Could it be impossible to provide cost effective insurance against "Acts of God" aka "Nature" to a nation of people without staggering efficiencies? I think it's a very real possibility that this could be a pipe dream right now for a country the size of the United States. Why is it so hard to believe that we may not ever be able to mitigate Nature?

If you would like to draw comparisons between the US and Canada, the U.S. has 315 million people with a 34% obesity rate. Canada has 33 million people with a 24% obesity rate. That's a difference of ~99,231,174 obese people. If you notice, that difference is actually three times larger than Canada's entire population.

I highly doubt we can apply very much of the implementation from Canada to the United States. The wheel very well may need to be re-thought. This is the equivalent of scaling any startup. Anyone can write a twitter clone in a couple hours, it's really not that hard. However, it takes some serious thinking, engineering, thought and complexity to scale that simple CRUD app to millions of users. Your comment seems rather like the owner of a small business complaining that the CEO of a Fortune 500 company can't control his employees as well as he can.

I know the Canadian system works. You agree that it works for Canada, but you say there are differences between the countries. I agree with that too.

I explain it to myself the same way I explain people living in Winnipeg. People aren't perfectly rational utility-seekers. They won't get up and move away from Winnipeg to avoid a flood. Likewise, they won't flood across the border into Canada to get our health care. You can say there aren't enough jobs or something, but the fact is we take as many immigrants as we possibly can these days, we'd love to have lots of Americans.

But they don't come to Canada. So one explanation is that people aren't perfectly rational in the sense that would drive them to seek out better health care or to move away from Winnipeg. Once you accept that, you can accept that people might not like the idea of spreading the cost of health care across a population through taxation. Never mind if I think it's rational, I also think it's rational to move off a flood plain.

Or any of a dozen other explanations for why it might not work in the US. It might not! I honestly don't think private insurance works very well, but I can readily accept the argument that public insurance might be worse in the US.

Once you accept that we sweat and love and sing patriotic songs and write mean things about each other on the Internet and all these other human things, you have to accept that the best we can hope from a blog post is to provoke questions rather than provide answers.