Category: health care

Good policy is pretty easy to create, and it’s also easy to recognize, but very few people know how to do either, because we so rarely see good policy in the real world. Almost every policy which comes out of Washington, and most other capitals, is sold as doing one thing, but is actually written and designed to serve the interests of those players which have bought various politicians. So, as a result you wind up with “stimulus” bills which don’t include food stamps and unemployment benefits or you wind up with tax “reform” which makes the tax code more complicated and gives most of the tax cuts to the rich. In fact, it’s very rare that any major bill either does what it’s supposed to (No Child Left Behind, for example, has almost certainly done more harm to American education than good) or if it does, that it does it in a way that is efficient and effective. Medicare drug benefits, which were designed to make drug and insurance companies money, not to deliver cheap drugs to Americans, are an excellent example.

Each post in this series will discuss one rule for judging or creating policy. We’ll start with the simplest rule of all:

Don’t Reinvent the Wheel

Sometimes another country, or a state or city, has already solved the problem, or has solved a large chunk of it. The prototypical example of this is health care. Every other modern (and some 3rd world) country in the world has universal, usually single payor, healthcare. Most of those systems produce as good or better results than the US on almost all metrics.

And these countries pay, total, about two-thirds of what Americans pay per person, for health care that covers everyone. A side effect is that GM and Ford price in $1,500 of insurance costs into every car, while Toyota avoids that expense, and continues to eat Detroit’s lunch. Meanwhile, 50% of all bankruptcies in America are caused by health care costs. There is virtually no downside to universal healthcare, even for the very rich (the very rich will always have private clinics. They did even in the USSR.) Every health expert who isn’t paid not to know this, knows that universal care is cheaper, and better.

We know it works, because it has worked in every 1st world nation which has tried it. The reason the US does not have universal healthcare, ironically, is the huge amount of money that could be saved—5.3% of the US’s total GDP. That’s a heck of a lot of money, and a lot of people are getting very rich off of it. And those who make a killing use the money to buy lobbyists and politicians and make sure that 50 million Americans don’t have insurance, another 20 million or so are underinsured, that 50% of all bankruptcies are caused by health expenses, and that US healthcare metrics continue to lag other first world countries. They stop real reform because the pain and suffering and financial devastation of all those millions of Americans is earning them a lot of money. Making a “killing” isn’t exactly a metaphor when it comes to US healthcare.

So we know one big, simple way to fix US healthcare and it doesn’t require reinventing the wheel, but simply learning from what others have done.

But healthcare isn’t the only place where this works—one could, for example, look to how other countries handle, say, drug use, and learn some lessons. Or look to their prisons. Or figure out how much smaller countries than the US are able to have effective militaries without spending 50% of the world’s military budget.

This is simple stuff, the basic rule is familiar to anyone who’s ever wanted to learn how to do something and gone to find out how other people do it, looking in particular at the people who are best, then copying what they do and making minor adaptations to your own situation. When I want to learn how to cook something I’ve never cooked, I look it up. When I want to buy a new car, I look up reviews. When I want to build something, I find out how others who have built something similar did it.

So the first rule of making, and recognizing, good policy is just common sense. Learn from others.

Don’t reinvent the wheel.

(Originally published June 17, 2008, at FDL.  Never did write the others in the series, may take it up.)