There’s a certain amount of lingo that comes with the provision of health care. In most developed countries, these words are “doctor,” “nurse,” “scalpel,” “appendix,” that sort of thing. But American health care has its own unique vocabulary: “co-pay,” “HMO,” “COBRA,” “doughnut hole” . . . And we’re always adding to it. The latest word is “exchanges.” A mere twelve months ago “exchanges” were something to do with stocks or trying to get a larger size when you’re given a too-tight thong for Christmas. Now, suddenly, it’s the new health-care buzzword. You go to the federal website for the “exchanges,” if you can get through, and they redirect you to the state websites for the “exchanges,” if they’re working. In Oregon, there are some 1,700 different rules that determine eligibility for the new “exchange.” In Maryland, you’re advised that “we may share information provided in your application with the appropriate authorities for law enforcement and audit activities.” But we’re used to all that by now, aren’t we? The point is it’s going to be complicated, time-consuming, and in breach of almost any elementary understanding of privacy. That’s what makes it quintessentially American.
Most developed nations have a public health-care system and a private health-care system — of variable quality, to be sure, but all of them far simpler to navigate than America’s endlessly mutating fusion of the worst of both worlds. Obamacare stitches together the rear ends of two pantomime horses and attempts to ride it to the sunlit uplands. Good luck with that. But we should remember that this disaster has been a long time incubating. The Democrats’ objection to the pre-Obama “private” health system is that Americans wound up spending more than any other country for what they argued were inferior health outcomes. But the more telling number is revealed by Avik Roy elsewhere in this issue: In 2010 (in other words, before Obamacare), U.S. government expenditures on health care were higher than those in all but three other countries in the world. Quick, name a European social democracy full of state-suckled wimpy welfare queens: France? $3,061 per capita in public-health expenditures. Sweden? $3,046 per capita. Belgium? $3,000. In 2010 the United States spent $3,967 in public-health expenditures per person — more than anywhere on the planet except Norway, the Netherlands, and Luxembourg. I am confident that, under Obamacare, we’ll be outspending even the Norwegians. But in reality our so-called private system was a public system in all but name.