When you compare the U.S. social-welfare system with those of other wealthy countries, what really stands out now is our neglect of children.
For now, at least, the attempt to repeal the Affordable Care Act appears dead. Sabotage by a spiteful Trump administration is still a risk, but there is — gasp! — a bipartisan push to limit the damage, with Democrats who want to preserve recent gains allying with Republicans who fear that the public will blame them for declining coverage and rising premiums.
This represents a huge victory for progressives, who did a startlingly good job of marshaling facts, mobilizing public opinion, and pressuring politicians to stand their ground. But where do they go from here? If Democrats regain control of Congress and the White House, what will they do with the opportunity?
Well, some progressives — by and large people who supported Bernie Sanders in the primaries — are already trying to revive one of his signature proposals: expanding Medicare to cover everyone. Some even want to make support for single-payer a litmus test for Democratic candidates.
So it’s time for a little pushback. A commitment to universal health coverage — bringing in the people currently falling through Obamacare’s cracks — should definitely be a litmus test. But single-payer, while it has many virtues, isn’t the only way to get there; it would be much harder politically than its advocates acknowledge; and there are more important priorities.
The key point to understand about universal coverage is that we know a lot about what it takes, because every other wealthy country has it. How do they do it? Actually, lots of different ways.
Look at the latest report by the nonpartisan Commonwealth Fund, comparing health-care performance among advanced nations. America is at the bottom; the top three performers are Britain, Australia and the Netherlands. And the thing is, these three leaders have very different systems.
Britain has true socialized medicine: The government provides health care directly through the National Health Service. Australia has a single-payer system, basically Medicare for All — it’s even called Medicare. But the Dutch have what we might call Obamacare done right: individuals are required to buy coverage from regulated private insurers, with subsidies to help them afford the premiums.
And the Dutch system works, which suggests that a lot could be accomplished via incremental…