Americans can't do healthcare like Europe (Meagan McArdle)

It’s the killer argument, the coup de grace that every advocate for universal healthcare coverage eventually delivers: “Other countries have better outcomes than we do at half the cost.” And since Democrats seem to be gearing up to make another big push for healthcare reform, you can expect to hear it over and over for the next few years.

Medicare for All is a catchall slogan for “more and cheaper healthcare coverage,” and would-be reformers will offer a variety of approaches ranging from Bernie Sanders’s vision of a universal, government-run, single-payer system, similar to the ones found in Canada and Scandinavia but more generous (and expensive), to proposals for some sort of government- run fallback for the private markets, more akin to what exists in Australia or Germany.

This isn’t the first time Americans have looked enviously abroad at some other country’s universal healthcare system and tried to import it here, that’s basically what the Obama administration did ten years ago. GovCare was designed along roughly the same lines as systems in Switzerland and the Netherlands, both of which have achieved universal coverage while spending a substantially lower fraction of their national income than America does.

Yet, when the United States implemented the same structure — mandatory private insurance that’s subsidized for lower-income people — it didn’t work here the way it did there. We’re still spending more on healthcare than the Swiss or the Dutch, and almost 15% of the US population continue to lack healthcare insurance.

Why these differences? Attempts to reform the US healthcare system are inevitably subject to the constraints of the US political system, which is more fragmented, and easier for interest groups to lobby, than most other systems in the developed world. So Democrats wound up passing (1) “a weak, flawed version of other systems, because American voters wouldn’t stand for a stiff mandate or stiff new taxes to pay for subsidies,” and (2) failed to impose “robust cost controls that would threaten the income of politically powerful hospitals and healthcare professionals.”

The next round of healthcare reform will encounter similar obstacles. If we try to go the route of Canada or Germany, we will probably end up in roughly the same place we did when we tried to go Dutch: which is to say with a system that looks like nothing else in the world.

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