Universal [single-payer] health care will be a long-time coming in America.
Matthew Yglesias has a good post on this matter today. It doesn't matter how good an idea single-payer health care is (it is a very good idea), there are lots of people making lots of money from the current system of health care financing in America. They will be quite happy to pay good money to defend the current system. This includes doctors, who in the United States, are better paid (overpaid? that would be a value judgment) relative to other professionals. I would trust doctors to design a health care system like I would trust a collision repair specialist to design an intersection.
Because doctors and other medical professionals are doing quite well under the current system, and because most people already see health care providers a lot, you could not feasibly reform American health care by paying doctors off to keep quiet about the changes in its funding. Let me back up a little here, and explain. There are problems with access to health insurance and health care, but it's a problem of 1/7 of the population lacking insurance and access to care, not the vast majority of the country. The rest of the country who have health insurance of some form (I'm not pretending that all health insurance is great, or that everyone can see the doctor as much as they want) on average see doctors quite a lot.
That is quite a different starting point for reforming health care than when single-payer health care was introduced in other western countries. Health care was a small part of the economy, and people didn't go to doctors or hospitals as much (partly because medicine was less effective). I'll give the example of New Zealand, because I'm familiar with it and it's a good example of the politics. New Zealand introduced single-payer health care in the 1930s (as in the U.S. it had been talked about for a long time). The British Medical Association (the professional association for doctors, they are now the NZMA) said it was implacably opposed to socialized medicine. Though they probably spelled it socialised. After the Labour government threatened to import hundreds of Jewish refugee doctors from Germany (you may discern the ironies here for yourself), and the government raised the per-consultation fee doctors would receive. And it turned out that opposition was not so implacable. Overall, doctors earned more from the socialised scheme because more people went to the doctor. Though as cartoonists of the time pointed out, many doctors resented that their golf handicaps went up as their time on the course went down. In short, when health care was a relatively smaller part of the economy and people didn't go to the doctor as much as they do now, it was easier to introduce large-scale changes in how you organized and financed health care.
This is a generalization that holds across other western countries. By and large the dominant features of the way health care is financed in most western countries date to before World War II. (Major exceptions that I can think of include Canada and Taiwan right now) I am limiting myself here to talking about health care financing and funding. There has been a recent vogue of reforming the ownership and organization of hospitals and clinics in many countries, but much smaller changes in the extent of public and private financing. Health care is now a large, mature part of all those economies—though smaller than in the United States—but the single-payer or social insurance financing systems were set up well in advance of recent increases in health care expenditure.
I think that you need to add this—health care is a more mature sector than it was in other countries when they introduced universal health care—to the long list of reasons why universal health care will be a long time coming in America, even with the best political strategy and conditions to get there.
Posted by robe0419 at March 4, 2006 2:28 PM