As I posted elsewhere, but I forgot where, failure and inefficiency are not just a symptom of bad design in a government-monopoly health care system (or any other such endeavor.) It's inherent in the concept of collectivized health care itself.

I can't come up with a way to make socialism work. Neither can anyone else. The best you can hope for is that you can come up with something that screws up as little as possible. Nations with largely homogenous populations, and small populations at that, can get away with collectivized medicine for a while. But not forever.

You can work with market principles, or you can let them run you over. You can't pretend they don't exist.

The way to deal with health care problems is to bring the market back into the system, and at the point we're at now, it's a LONG trip. Such a reversal would involve, at various stages:

- Allowing more of the costs of medical care to pass through to the patient. Medical savings accounts could be an important part of managing this. This is the most important part. There is very little incentive to save money if you aren't picking up the bill. There is no incentive for providers not to charge high prices if the patient doesn't care. Naturally, this would need to be eased in over a time period.

- Reduce the regulations required to come up with a new drug or treatment to something a bit more reasonable.

Bureaucrats fear the "thalidomide disaster." However, they are not penalized for countless lives lost while "good enough" treatments go through years of testing. There is a balance, and right now it's too far in the "careful" direction, although fortunately there have been important exceptions made for lifesaving drugs. There should, of course, be clear labeling and disclosure of any treatments or drugs that have gone through a "fast track" process, or especially of any drugs that have not been officially tested at all.

- Bring the FDA around more to the line of "safety," and less to the line of "effectiveness," although again we need truth in labeling.

- Reducing the legal restrictions on alternative forms of health care and maintenance. The current regulation environment is part of this. There is not much incentive for researchers to spend millions testing medicines that one can grow in the back yard, or get off-the-shelf at the drugstore. So things like using aspirin for heart disease or the benefits of natural medicines tend to come about very slowly.

- Ease the restrictions on practicing medicine. Again, truth in labeling is required. I want to know if someone has a medical degree, but I don't want the law telling me I can't go to the local shaman if I want.

Can this all be pulled off? God knows. We've been trained in this country to believe that we should not have to fork over any money at all for health care. People blow a gasket if they have to make a twenty-dollar copayment. As with other wealth-redistribution systems, they don't see where the money is coming from, and who pays.

The transition to free market solutions for problems is not a matter of suddenly waving a wand and everything becomes Galt's Gulch. What it is, is a decision by government and the people to say, from here we're going to stop going down the road to socialism, and begin walking slowly the other way. It's a choice of direction.

This is why something like privatizing a small portion of Social Security is so vital. Even a few percent is a change of direction. Maybe that's why some people are so opposed to it.