Universal Health Care is not the Borg

Although it’s generally recognized in the US that the health care system is broken, conservative tendencies are powerful. There are a myriad differen ways to reform the health care system; when reformers argue amongst themselves, the political process tends to produce compromise reform proposals that barely improve upon the existing system, which enjoys massive inertia.

Ezra is therefore wrong when he says that not only is the USA’s health care system broken, but also the shift to universal coverage is irresistible.

[Link] The most compelling evidence that resistance to reform is futile, however, is coming from the insurers themselves. Cognizant that Congress and the nation are tiring of the current dystopia, the insurance industry recently released its own plan for universal healthcare.

It’s a bad plan, to be sure. Its purpose is more to preserve the insurance industry’s profits than improve healthcare in this country. But the endorsement of universality as a moral imperative, and the attempt to get in front of the coming efforts at reform, mark the emergence of a distinct rear-guard mentality within the insurance industry. Their game is up, and they’re turning some of their attention to shaping their future rather than betting that they can continue protecting their present.

Reforms are the most politically acceptable when the direction of reform is obvious. When everyone recognizes it’s impossible to live on a minimum wage job, the solution is obvious. When everyone recognizes that American health care is broken, the only generally agreed-upon solution is universal coverage, which can still be done in too many ways.

For example, one debate that hasn’t even begun is the one about Medicare versus the VA system. Paul Krugman has tried igniting such a debate, but even the Democratic Party is too conservative to listen to him. The idea of letting everyone buy into Medicare has a striking simplicity that is only matched by its utter inability to rein in administrative spending.

A related debate is about a mixed system that covers everyone versus single-payer. Switzerland’s health care system is very capitalist, and has the highest per capita private spending on health care outside the US. There’s a broad continuum from Switzerland via Germany, Japan, France, and Britain to Canada; unfortunately, the only existing system Americans are familiar with is the Canadian one. Although Canada’s system isn’t bad, the French one is even better, and at any rate the state-based piecemeal solution that seems to be in vogue in Massachusetts is more Swiss than Canadian or French.

Absent a clear alternative to the current mixed system that’s in place in the US, different reform ideas can only compete with one another, probably with negative results.

On the one hand, the progressive method for change, social and legal action, can only work when the solution is obvious – abolition of slavery, legalization of SSM, amnesty to illegal immigrants – but is useless at figuring out how to solve complex problems. On the other, the reformist method always faces an uphill battle when different reformists attack one another while the powerful conservative interests can rely on apathy and inertia to stay in power.

It’s not that progressivism can’t do anything complex, but that it takes a lot more time to figure out which bureaucratic hierarchy to trust to solve the problem. Reformism can work when there’s a great impetus for change, but the only successful example I can think of, New Zealand’s 1993 electoral reform, involved a contest between the status quo and just one reform proposal.

7 Responses to Universal Health Care is not the Borg

  1. Bruce says:

    The Canadian system does leave much to be desired, including inter alia the felony prosecution of physicians who provide medical services to anyone outside the system. Part of Canada’s problem with its health service is that it has become symbolic of Canadian national identity itself, such that its reform or modification gets attacked not as unwise or inequitable, but as treasonous or (gulp) American.

    In Sweden, there exists a modest co-pay for most services (waived for the indigent, IIRC). I think this is sensible and Canada should consider adopting it. But the 5 pillars of the Canada Health Act (including no cost at point of service) are about as hard to modify as the U.S. Constitution.

    Surely we can get to the point politically where all U.S. minors are covered.

  2. Axel says:


    why are you always so pessimistic about political reforms? Americans are much more pragmatic, forward-looking, goal-oriented and optimistic than the rest of the world – that’s what we always hear from our politicians when it comes to political reforms and social cuts. So be a prime example! If someone has tons of money then it’s the US… I learned from a linguist that the word “compromise” has a positive meaning for most Europeans, contrary to the understanding in the US where it’s typically valued negatively. Is that true?

    Since January 1st 2006 there is a new healthcare insurance system in the Netherlands . I’m not sure how “radical” the reform was but anyway it was a great political effort, if I remember right.

    A very good source dealing with country-specific health care systems and the diverse reforms that are actually on the way is the homepage of the European Observatory on Health Systems and Policies: http://www.euro.who.int/observatory.

    BTW, there’s also a new study on sexuality education for young people in different European countries (“Sexuality education in Europe – A reference guide to policies and practices”). See

  3. Alon Levy says:

    Bruce, it’s funny that Canada has the purest socialized medicine system and still has one of the highest private expenditures on health care in the developed world (in 2003 it was the 6th highest, I think). But I agree with Ezra here in thinking health care reformers should draw not only from Canada but also from Japan and Western European countries, which overall get better results.

    Axel, I’ve mostly heard the word “compromise” used with a negative connotation, but a considerable amount of my social contact is with other liberals who are thoroughly tired of the Democratic Party’s obsequity. The US is supposedly more pragmatic than Europe, but I’m not sure to what degree it’s actually true – for a start, social cuts make sense in most European countries, but not in the US, where corporate welfare costs the government about an order of magnitude than welfare to poor individuals.

    More to the point, I’m actually fairly optimistic here, in the sense I think it’s likely the US will have universal coverage by 2015 and plausible it’ll have universal coverage by 2010; what I’m pessimistic about are the notion that universal coverage is irresistible and the current proposals’ poor cost control.

    Do you have any link about the Dutch reform? As far as I can tell, the European Observatory only has information about the Dutch system as it was in 2004. Either way, thanks for both links.

  4. Axel says:

    At the moment, I only know about the official pages of the Dutch Ministry of Wealth, Welfare and Sport, especially:

    The new care system in the Netherlands (in three languages)
    Documentation, 9 May 2006

  5. Alon Levy says:

    Ah, alright… thanks. It looks like the sort of thing that might pass in the US: a German-style multiple payer system, only with even more privatization, and a rule that health insurance companies are not allowed to discriminate in premiums. The depressing thing is that Wyden’s proposal focuses on prohibiting discrimination in premiums and is slated to save $500 per capita per year, while the difference in cost between the US and NL is closer to $3,000.

  6. peter says:

    Shopping for life insurance quotes for adult children isn’t any different than it is for adults or seniors.

  7. Ed says:

    Nice blog post – I found your site through Yahoo.

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