When you have a NHS you are agreeing on a single standard of care as a nation. The problem that the author illustrates is that it is difficult to have an honest

When you have a NHS you are agreeing on a single standard of care as a nation. The problem that the author illustrates is that it is difficult to have an honest dollars and cents conversation about what that standard of care should be. It certainly can't be 'whatever is necessary at any cost' without bankrupting the program. Where the dollars do get spent will be determined by political expediency rather than individual choice. As with most government programs the incentives will be with what's popular rather than what is effective. Politicians will get elected to put more money towards $cause of the day$. Also consider the moral hazard involved with national healthcare combined with our two party system and electoral process. Who would be surprised if Iowa and New Hampshire end up with more hospitals per capita than other states? What if CA and NY end up with a lions share of the healthcare dollars? What if they don't? IMHO, the right way to run a NHS for the US would look very different than the UK's NHS. Perhaps something similar to a minimum wage. I.E. A federal minimum standard of care that is uncomfortably low, with state and private coverage able to build on top of that as determined at a local level. But we have to be able to look at something like a "death panel" and say 'yes of course that would be necessary'. Until we can have honest conversations about varying standards of care, we won't see meaningful healthcare reform in the US.