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Health Care and National Character

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"Health Care and National Character"

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There’s really nothing I find more annoying that the lazy attribution of policy differences to vaguely defined “cultural” norms. For example, Jacob Weisberg writes that:

Health care systems are not just policy choices but expressions of national character and values. The alternatives he describes work better than ours not just because they’re well-designed and competently managed but because they reflect the expectations and traditions of their societies.

It’s hard to know how to test a proposition like that. But since Weisberg’s thoughts were inspired by T.R. Reid’s book, consider Reid’s explication of the three broad families of national health care systems.

Beveridge: “Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand.”

Bismark: “The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.”

National Health Insurance: “The classic NHI system is found in Canada, but some newly industrialized countries — Taiwan and South Korea, for example — have also adopted the NHI model.”

Of course the United States of America is in a fourth category, applying the so-called “make everything terrible” model. Now the implication of the Weisberg Thesis is that the UK is more culturally aligned with Spain than it is with Canada. And that Canada is more aligned with South Korea than with the UK. And that the Netherlands has more in common with Japan than with Scandinavia. I don’t think that outside of the context of trying to make a cute point about health care, anyone would seriously try to argue in favor of any of those claims.

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