Tina Dupuy had a nice item in the Huffington Post yesterday noting that urban firefighting in the United States was once a private for-profit industry. Then around the middle of the nineteenth century, cities began to decide that this system was too haphazard, corruption-prone, and unfair and thus began the dread big-government takeover of firefighting:
Yet if we had to have the “conversation” about the firefighting industry today, we’d have socialism-phobic South Carolina Sen. Jim DeMint on the TV every chance he could get saying things like, “Do you want a government bureaucrat between you and the safety of your home?”
Rep. John Boehner of Ohio would hold press conferences and ask, “Do you want your firefighting to be like going to the DMV? Do you want Uncle Sam to come breaking down your door every time some Washington fat cat says there’s a fire?”
It’s a good point. Anyone who’s honest about it is ultimately going to have to admit that direct public-sector provision of services is something that can be done in a quite high-quality way. Obviously, low-quality service is also possible. The fact of the matter regarding the DMV is that even though people find DMV lines important, people also just don’t care about it very much. No lifelong Democrat has ever crossed party lines to vote for a Republican gubernatorial candidates because he’s fed up with the low-quality of the DMV and excited about injecting some new blood into the stodgy motor vehicles bureaucracy.
By contrast, people do care about crime and Rudy Giuliani was able to get elected in super-Democratic New York City. Any mayor with a lick of sense at least attempts to provide a crime control agency that performs well. I think the evidence from the UK is that NHS quality is a constant subject of political debate and politicians are forever attempting to achieve better performance. This, I take it, is the reason why the NHS is so successful at delivering cost-effective treatment outcomes. A very low budget by world standards is why its outcomes don’t look great in absolute terms.
Meanwhile, in the United States it is worth keeping in mind that public provision of health care services isn’t on the table. And we don’t need to guess what public provision of health insurance might look like; Medicare is a very large and not-at-all obscure government program. It’s not perfect, I’m not even sure I’d say it’s great, but it measures up quite well in terms of both cost and quality relative to the private sector.