Diversity and Health Care

Ezra Klein got the following question doing some live-chatting:

Lexington, Va.: Hey Ezra – I really enjoyed your article, but I’m wondering, with all the references to European-style health care, what role homogeneity plays in the success of these systems? Many European countries are far less diverse (economically, ethnically, etc.) than the US, and going beyond Europe, Japan’s population is almost entirely homogeneous. Don’t these systems that you have mentioned depend largely on the ease of applying universal care to a population that doesn’t vary from person to person like the US does?

Ezra Klein: Not really. Some of those countries are more and less diverse than others, for one thing. And it’s not as if Montana, which isn’t very diverse, has an awesome health-care system. It’s arguably the case that there are fewer political obstacles in a more homogenous system because it’s easier for voters to feel connected to one another. But there’s no real reason national health insurance should work with 20 percent diversity but not 35 percent diversity.

To back this up with a bit more in the way of demographic information, there’s no objective measure of which society is “most diverse” but I think in a commonsense way the most ethnically and religiously diverse European country is probably France, which is also the country with what’s probably the best health care system. In a different sense of diversity, Belgium is strongly binational, which creates a lot of problems, but hasn’t prevented them (or Canada for that matter) from constructing a reasonable health care system. Meanwhile, citizens of super-homogenous Japan are extremely healthy but my understanding is that their health care system actually delivers a pretty low standard of care.

I think what you can say about America’s diversity and health care is that segregationist sentiment was a major impediment to creating a universal health care system back in the 1930s, 40s, and 50s as there was fear that a national health care system would come under pressure, like the military, to be desegregated