Let’s Do Like Them

I finally watched the movie Sicko.  Though it argued quite unfairly (which of course does not make its conclusion wrong), it did make one good point at the very end.  Since I can find no script online, let me paraphrase:

If another country makes better cars, we drive them.  If another country makes better wine, we drink it.  So if other countries have found a better way to take care of each other, why shouldn’t we adopt that too? 

As we prepare to vote on Super Tuesday, let us remember that there is little new under the political sun.  Most policy issues faced by a city, state, or nation are pretty similar to issues faced by other similar regions.  Thus when considering how to solve their problems, each locale should pay close attention to other locales’ experiences.  A successful new approach will be tried first in one locale, and then copied by many other locales.  So the typical good policy will be to copy and adapt a new approach first tried somewhere else. 

Yet when politicians propose solutions to long-standing problems, they rarely describe their solutions as variations on solutions tried elsewhere.  They rarely say "that idea seems to be working well over there; let’s try it over here."  Voters would apparently feel insulted to have to follow another locale’s lead, and politicians would seem weak to suggest such following.  Alas, "not invented here" is not just for corporations.

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  • Colin Reid

    Politicians are socially expected to follow a number of quite restrictive conventions to show they are ‘strong leaders’. These include:

    – don’t be seen to follow others
    – never say sorry or admit any kind of failing as leader
    – never change your mind about the virtues of a policy you enacted (this is seen as tantamount to admitting you made a mistake in adopting the earlier policy)
    – never admit that your policies involve any kind of trade-off: they must be portrayed as giving Pareto/’win-win’ improvements

    Any deviation from these is punished by the media, and it seems by the voter as well. It’s a wonder governments don’t do an even worse job than they do, given the social expectations on them. I suspect the main thing giving some hope of good governance is that voters will eventually realise something has gone wrong in the country (eg a recession), and elect a new lot, who then have the freedom to change policies. But this doesn’t mean voters or politicians are at all aware of how economic etc problems could be caused by specific policies, so electing new politicians often basically amounts to a new throw of the same dice in the hope of getting better numbers.

  • Chris Masse

    The other side of the coin of the French Health system is that it is very costly for the taxpayers, and a drag on the economy, which leads to high unemployment rate. Will the US voters want to get that, too?

  • Colin Reid: spot on. A friend referred to this as the media-public stupidity complex – all the things the public say they dislike most about politicians are all things the public and the media conspire to enforce.

    What could we do to change it?

  • James Blair

    The following is not backed up by any checking but I’ve noticed that at least some of policy discussions in my country (New Zealand) actually DO talk about other countries. (No ready examples come to mind, but) I’ve also noticed media reports about policy in other countries. (Something recent are measures to reduce plastic bag waste, discussed in a local context here and a foreign one here, even the local context makes the Obligatory Reference To Australia.)

    I wonder if this is a more US-centric thing?

  • The New Zealand reference reminds me that while we may not make the comparison in politics, we do in government. Executive agencies are fond of adopting programs that worked elsewhere, granted with enough adjustments to let managers feel ownership. When sending ideas up the chain of command, showing that the program has worked elsewhere is a good thing. (New Zealand was a frequent example, having adopted best practices and therefore become a good place to look for best practices.)

    Adapting a point from Colin Reid, a reason not to mention other areas with similar programs is that those programs had problems. We do not want France’s system; we want a system just like it except without the problems (assume you do, for the argument). Saying you want to adopt the French system means that you want all its problems; proposing a system just like it, while vehemently denying that it will be anything like France except for the benefits, lets you keep all your argument-soldiers in line. It is hard to argue that your policy is perfect if it has any trade-offs elsewhere.

  • Americans taking policy ideas from another country? Isn’t there something in the Constitution forbidding that sort of thing?

    …it is very costly for the taxpayers, and a drag on the economy, which leads to high unemployment rate.

    Those pesky sick people and their constant drain on the market. We barely cope with it in the UK (unemployment around 5%).

  • Colin, a nice if sad list.

    James, it may well be stronger in the US, but is surely present everywhere.

    Chris, I did not endorse the French health system. But it must be admitted that it is overall cheaper than the US system.

  • Max

    Chris Masse,

    the US leads the world in healthcare spending, both in the dollar amount and percentage of GDP, so the US system is even more expensive than French, and an even bigger “drag” on the economy.

  • Max

    Colin Reid,

    I think the refusal to consider policies of other countries is a cultural predisposition of American politics. It may have something to do with how the US was born as the partial opposition to the Old World, so to adopt any meaninful policy from Europe would be seen as un-American. As others have pointed out, the political discourse is different in other parts of the world.

  • I’ve oft heard it alleged that US healthcare pays the world’s R&D costs. Don’t know if it’s true. If so, that may mean that other healthcare systems are just as inefficient as ours, but with one less expense.

  • Silas

    Eliezer_Yudkowsky: Insofar as other contries free-ride off U.S. pharmaceutical R&D through various patent circumventions (not just ignoring patents, but e.g. price controls that prevent charging the full market price given IP in the drug), that claim would be absolutely correct.

  • Manon de Gaillande

    To clarify: the French system may be expensive, but not that much; some of the money it generates is moved to other state services, sometimes as a side-effect of other policy decisions, sometimes to blame problems on the healthcare system.

  • Bob

    Does anyone know of any plausible estimates of US Healthcare R&D?

  • George Weinberg

    It’s not necessarily true that the US could adopt something like the French system and get French results at French prices. Why is healthcare in the US so much more expensive than in France? I presume it’s mostly because our doctors make more and we have more procedures done. Switching to a tax-funded system isn’t necessarily going to change either of those.

  • Douglas Knight

    It may be reasonable to claim that the US pays the world’s pharmaceutical R&D, but this isn’t much compared to the whole pie. Doctors’ salaries are a bigger chunk, but still not so much of the story. Those two figures are pretty objective, but the US system of nominal prices negotiated between insurers and hospitals makes is pretty hard to tell what all the rest of the money is doing. The same is true under socialized medicine, but, I think, to a lesser extent.

    Singapore, with something closer to a real price system, spends half as much as France (as a percent of gdp). That’s so little that the doctors’ salaries are half of it.

  • American politicians are working in a country with a Federal tradition. The Platonic American practice would be to have some states that were like France, and some states that were like Singapore, and to see which ones people wanted to live in.

  • Steve

    I’ve heard a lot of things that I don’t know are true. If they were all true, then that may mean a lot of things.

    I am going to make a list of all the things that I have heard that I don’t know are true. After I do that, I’ll go from there.

    In the mean time, I’ll stick to the one thing I know is true. There is an imaginary line over which were I to cross, I could get drugs cheaper than if I stayed on this side of that line.

    The reason we can not cross that over that line, or have the ‘other-side-of-the-line-people’ ship the drugs to us at the lower price is that the people who have the power to make us pay more have persuaded the people who have the power to let us pay less to stop us from paying less.

    In a nutshell, we are paying a sales tax to the pharmaceuticals. They are just tossing out strawmen to cover the action taken by our ‘duly elected representatives in our democratic nation’.

    Nothing new or rare in that for our ‘duly’ folk.

    As for the remedy for that, that too is a prescription issue.

  • yupieyoe

    I live in Belgium; here, it’s the other way around: comparison of announced government measures or law proposals to the ones of other countries, is made extensively (“In The Netherlands, they have a system which…” / “Look what a disaster the UK Railway privatisation was, let’s not do that here” / …).

    To the extent that it is mostly an excuse to hide ideological motives. For every possible change, there has to be a neighbouring country which applied just that (or further away, we recently had a fierce discussion about the “kiwi model” consisting of the New Zealand way of using government tenders for drugs). Regardless of any other circumstances which might differ and make the comparison worthless.