From the New Yorker, which usually manages at least one fascinating piece every issue, comes this revealing study of how every citizen in (almost) every industrialized nations gets health care. In short, the United Kingdom, France and Switzerland, among many other countries, all have radically different health care systems that do one key thing: every citizen has health care. But the paths to such an end were startlingly dissimilar.
Many would-be reformers hold that “true” reform must simply override those fears. They believe that a new system will be far better for most people, and that those who would hang on to the old do so out of either lack of imagination or narrow self-interest. On the left, then, single-payer enthusiasts argue that the only coherent solution is to end private health insurance and replace it with a national insurance program. And, on the right, the free marketeers argue that the only coherent solution is to end public insurance and employer-controlled health benefits so that we can all buy our own coverage and put market forces to work.
Neither side can stand the other. But both reserve special contempt for the pragmatists, who would build around the mess we have. The country has this one chance, the idealist maintains, to sweep away our inhumane, wasteful patchwork system and replace it with something new and more rational. So we should prepare for a bold overhaul, just as every other Western democracy has. True reform requires transformation at a stroke. But is this really the way it has occurred in other countries? The answer is no. And the reality of how health reform has come about elsewhere is both surprising and instructive.
As well as being an enlightening expose on an important issue, Atul Gawande reveals several cases of path dependence, an interesting phenomenon and important factor in many seemingly massive reforms. Human beings like familiarity and great changes are often best accomplished when they graft onto or (seem, at least) to grow out of existing systems. People have less trouble processing them, there's less opposition and before they know it, they've changed their lives and society.
It's been said that life is what happens while you're busy making other plans. The same can be said of the future. There was a time when anyone outside of the elite having access to health care was nothing but a daydream. Yet now it's a blunt fact of life in much of the world and nowhere did it come about by someone yelling "Hear ye, hear ye! Here's a radical new health care system! Huzzah!" Though plenty of the systems were a radical departure from the past.
One of the keys to making wonky future visions become reality is convincing huge masses of people that "it's inevitable" or doing it so subtly that the change doesn't even seem to occur. As I've commented before, plenty of would be futurists deride mass behavior. But it's part of the human condition. Understand it and there's just another tool to bring tomorrow a little closer.
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