U.S. Health Care System - Is American Health Care Manageable?

I see in the December 13th New England Journal of Medicine that Alain Enthoven, the Stanford economist who inspired Hillary Clinton’s failed managed-competition plan in 1993-1994 is at it again. This time he’s proposing America emulate the Dutch plan (“Going Dutch—Managed-Competition Health Insurance in the Netherlands”).


Enthoven’s thoughts brought to mind something I wrote back in 2005 in Voices of Health Reform after interviewing 42 “experts” on health reform.


Americans, I said, are individualistic, pro-opportunity, pro-democracy, and anti-government. These attitudes, I added may explain why Americans:


• prefer local health solutions,


• reject federally-mandated coverage with inevitable rationing,


• feel capable of making their own health care decisions,


• seek equal opportunity access to high technologies,


• prefer pluralistic payment systems,


• allow market-based and public-based institutions to co-exist and compete,


• let doctors, hospitals, and health plans act independently from government..


Elites run our dominant institutions. Their opinions don’t necessarily coincide with those of the general public. Liberal elites think we ought to have universal mandatory coverage with government making basic decisions; conservative elites think we ought to have a market-driven care with patients and doctors making decisions.. Elites on both sides control media information supplied to citizens.


Personally I wonder if this mix is manageable and if it can possibly end with a “unitary” health system. Meanwhile the rest of the civilized world wonders why affluent America doesn’t have a system that covers everyone.


Recently I ran across a book The Eagle’s Shadow: Why America Fascinates and Infuriates The World (Farrar, Straus and Giroux, 2002). The author, Mark Hertsgaard, a well-traveled journalist who has interviewed countless foreigners what they think about America, says the following reflects what others think of us.


1. America is parochial and self-centered – In health care, for example, we don’t necessarily care what others think of us.


2. America is rich and exciting – Our health system interests them because it generates most of the world’s new innovations in the realm of acute care and “medical miracles.”


3. America is the land of freedom – That’s why so many foreign physicians come to America to train and to practice, and once here, often stoutly defend America’s approach to health care.


4. America is an empire—We are hypocritical, dominant, and domineering, not our most endearing traits.


5. America is naïve about the rest of the world – Two oceans insulate us, we listen, only to our own media, and we don’t speak other people’s languages.


6. American is philistine – We;e materialistic to a fault and indifferent to the rest of the world.


7. America is the land of opportunity – We attract 85% of the world’s immigrants and generate much of the world’s wealth (and its pollution).


8. America is self-righteous about its democracy - We think we have all the answers despite our many faults.


9. America is the future - America’s arts, movies, news, Internet, and technologies set the pace for the rest of the world.


10. America is out for itself – We may proclaim ourselves as generous but down deep we’re greedy.


A national health policy might settle a couple of things. There might finally be unity in health care in the American Republic, and the old theory of states having the right to impose mandates (There are more than 1000 in individual states, including 83 in Minnesota alone) might wither away. Also people ought to able to shop across state lines for health policies anywhere in the union as advocated by the Council for Affordable Health Care (“A Health-Care Solution,” WSJ, December 12, 2007). This would do away with such abominations as the cheapest family health plan costing $20,000 in New Jersey while being available at 1/3 that cost in neighboring Pennsylvania).


My own view is we’ll muddle along. We’ll manage. In the end, we’ll do the right thing –having choice and affordability for all.


Is American Health Care Manageable?

I see in the December 13th New England Journal of Medicine that Alain Enthoven, the Stanford economist who inspired Hillary Clinton’s failed managed-competition plan in 1993-1994 is at it again. This time he’s proposing America emulate the Dutch plan (“Going Dutch—Managed-Competition Health Insurance in the Netherlands”).


Enthoven’s thoughts brought to mind something I wrote back in 2005 in Voices of Health Reform after interviewing 42 “experts” on health reform.


Americans, I said, are individualistic, pro-opportunity, pro-democracy, and anti-government. These attitudes, I added may explain why Americans:


• prefer local health solutions,


• reject federally-mandated coverage with inevitable rationing,


• feel capable of making their own health care decisions,


• seek equal opportunity access to high technologies,


• prefer pluralistic payment systems,


• allow market-based and public-based institutions to co-exist and compete,


• let doctors, hospitals, and health plans act independently from government..


Elites run our dominant institutions. Their opinions don’t necessarily coincide with those of the general public. Liberal elites think we ought to have universal mandatory coverage with government making basic decisions; conservative elites think we ought to have a market-driven care with patients and doctors making decisions.. Elites on both sides control media information supplied to citizens.


Personally I wonder if this mix is manageable and if it can possibly end with a “unitary” health system. Meanwhile the rest of the civilized world wonders why affluent America doesn’t have a system that covers everyone.


Recently I ran across a book The Eagle’s Shadow: Why America Fascinates and Infuriates The World (Farrar, Straus and Giroux, 2002). The author, Mark Hertsgaard, a well-traveled journalist who has interviewed countless foreigners what they think about America, says the following reflects what others think of us.


1. America is parochial and self-centered – In health care, for example, we don’t necessarily care what others think of us.


2. America is rich and exciting – Our health system interests them because it generates most of the world’s new innovations in the realm of acute care and “medical miracles.”


3. America is the land of freedom – That’s why so many foreign physicians come to America to train and to practice, and once here, often stoutly defend America’s approach to health care.


4. America is an empire—We are hypocritical, dominant, and domineering, not our most endearing traits.


5. America is naïve about the rest of the world – Two oceans insulate us, we listen, only to our own media, and we don’t speak other people’s languages.


6. American is philistine – We;e materialistic to a fault and indifferent to the rest of the world.


7. America is the land of opportunity – We attract 85% of the world’s immigrants and generate much of the world’s wealth (and its pollution).


8. America is self-righteous about its democracy - We think we have all the answers despite our many faults.


9. America is the future - America’s arts, movies, news, Internet, and technologies set the pace for the rest of the world.


10. America is out for itself – We may proclaim ourselves as generous but down deep we’re greedy.


A national health policy might settle a couple of things. There might finally be unity in health care in the American Republic, and the old theory of states having the right to impose mandates (There are more than 1000 in individual states, including 83 in Minnesota alone) might wither away. Also people ought to able to shop across state lines for health policies anywhere in the union as advocated by the Council for Affordable Health Care (“A Health-Care Solution,” WSJ, December 12, 2007). This would do away with such abominations as the cheapest family health plan costing $20,000 in New Jersey while being available at 1/3 that cost in neighboring Pennsylvania).


My own view is we’ll muddle along. We’ll manage. In the end, we’ll do the right thing –having choice and affordability for all.




I see in the December 13th New England Journal of Medicine that Alain Enthoven, the Stanford economist who inspired Hillary Clinton’s failed managed-competition plan in 1993-1994 is at it again. This time he’s proposing America emulate the Dutch plan (“Going Dutch—Managed-Competition Health Insurance in the Netherlands”).


Enthoven’s thoughts brought to mind something I wrote back in 2005 in Voices of Health Reform after interviewing 42 “experts” on health reform.


Americans, I said, are individualistic, pro-opportunity, pro-democracy, and anti-government. These attitudes, I added may explain why Americans:


• prefer local health solutions,


• reject federally-mandated coverage with inevitable rationing,


• feel capable of making their own health care decisions,


• seek equal opportunity access to high technologies,


• prefer pluralistic payment systems,


• allow market-based and public-based institutions to co-exist and compete,


• let doctors, hospitals, and health plans act independently from government..


Elites run our dominant institutions. Their opinions don’t necessarily coincide with those of the general public. Liberal elites think we ought to have universal mandatory coverage with government making basic decisions; conservative elites think we ought to have a market-driven care with patients and doctors making decisions.. Elites on both sides control media information supplied to citizens.


Personally I wonder if this mix is manageable and if it can possibly end with a “unitary” health system. Meanwhile the rest of the civilized world wonders why affluent America doesn’t have a system that covers everyone.


Recently I ran across a book The Eagle’s Shadow: Why America Fascinates and Infuriates The World (Farrar, Straus and Giroux, 2002). The author, Mark Hertsgaard, a well-traveled journalist who has interviewed countless foreigners what they think about America, says the following reflects what others think of us.


1. America is parochial and self-centered – In health care, for example, we don’t necessarily care what others think of us.


2. America is rich and exciting – Our health system interests them because it generates most of the world’s new innovations in the realm of acute care and “medical miracles.”


3. America is the land of freedom – That’s why so many foreign physicians come to America to train and to practice, and once here, often stoutly defend America’s approach to health care.


4. America is an empire—We are hypocritical, dominant, and domineering, not our most endearing traits.


5. America is naïve about the rest of the world – Two oceans insulate us, we listen, only to our own media, and we don’t speak other people’s languages.


6. American is philistine – We;e materialistic to a fault and indifferent to the rest of the world.


7. America is the land of opportunity – We attract 85% of the world’s immigrants and generate much of the world’s wealth (and its pollution).


8. America is self-righteous about its democracy - We think we have all the answers despite our many faults.


9. America is the future - America’s arts, movies, news, Internet, and technologies set the pace for the rest of the world.


10. America is out for itself – We may proclaim ourselves as generous but down deep we’re greedy.


A national health policy might settle a couple of things. There might finally be unity in health care in the American Republic, and the old theory of states having the right to impose mandates (There are more than 1000 in individual states, including 83 in Minnesota alone) might wither away. Also people ought to able to shop across state lines for health policies anywhere in the union as advocated by the Council for Affordable Health Care (“A Health-Care Solution,” WSJ, December 12, 2007). This would do away with such abominations as the cheapest family health plan costing $20,000 in New Jersey while being available at 1/3 that cost in neighboring Pennsylvania).


My own view is we’ll muddle along. We’ll manage. In the end, we’ll do the right thing –having choice and affordability for all.