Abundance

by Ezra Klein

The big government–small government divide is often more a matter of sentiment than substance. Neither side focuses on what scholars call “state capacity”: the ability of the state to achieve its goals. Sometimes that requires more government. Sometimes it requires less government. But it always requires a focus on what the state is trying to achieve and what is in its way. In the absence of that focus, absurdity reigns. Across Europe, government-administered health-care systems negotiate down the prices of drugs and treatments. In America, our fear of socialized medicine has led to a hodgepodge of private and public insurers who do not coordinate and do not effectively negotiate. The weight-loss drug Ozempic, for instance, costs about ten times as much in America as it does in Britain or France.9 Those countries have national health-care systems that restrict what pharmaceutical companies can charge, and we do not. As a result, taxpayers in Europe spend less on health care, as a percentage of GDP, than taxpayers in America. And then Americans have enormous private bills atop our public spending.