Gary M C Shiu asks

The real puzzle is: If national health care is indeed that “inefficient” as Arnold claimed. Why is it so prevalent across the world, and why it is so difficult to get rid of?

I don’t have a definite answer, but here are some possible ones:

1) National health care, though seemingly inefficient, actually is pretty good compared with the alternatives…

2) The costs of reforming the national health care are high…

3) People are stupid, they do not know the national health care system is inefficient.

This is a good question. In that spirit, let me ask:If state-run health care is truly efficient, then why is there not a state in the U.S. offering health care coverage to demonstrate that fact? (Imagine it were Maryland offering health care coverage.)

1. Perhaps it would be difficult to keep residents from other states from free riding, although I cannot see why you could not restrict your coverage to legal residents of Maryland.

2. There would be adverse selection, as sick people from other states move to Maryland and healthy people move out of Maryland to low-tax, low-coverage states.

I recently wrote that Massachusetts should adopt single-payer health care. One thing this would do is help resolve the issue of whether state-run health care truly is efficient.

For Discussion. Assuming that state-run health care is efficient, what other factors could cause it to fail if, say, Maryland were to adopt it?