Sister Rosetta Thorpe

Health Care -- Moving Forward

By Jonathan B. Wight

We’ve dodged the bullet on destroying the ACA, and Krugman asks “What’s next?”

His answer is to learn from the experience of other high income countries, notably the Netherlands, which has a system similar to ACA. 

Fixing the current system is preferable to trying to get the best system:

“I have nothing against single-payer; it’s what I’d support if we were starting fresh. But we aren’t: Getting there from here would be very hard, and might not accomplish much more than a more modest, incremental approach. Even idealists need to set priorities, and Medicare-for-all shouldn’t be at the top of the list.”

This sounds right, and sounds a lot like Adam Smith’s injunction that we can only try to get the best system that people can currently support.  Smith was a pragmatist and a realist, despite his lofty pronouncements at times. 

In making policy, two ideas seem key:  (1) path dependency means that you generally cannot start from scratch; you’ve taken one path and you have to go from where that path has left you.  Robert Frost reminds us that you can never start anew down a different path. 

(2) Incremental reform can make things better, even when the best alternative exists elsehwere.  But as Voltaire supposedly said, “Don’t let the best be the enemy of the good.”


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