At The Conversation Timothy Callaghan outlines three reasons that the United States doesn’t have a national health care system:
- The United States is uniquely more individualistic.
- Interest group opposition.
- It’s hard to us to enact entitlement programs.
and concludes that a national health care system is unlikely in the United States for the foreseeable future:
Its culture is unusually individualistic, favoring personal over government responsibility; lobbyists are particularly active, spending billions to ensure that private insurers maintain their status in the health system; and our institutions are designed in a manner that limits major social policy changes from happening.
As long as the reasons above remain, there is little reason to expect universal coverage in America anytime soon.
Let me suggest some other reasons that a national health care system is unlikely in the United States.
- The U. S. is too large and diverse for the idea of a national health care system to gain much traction. No country of 200 million or greater in population has a national health care system (press releases to the contrary notwithstanding).
- The U. S. is geographically too large for a national health care system. Canada’s system is administered by the provinces. Russia’s system is national. Do we really want to compare ourselves with Russia?
- Path dependency. Other OECD countries adopted their systems a long time ago when health care was much less expensive and represented much less of their economies than it does now. We might have been able to implement a national health care system 60 years ago (when such a system was vehemently rejected by the AMA). Now?
- Proponents of reform insist on a national system. That’s the Great White Whale. Try Vermont (or Hawaii) first.
It would be helpful if proponents of reform stopped comparing us with Denmark or Singapore. The latter is a city; the former is the size and population of one of our counties. Such comparisons just make them seem ridiculous. The comparisons should be to Russia, Mexico, Brazil, Indonesia, India, or China.
The reality is that the U. S. is sui generis and systems for it need to be adapted to it and the unique conditions that obtain here.
If we could stop the DNC from sending operatives to stop states from adopting single-payer, we might make some progress in experimentation.
Did the DNC stop Vermont from adopting a statewide single-payer system? Is the DNC intervening in California?
The problem is money, single-payer is way too expensive absent other reforms. I doubt it will get passed in any state because of the cost.
Did the DNC stop Vermont from adopting a statewide single-payer system? Is the DNC intervening in California?
Those are legislative agendas, so all the DNC has to do is make telephone calls. In Colorado, where the initiative was via referendum, it most certainly did send operatives to organize against.
“There are a number of Democrats who are opposed [to ColoradoCare] – like president of the Denver chamber of commerce, Kelly Brough. And now that the legislative session is over I’m sure other Democrats will be speaking out,†said Sean Duffy, a spokesman for Coloradans for Coloradans, which is fighting ColoradoCare. “We even have Democratic consultants running the campaign.â€
Global Strategy Group, the Democratic consultant firm that Coloradans for Coloradans has retained, is also currently working for Priorities USA Action – a Hillary Clinton Super Pac.
Clinton has received $13.2m in donations from the health sector over the years, according to nonpartisan Center for Responsive Politics. This well-funded industry is also the chief financial backer of the effort to destroy ColoradoCare.”
https://www.theguardian.com/us-news/2016/may/20/coloradocare-healthcare-plan-faces-opposition-from-democrats
The insurance model is dead, but it has been mummified and placed in the town square to be worshiped.
Subsidies cannot help. A $4,000 deductible for many people is no different than a $4,000,000 deductible, and giving them the policy for free does not suddenly make the deductible go away.
The only way to solve the problem is to subsidize their medical costs (or deduction), but this breaks the free-market solution to rising prices. Single payer is no different than subsidizing the premium and the deductible, and therefore, the free-market cannot slow the costs of healthcare.
If neither the free-market solution or the single payer solution can lower or stop price increases, the system can either continue with the cost increases as usual, or the system must be fundamentally changed.
As to a national public healthcare system, it is doable. We have a public school system, and we have a national postal service. For places that are too small, there can be a limited schedule of doctors rotating in and out of the local clinic. Initially, private services can be contracted for the public health system. Furthermore, technology will solve a lot of initial problems.
With gangrene, you can pretend it will get better. When you finally agree to cut off the limb, there will be more amputated, or you could let it kill you. It is “Socialism or Bust”.
Andy- Single payer is neither intrinsically expensive or cheap. The NHS in the UK is essentially single payer and is cheap. If you told the GOP they had to come up with a single payer plan, and they came up with a single payer catastrophic that covered everyone, but had a deductible of $50,000, everyone would be covered and it would be very cheap, but few would really have coverage in a meaningful way.
“The reality is that the U. S. is sui generis and systems for it need to be adapted to it and the unique conditions that obtain here.”
This should also apply to the idea that markets can lower costs and also improve access while maintaining quality. That said, while I think your basic sentiment is correct that does not mean that we cannot learn from other countries.
Steve
Steve,
I understand that which is why I said it would be way too expensive “absent other reforms.”