If we were a saner nation with a functional political system, we’d be having a very different debate about health care. Congressional Republicans wouldn’t be trying to put health-care coverage out of the reach of millions of people (but only after the next election or two). Democrats wouldn’t insist that the only alternative to the clunky status quo is a single-payer system that, as Vermont and California have already discovered, would require a doubling of taxes and government spending. In this saner nation, Republicans would see that it’s foolish, and ultimately futile, to try to reverse Obamacare’s primary success: Most Americans now see health care as a right, not an optional consumer good. But Obamacare needs fixing because it was conceived as a patch on a fundamentally incoherent system. The U.S. spends 50 to 100 percent more of its GDP than other advanced nations do on health care, to produce a system that still leaves millions uncovered and ranks at the bottom of every independent assessment of quality.
If we were a saner, more rational nation, we’d begin a new health-care debate with a blank piece of paper. Congress and the White House would study successful health-care systems in nations such as Singapore, Switzerland, and France, which are not purely “socialistic” or “free market.” Instead, these hybrids mix government-mandated universal coverage and sizable subsidies with consumer choice over doctors and hospitals. No one is left out, but free-market competition drives costs down and improves care. If this is possible elsewhere, why not here? Partisan ideology—and our endless binary debate about the role of government— stands in the way. So does the now-hardened belief that politics is a zero-sum game in which conservative and liberal principles are mutually exclusive, and one side wins only if the other side loses. A saner, more functional nation? I know: It’s just too much to ask.