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Will It Be Labatt's Or Amstel? Continued...

Blogger Michael Reinhard suggests I am "interperate." My sin: Accusing conservatives of lying when they suggest Democratic-led reforms of health care might make American health care look like Canadian health care. Reinhard writes:

It may certainly be that Obama is aiming for France but he still is more likely to hit Canada, whatever the specifics of his proposal.  The culture and political institutions of a country are going to determine what a national health care system look like in the long run more than the details of the current proposal--not that those aren't bad enough.

Actually, he makes a good point. Habits of medical treatment, attitudes about equality and solidarity--these tend to shape medical care as much as the insurance architecture does.

But Reinhard is wrong when he assumes that means reform here would end up producing Canadian-style health care. Based on what I've seen and read over the years, we are actually more like the French than the Canadians, at least when it comes to the expectations of our health care systems.

Physicians and patients in France expect to get the latest and greatest treatments, with minimal interference and minimal waiting. They're also willing to tolerate some inequality, albeit far less than Americans are. In France, private supplemental insurance and an allowance for some doctors to charge extra fees combine to create a de facto two-tiered system, although the gap between the two tiers isn't that large. (Even people in the lower tier get timely, high quality care along with generous protection from medical expenses.)

Canadians don't like to wait and don't like to be denied the most advanced care, either. But they seem to have more strongly egalitarian values than the French do. That helps explain their rigidly centralized system, which provides extraordinary financial protection for all people, does so uniformly for the entire population, but sometimes sacrifices convenience and immediate access to advanced care. 

my previous analogy

Anybody for a Kronenbourg


--Jonathan Cohn