Integration vs Decentralization in Health Care

Here's a different way of looking at the health care issue:

What I hope is that my material can go to Washington as nonpartisan, as just a foundation of understanding. If they have the same way to frame the problem, then the Republicans and the Democrats should be able to work together much better. The Americans look at Canada, Europe and Australia, where the government is the payer. Maybe we ought to adopt their model. And the Europeans and the Australians are saying, "You know, this isn't working very well, maybe we ought to adopt the U.S. model." That's the wrong categorization scheme. The right one question is "Should we be integrated (like Kaiser Permanente or Finland), or should we be modular (like Partners in Boston and the Canadian and German systems)?" It's not public versus private.

Although I do think part of the issue here may be simply that the contrast between the payers may not be as large as conventional wisdom suggests. After all, Americans over the age of 65 have long benefitted from a Canadian-style single-payer health insurance system. And the elderly are in many ways the core clients of the health delivery system. Nonetheless, I think the integrated vs centralized analysis has a lot of force and is a useful way to look at the issue.