One big difference I observed between my life under Canadian medicare (30 years), and UK NHS (13 years) is that in the former, there is no private option, so rich people have to advocate for EVERYONE'S care in order to improve their own.
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I think the relative fortunes of the NHS and OHIP can be largely explained by this difference. Allowing the rich to opt into a private system reduces the political costs of slashing the public system.
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In the US, this process proceeds on steriods. Those in the USA lucky enough to have "insurance" find that their massive premiums buy them little-to-no healthcare, with endless bureaucracy and denials.
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Meanwhile, wealthy Americans buy their way out of the system altogether with "concierge doctors." In good times, this is merely an injustice. During the pandemic, it's an invitation to start building guillotines.
wbur.org/hereandnow/202…
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wbur.org/hereandnow/202…
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Concierge services have finagled all kinds of pandemic unobtanium: respirators, tests, swabs and masks. These are not going to unwell people, they're going to the "worried well": rich people who just want to be on the safe side.
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This could make us all much sicker. We need tests for exposed people, masks for health-care workers, respirators for emergency cases. The fact that these are piling up in mansions in the Hamptons and other wealthy enclaves is proof that markets are not efficient allocators.
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We're supposed to tolerate inequality because it is an unavoidable consequence of efficient market allocations, making us all better off in the long run. But when inequality allows plutes to hoard pandemic supplies and endanger every human on Earth, the pretence runs thin.
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There's a great book about this, The Velvet Rope Economy: How Inequality Became Big Business, by @NelsonSchwartz: "In every realm of daily life–from health care to education, highways to home security–there is an invisible velvet rope that divides how Americans live."
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