A couple of thoughts:

In that context, successful reform would only cement the political dynamics of the moment. This, incidentally, is the real reason health reform is so hard. It's not opposition from the industry, which fears for its profits. It's opposition from the minority, which fears for its relevance.

Agree with this wholeheartedly, and is actually one of the biggest lessons from 1994. I'd add that if people are actually concerned with reforming health care, rather than using health care reform to strengthen the Democratic party they'll figure out how to let the Republicans save face sufficiently that a decent reform package has a chance of succeeding. It depends what you want more-- a better health care system or trying to win short-term partisan politics.

but tries to twist away from the implications by suggesting that Americans wouldn't like government health care, but would want to keep it and expand it anyway. That doesn't fit with the evidence, but I'll allow it as a necessary self-deception.

I'm not sure what either of you are exactly saying, but here's the important point. A government-run system will be able to deficit spend until the financial system can no longer tolerate it, and the experience with Medicare suggests that's very likely to occur. Discussions of any change in Medicare benefits is a complete political no-no. The long-term policy cost of continued deficit spending on health care will alwayslose out to the short-term political interests of not stopping people from accessing health care. And that's pretty much what we've seen with Medicare for a few decades. With no real hints of even a public discussion of alternatives. So the fear is that while we are seeing a growing number of experiments in W. Europe and Australia to increase private control over health care expenses (they too all face cost growth curves that are unsustainable) because the political system is unable to make these tradeoffs alone, the US will spend the next 10-20 years transforming our system to look more like theirs do today, with limited cost controls in place, like theirs do today. In the meantime, they'll be moving to more sophisticated joint public-private smart cost-sharing techniques that are more likely to solve the problem of health care cost growth in the long-run. So we're left with a system 10-20 years from now that hasn't solved the cost problems, has added another $10-20 trillion in unnecessary health care expenditures, and our momentum towards a fully public system will be going the opposite of where other countries will be going-- towards a more public-private mix. Its basically a fear that we're spending all of our energy going from Health Care version 1 (USA today) to version 2 (Europe today), when we already know that version 2 isn't sustainable in the long run and people with version 2 are searching for version 3. Why don't we develop a system that is version 3?

A couple of additional thoughts:

Cannon's quote really, really upset me when I read it a few days ago, but I dealt with that then. So I should caveat my first point above by saying that while Democrats should play nice because reforming the health care system is more important than partisan politics, Republicans should really stop the crap Cannon is suggesting-- because they are playing partisan politics andnot fixing the system.

When looking at the chart above-- no doubt the US fairs worse than others, but are the others really in that great shape? Those numbers look pretty bad across the board. So beyond the facts that the financial shape of their systems require them to "upgrade" from version 2 to version 3, their constituents also think major reforms need to be done as well. Shouldn't we try to take the lead on version 3, rather than just play catch-up to version 2?

What conclusions can we actually draw from the chart in the post? It looks like Americans are most favorable to rebuilding the system completely, but it also looks like we're the least favorable to making fundemental changes (the difference between us and the Netherlands is statistically insignificant, but we're definitely in the bottom two). WTF?

OK, so suppose that both of the bottom two answers amount to the same thing. 73 percent of Australians think that either fundemental changes are needed or the system should be rebuilt completely, as do 72 percent of Canadians, 78 percent of Germans, 58 percent of Netherlanders, 73 percent of New Zealanders, 72 percent of UK residents and 82 percent of Americans. A majority in all those countries think big changes are needed, but Americans are even more convinced of it than residents of the other countries. Let's look at the other outliers: Germans are almost as dissatisfied as we are, while Netherlanders are the least dissatisfied. What differs between them? Between Germany and us?

for more on international comparisons of health care as it relates to today's policy debate see:

http://www.dailykos.com/story/2008/11/25/7564/6432/1022/666148

peace & health

I've heard Germany's public-private model put out there as something the US should emulate, but it seems that the Germans themselves don't seem particularly enthusiastic about that model.

Blocking Obama’s health plan is key to the GOP’s survival.

I read this particular gem from James Pethokoukis a few days ago and my conclusion is he's completely wrong.

Now, as everybody knows, the vast majority of folks tend to stay with their voting preferences from election to election. Winning elections in America is all about getting your supporters to turn out in greater numbers than your opponent's, and capturing the relatively modest number of voters who are persuadable. The GOP obviously lost some ground on both counts in the last election. Bottom line is lots of people are simply too scared of this economy to vote Republican right now. Passing UHC isn't necessarily going to turn all of them into permanent Democratic voters, however. I think if the economy is repaired in broad terms at some point -- and UHC is part of this repair work -- eventually we're likely to see a fair number of voters who are no longer afraid of the Republicans (provided the latter accept the new, UHC-equipped status quo). In other words, bolstering the safety net in substantive form will render the US political spectrum closer to that in Canada, say, or Britain. A Canadian or Briton for the most part can vote for his country's party of the right safe in the knowledge that a right wing victory will not translate into a dismantlement of the safety net. If the Obama administration manages to achieve UHC -- and the GOP eventually throws in the towel and accepts this new reality -- I predict we'll eventually see a kinder, gentler politics here in America.

Jasper,

You simply don't seem to understand that the US "conservatives" have very little to do with most "conservatives" elsewhere. There is a very illuminating exception, however, in Berlusconi. Most conservatives elsewhere in the world are on the Christian Democratic model (and Gaullism is a variant of the CDU-model). This is the only model of modern conservatism that consistently works in the modern world, except for very primitive polities like the US, Italy and South America. And current US conservatism is essentially equally opposed to the Christian Democrats as they are to the CDU's Social Democratic rivals.

So, yes, UHC might make it more possible for CDU-like conservatives to perform better politically. But since American conservatives are fairly strongly opposed to being CDU-like, that is not particularly attractive to them.

It's worth noting that Hayek was actually in favor of socialized medicine. He believed on theoretical grounds that such a system would necessarily be less efficient than a market-based one, but thought that a wealthy society such as ours could afford to overpay a little for health care to ensure universality, and that since we could, morally, we should. In any case, the evidence of the last half-century has certainly cast doubt on the idea that the socialized system must be less efficient.

You simply don't seem to understand that the US "conservatives" have very little to do with most "conservatives" elsewhere. There is a very illuminating exception, however, in Berlusconi. Most conservatives elsewhere in the world are on the Christian Democratic model

burritoboy: I quite understand your point about most conservatives and the "Christian Democratic model," but I'm not talking about the Republicans of 2008 but rather the Republicans of, say, 2015. What I'm saying is, if the Obama administration and the Democratic congress succeed in enacting universal health care -- and perhaps one or two other progressive goals (higher energy taxes, a more progressive income tax, etc.) -- then the political economy of the USA will have moved much closer to the rest of the developed world. In such an environment I predict there will be very little to be gained -- politically speaking -- from trying to tear down the edifice of the safety net. Globalization is only going to continue to make it more difficult for families and individuals to attain economic security.

I think eventually, therefore, most Republicans will have no choice but to move to the mainstream center on economic affairs. A GOP that is "reformed" along these lines is a GOP that will eventually be able to position itself as the non-crazy opposition -- along the lines of Canadian or British Conservatives, or, as you remind me, of the Christian Democrats of the Continent. If I'm wrong, and over the medium and long term the Republicans continue to adhere closely to their current, ideologically rigid mindset, they'll become a rump, tiny minority party. I just happen to think that's unlikely (though not impossible). Time will tell.

The flip side of Pethokoukis' argument--that turning people into investors helps Republicans--also strikes me as questionable. Watching my investments soar during the Clinton years and sink during the Bush years certainly hasn't done anything to make me more inclined to vote Republican.

The flip side of Pethokoukis' argument--that turning people into investors helps Republicans--also strikes me as questionable.

Right. We've seen steady erosion of late in the degree of support the Republican party enjoys among upscale voters. Nearly all those upscale voters are investors. Also, it's hardly impossible to be both a fan of free markets and a supporter of much of the progressive agenda (plenty of liberals, in other words, are big fans of capitalism). Indeed, I suspect there's more support for tradionalist, protectionist, dirigeist policies (a la Pat Buchanan) among culturally conservative GOP-leaners (think "Joe the Plumber") than there is among most Democratic-leaning members of the investor class.

"Germans are almost as dissatisfied as we are, while Netherlanders are the least dissatisfied. What differs between them?"

Let me give you a blunt answer: Germans are whiners. When Americans are constitutionally optimistic, always ready to believe that their country is the greatest, Germans revel in gloom and will tell anybody who wants to listen that nothing works in their country. When you look at the details of the survey (which is actually a rather old one), you'll find that Germans are more likely than most to be able to see a doctor evenings or weekends, etc. The specific answers they give actually look like the system is working quite well. At the same time, German politicians are constantly in the process of reforming health care, and much of it involves patients having to pay more, which puts people off and creates the lasting impression that the system is broken. Years ago, a co-payment of 10 Euros every three months was introduced. Here in the US, my copayment is currently $25 *per visit*. But when you are used to no co-payment at all, 10 Euros seems like a lot. It's that kind of things that pisses people off. And because this is government policy, as opposed to a private business decision, people know who to blame: the government.

"... a short time ..."

Pethokoukis and Cannon use the UK as their example. Neither of them know what they're talking about (and neither, apparently, does the leftist they deploy as a stooge in their argument).

The National Health Service was set up in 1948. Within three years, Labour was out of power. Conservatives governed for the next 13 years.

Hunter Washburne above cites intellectual support up to and including Hayek. More practically, on a political level even Margaret Thatcher never dared make any case against the NHS model of universal healthcare. (She confined herself to market-based reforms of internal management.)

Pethokoukis and Cannon suggest that the conservative movement's future is dependent on opposing and defeating UHC. But evidence from the British experience that they explicitly use to support their argument suggests exactly the opposite: by embracing a cross-party consensus, the Tories neutralized the issue and allowed people to vote conservative on other grounds.

By the way, the politics of that Labour government are interesting for today's United States.

There was a split between progressives and moderates. The government essentially fell apart when the leading progressives resigned en masse in protest at the introduction of charges for some of the new health services. They were led by leftwing icon and, as Health Secretary, founder of the NHS, Nye Bevan.

The charges were part of a package of spending cuts introduced by the leader of the moderates in order to pay for British involvement in the Korean War. He stayed in office, became party leader, and remained party leader until his death.

Actually, the evidence in your chart supports Ponnuru. Majorities in every country listed above, including countries with universal health care, believe in fundamental change or total overhaul. The status quo in these countries is not a popular solution to the problems inherent in modern health care funding. Yet health care entitlements prove very difficult to eliminate.