The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care

other countries do allow health insurance companies to make a profit on some supplemental policies—but not on the basic coverage plan available to everybody.

The most distinctive lesson we could take, though, from Canada’s health care system is the key point of the Tommy Douglas saga: Universal health care coverage doesn’t have to start at the national level. Once Douglas established free hospital care in a poor rural province and made it work, the demonstration effect drove other provinces to do the sa

But some Americans have been pressing their countrymen to deal with that “first question” as a foundation for building a new national health care system. Professor Uwe Reinhardt, the economist at Princeton University and global leader in the field of health care economics, argues that U.S. policy makers have deliberately avoided the moral question.

The ethical issue of universal coverage—Professor Hsiao’s “first question”—was not part of the conversation.

But the 2010 reform law did little to reduce the fragmentation of American health care; if anything, it will give us a system that is even more complex.

Defending his medical and unemployment insurance schemes in 1884, Bismarck argued that “the greatest burden for the working class is the uncertainty of life. They can never be certain that they will have a job, or that they will have health and the ability to work. We cannot protect a man from all sickness and misfortune. But it is our obligation,

Professor William Hsiao, the Harvard economist, has helped design health care systems for more than a dozen nations. He says the creation of a national health care system involves political, economic, and medical decisions, but the primary decision to be made is a moral one.

“But our Krankenkassen compete because the executives earn more money, and higher prestige, if they have a larger pool of insured members.

But no other country relies on for-profit insurance companies to pay for basic health care.