In any system there is healthcare rationing and the average person gets only average care

[cthulu2016]

These are the two thing no healthcare system can fix:

1) There will be rationing of healthcare
2) The average level of care will be average

Those things will be true of the worst system and the best system.

As with any set of real-world limitations we have to do the best we can do within those limitations. What we seek, ultimately, is to maximize justice in healthcare.

And we do not currently maximize justice, of course. Our healthcare system sucks less, but it still sucks.

And even when it is perfect it will still suck, since we will continue to be subject to age and mortality, but that reality is no excuse to not try harder... to achieve the best we can.

In a libertarian system, like what we had until the 1960s, healthcare is rationed on the basis of how much money one has, with dollar bills being ration coupons.

In a single payer system, like I hope we will have in the future, healthcare is rationed based on a calculation of net social priority. It is also rationed on the basis of what nation you live in—the ultimate rationing.

It is literally impossible for everyone to get the best care. There is not that much money in the world.

I am not happy about it, and I think things need to be way better.

All we can do is to try to have average care available to all, and for that average to be as good as we can make it.

I applaud Obamacare. I thnk Obamacare sucks. There is no contradiction there. It is better than things were, and it also sucks.

[KansDem]

1. There are national-security concerns that should not be controlled by the private sector

Health care
Education
Energy
Environment
Defense

If you want to sell shampoo, CDs, running shoes, and the like, capitalism works fine. But these five national security concerns should not be in private hands.

Until we realize that we'll always have the dilemma you described.

[Mika]

4. Capitalism is a system of rationing.

Those with money have. Those w/no or little money don't have.

[Egnever]

5. Even in a government run health care system

there is rationing.

There is no Utopia.

[Zorra]

2. I disagree. Cuba has a substantially greater number of doctors, per capita, than any other country.

Cuba 6.7

United States 2.4

Canada 2.1

http://data.worldbank.org/indicator/SH.MED.PHYS.ZS

The Cuban government operates a national health system and assumes fiscal and administrative responsibility for the health care of all its citizens.[1] There are no private hospitals or clinics as all health services are government-run. The present Minister for Public Health is Roberto Morales Ojeda.
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In 2000, Secretary General of the United Nations Kofi Annan stated that "Cuba should be the envy of many other nations" adding that achievements in social development are impressive given the size of its gross domestic product per capita. "Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities - health, education, and literacy."{88] The Kaiser Family Foundation, a non-governmental organization that evaluated Cuba’s healthcare system in 2000-1 described Cuba as "a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources"[89] President of the World Bank James Wolfensohn also praised Cuba's healthcare system in 2001, saying that "Cuba has done a great job on education and health", at the annual meeting of the Bank and the International Monetary Fund. Wayne Smith, former head of the US Interests Section in Havana identified "the incredible dedication" of Cubans to healthcare, adding that "Doctors in Cuba can make more driving cabs and working in hotels, but they don't. They're just very dedicated".[90] Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it.[91] Furthermore, London's The Guardian newspaper lauded Cuba's public healthcare system for what it viewed as its high quality in a Sept. 12, 2007 article.[92]

http://en.wikipedia.org/wiki/Health_care_in_Cuba

IMO, the key is right here:

"Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities - health, education, and literacy."

[Mika]

3. Raul Castro's greatest legacy ... decomissioning the military for war.

And redirecting resources to the people. The military is now, more or less, an emergency relief agency.

[Zorra]

8. That's wonderful. It's surprising how backward Cuba still is on LGBT rights issues.

Mariela Castro has been trying to fix this, but it appears to be slow going.

Cuba does offer free Gender Reassignment Surgery for transgenders, at least.

Fidel Castro takes responsibility

In his autobiography My Life, Fidel Castro criticized the "machismo" culture of Cuba and urged for the acceptance of homosexuality. Furthermore, he has made several speeches to the public regarding discrimination against homosexuals.

In a 2010 interview with Mexican newspaper La Jornada, Castro called the persecution of homosexuals while he was in power "a great injustice, great injustice!" Taking responsibility for the persecution, he said, "If anyone is responsible, it's me.... We had so many and such terrible problems, problems of life or death. In those moments, I was not able to deal with that matter [of homosexuals]. I found myself immersed, principally, in the Crisis of October, in the war, in policy questions." Castro personally believed that the negative treatment of gays in Cuba arose out of the country's pre-revolutionary attitudes toward homosexuality.[48]

http://en.wikipedia.org/wiki/LGBT_rights_in_Cuba#Fidel_Castro_takes_responsibility

[Mika]

9. Homophobia and egregous treatment *was* status quo in the Latin Americas.

Cuba has come a long way, so I'm not going to agree with you on this point.
Cuba does recognize same gender civil unions. First one was in 1999.

[Zorra]

12. I know, and that's fine, but still, Raul needs step up to the plate right now and give

LGBT full equality immediately. Why is there a problem? A good leader never bows to the perverse wishes of bigots.

It's hypocritical for a government/nation that claims to be socialist/communist not to allow equal rights for LGBT. Even the quasi-fascist US is outpacing Cuba in LGBT rights.

[Mika]

13. What issues of inequality are you referring to?

[cthulu2016]

7. The average Cuban receives average Cuban care

I really don't understand your disagreement. How does saying one healthcare system is better than a different system possibly mean that there is no rationing or that everyone gets the best possible care?

[Zorra]

11. OK, sorry, I did not realize you were speaking of absolute essential ideal forms as standards

of healthcare perfection.

Under those guidelines, yes, it is most likely impossible for anyone, anywhere, to ever receive the best possible care, and most likely impossible for there to be no rationing.

However, considering the real world definition(s) of rationing posted below, it is possible to evolve a health care system where rationing is nonexistent.

Just because something is not manifest in substance today does not mean it cannot be manifest in substance tomorrow.

“Imagination is more important than knowledge. For knowledge is limited to all we now know and understand, while imagination embraces the entire world, and all there ever will be to know and understand.” ~ Einstein

Hence my example of Cuba, it is an example of how healthcare systems can evolve and improve because a society places a high value on the health of its citizens, even despite meager resources, and, with more abundant resources, could evolve a healthcare system where the type of rationing, as defined below, is completely eliminated. Contrived, profit driven "real world limitations" can be eliminated.

The ACA is most likely a step forward in the evolution of the US Healthcare system, but a disappointing one considering our abundant national resources. We can and should do much better, but it is what it is for now. Even tiny, cruelly embargoed Cuba does much better than us. Maybe we need to work on changing our priorities and value systems, so that "all the money in the world" becomes irrelevant to the promotion of human well being.

[Imagine how fast we could evolve if we as a people used our government as an agency primarily focused on the the well being, quality of life, and happiness of human beings rather than focusing on greed, war, and profit. Another world really is possible, why limit ourselves to way below average simply because our system dictates it?

ra·tion
[rash-uhn, rey-shuhn]
noun
1.
a fixed allowance of provisions or food, especially for soldiers or sailors or for civilians during a shortage: a daily ration of meat and bread.
2.
an allotted amount: They finally saved up enough gas rations for the trip.
3.
rations.
a.
provisions: Enough rations were brought along to feed all the marchers.
b.
Chiefly South Atlantic States. food or meals: The old hotel still has the best rations in town.
verb (used with object)
4.
to supply, apportion, or distribute as rations (often followed by out ): to ration out food to an army.
5.
to supply or provide with rations: to ration an army with food.
6.
to restrict the consumption of (a commodity, food, etc.): to ration meat during war.
7.
to restrict the consumption of (a consumer): The civilian population was rationed while the war lasted.
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"There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not?"
RFK, paraphrasing George Bernard Shaw

[Revanchist]

6. I wish we could move to the English model

Everyone gets free healthcare but you have the option of purchasing private insurance also.

[hunter]

10. That's not really true. It's a very subtle thing.

"Average" medical care is often the best. Pushing in either direction of "high cost" or "insufficient cost" can be where things go wrong in medical care. Overly aggressive and expensive treatment or "doctor shopping" by wealthy people can turn out just as badly as inadequate, negligent, or no medical care.

It's possible to get inexpensive and very appropriate care in a free clinic and it's also possible to get horribly expensive and inappropriate care with a platinum insurance policy and great wealth.

Same malady: A guy doesn't see a doctor and it turns out badly. Or a guy goes to the free clinic, is treated inexpensively and appropriately, and it turns out well. Or a guy with money pushes hard for the latest expensive pharmaceuticals and the most expensive celebrity doctors, and it turns out badly.

If achieving the "highest quality of life" is the goal then medicine per capita doesn't tend to be wretchedly expensive, even when a few people are receiving organ transplants and the like. If corporate profits or "fighting a war with death" are the goals, damn the suffering, then the sky's the limit on health care costs.