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Fundamentally Different from Western Europe and Canada

In: Business and Management

Submitted By ricf
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United States is the only industrially advanced nation with over 15 percent of its population uninsured for health care services.(1) This aspect of American health policy has earned us a reputation of "backwardness"; for both Western Europe and Canada have systems of universal entitlement to health care. Should we adopt the Western European or Canadian models of health care financing and organization? Or should we maintain our present system and recognize that it is a manifestation of American exceptionalism, i.e., of the ways in which the United States is fundamentally different from Western Europe and Canada? Comparative analysts often emphasize the possibilities of adopting elements of health care systems from abroad. But there is also a deeply rooted skeptical variant to this school of thought: those who emphasize the importance of American exceptionalism and who presume that comparative studies of health systems are not useful for policy learning.(2) Both of these responses are probably inappropriate. The second response - that comparative analysis is not useful - insulates us from the experience of other nations. It is ethnocentric; it tends to make us conservative; and, therefore, it supports the status quo in the United States. The first response - that we should adopt the Western European or Canadian models - relies too heavily on the experience of these nations. It is misleading because there are serious limitations in the Western European and Canadian health systems. Moreover, the United States is less backward than it appears. Many of the present institutional arrangements of health care delivery are superior to those abroad. Thorstein Veblen has pointed out the basic advantages of "backwardness' in learning from abroad: the mistakes of those who are "ahead" need not be repeated.(3) Drawing on Veblen's idea, I propose a third response to the question of whether we should adopt Western European or Canadian models of health care financing and organization, or maintain our present system. I suggest that it would be appropriate to ask how the best features of each system might be combined. Instead of studying health systems abroad to learn how we can adopt certain of their characteristics in the United States, I win focus on three proposals for health sector reform in France, Canada and Britain. Each proposal introduces an innovative American idea - Health Maintenance Organizations (HMOs) - into national systems that provide universal entitlement to health care. This represents a new approach for comparative studies of health policy. It recognizes the nature of American exceptionalism in the health sector. Also, it highlights common problems of health care financing and organization in Western Europe, Canada and the United States. Finally, it provides an opportunity

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