Germany's lessons for H. Aaron and his cautious approach
Healthy Choice
By Henry Aaron
The New Republic
September 29, 2008
A lot of Democrats want universal health care to be the next president’s top priority. But it shouldn’t be.
The ‘Big Bang’ Approach to Health Reform is the Wrong Strategy.
Congress is unlikely to change how the entire U.S. health care industry operates with one bill. And if it did so, it would probably make a hash of the job. Differences among the states in the cost and style of delivery of health care approximate those of the European Union. More importantly, apart from periods after major wars or depression, democracies typically make large social and economic changes gradually, through laws enacted successively over many years.
So, rather than ‘betting the administration’ on one shot, the sensible strategy would be to enunciate a broad vision for reform and propose practical steps to move in the envisioned direction. Get them through Congress, see what works and what doesn’t, and then move forward again.
http://www.tnr.com:80/politics/story.html?id=208db068-4a74-4083-b14c-79e8b21b97ae
And…
Health Care Financing Reforms in Germany: The Case for Rethinking the Evolutionary Approach to Reforms
By Percivil M. Carrera, Karen K. Siemens and John Bridges
Journal of Health Politics, Policy and Law
October 2008
Abstract (excerpt)
In this article, we document twelve significant attempts to reform health care financing in Germany and critically appraise them according to the principles of solidarity and subsidiarity on which SHI (social health insurance) systems were built. While the reforms in the aggregate offered the prospect of addressing the challenges faced by the system, the modest results of the reforms and remaining deficiencies of the system underscore the limitations of the evolutionary approach to reforms. This suggests that reformers should consider a more revolutionary approach.
Concluding Remarks (excerpt)
An appraisal of health care financing reforms in Germany since reunification offers three lessons. First, while evolutionary reforms may be more politically feasible than radical reforms, evolutionary reforms are inadequate in addressing the issue of the sustainability of health care financing. Second, the impact of evolutionary reforms can be substantial when they extend and build on and not contradict or undermine previous measures. Finally, the biggest challenge to health care financing reform is the aversion to take the revolutionary route.
http://jhppl.dukejournals.org/cgi/content/abstract/33/5/979?etoc
Comment:
By Don McCanne, MD
The logic of Henry Aaron and other incrementalists seems to be as follows: Comprehensive reform of health care financing is not feasible because, if it were, we would have it by now; therefore we should abandon any thoughts of a single comprehensive reform package and move forward with tinkering around with various steps to see “what works and what doesn’t.” Of course, the discontinuity of this framing belies the alleged logic.
Aaron suggests that history shows us that only “major wars or depression” motivate democracies to make “large social and economic changes.” Is our current war too small, with too few U.S. casualties? Is our current recession too shallow, with too few unemployed and bankrupt? Is the home foreclosure rate too low, and the meltdown of the financial services industries too limited? Perhaps, perhaps.
If these don’t concern us enough, then what about the sputtering of the engine of the great American Dream? You know, that Dream that everyone could have a home, educational opportunities, healthy food, transportation, retirement security, and… health care. That engine has been redesigned to produce wealth transfer - a transfer of wealth from the masses who have increased our nation’s productivity, to the few who commandeered the machinery of Wall Street. Isn’t the sunsetting of the American Dream a crisis of proportions that finally would make us demand action?
If we are going to make our economy work for everyone, we are going to have to have to take “the revolutionary route” to health care financing reform. If we don’t fix our health care financing system, we will continue to see further erosion of the other elements of the American dream.
We do know how to do it, but first we are going to have to send Henry Aaron and his ilk off to their policy laboratories to tinker with their evolutionary reforms that never get us there. We can’t allow them to stand in our way any longer.
We need to throw out the current health care financing system and replace it with a system that would pay for all necessary health care services for everyone: a single payer national health program.
As Katrina vanden Heuvel and Eric Schlosser stated in today’s Wall Street Journal, “A universal health care system would help American families, while cutting the nation’s long-term health care costs… A new New Deal… would simply ensure that federal spending is driven by the needs of every American. Anything less than this — any proposal that rewards those who created the problem and penalizes those who can least afford it — is a raw deal.”
America Needs A New New Deal
http://online.wsj.com/article/SB122246953790280655.html