It's not about efficiency, it's about need. These services need to stay at a basic level for everyone regardless of economic conditions. That's why you can't (fully) leave them to the market. However, hybrids between markets and governments can work very well. In the Dutch health insurance system, for example, the market is forced to provide basic health insurance to everyone, but is otherwise free to compete on price, service and additional products.
> It's not about efficiency, it's about need. These services need to stay at a basic level for everyone regardless of economic conditions.
It's always about efficiency. More to your point, the more important the need, the more important efficiency is.
Do you really think that it's better to provide water for $100 than it is to provide it for $10?
Remember - the claim was "Economies of scale make taxation efficient". Economies of scale aren't the only factor as taxation isn't necessarily efficient. In fact, it tends to be inefficient because it's folks spending other people's money on other people's behalf, which is the worst possible situation for efficiency. (Your money for your benefit is the best - you care about cost and quality. Your money for someone else's benefit, you care less about quality. SOmeone else's money for your benefit, you care less about cost.)
I'm glad that the Dutch govt seems capable of doing certain things. However, that experience doesn't translate. (Current US govt healthcare isn't as good as govt healthcare advocates assert that US govt healthcare will be. In other words, we have an existence argument. Fix US govt healthcare, and their argument becomes credible.)
Taxation is efficient for true public goods: goods which are non-rivalrous and non-excludible. Of the examples you mentioned, only roads fall into that category.
If such goods are provided by taxation, this will encourage overconsumption. If I'm already paying for it, I might as well use it, right? It also forces a "one-size fits all" solution. I.e., rather than purchasing the amount of mass transit I want, I'm forced to purchase the amount that the average person (as envisioned by politicians) wants.
That question is reasonably answered in many countries across the world.
Usually it is defined as 'essential' and not optional services. Breast implants aren't covered, but breast cancer surgery is (potentially finishing with a breast implant).
The details are really a moot point - the bigger issue is whether it is a basic human right to receive treatment regardless of your economic situation.
"the bigger issue is whether it is a basic human right to receive treatment regardless of your economic situation."
Isn't housing a basic human right? How about clothing? Or food? Or heat? Why is health care singled out?
There are programs to help the poor with those things, and there are programs that do the same with healthcare. Not all states fund it to the same level. Just increase the funding, and be done. There is no need for a national program.
This is how things are generally arranged in national health systems. In the UK for example, the NHS is actually made up of many local Primary Care Trusts (PCTs) which run the hospitals and whatnot in a local area; in larger cities a PCT can be one very large hospital, in more rural areas, maybe a whole county or two's worth of healthcare facilities. PCT's are funded centrally based on performance and patient load but managed and run locally. There is a reasonable attempt to learn from and spread best practice between PCT's but, obviously, no system created by humans is perfect.
NHS is an exception in that it constantly self-evaluates, etc. In one case it published a report admitting that it would have been better off (for outcomes and costs) simply contracting Kaiser (a US firm) to deliver care. This sort of honesty is truly unprecedented.
Why do people always equate universal healthcare with some kind of extreme socialist conspiracy to remove healthcare from the wealthy and place it in the hands of the poor?
I can't think of a single jurisdiction where universal care is provided that prevents a private individual from going out and purchasing more or better care if they want it. The point is to put a floor under the quality of care, not a ceiling.
Canada's health care system essentially bans private health insurance for core health services.
"The system is unique in the world in that it bans coverage of these core services by private insurance companies, allowing supplemental insurance only for perquisites such as private hospital rooms. This ban constrains the emergence of a parallel private medical or hospital sector and puts pressure on the provinces to meet the expectations of middle-class Canadians."
The system in the UK bans members from paying for additional care that is not covered by the system.
Suppose you are willing to sell your house to get an expensive procedure... in the UK that requires opting out of all of the free care (and getting a retroactive bill for it).
What this ends up meaning is that elites pull strings to get superior care while telling the masses how great the free healthcare system is.
This has largely changed now - and is still changing. There are more options for people who wish to pay for extra treatment, even to the extent of the NHS funding medical tourism where it's cheaper to do so - and the option to go private for most treatments if you wish, without penalty - except having to pay for it yourself, of course.
As far as I know, I am not a member of any shadowy elites and I've never felt the need for any form of private healthcare. The NHS has always sorted me out - and on several occasions cheerfully saved my life - with no bills and minimum of fuss.
There was a big story last year about a woman who was denied the ability to pay for her own care. I'm glad to hear things are changing.
But, that things are changing suggests that the system is not working to provide equal care, since there is significant demand for going above and beyond what the NHS offers.
It's essentially turning into an apartheid style system where the poor get one thing and the rich get another. Which may be the reality of the world in some sense, but is surely not the objective of the system.
That said, I think the NHS is the best nationalized healthcare system in the world b/c it does actually impose accountability on itself for costs and outcomes, and publishes the results.
