Leaving aside, for the purposes of this discussion, the inefficiency of the NHS in the UK, my biggest objection to socialised medicine is that the authorities feel entitled to prescribe lifestyle choices. We see it with the 21 units of alcohol nonsense and the 5 a day nonsense, not to mention smoking.

Other readers may be more familiar than me with the idea that ‘the difference between a welfare state and totalitarianism is a matter of time.’ I don’t know who said that.
Individual accounts would avoid being subject to state diktats.
Savings yes, for conditions that are inevitable or almost inevitable. I take that point.
Insurance for bad luck.

Would that work?

Laird, where do you want to get to, and what is your route?

In my opinion, one of the most sensible health-insurance reforms would have been to make health insurance less tied to employment. We have lost important employment mobility with people too scared to change jobs because they lose healthcare. Another would be to remove certain restrictions in play that make it hard for companies to compete across state lines.

The problem with insurance is that it is not in fact a great model for paying for healthcare. We insure against relatively random, non-common risks such as theft and fire. With health, on the other hand, you can more or less predict that spending on health tends to map with age. As you get older, then – other things being equal – your spending on healthcare tends to rise, especially beyond middle age.

As reforms go, a much smarter move, in my opinion, is to encourage personal health savings accounts. To get them started, you could put these on a tax-advantaged basis, such as a mutual fund plan that many people have. They would be controlled by the individual, but tax benefits would only operate if the money was devoted to health. If, upon death, there was money left in the pot, this would fall into the deceased’s estate like any other asset.

Insurance is fine for catastrophic and hopefully rare events, and should not be dismissed completely. But in the main it is not in my view the right way to pay for healthcare.

For years, I was a “Sponsor” at Cato; not of the Koch classification, of course, all back before the expansion of Cato’s fields of policy concerns, and the move to Mass Ave, but continued for some time after. I had shifted from American Heritage when two squirrels there (from the U K as I recall) came out with a plan for compulsory health insurance – goodbye to Ed Fuelner, hello Ed Crane.

To shift the function of this Think Tank (Cato) to “political targeting” will be to lose a principal offset (and function of principle) to the still deficient conditions at our universities, and their self-perpetuating faculties and staffs.

However, if that happens, another enterprise will rise in its place, peopled by Cato alums.

I hope The troops at Koch (I don’t think it is Charles) will proceed with caution.