Should the US adopt a single-payer health care system?

[Filuwaúrdjan]

The so-called Bismarck model does not actually exist; it is a fiction largely created by American policy wonks who want to imagine that the world was (and is) created by people like them (thankfully this is not the case). The system of social insurance introduced by Bismarck was certainly highly influential and can be seen as foundational in terms of German social policy (which, by the way, is insanely complex and reflects well over a century of constant tinkering by governments red, blue, black and brown. As regards healthcare, some particularly important changes - aimed at greater uniformity - were introduced by the SPD-led coalition in the 1970s), but it was not a universal service and nor was it ever envisioned as one; it only covered manual workers in industry and lower grade public servants. These groups were chosen for blatantly political reasons as they were most likely to vote for the SPD, an organisation then regarded as subversive and dangerous. Subsequent expansions of coverage (and changes to regulation, to administration, to the nature of coverage and so on) have also tended to be inspired by short term political calculations, as is often the way with incremental reform. The resulting system might look to be the creation of a singular vision, but this is basically an illusion.

[Filuwaúrdjan]

As soon as you say 'model' you imply something a little more directed than 'patchwork of legislation and agreement that over time created a semi-coherent structure that covers basically everyone'. Of course it is at least better than writing 'Beveridge model' when that old duffer did not actually favour the sort of socialist set-up that American wonks now use his name as euphemistic jargon for...