Not only does a proposal’s making objective sense not particularly make the proposal more likely to be adopted, it’s practically a guarantee it will not gain much support. That was my reaction to William Hazeltine’s Fiscal Times op-ed on healthcare reform for the United States, based on Singapore’s model:
Singapore teaches us that patients must understand that health services cost money and that they should pay a portion of those costs. It teaches us that hospital and doctor incentives must encourage them to provide the best service at the best price. Government can create a framework of rules that does that. And it does not have to be a cold-hearted solution. The framework must also assure that people have the ability to pay, and it must provide a safety net for those who cannot. Lastly, all health costs and outcomes should be transparent to the patient and the payer.
Who would support such a plan? Not healthcare providers. The sad reality is that any healthcare reform plan that actually reduces costs necessarily means that providers get less money.
Certainly not the elderly. Higher co-pays, even for the wealthiest elderly, will be fought tooth and nail if only on a slippery slope basis.
Not most Americans with employer-supported healthcare. For most Americans, employer-supported healthcare comprises a hefty and rising proportion of their total compensation. Making them pay more or receive less necessarily means demanding that they take a pay cut.
A lot of the increase in costs in healthcare are necessary to support healthcare’s growing bureaucracy. Anyone who owes his or her job to inefficiency isn’t likely to demand its end. And, as I’ve mentioned before, bureaucracies do not scale linearly. The medical bureaucracy for a country of 300 million won’t just be 60 times larger than one for a country of 5 million souls. It will be closer to 100 times the size or larger. That’s a lot of inefficiency.
I guess the bottom line is that it’s a lot easier to implement a sensible plan in a relatively small, authoritarian polity than it is in a large boobocracy.