Bibliographic record
Abstract
While political realities make it quite unlikely the United States will move to a single-payer system, there may nevertheless be lessons to be drawn from Canada’s experience as well as from the experience of other nations. Canadian Medicare is presented as both a savior and a foe to American patients. On the one hand, it is a symbol to progressive American scholars of accessible health care without the command-and-control features of, for example, the UK system. On the other, its effective bans on supplementary PHI for queue jumping and top-ups leave too little room for embedded private insurance companies. The most likely model would see a significant role for private health insurance in providing the core plan to which there is universal access.This paper argues that whatever the path forward for the United States, there will be a need to attend to the interplay between private health insurance (supplementary and complementary) and the established “basic” or core plan — whether single payer, social health insurance, regulated universal private health insurance, or some variant thereof — with a view to balancing access, equity, and cost. If the basic or core plan is bare bones, the role for complementary/ supplementary private insurance will be proportionately large, particularly if co-payments are high. If rationing is too severe within the core or basic plan, this will generate demand for private alternatives to avoid queues. If private insurers are harnessed to provide the core or basic plan and are also allowed to tie this product to offerings of supplemental or complementary private health insurance, then regulation will likely be required to ensure that the tied products are not used to effectively circumvent requirements that private insurers not select on risk in the basic or core plan. The dynamics within a particular system are very context specific, which, it must be conceded, limits our ability to reliably transplant lessons from one country to another Hence, the enormous challenge facing U.S. lawmakers as they attempt to design and implement foundational changes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.010 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.025 | 0.009 |
| Scholarly communication | 0.016 | 0.005 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.008 | 0.008 |
| Insufficient payload (model declined to judge) | 0.055 | 0.007 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".