Paul Krugman: Can It Happen Here?

What are the chances that we’ll actually get guaranteed health care for all?: 

Can It Happen Here?, by Paul Krugman, Commentary, NY Times: The draft Democratic Party platform that was sent out last week puts health care reform front and center. “If one thing came through in the platform hearings,” says the document, “it was that Democrats are united around a commitment to provide every American access to affordable, comprehensive health care.”

Can Democrats deliver on that commitment? … For one thing, we know that it’s economically feasible: every wealthy country except the United States already has some form of guaranteed health care. The … risk of losing your insurance, the risk that you won’t be able to afford necessary care, the chance that you’ll be financially ruined by medical costs … would be considered unthinkable in any other advanced nation.

The politics of guaranteed care are also easy, at least in one sense: if the Democrats do manage to establish a system of universal coverage, the nation will love it.

I know … some pundits claim that the United States has a uniquely individualistic culture, and that Americans won’t accept any system that makes health care a collective responsibility. Those who say this, however, seem to forget that we already have … Medicare. It’s a program that collects money from every worker’s paycheck and uses it to pay the medical bills of everyone 65 and older. And it’s immensely popular.

There’s every reason to believe that a program that extends universal coverage to the nonelderly would soon become equally popular. Consider … Massachusetts, which passed a state-level plan for universal coverage two years ago.

The Massachusetts plan has come in for a lot of criticism. … And its costs are … higher than expected, mainly because … there were more people without insurance than anyone realized.

Yet recent polls show overwhelming support for the plan — support that has grown stronger … despite the new system’s teething troubles. Once a system of universal health coverage exists, it seems, people want to keep it.

So why be nervous about the prospects for reform? Because it’s hard to get universal care established in the first place. There are, I’d argue, three big hurdles.

First, the Democrats have to win the election … by enough to face down Republicans, who are still, 42 years after Medicare went into operation, denouncing “socialized medicine.”

Second, they have to overcome the public’s fear of change.

Some health care reformers wanted the Democrats to endorse a single-payer, Medicare-type system for all. On the sheer economic merits, they’re right: single-payer would be more efficient than a system that preserves a role for private insurance companies.

But it’s better to have an imperfect universal health care plan than none at all — and the only way to get a universal health care plan … is to inoculate it against Harry-and-Louise-type claims that people will be forced into plans “designed by government bureaucrats.” So the Democratic platform emphasizes … that Americans “should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan.” We’ll see if that’s enough.

The final hurdle facing health care reform is the risk that the next president and Congress will lose focus. There will be many problems crying out for solutions, from a weak economy to foreign policy crises. It will be easy and tempting to put health care on the back burner…— and then forget about it.

So I’m nervous. The history of the pursuit of universal health care in America is one of missed chances, of political opportunities frittered away. Let’s hope that this time is different. …


Originally published at Economist’s View and reproduced here with the author’s permission. 

5 Responses to "Paul Krugman: Can It Happen Here?"

  1. Anonymous   August 23, 2008 at 8:30 pm

    I agree with your points. The only thing that I would add is that the Medicare/SS shortfalls are going to force the issue…sooner or later. I’m 35 with 2 kids and there is literally no way I can manage another penny to pay for something I will in all liklihood never see. Now, if we ALL benefited AND sacrificed for a universal system, there may be a way to salvage it. Otherwise, based on what is being said by those in my age group and younger, not only are we not going to have Universal health coverage, but we won’t have Medicare either!

  2. Anonymous   August 24, 2008 at 10:22 am

    Sir you state : “For one thing, we know that it’s economically feasible: every wealthy country except the United States already has some form of guaranteed health care.”…..Have you ever been treated in one of these “Guarranteed” systems.I had a friend hurt in England. They told him come in to the Hospital…we have socialized med…no problem…..The Emergency room door was at the ned of a narrow alley. They refused to do anything to his blownout knee because of liability, they refused to give him a pair of crutches because they said cruthes could hurt his arm pits. They refused to give him a Rx for pain because it could cause addicition and they didn’t want the, you guesed it, liability. They gave him some polio type cruthes and sent him on his way. Socialized medicine is an urban ledgend. Try it out for your self before believing it exists as feasible.

  3. Anonymous   August 29, 2008 at 7:16 am

    In Australia; overall the system works fine. And a high quality standard of health care too. (Dental isn’t covered, however.) And it’s very popular such that the political side that would prefer to be without it, doesn’t touch it.

  4. Guest   August 29, 2008 at 12:39 pm

    To the Gentle Teader who suggested that national health care plans are inadequate, and used the instance of his friend with the blown-out knee.Try hypothesizing what such a person (let’s say an “average” person, i.e., one without insurance), would encounter upon approaching our richly-appointed emergency room doors at any major hospital:I contend that he would be queried as to his ability to pay, and then almost certainly turned away upon revealing that he had no insurance (regardless of his ability to pay). Consider that the injury is not life-threatening, is fairly complex with substantial liabilities involved in the treating it. Being turned away is almost certainly what would happen, even if he slapped down a credit card with a generous credit limit. GO try the experiment, if you don’t believe me.Now devise a better system. We’ll call it National Health Care.

  5. Anonymous   August 31, 2008 at 8:26 pm

    When the responsibility of society to care for the individual becomes cast into law, the responsibility of society to minimize risks to the individual will also become a matter of law, much to the dismay of those of us who enjoy a greasy hamburger, even if once or twice a year.Can we all agree to maintain the distinction between “health”, “health care”, and “health care insurance”? I can pay for all of my current health care needs, without health care insurance (lucky me!). The number of citizens with “poor health”, “poor health care”, and “poor health care insurance” are all different, and subject to different degrees of uncertainty, yet usage is often ambiguous.