There's a good read in Slate about how a country's health care system tends to reflect that country's values:
Health care systems are not just policy choices but expressions of national character and values. ...
All advanced, wealthy countries have structures that are more egalitarian and cost-effective than ours. Each also has its quirks, which tend to reinforce familiar stereotypes. Britain, land of the stiff upper lip, rations care explicitly, providing what to us would seem shockingly minimalist treatment. It doesn't cover many procedures we regard as standard, such as PSA tests for men in their 50s or even regular physical exams for adults. That's what you get when you spend 8 percent of your GDP on health care (versus our 16 percent). The Japanese, on the other hand, venerate doctors and visit them 14.5 times per year on average, three times the U.S. rate. They do this in an orderly, ritualized way, usually bringing a bottle of sake or cash in an envelope as a gratuity.
America's evolved, undesigned system is also an expression of our culture at its best and it worst. Health care in the United States is innovative, entrepreneurial, expensive, litigious, and wasteful. It is decentralized, driven by self-interest, excellent at the high end, and increasingly unequal. It resists acknowledging trade-offs or limits and is characterized by shocking gaps in basic care. As we plunge into a long-overdue comprehensive overhaul, it's useful to think not just about how we can build on what works in this hodgepodge but about how we can bring health care into better alignment with our own national identity. In reforming our system, we need to create something that is "more like us," in the phrase of the journalist James Fallows—not more like what the French, Finns, or Swiss have, as appealing as that might sound.
The author plugs a health care proposal by Ron Wyden which acknowledges and compensates for a significant change in the workplace:
It is on the sociological level, though, that we're missing the boat most completely by sticking doggedly with a workplace-based system that no longer makes sense. America has always been a mobile society with a labor market that grows more fluid over time. Once, the norm was to work for a single employer for one's entire career. Today, people change jobs an average of 11 times before they reach 40. Fear of losing health coverage keeps people in jobs they would otherwise leave, creating a drag on economic efficiency. As the Senate's smartest health care wonk, Ron Wyden of Oregon, says: "A big part of the reform challenge is to look at how the culture of the American workforce has changed since the basic structure of American health care was put in place. Today's culture is all about flexibility."
The premise of Wyden's bipartisan bill is that we should move away from job-based insurance. It would do this by converting the tax deduction for employer-provided health insurance into a tax credit and requiring that individuals use it to buy insurance. Wyden's bill would achieve universal coverage, apply meaningful cost controls, and, according to the Congressional Budget Office, pay for itself within a few years. It's going nowhere.
