Working for an international company that provides important services to health care providers, I know of some of the problems in other countries.

>So-called "socialised" and fee-for-service medical care are not mutually exclusive. There are several successful models that effectively "insure" all citizens for acute/trauma and hugely expensive unusual care (e.g. massively expensive cancer drugs) but also provide a fee-for-service and/or personal insurance model for more routine care.
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>In this model you can be sure you will receive excellent care if you are hit by a car or have a heart attack; but if you have a painful varicose vein, you can either wait for a century or get it done yourself.

It depends what country you are in.

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>Also, let me tell you something about waiting lists. Waiting lists are not always "bad"; they are in fact a very successful rationing mechanism. Because demand for healthcare is infinite, one way or another there has to be a rationing mechanism- even in fee-for-service models where HMOs ration using clumsy rules that may be worse for patients than a short waiting list.

Every few months there is a news story here in the US about how Canadians are coming here for better medical care or for care they are having to wait for in Canada. But then, there are also stories about US citizens going to Canada to get medicinces that they can't get here.

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>Much rationing in socialised care is carried out by physicians who act parsimoniously to conserve resources. But in an environment where litigation is rife, physicians can hardly be blamed for investigating and spending every-which-way in case there is a 0.001% chance the patient might sue.
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>I must also observe that apparently > 50% of health spending is consumed by people in their last year of life. Such facts are uncomfortable but society cannot both complain about cost and avoid grappling with uncomfortable issues that impact significantly on that cost.

Yes, I understand that. One of the reasons Medicare is in trouble here in the US.

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>Regards
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>JR