about the human heart and autism than about volcanoes but the tradeoff is worth it. How refreshing is is to read a top notch story that shows restraint (especially volcanically), imperfect heroes and hope, above all. It’s especially gratifying to read the government isn't evil and order is maintained. Thoroughly enjoyable novel. C+, G+, P+, T-immediate, no warning, though protagonist believes the scientists knew but had “learned their lesson” from warning the public before Mt. St. Helens. V-”mankind’s largest volcano,” ash spread too slow, much more threat to health from ash than enflaming asthma, Will would have called for mask use much earlier than he did, “11 VEI 8 events” total in world with “3 from Yellowstone.” All is forgiven in light of this celebration of wonder from the perspective of an island of unconcern, of love.Jack Hunt The Year Without Summer 9 October, 2018 Steals title misleadingly of book by Nicholas P. Klingaman and William K Klingaman The Year Without Summer C+, G mostly+, P+, S+, T-much too quickly but caused by NASA drilling, “poking a hornets nest with a stick,” V-This very entertaining read is much better than most and researched better. He actually correctly locates landmarks in the park mostly where they are. There are odd lapses such as having campsites above Bridge Bay Marina wiped out by a wave whilst people by the marina escape unscathed. A truck driving on a hiking trail, electricity in a backcountry cabin and cell service in 50% of the park are huge errors. I admit that number is reported online but includes back country high terrain and only one bar service areas too. My experience is no more than 20% of front country, including poor service. Dinner served in Mammoth’s map room? There are more errors such as never any talk of magmatic earthquakes but only frequency. The magma chambers are correctly identified as being too solid to super erupt but supposedly knowledgable characters still fear “the caldera unzipping.” As enjoyable as the characters and action story are, it’s driven by recent Yellowstone science headlines of the past two years, almost all of them, which are turned to upend all the current reassurances of geoscientists on their heads because of human interference. Drilling near magma doesn’t quite work that way. But it sounds right, to some or many. Praise to author for not padding story to excess and showing restraint with his eruption. An economical, well-paced story.Linda Jacobs Rain of Fire 1 June, 2006C+, G+(best of all reviewed), P+, S+, T: one month but is realistic for type of eruption described, V + only author with apparent geologic background. Small errors like 1–10,000 YA cinder cone in Yellowstone forgiven for sake of overall astuteness. Excellent read. I should say more but actually most of what I say in other reviews are criticism. Brevity here means I found little displeasing and much to praise.H. O. Knight Life After Chocolate: The Full Novel (Yellowstone) 31 May, 2018 Life After Chocolate C+, G-there aren’t 1,000,000 people within 100 miles of YNP, P+, S+, T-3 weeks, V-only to set story in motion, to cut off food supplies. There’ve been young adult fiction novels regarding dystopian society, vampires, angels, zombies and seemingly every other fantastic scenario when just being a young adult is already drama enough without needing to actually be during the end of the world. However, these characters are so well written and the story was compelling enough to get me past skepticism; I enjoyed this book greatly, prompting my first review ever of a work on Amazon. Author doesn’t know Yellowstone volcanism and, unlike most I’ve reviewed here, doesn’t depend upon it failingly but instead writes successfully and compellingly of humanity and what is worth striving for.Larry Lavoy Caldera: A Yellowstone Park Thriller, 14 December, 2012. Extremely well-written book! C+, G- more than an hour from north gate to Lake, P+, S+, T-2 months, V-. I’m sad to downvote volcanology because this author is better than most. Reasons: “magma” on surface, only “seven supervolcanoes” on Earth, common confusion of water/steam venting with volcanic pressure venting, all destroyed within 600 miles, “600,000 years of pent up energy,” “end of humanity as we know it,” overdue by 300,000 years, Mallard Lake dome normal uplift 2 mm/year, Lava Creek eruption 500 x Mt. St. Helens, Yellowstone region called the Midwest, [only] more than 2,000 square miles in area, lake slanting wrong direction from uplift, “this all happened before [in human history]” — no, not lava eruptions, ““Roosevelt elk,” “nuclear winter,” ashfall ended too soon, engines were able to operate during ashfall, and, the new ice age predictions have been abandoned by Yellowstone observers since the time when this book was written. Exciting, realistic read.andEscaping Yellowstone, 17 March, 2018, a title which has already been used. Not a sequel to Caldera.Kennedy Layne Essential Beginnings (Surviving Ashes Book 1) 21 July, 2015 1 of 5. It got off to a rough start and proceeded to present love at the end of the world. Book has believable romantic conflict and especially good thought put into realistic prepping but everything else seems very contrived and cliche. C-, G-no YNP at all but counting on local landscape to shield them from ash without considering the umbrella cloud effect. Also, Burke in Texas would be better off there than in the Pacific Northwest. S- padded, cliched, full of overdescription, P+, T- atrocious: 2 days after a destabilising earthquake, V-doubly deplorable: “overdue for more than 40,000 years.” Talk of going north to Canada which would be the wrong direction in volcanic winter. Not well researched at all. Filament for firmament? Trying too hard. But, this is the most sensual supervolcano fiction I’ve yet seen! “This end of the world crap was getting real old,” said the protagonist to himself when it interrupted passion. But then, when I’m convinced it’s a turkey, I began to enjoy the military depth of knowledge and developing conflict until the final pages reinforced my initial qualms. Won’t be reading book two.Amazon.com: Eminent Domain: A First Contact Thriller (The Eminent Series Book 1) eBook: Lafferty, W E: Kindle Store 27 February, 2020 C+Solid, enjoyable, G-messed up: 50 miles from Tower to Lake, Devils Den located at north end of park as well as east end of lake, flying to Cody to go to Old Faithful, P+mostly: “Ground Loop Road?” Editing errors, “Lookout Point,” ”Old Faithful Lodge” and “Lake Lodge” named though Inn and Hotel described. Camping at West Thumb Geyser Basin. Protagonist says she’s flying to JH but goes to Cody, YVO a physical building at Old Faithful. S-exciting but extremely derivative, T-weeks, V-terrible, especially from a skilled writer who’s done some homework: “worlds largest supervolcano,” “100,000 years overdue,” 16,500,000/142=116,197. “640,000 years,” “Almost 700,000 years since the last eruption,“ “Rhyolite less viscous than basalt,” “caldera becoming a supereruption,” continental plates “move around on top of magma,” huge underground aquifers holding down magmatic pressure, threat to most life on planet, “extinction level event.” Ejecta blown into space to destroy satellites and the ISS! The same old story, only written better. Nice to read an explanation for how advanced evolution could come about in only 4.5 billion years, we had help. As a bonus, in the afterward we learn Mr. Lafferty really does know there’s no YVO building at Old Faithful and that some of his geophysics is a bit fanciful. Really? An interference pattern from 36 black holes created a vaccuum that froze the magma to permanently cap the hot spot? He says he researched the most up to date USGS knowledge. That’s good to know but his controlled-collapse caldera wouldn’t spare the continent the physical consequences of collapse, no matter the cause, such as pyroclasts, gas and ash. It’s fine he realizes he took liberties with a known place that it’s obvious he visited. Abut, a $300 round-trip flight ticket from Albuquerque to Jackson? A 4 Hour drive to Jackson hole airport from Old Faithful? Ridiculous. My point is if you’re going to ignore real life locations you might as well invent your own setting, except, that wouldn’t bring in the readership. Talented but commercial. “The structure of the chamber beneath this volcano is enormous and not well understood. I took advantage of this and created a structure for the super volcano that is based on a few facts but is exaggerated in many ways.” There you have it. (It’s much better known than he’s aware.)Darrell Maloney Fire in the Sky 1 of 8 17 February, 2017 Fire in the Sky (The Yellowstone Event, #1) C-cliched, G-Caldera field measurement stations far too close to gateway community, P+ all the more sad how disappointing this is as the author has skill, S-we’ve seen it all before, T-decades in development! Should be +, except it was only temperature and pressure rising without other necessary telltale markers which presumably will escalate too quickly in subsequent books, V-last eruption 300,000 years ago. Brown park service uniforms. Title has been used before but with more fire and more sky, both lacking in this story. But everything else we’ve seen too much of in other works and especially in second rate television shows. It’s not deja vu I sense but plagiarism. Do you remember the show where all the rural police are corrupt good ol’ boys railroading people passing through? And there’s a helpful bail officer who replaces his desk name plate as a new kind of public servant each time the protagonist has need? I think it was on Green Acres. Oh, and the government agents are covering up a conspiracy and murdering contract geologists to avoid a panic because a super eruption is much less messy to deal with after it occurs than before. Padded excessively to stretch one book out into eight, so far. It’s a shame, too, because it got off to such a good start with unexpected mysticism. But initially likable characters became wearying with forcibly clever dialogue that must have sounded better in author’s mind than what made it onto the printed page.Frank Montgomery The Wrath of Yellowstone 2 April, 2015 1 of 3Mike Mullin Ashfall 27 September, 2011 book 1 of 3.5. C+, G+, P+, S+, T - one month after large earthquake, V: Mullin avoids pitfall of not knowing geology by beginning his story immediately after eruption and far from it, also saves not knowing layout of Yellowstone. Too much ash in eastern Iowa; I’m ok with that, the rest of the book is done so well. Very enjoyable.K. R. Nilson The Yellowstone Traps 30 July, 2018 1 of ? C + but stereotypes, G - Knows park better than most, then ignores it. P + not many mistakes, S - hackneyed, T - 6 months after harmonic tremours, V - same old errors. Sounds good but full of holes. Clever title! Traps are large igneous provinces but this could also be a life or death trap for protagonists! That is, if the reader endures the laboured, bruised prose to learn who lives or doesn’t. One reader’s impressive vocabulary is another’s bludgeon: “Pandemonium erupted as passengers recoiled in fright at the careening female flyer slamming about the cabin interior on the heels of the explosive noises.“ Caldera “lurks under much of Yellowstone,” “largest non-marine volcanic structure on earth,” “erupts violently at intervals of between 6–800,000 years,” big, male moose roaming all over the park day and night, superheated rock “plasma” three miles down, 640,000 years, book of “Revelations,” reservoir of magma expanding; stretching and flowing for 1,000s of centuries, walking quietly when known grizzly is near, 1959 quake killed a dozen souls? Walking from nonexistent geological station on Plover Point to Grant Village in a day, “Yellowstone Lake Inn” and uphill Lodge destroyed by only 20 foot waves. Road from Grant to Lake destroyed so protagonist drove to Mammoth to get there. I couldn’t read any more.A. J. Powers As the Ash Fell 23 April, 2015 1 of 2. C+, G: bypassed! Like Mullin did. P+, S+, T? Story begins 7 years after, V-: no ash has fallen but is confused with suspended aerosols. Sincere and good natured. Too many small batteries and too much propane and ammunition available in a scarcity society but forgivable as its stipulated 80% population has died. Knows his guns! Protagonist self loads.John D Randall The Yellowstone Conundrum (Is This It?) (Volume 1) June 28, 2016 1 of 6 C+, G-, P-, S: includes ISIS, Ebola, flooding rivers and a Texas-Mexico drug war, T: out of nowhere, V: could not read past p. 39. In comments, chastises FEMA for patterning their emergency preparedness drills on his book and not giving him credit. I’m not making this up. Please see Preparing for “The Big One”S. M. Revolinski Ashes into Stardust 16 April, 2016E. S. Richards and Mike Kraus Eruption 13 September, 2019, Escaping Darkness book 1 of 6. Very good-hearted book earnestly written and researched but not set in the real world. C-generic. If this was a movie, their headshots would line one side of poster in boxes- “who will survive?” G-. P- mostly solid but strange word choices could have been edited better, S-padded, predictable. We’re being set up for multiple volumes. T-weeks of less than expected evidence. V-It turns out “Yellowstone’s small airport” has an extremely long runway, though I don’t think authors have seen it. If you’re flying to Texas from it, you would be far from the centre of the park. Oh, I get it, they must have meant Gardiner MT, not West Yellowstone. Geysers are frequently already “at their boiling point” independent of increased ground uplift in story. Most of the northern hemisphere would not be blanketed by inches of ash though much of the US west would be and by more than that. It would take much more than weeks of microquakes and a “feeling” the earth had risen over a year to bring about a large scale eruption; these things are measured instead of merely sworn by. Plane crashed 200 miles out on north edge of Helena Montana whose airport they approach by a gravel road! Characters walked out of ash cloud even though so close, wondering where other people were, all killed it’s speculated. An arm floats by on a river of lava which is jumped across. Winds blow ash into the stratosphere? This is obviously written by people unfamiliar with Yellowstone and with large volcanoes. Eruptions average seven weeks? Next year I expect a new post-apocalyptic series from this team.Katie Slivenski The Seismic Seven 5 June, 2018. Very well written book and enjoyable to read with excellent, realistic characters; powerful dramatic twist. Author avoids criticisms from Yellowstone locals by not describing surface geography at all after the Beartooth Highway! Sadly, beneath the ground, I think she’s made up a new location, one with coal mines, tiny steam pockets in granite and rock which defies limitations of drilling at high temperature. I recognize her drilling “pods” are a dramatic creation calling for the unique stature of the protagonists but it’s a fantasy. Tracks don’t need to fastened to borehole walls in order to place explosives deeply. Also, at depth with increased temperature above a magma chamber, boreholes cannot maintain their structural definition let alone be a survivable location for humans. Then there’s having internet service whether from cables or cell towers in the midst of an eruption, it’s almost impossible on a good day. C+, G-, P+, S+, T-proposed as humans-induced—-not possible, V-. Finally, no matter how much they love their humans, ferrets (Eurasian polecats) aren’t apt to run on command nor come when called; they are distracted by everything. It’s true they were used to run wires through airplane wings. But train them to turn lights on or off? That being said, the author accurately depicts them traveling in and about their owners hood. Additionally, the entire idea of releasing a little magmic pressure to unzip an entire chamber depends on mythically already pressurised, fluidic magma; the upper chamber is only 9% melted and the lower one only 2%. Only small pockets could erupt. But that’s more feasible than rapidly drilling a borehole kilometres to under an eruption site rapidly in the middle of a cataclysm, the utter impossible engineering melee the climax turns into…Heath Stallcup Caldera 14 December, 2017 1 of 8 Caldera Book 1. Co opts title already in use. C+Believable, conversational, except for constant glib quipping during end of world drama a la Bruce Willis, gets old quickly, G-does not know Yellowstone, P+, S-, T-no lava or ash but no warning either; long-buried virus that killed neanderthal’s re-emerges now, V-does not know volcanoes. The caldera makes you into a zombie. Eek. Even with the most inventive source of conflict imagined, an author still profits from knowing a little bit about the scene of his novel. A rock concert in the park, USFS trying to thin forests, replanting NPS land, hundreds of millions of dollars spent fighting the fires of ‘88, a campground with no indication if it’s for legal camping or not, “natural jacuzzi” adjoining pullout, “natural ampetheater” near visitor centre, geysers and hot springs releasing enough pressure to keep the volcano from erupting, “ Speeding, drug dealers, alcohol to minors, public intox, burglaries, public displays, one guy with a gun-shaped bubble blower that almost got shot, what more could go wrong tonight?“ Funny you should ask… Author knows police procedures and crafts realistic characters but banks too much, 8 books! on there being a receptive, ready-made audience for horror of loved ones turned zombie with attendant emotional conflict. Padded, tedious, I expect the flirtatious genetic scientists that open the book will be seen again in another volume but not by me.Edward Tellar The Would-Be Mystic: And the Yellowstone Premonition 8 January, 2019S. J. Tellor Yellowstone 1 February, 2019 Yellowstone Refreshingly restrained and nicely psychological. C+, G+ safe, no YNP locations, P+, S+, T+/- on one hand there were years of notice in which to construct bunkers. On the other hand, the precise day of eruption was known. V+ Mostly enjoyable.Nick Thacker, The Enigma Strain 1 of 12, 27 November, 2014Jeff Thomson Fall #1 Pressure series 23 June, 2018 Fall (Pressure Book 1) Thomson employs much greater skill with the English language than in most titles listed here. Unfortunately, he’s so aware of his facility that the book simply oozes smugness. C+ likable yet cliched, from whore with a heart of gold to corrupt televangelist to obtuse government official to humble war hero to hottie geologist to perky cougar mom of adult character. G+ overall good though there is no physical “Yellowstone Observatory” in the park, P+, S- belaboured. Formulaic. Padded in typical multi-book epic style. But then, his chapterisation and successful story building hits his stride most successfully; he knows he’s good. T- just a few days, even though accelerated by continent-spanning earthquakes. V- harmonic tremours well after the magma began flowing, only one magma chamber, only one magma conduit leading to two vents too far from each other, Krakatau listed as greater than Tambora, pH “skyrocketing” to acidic rather than falling. A bus on the park roads in winter. He’s done his homework but needed to be vetted by someone more knowledgeable. “Thomas knew this was what people wanted to hear, needed to hear….a place to point their fingers.” I truly appreciate his references and his vocabulary. But his characters’ minds are so slick in their glib rejoinders and inner monologues that he reads like a more polished version of Harry Turtledove; it gets old fairly quickly. “How do you rape a whore?“ “I sound like some B-movie tough guy.” “Dogs and cats living together.” Book got better toward end. Author bravely avoided cliche of protagonists escaping ground zero narrowly. I like most of the characters and care for them almost enough to read subsequent books. But it’s all a bit too much.Harry Turtledove Supervolcano Eruption 6 December, 2011 1 of 3 (A fourth is threatened) Kudos for painting post eruptive horror in breakdown of technology. That’s all the good I can say. Characters are very busy trying to pretend the world isn’t ending. C-unpleasant, G-, P+, S- excessively padded, T: 2 years, V -. Tedious to annoying.Layne Walker Escaping Yellowstone 4 March, 2012 1 of 3Tim Washburn Cataclism 25 October, 2016 CataclysmBill Wetterman Yellowstone: A Fall From Grace 24 September, 2015Campbell Paul Young Ash: Rise of the Republic 25 May, 2015“2012” Screenplay by Roland Emmerich and Harald Kloser 2008-2009, Columbia Pictures. Only four words: “The neutrinos have mutated!” Jesse Lee O’Connor 李杰西's answer to If the volcano in Yellowstone exploded, how far would the eruption extend? Would it be something like the movie 2012, or is that over-dramatic?“Super Eruption” 2011, SyFy presents. Utter drek. C-, G-main park roads are dirt, S-, T-two days, 30 days after earthquakes. V-“crystallising olivine to force magma into a crude state to prevent an eruption.” “Yellowstone hasn’t erupted for 148,000 years.” “Drain Yellowstone Lake into magma chamber to cool it down.” Old Faithful and Riverside Geyser going from water to lava eruption. One character is warned from the future which makes all the difference, but another isn't warned yet behaves differently for no reason than he did the first time around. “It seems science fiction can become science fact, sooner or later.” And helicopters fly just fine in heavy ashfall.“Supervolcano” Teledrama by Edward Canfor-Dumas and Julian Simpson 2003-2005, BBC. Jesse O’Connor's answer to What do you think of the 2005 movie made about the Yellowstone Supervolcano

As of March 20, more than 3,300 Air and Army National Guard professionals in 28 states are actively supporting the COVID-19 response at the direction of their governors. The numbers may change rapidly as states identify needs and communicate them to their National Guard, according to the National Guard Public Affairs office.My state, Georgia, is one of the 28 states.The following States have National Guard Personnel Activated:ArkansasArizonaCaliforniaColoradoDelawareFloridaGeorgiaIowaIllinoisKansasKentuckyLouisianaMarylandMaineMichiganMontanaNorth DakotaNew JerseyNew MexicoNew YorkOklahomaPennsylvaniaPuerto RicoRhode IslandSouth CarolinaVirginiaVermontWisconsinThe current National Guard COVID-19 response missions include, but are not limited to:- Weapons of Mass Destruction - Civil Support Teams (WMD-CSTs)- Personal Protective Equipment (PPE) training and sample collection; response planners; support to medical testing facilities; response liaisons and support to state Emergency Operations Centers; support to healthcare professionals - assessments, transportation; logistics support; assisting with disinfecting/cleaning of common public spaces; providing transportation support for health care providers; collecting and delivering samples; and assisting with sample administration."We expect multiple states to use their WMD-CSTs to assist in sample collection, donning and doffing PPE techniques and decontamination techniques," said Lt. Col. Jennifer Cope, Chief, National Guard Bureau Weapons of Mass Destruction Program Office.The National Guard Bureau (NGB) facilitates integration and synchronization of National Guard support to civil authorities and associated planning between states, the Department of Defense and federal partners. The National Guard's Coordination Center is a 24/7 operation working at increased capacity in anticipation of COVID-19 requirements and to ensure unified and rapid response efforts between its state and federal partners."Our history as a state-controlled organization naturally led to partnerships with state and local agencies and their officials. Governors leverage our presence throughout the nation through multiagency integrated planning and response efforts for crises like this," said Brig General Thomas Hatley, Vice Director, National Guard Bureau Strategy, Plans, Policy and International Affairs.The National Guards of the 50 states, three territories and the District of Colombia have a very deep bench of nearly 450,000 experienced and proven Air and Army National Guard professionals. Guard units frequently train side-by-side with state and local emergency responders, making them well-suited for domestic operations.Despite the growing number of activated Guard components, during a Tuesday press conference, Secretary of Defense Mark Esper did not commit to federalizing the Guardsmen, instead opting to support governors in their individual responses.“As we get requests in, we will look at activating, if we need to, at the federal level or using the Reserves, whatever the case may be. We want to be very supportive with regard to our prioritization in terms of supporting the American people and the governors,” Esper said. “Right now, we are really focused on Guard and Reserve — in that order. There hasn’t been a need yet, a request, for active duty. So we will take these requests in due time.”Members of the Florida National Guard (FLNG) gather with local hospital staff to collaborate on donning and doffing personal protective equipment (PPE) during Task Force – Medicals’ response to the COVID-19 virus, March 17, 2020. The FLNG is mobilizing up to 500 Citizen-Soldiers and Airmen in support of the Florida Department of Health response in Broward County. (Sgt. Leia Tascarini/Army)Here are the latest updates of National Guard activations across the United States:ArkansasAs of Tuesday, Arkansas Gov. Asa Hutchinson has activated 20 National Guard personnel to state active-duty status to support the state’s emergency operations center. The mobilized guardsmen are medics from the 39th Infantry Brigade Combat Team, headquartered at Camp Robinson.There are currently 22 confirmed cases of COVID-19 in the state, according to the Arkansas Department of Health.CaliforniaLate Tuesday night, California Gov. Gavin Newsom placed the California National Guard “on alert” in preparation for state-wide mobilization.“The National Guard has been directed by the governor to be prepared to perform humanitarian missions across the state including food distribution, ensuring resiliency of supply lines as well as supporting public safety as required," a press release stated.“As Californians make sacrifices over the coming weeks to protect our shared health, we are all grateful for medical providers, first-responders and National Guard personnel who are assisting those who are most vulnerable to COVID-19," Newsom said in the release.CaliforniaGuard@CalGuardPreviously, the California Air National Guard activated a 10-person “medical augmentation team" from the 144th Fighter Wing of the California Air National Guard “to provide emergency pre-hospital stabilization response for up to 24 patients per 24-hour operations,” according to the National Guard Bureau.Currently, state health officials have confirmed 472 cases of COVID-19 with over 11,000 people self-monitoring.In a Tuesday press conference, President Donald Trump mentioned the possibility of sending the Army Corps of Engineers to California to increase hospital bed capacities.“The Army Corps of Engineers is ready, willing and able. We have to give them the go ahead if we find that it’s going to be necessary," the president said. “We’re talking to California about different sites, but we can have a lot of units up fairly quickly if we need them.”ColoradoColorado has 50 guardsmen mobilized on state active-duty status, “assisting local and state agencies with medical support and logistics at drive-up COVID-19 testing centers in various communities throughout the state," according to the National Guard Bureau.In addition, 30 full-time Guard personnel are advising state and local partners across Colorado on “validated tactics, techniques and procedures for future screening missions in Colorado," a release added.FloridaFollowing early emergency declaration from Gov. Ron DeSantis, the Florida National Guard activated additional personnel over the weekend, bringing a total to 300 guardsmen.These guardsmen are assisting with planning functions in the State Emergency Operations Center and logistics in the State Logistics Readiness Center.A medical task force is also being stood up in Broward County, state officials said, and Gov. Ron DeSantis said in a Wednesday press conference that 800 sets of personal protective equipment (PPE) are being provided to National Guard personnel.Florida currently has 314 confirmed cases of COVID-19 with seven deaths and over 950 tests pending, according to the Florida Department of Health and state officials.IowaSix guardsmen of the Iowa National Guard are serving as liaisons officers in the State Emergency Operations Center, while the Iowa Air National Guard is providing facilities and flight line support to the Iowa Department of Public Health, according to Col. Michael Wunn, Iowa National Guard director of public affairs.There are 29 confirmed cases in Iowa with 199 persons being monitored, according to the Iowa Department of Public Health.IllinoisGov. JB Pritzker of Illinois has recently mobilized 60 Army and Air National Guard personnel to state active-duty status, according to Lt. Col. Brad Leighton, public affairs director at the Illinois National Guard.Forty-three of these guardsmen are from the 182nd Airlift Wing Medical Group out of Peoria, Illinois, who will assist state health officials, including with COVID-19 screening and testing.Seventeen planning liaison officers are also assisting officials throughout the state with logistics and planning.Illinois currently has 160 confirmed cases with one death, according to the Illinois Department of Public Health.LouisianaGovernor John Bel Edwards directed the Louisiana National Guard to activate over 238 soldiers and airmen so far, not including full-time Guardsmen, to assist with the COVID-19 responseAnd the number Guardsmen and equipment is anticipated to increase until the situation is stabilized.More than 100 soldiers and airmen are stationed at three sites in Jefferson Parish and New Orleans to assist local agencies with COVID-19 testing. The drive-up testing stations have begun to take delivery of the necessary testing kits and protective equipment and are scheduled to become operational within the next few days.MarylandIn Maryland, Gov. Larry Hogan activated around 400 guardsmen from the Maryland Army and Air National Guard over the weekend to augment the state’s capabilities.In a press conference on Monday, Hogan said a total of 1,000 guardsmen will be activated by the day’s end with an additional 1,200 on “enhanced readiness” status, expected to be activated this week.These guardsmen include two Area Support Medical Companies to assist state health officials in screening patients, transporting supplies and distributing food.“One of things that the governor mentioned was the distribution of the Strategic National Stockpile mission, particularly personal protective equipment,” said Maj. Gen. Timothy E. Gowen, Maryland adjutant general, in the press conference. “That’s always been a standing mission for us, and we are going to execute that in the coming days.”New JerseyOn Monday, New Jersey Gov. Phil Murphy activated the New Jersey National Guard to assist in the state’s response.“We will be working closely with the [New Jersey] Office of Emergency Management to assist fellow residents as we change from our civilian attire and put on our uniforms to serve this state…. Our most likely mission sets are focused on capability gaps.” said Brig. Gen. Jemal Beale, adjutant general of New Jersey. “They are things like advise and assist, logistics, transportation, traffic control, security or bringing in our engineers to maybe bring a facility back online that’s needed in some way, shape or form for COVID-19.”Gov. Murphy said the role of the Guardsmen will likely focus on food delivery and manning drive-thru test locations in the intermediate — with the possibility of converting "a building for some self-quarantine reasons” if needed.New YorkGov. Andrew Cuomo of New York has specifically called for an increased role for the National Guard and for involvement from the Army Corps of Engineers in combating COVID-19.In a Wednesday press conference, Gov. Cuomo stated that President Donald Trump has agreed to send the USNS Comfort to New York Harbor to provide additional beds for patients. The hospital ship has around 1,000 beds, although Secretary of Defense Mark Esper noted on Tuesday that the Pentagon’s medical resources are “focused on trauma."“[Hospital ships] don’t necessarily have segregated spaces to deal with infectious diseases,” Esper said. "One of the ways you can use field hospitals or hospital ships in between is to take the pressure off of civilian hospitals when it comes to trauma cases, to open up civilian hospital rooms for infectious diseases.”Gov. Andrew Cuomo of New York has called for an increased role for the National Guard to retrofit facilities for in-patient care and for involvement from the Army Corps of Engineers to build additional hospital facilities in his state's response to the spread of COVID-19.This announcement follows Cuomo’s call on Monday for the New York National Guard to assist state officials in expanding in-patient hospital capabilities in anticipation of a spike in positive novel coronavirus cases requiring hospitalization.“We are going to organize the National Guard to work with the building unions and work with private developers to find existing facilities that could most easily be adapted to medical facilities," Cuomo said in the press conference. “Meaning dormitories, meaning former nursing homes: facilities that have that basic configuration that could be retrofitted.”As of Wednesday, the New York National Guard — including personnel from the Army and Air National Guard, the New York Guard (state defense force), and the New York Naval Militia — has 900 personnel activated to assist in the state’s response, according to a press release.Guardsmen are manning five drive-thru testing sites throughout the state, according to Col. Richard Goldenberg, public affairs officer at the New York National Guard.Cuomo was the first governor to activate the National Guard to assist in the state’s response in New Rochelle, New York, a suburb of New York City, where a “cluster” of cases were confirmed.Guardsmen continue to assist with food delivery, logistics and cleaning services in the previously identified “containment area.”In addition, guardsmen, including Army National Guard combat medic specialists and Air National Guard medical technicians, are “assisting state officials with the collection of samples” at drive-thru testing locations, the official added.According to the governor, New York State has 2,382 positive cases of COVID-19, including 1,000 new cases and 549 hospitalizations, as of Wednesday morning.OregonThe Oregon National Guard is also providing support and on Thursday announced that approximately 25 Citizen-Soldiers are assisting the Oregon Health Authority with the setup of a medical facility in Salem, Oregon.Officials say the assistance ranges from Military Department Civilians providing maintenance and mechanical support, to uniformed personnel setting up facilities for civilian medical personnel.Guardsmen have coordinated with Oregon Health Authority, the Oregon Military Department, Department of Homeland Security, Oregon Department of Transportation, Department of Corrections and other state local and non-governmental agencies.PennsylvaniaGov. Tom Wolf has activated 50 National Guard personnel to serve as “subject matter expert planners to assist the Pennsylvania Emergency Management Agency," the National Guard Bureau said.“One of the most important National Guard missions is to support our own communities,” said Maj. Gen. Anthony Carrelli, adjutant general of Pennsylvania. “Assisting and serving our fellow neighbors is a very personal effort as this is where we live. We are all in this together.”Guardsmen will also be supporting dozens of Pennsylvania residents who had previously been quarantined at Dobbins Air Reserve Base in Georgia, after departing from the Grand Princess cruise ship.Puerto RicoThe Puerto Rico National Guard has been activated by Gov. Wanda Vázquez Garced to screen passengers arriving on the island via the airport and cruise ship ports. This mobilization follows extended missions to respond to multiple hurricanes and earthquakes.“We are currently structuring this new mission to support the mitigation and control efforts of state and federal agencies in response to the COVID-19 emergency,” said Brig. Gen. Miguel Méndez, commanding officer of Task Force-Puerto Rico, in a press release. “Our staff is being evaluated and trained for this new contingency and is being deployed at Luis Muñoz Marín Airport to carry out the assigned functions.”Rhode IslandRhode Island Gov. Gina Raimondo has also activated a handful of National Guard personnel to State Active Duty Status. Currently, around ten Guardsmen are “providing response planners, liaisons and support to the state Emergency Operations Center, and logistics support,” according to officials.The state has confirmed 23 positive cases with over 300 pending results, according to state health officials.This is not a list of all the states that have mobilized the Guard but what I could find.National Guard activation powersIn addition to what I discussed earlier, a governor may also activate the guardsmen to support other states through assistance agreements in a multi-state response to an emergency, although the funding comes from the federal government under Title 32 U.S.C. status. No states have sent personnel to neighboring states thus far.“The National Guard has unique capabilities such as its Civil Support Teams and [Chemical, Biological, Radiological, Nuclear, and high-yield Explosive Enhanced Response Force Packages (CERFPs)] that could provide local first responders with additional resources to combat COVID-19,” the previous release added.“20 National Guard Civil Support Teams (CSTs) have provided COVID-19 response support by conducting Personal Protective Equipment (PPE) training for first responders at the request of civilian agencies,” a National Guard Bureau press release stated. “CST professionals’ HAZMAT and biohazard expertise make them well-suited for training how to properly don and maintain PPE.”The defense secretary retains the authority to order National Guard forces to active duty under Title 10 U.S.C. when “necessary to maintain the national health, safety, or interest,” according to the Department of Homeland Security’s National Response Framework.