>>Mike, hate to tell you this, but Commonwealth Fund (which published the survey) is made up of several individuals who pushed hard for ACA (and even established a commission with the aim of doing so). Their surveys have been characterized as self-reported. Honestly, some of their ads are so rose-colored that I'm not sure any serious defender of ACA would use them as evidence.

You are accusing the Commonwealth Institute of "Junk Science" - the habit of forming a fixed position and then hunting for evidence that supports it.

Not sure whether that criticism isn't better expressed in reverse. If you disagree with the Institute's collection of data or analysis, that's what needs to be critiqued rather than an ad hominem/instututem attack.

As for your "much better analysis" that was published in August, long before the latest surveys confirmed that things are trending well: since everywhere else in the free world has a nationalized scheme it is inevitable that appointing anybody with experience at such transition, comes from a national model. The administration appointed experienced people and now is criticized for appointing people who come from national models. Puh-leez.

The "analysis" moves on to cherry pick those areas where the US does well. The problem for Atlas is that the Commonwealth Institute also identifies these areas and comments on them specifically, including them in its findings. Obviously this is not a sensible rebuttal of the Institute's findings, though that is how it is presented by your author to a lay audience that has not read the report.

Next comes an absurd paraphrase of the current state of the NHS. The NHS certainly has issues but they are not those identified by this "analysis" and they would be solved overnight if the NHS were allowed to spend even 25% less than US on healthcare. Yes, the NHS is short of funds despite publishing a surplus. And contrary to Atlas' rendition, even the responsible politicians now agree that opening the NHS to "competition" and requiring facilities to bid to provide services has created confusion, lack of purpose and almost certainly increased cost and inefficiency, while the failing private fund initiatives often need bail-outs and have resulted in low return for taxpayers as usual when facilities and valuable assets are transferred to private ownership. Ironically, latest proposed solutions include bringing more services under the same outpatient roof under physician control- the same behavior in the US that is accused of pushing up costs! Also there are suggestions that "free" healthcare for all may no longer be a viable model. Fair enough- this is the same point Bill makes, that if there's no direct cost to the patient there's no motivation to moderate demand. But it's a highly complex situation and as usual, confident attributions of fault to this or that often are just prejudice.

IMHO this "analysis" is a superficial hit piece for consumption by junk scientist folk who already know the ACA is no good and enjoy learned treatises confirming their position.

If people want to compare systems, IMHO there's a very easy start point: cost. Consider how each system would fare were it required to work within the cost structure of the compared system. E.g. consider how the US system would get on were coalface prices reduced to 50% of current levels (hint - chaos.) If the real criticism is that national schemes have less $, then that's entirely in taxpayer/policyholder hands and there is no obligation for the US to halve its expenditure to implement the ACA.

Here's a prediction for you: with rising demand, in the next decade every society/policyholder population is going to have to make tough decisions either to keep growing policies/taxes to fund the demand, or to open up rationing processes for public decision. Certain heroic measures, particularly for the elderly, are likely targets. Those who shrieked about death panels under the ACA may not appreciate the opportunity to demonstrate how they think things should be done.