It’s often claimed that other Western nations achieve as good or better outcomes from their nationalized health care systems as Americans achieve with our strange mix of private and government-funded health insurance—and at far less cost. Assuming that claim is true, it might be true for a reason policymakers haven’t considered. Right now, a hugely disproportionate share of the world’s medical innovation happens at the high end of America’s health care market. People like me benefit hugely from that innovation: I’m a well-insured cancer patient living near Boston, which may have the world’s highest per capita concentration of medical talent outside Rochester, Minnesota.
But we’re not the only ones who benefit. The most successful of those medical innovations soon filter down to the rest of America’s unsystematic health care system, and then to other parts of the rich world. Those nationalized health care systems in Canada and Western Europe achieve such good outcomes partly by relying on American medical research, much of which is funded by that high-end medical market.
Why does any of this matter? It matters because we are about to take a large step toward nationalizing our own health care system. The funding has to come from somewhere, and the most natural “somewhere” is the money that now flows from companies that insure patients like me to institutions like Massachusetts General Hospital, the Mayo Clinic, or Sloan-Kettering. One must tap the money at the top of the market in order to have enough to “spread the wealth around.”
But that ignores the character of the medical market we have now. The best-off patients don’t get better care than everyone else; they get the best care sooner than everyone else. Take away the high end of America’s medical market, and a large fraction of the life-saving innovation that market produces may disappear. That will hurt all of us—in the United States and abroad.
Let me be clear: I don’t believe I have any moral entitlement to the extremely high-quality (and extremely expensive) health care I’ve gotten. I’d happily sign on to a health care system that distributed its benefits more equitably, even if I lose out in such a system. I’m less willing to go along with a system that doesn’t protect this most innovative sector of America’s economy. I hope some of the key players in the Obama Administration share that concern. I fear they don’t.