We Americans have a fiercely independent streak (try the google with "uniquely American solution", it's fun!). Even our adversaries fellow Americans over at America's Health Insurance Plans (AHIP) have a take on this phrase. Sometimes it serves our best interests, other times it causes us to fall flat on our faces. Is healthcare reform one of these instances?
This diary entry represents a bit of a departure for me. I try to throw light on concrete issues in the area of single-payer healthcare financing to bring this idea more squarely in front of my fellow Kossacks for discussion and edification (mine and yours). Consider this to be an open thread on a much more speculative plane.
We often hear the following, in some form or another:
Americans are adept at coming up with uniquely American solutions
To some of us, this is a quaint meme, but I honestly believe there is enough power in this mythology that it is the reason why nonsensical utterings such as this aren't shouted down with more vigor:
"Some people suggest the United States should have a single payer system. I disagree. I don't think a single payer system makes sense in this country."
- Chairman of the Senate Finance Committee Max Baucus
This diary, posted recently on dKos, addresses a related idea, "American Exceptionalism", which has repercussions beyond our borders, but I think the general thinking is in the same vein.
One can only wonder what Max meant with this statement. Why does single-payer seem to make pretty good sense in most other developed countries but not ours? Why did Taiwan, when designing it's healthcare financing system, decide on single-payer after looking all over the world for the best systems (including ours, which was pretty much dismissed as not really a system, but a "market")?
Do we really think we can do better? Well, I actually do. Most single-payer financing systems are subject to constant harassment by the forces of "free market" ideologues, and the exigencies of proper funding. All of these take their toll over time and start to erode away the cost-reducing power of the single-payer system. We've seen this in our country most pointedly with Medicare. There is almost a direct relationship between privatization and cost increases in this system.
The biggest problem with single-payer is that you are immediately confronted with making decisions about allocation of resources without being able to hide behind the excuses inherent in the market system (you're poor, you can't have that, you're sick, it's gonna cost you more, and so on). Free market worshipers believe that the market creates its own morality and this is a good thing because the market can do no harm - it always makes the right decision via the invisible hand.
Market-based financing of access to healthcare is an abject failure. The hand is not only invisible but completely non-existent for a large segment of our citizens. But getting everyone to accept this idea completely is hard. Even people who were once single-payer advocates (like Paul Krugman, Nobel laureate) have slid into toying with allowing market-based solutions to financing our access to healthcare - private insurers are allowed to have some role in reform of the healthcare system. Krugman even mentions today's theme ("some pundits claim that the United States has a uniquely individualistic culture").
So is this really what's killing us when it comes to enacting a single-payer plan for financing our access to healthcare? Really? Or is it just a capitulation to entrenched institutions? As Kos says, there are three ways to deal with gatekeepers: change them, destroy them, or go around them. I don't think we are going to change the private insurance industry. I really doubt that we will or even want to destroy them - they can always move to selling other types of insurance, just not health insurance. So let's just go around them, what say? Sounds pretty uniquely American to me!