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Saturday, 5 January 2013

Victor Fuchs on health reform

I've never met Victor Fuchs, but I've admired and learned from his writings for years. His article in this week's JAMA on "How and Why US Health Care Differs From That in Other OECD Countries" is a gem. Here's a summary:

US expenditures differ from the average OECD country in three ways:
  1. As a percentage of GDP, US expenditures are twice as high.
  2. The share of expenditures funded by government in the US is 46%, compared to a 75% average for other OECD countries.
  3. The mix of services differs substantially - intense focus on technology vs more basic care.
Here's how Fuchs explains the difference, again in a series of three:
  1. The US population has a much more distrustful attitude towards government - a trend with deep historical roots.
  2. The US population is much less committed to equal outcomes through redistributive policies.
  3. The US political system provides many "choke points" that allow special interests to block or reshape reform efforts.
Finally, Fuchs draws three practical conclusions for future reform efforts:
  1.  "[G]overnment's role should be limited to what is necessary, not just desirable."
  2. "[P]rovision of basic coverage for all should not require equality for obtaining additional coverage...individuals should be free to purchase more than basic care."
  3. "[R]eform should have features that would appeal to some special interests, or to some elements within each special interest group."
Fuchs, who is presumably in his mid 80s (he graduated from NYU in 1947), is giving us the gift of his wisdom. His two page JAMA piece ends this way:
Comprehensive health care reform in the United States is necessary to avoid a financial disaster, but enactment of such reform will require attention to US history, values, and politics."
Fuchs' analysis is relevant for liberal critics of the Affordable Care Act. In the eyes of single payer advocates and other progressives, the ACA is a disappointing flop. But by Fuchs' three practical conclusions, the ACA was the best that could be achieved in 2010. The right approach for progressives is to do all we can to make it work.


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