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.