Thanks to Rita Marie Goering for her supportive comments, as well as for a
strongly relevant rejoinder on the American health care system. US private
sector middlemen take out such high costs for their services that also
total health care sector expenditures become inflated. It seems that the
public authorities do play an underwriting role of sorts in the US as
well--the private billing takes place not only at the expense of consumers,
but also of government. It seems here that "public-private partnerships"
are no panacea for the possible disadvantages of administration in either
sector. They may indeed combine the worst of both, creating a system where
cost-shifting is endemic and accountability is nil. Sometimes it seems to
me that the Third Way is paved with good intentions..
An additional comment on birth rates--educational programs which
decrease Third-World birth rates to First-World(ish) ones are difficult
to argue with. However, it seems possible that in the long run, the
marginal social utility of decreasing birth rates may actually become
negative. Who's going to support pay-as-you-go pension systems, or other
social benefit systems, if the working-age population keeps shrinking in
relative terms? Benefit reductions and funded systems lead to
second-order problems of their own--I believe that child benefits, child
care services, and wage loss insurance in parenting are also needed to
keep birth rates from shrinking too far.
EC
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