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Friday, August 28, 2009

THE USA, FRENCH, AND CANADIAN HEALTHCARE SYSTEMS: MYTHS AND PROBLEMS, CONTINUED

Today's Buggy Topic

. . . continues the analysis of the merits and problems of the US and French healthcare systems, only with the comparative thrust extended to include the Canadian system.  As before in the previous buggy article on the subject (August 26th, 2009)  the main aim of the current analysis is to debunk certain myths about the superior condition of these two state-run healthcare systems.

You'll find the continued buggy argument in the same thread at Economist View --- click here --- where the original two buggy posts appeared.  Today's adds two more.

Note Quickly

To puncture rife urban myths about those two foreign systems doesn't mean that the US healthcare system isn't troubled with certain real problems too --- let alone that we do everything better than they happen to and shouldn't be attentive to see if certain of their "best practices" can be imported here.  Prof bug deals with many of our healthcare problems in the Economist View thread, but the same analytical intent dominates: to counter the ex-cathedra beliefs of left-wing liberals and radicals that these state-run systems are superior to the US system in all relevant healthcare matters.

One Other Point Is Worth Mentioning

The largely unplanned and uncoordinated American healthcare system --- which is unique in the world in its heavy reliance on employer-based healthcare insurance, plus rapidly growing government-run programs of Medicare (and Medicaid )in the last few decades --- reflects our political heritage and institutional arrangements that are also . . . well, if not unique, highly unusual:

  • A central governments that separates the branches of government, court-supervision of all legislation and regulations,
  • A strong federal system spread out across a large continent with Alaska and Hawaii geographically far away,
  • A revolutionary birth of our government based in no small part on suspicion of concentrated political power --- not least motivated by tax rebellions against the British colonial crown,
  • The absence of socialist ideological influences on the left, and --- on the right --- the further absence of a pre-industrial, pre-democratic right-wing rooted in feudal traditions that supported strong government in European history for reasons of domestic stability and  power-politics that entailed almost continual warfare  with other countries for centuries,
  • Massive and almost continual immigration from other countries for centuries now, which has lessened the sense of social solidarity as compared with the far more homogeneous populations of West Europe (with Canada something of a minor exception), but which --- please note --- has also been intense in West Europe and Canada for four or five decades and is nibbling away at the foundation of cultural cohesion there too,
  • A powerful and largely unchallenged Protestant ethos of individual self-reliance, to which over time even non-Protestant immigrant communities adapted . . . reinforced by marriage across historical ethnic lines.
  • And, finally, an unusually successful capitalism and a strong sense of individual economic self-reliance that has no full counterpart elsewhere in the rich countries . . . no, not even in Britain these days.

The Outcome?

Any reforms of our healthcare system, now or in the future, will very likely embody compromises that reflect these historical, cultural, and institutional influences.  Those compromises will not satisfy fully any one bloc of voters: left-wing Democrats, moderate Democrats and Republicans, libertarians, and Conservative Republicans.