Sister Rosetta Thorpe
Gestures

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.”

Comments

Feed You can follow this conversation by subscribing to the comment feed for this post.

Verify your Comment

Previewing your Comment

This is only a preview. Your comment has not yet been posted.

Working...
Your comment could not be posted. Error type:
Your comment has been posted. Post another comment

The letters and numbers you entered did not match the image. Please try again.

As a final step before posting your comment, enter the letters and numbers you see in the image below. This prevents automated programs from posting comments.

Having trouble reading this image? View an alternate.

Working...

Post a comment

Your Information

(Name is required. Email address will not be displayed with the comment.)