The Politics of Health Care

Tyler Cowen posts an interesting thought in his Marginal Revolution web site:

The prospects for health care reform seem to be dimming. If I were a progressive I would be wondering right now whether Medicare was a tactical mistake. The passage of Medicare meant that most old people get government-provided health care coverage. Yet the way to get things done in this country, politically, is to get old people behind them. Further health care reform doesn't now seem to promise much to old people, except spending cuts on them. Given their limited time horizons, old people don't so much value system-wide improvements, which invariably take some while to pay off.

If Medicare had not been passed, might this country have instituted universal health care coverage sometime in the 1970s?

This posting demonstrates the ugly reality of special interest politics in a democracy. Everybody agrees that democracy is an ugly way to govern, but as Churchill pointed out, compared to any other way to organize a society, democracy is the best of a bad lot.

Humans tend to be altruistic, so you can appeal to altruism to try to put in place a universal health care system. Whether that can overcome the special interests is not clear. For what it is worth, getting a universal healthcare system in Canada was a long and ugly battle against doctors and insurance companies. But they weren't as organized in Canada, so it was easier for Canada than it will be for the US.



If you watch the news reports of this time, you would get a sense that everybody was opposed to Medicare and that the program was a disaster. Quite the contrary. Canada has had universal medical care for 43 years and it is one of the most cherished government programs.

There was and continues to be, vocal opposition to the medicare system. This gets highlighted because these people are affluent and well spoken (they are part of the elite in society), so it is easy to confuse their dogged opposition with popular sentiment. Reality is something else. The overwhelming majority of Canadians favour their system.

The US is experiencing the same kind of determined opposition to universal health care as Canada did. It would be wise for Americans to look at the history of Canadian medicare to understand its benefits as well as how tough the fight will be.