It’s easy to bash the American healthcare system and point out instances where it’s lacking. To me, it seems to be more about billing systems than medicine. A friend told me about his experience in France, where he, as a foreigner, was seen and treated by a doctor at his hotel, and upon trying to pay was dismissed: “You Americans, always wanting to pay for things.” Yeah, they pay high taxes and don’t typically have single family homes, cars or enormous flatscreen TVs. They also seem to generally believe in their government. Whereas Americans like to euphemise imperfection as “good enough for government purposes.”
Anyway, if you care about the balance of costs versus quality of care, you should check out this article in the New Yorker about how a small town in Texas has one of the highest healthcare costs per person. I found it a well-written article that’s chock-full of helpful tidbits for your next healthcare debate at a bar, cocktail party, cafe, or late-night dorm room philosophizing session.
Here’s one tidbit from the article:Â “In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars.”
Another: ” Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be.”
One thing to keep in mind, though, is that historically France has had a political culture of strong, capable civil service for quite some time now (I think dating back to the monarchy?), and, for them, being in the civil service is a highly desirable job for those from the very best schools in France. See this in contrast with historical American political culture; the US was born in a revolt to separate itself from a strong government, and the republic was conceived because its framers were suspicious of strong government.
Ah, this is new information to me.
This conflict between sending our very best or our most “average Joe” to government comes up pretty regularly. As far as I can remember, every presidential election involves some questioning on which candidate can “feel your pain” or represent “the American people.” We poll on which candidate we would “most like to have a beer with” or “have dinner with.” We want our candidate to be the most capable, but we are mistrustful of those from “elite schools.”
I also note that loose confederations have been largely unsuccessful (e.g., League of Nations, Confederate States of America) even though they were founded by members who were sick of strong authority. Wasn’t Washington (of the cherry tree) a respectably strong central authority. (I was never that good at history.) Wouldn’t this mean that the US would be stronger if its constituents believed in civil service?