“This is a big f*ckin’ deal.”
– Joe Biden, immediately following the president signing the ACA into law
You said it, Joe. Healthcare in the United States is a big deal – a huge deal, in fact. It’s so big that modeling our system off of European nations with a fraction of the population, perhaps, doesn’t make sense. Oftentimes, detractors of the ACA spit venom at those who hold European policies in high-esteem; at those who hold Europe up as a beacon of social progress; and usually counter the pro-ACA / pro-European-social-democracy arguments with claims of “American exceptionalism.”
While the term “American exceptionalism” doesn’t necessarily imply that America is just terrific and “exceptional” all around, it does – I must admit – sound at least somewhat self-congratulatory. I can understand why people on the other side of a debate might remain unswayed by the American exceptionalism argument. However, I think there may be a better way to phrase the objections of those opposed to instituting European-style, social democratic policies in the United States.
The reason it doesn’t make sense to compare the United States to individual European nations is because we’re really, really nothing like individual European nations. The United States is the third most populous nation on the planet. The term “nationwide” in America means something very different than it does in Europe. A 3.5 hour flight can take you from Vienna to Tel Aviv; in the U.S. that same flight will get you from New York to Disney World. We are a very large country and, ideology aside, we are always going to face very different practical problems when trying to implement federal laws and mandates.
While we applaud the relative success of certain European models of national healthcare, what they’ve achieved – practically speaking – is analogous to proposed models of state-run healthcare in the United States. A closer comparison would be to liken the ACA to a hypothetical EU-controlled central healthcare system. Now, while the European Union has a larger total population than the United States, at least the EU’s and the US’s populations are on the same order of magnitude. If you think it makes little sense to liken the ACA to a centralized EU healthcare system, it makes even less sense to compare the ACA to the Swiss model.
The ACA is a monster of an undertaking. I can’t think of a single business that launched on day one to over 300 million people nationwide. Even Facebook didn’t do that; Facebook – a digital platform with no inventory, no overhead, no physical retail locations, and – until recently – very little focus on monetization. No, Facebook – like virtually all other successful businesses – started with a fairly simple business model and rolled that business model out to a limited market, gradually increasing their user base as the model proved successful.
Phrasing the argument as “government healthcare” vs. “private healthcare” actually doesn’t make sense either. In reality there are a plurality of potential solutions that could be implemented, of which the ACA is only one. Why not try several “business models” for healthcare on as local of a level as possible – just like small startups do? Maybe you could have one city go full single payer; another city could try government-regulated exchanges; another could designate itself a “special healthcare zone” of sorts, allowing out-of-state residents to shop around for deals, and even – dare I say – lift the restrictions of medical licensure laws? Just imagine what would happen if you granted such a “special healthcare zone” in, say, Detroit. How many perfectly qualified doctors the world over would jump at the opportunity to get into the American market to provide healthcare, but don’t simply because they can’t navigate the muddy waters of AMA licensure?
American healthcare is a massive problem in a massive country with a massive population. I’m not entirely convinced that because a certain model of national healthcare worked in Europe, that a similar model of national healthcare will work in the United States. I say this not because I’m “anti-progress” or “anti-Europe” or because I bleed red, white and blue, I say this because I think we’re faced with a much different problem.
The ACA is an idea. What we need are ideas.