But We Already Have It. . .


I agree with your criticisms of the about the problems with the Swedish health care system. But, of course, we have pretty much the same thing here. The government–through Medicaid, SCHIP, and occasionally Medicare–already provides health insurance to almost half of all children. Medicare “takes care” of all of the old and disabled. Many efforts to graft “private” features onto these programs–all of SCHIP and Medicare Advantage–can sometimes be worse than the pure-government programs that preceded them.

The Canadian Health care system, a bugbear to much of the Right, is not very different from the American system: it’s somewhat better for preventative care, somewhat less likely to waste money on MRIs for every broken bone, and somewhat worse at end-of-life care. Like the U.S. system, it’s made up of private doctors and private hospitals who get paid mostly by the government. There’s a little more political juice in the Canadian system (waiting lists disappear for the powerful) but, because its smaller and simpler, the Canadian government bureaucracy is generally less intrusive on the way that doctors practice day-to-day.

The U.S. does not have the world’s most free market health care system. Israel and Switzerland have health care systems that are significantly more free market than the U.S., cost less, and deliver better health outcomes. Canada and Switzerland, in fact, don’t try to centrally plan things like hospital locations the way that the U.S. does.

In the original sense of the word–collective ownership of the means of production– “health socialism” exists in only one G-8 country–the U.K. It is highly efficient in terms of health outcomes delivered per dollar spent. (I believe that’s absolutely the wrong way to measure health care but I think it’s still worth noting for people who want to focus on making Medicare “more efficient.”)

The real question isn’t trying to avoid government control–it’s too late for that–but, rather, trying to figure out how to get market forces back into the system.