In many avenues of life, one person’s “complex system” is another’s “information-rich menu of choices.” In the discussion of healthcare.gov’s problems most reasonable people are beginning to understand that the present mess isn’t just the result of overrated nerds biting off more than they can chew or of Overreaching Socialism, either. And Kevin Drum argues yesterday in response to Mike Konczal that it’s also not just a matter of letting those evil capitalists play a role in health insurance:
[I]t’s not clear to me that you can blame the rollout problems on [private insurance]. Take a look at the Netherlands…. Their health care system is well thought of, and it’s remarkably similar to Obamacare: a public-private system that relies on private health insurers, public funding, and an individual mandate…. [T]he Dutch system has some features that make it simpler than Obamacare, but it also has some features that make it more complex. But these are mostly nits. In the end, the Dutch system is really quite similar to Obamacare. And it works fine.
I’d submit that a big part of the reason for this is path dependence: the Dutch system is one that replaced an older single-payer system. In other words, they went in exactly the opposite direction from the one Konczal recommends. But it worked OK because the Dutch universally approved of national healthcare already and were universally covered by it. I assume that the details of the new system were contentious, but they were contentious primarily at a technocratic level. Nobody was fighting the basic idea of providing health care for all. That meant the new program could be rolled out on a reasonable schedule and without any big surprises or massive resistance.
Obamacare doesn’t have that luxury. It’s fighting not only technical issues, but also massive cultural and political resistance. This is what makes the rollout so hard.
All true. It’s also true that the Dutch system involves a relatively small country, and doesn’t bother with offering all sorts of different kinds of health insurance products, and also doesn’t have to deal with anything like our system of federalism. But the point’s well taken that Obamacare didn’t just come out of the blue as a brokered, impure compromise between socialist and capitalist models of health insurance. But to the extent that it’s not a “pure” single payer or market system, there will of course be greater complexity, and the question isn’t whether that’s necessary but what you’re willing to give up for something much easier to navigate.