In the comments to an earlier post, KennyBoy asks:
And Megan, no one on your side of the argument seems willing to answer two simple questions. If every other country (don't split hairs, you know what I mean) can cover ALL of their citizens for LESS than the US does, with better outcomes, why can't we do that?
This is a favorite question of would-be reformers. There are two answers, one theoretical, and one empirical. We'll start with the theory, which won't be new to regular readers; I've gone over the that I think we aren't the same as Europe a bunch of times:
- More wage inequality means doctors need to make more
- The American political system is especially easy to lobby
- American public services culture is, in general, less effective than the Nordic countries, and no, this is not simply an artifact of Republicans criticizing government bureaucrats; the government bureaucrats do a great deal that is worthy of criticism
- Path dependence: it's a lot easier not to give people a new drug or treatment than to take one away.
- Intolerance of tradeoffs: we do not even do the very obvious things to control costs in the system, like rethinking extraordinary measures at the end of life. The harder tradeoffs are simply non-starters.
- American attitudes toward government: when told they can't have something they want, Americans do not say, oh, okay. They go on the news and call their congressman.
- Federalist and non-parliamentary democracy: in most other systems, the head of the government tells the government what to do. In our system, you need 220 congressmen and 50-60 senators. There's no way to implement the sort of technocratic change that reformers envision; the politicians will keep sticking their fingers in the pie.
- Conservatism: the American public is considerably to the right of any European electorate, and no, this isn't just an artifact of Republicans lying to them. They have different attitudes about how much they want the government to do, and how much they are willing to pay to do it. Many of the reforms that hold costs down in Europe are simply non-starters because they smack too much of socialism.
Now, the empirical part: everyone asking this question is looking longingly abroad while ignoring the evidence much closer to home. Exhibit A: we've got a single payer system, called Medicare. It negotiates huge cost discounts with providers. It has low administrative costs. It has a gigantic apparatus to evaluate reimbursements for various treatments. It has . . . a faster rate of per-capita cost growth than the rest of the health care system, according to a CBO report issued by one Peter Orszag.