Wednesday, September 30, 2009

american exceptionalism

whenever i read articles like this one about what we can learn from the dutch health care system, it reminds me of how strange the american health reform effort is. no matter what the article says, we're not going to adopt the dutch system. we're not going to adopt any other country's system. instead, we're going to make up our own system. which is odd because there are a whole bunch of universal health care systems in the world with actual track records. some of them have been around for a while--germany's is 125 years old. the old ones have all been revised and tinkered with over the years, improving the system, patching loopholes, et cetera along the way. they all have problems, but there's also a lot of literature analyzing those problems and suggesting how each system could further improve.

potentially the u.s. could benefit from the rest of the world's experience. there's a wealth of data out there about a lot of different health care systems. we could copy the stuff that works and leave out the stuff that doesn't. but instead we're going to reinvent the wheel. don't get me wrong, that will still be an improvement. but it also means that we might just end up making the same mistakes that other countries made and then fixed years ago.

it's probably too late to go another route on health care reform at this point. the basic plan seems to be shaping up and almost certainly will pass in one form or another.

there's this phrase people sometimes use in the u.s.: "the laboratory of the states." the idea is that our federal system, with 50 autonomous state governments each passing their own legislative solutions to problems, helps improve the legislative outcomes as a whole. states keep an eye on one another and copy the ideas that work and discard those that don't. sometimes really successful ideas are copied on the federal level. i wonder if that phenomenon doesn't deter the u.s. from looking outward for its legislative inspiration. the current federal health reform effort is basically modeled after the mitt romney's massachusetts health reform plan. it's hardly as successful in achieving universality or bringing down costs as most foreign health systems. but dammit, it's ours. so that's the way we must go.