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Beyond the broad statement that the United States tends to rely more on markets in health care and other coun- tries more on regulation, few generalizations are possible. This is not surprising. Every nation mixes markets and regulation. As James Morone describes in the Introduc- tion, more than half of all health care spending in the United States is by government, and private providers (if not private financing) play a dominant role in most developed countries. It should be apparent by now that markets and govern- ments are not all-or-nothing propositions. Rather, they need to be used in conjunction with each other. Private markets help ensure that government is not too inefficient or too beholden to special interest groups; government helps ensure that insurers do not select only the healthiest people, that access to providers is available to the general public, and that people can afford such access to care (to name just a few things). The real issue is the balance be- tween the two. It is noteworthy that the new health care reform legislation in the United States takes advantage of both the private market (through subsidies and insur- ance exchanges) and government (through an expansion of low-income coverage through Medicaid) to reduce the number of uninsured. Can we say unambiguously what this balance should be? Unfortunately, the answer is no. There are at least four reasons why countries may want to approach these issues differently: • Different countries want different things from their health systems. Some may want to emphasize access, others cost control; some opt for efficiency over equity, and others the opposite. Moreover, historical and cultural factors are critical determinants of how different countries’ health services systems have developed, making it risky to suggest that any one country’s system be replicated by others.

• It is probably impossible to come up with an agreed-upon set of weights among the different outcomes. How does one weigh, for example, the short waits (a characteristic of the market-based US system) against the equity of health system financing (a characteristic of the government- controlled British system)? Selecting between such clashing values is the heart of politics. When it comes to these basic tradeoffs, the often heard plea—“Can’t we get beyond politics?”—is a sure sign of political nai¨vete´. • It is also hard to characterize the countries according to the reliance of each on markets versus regulation. Germany offers a good example. Although there is little explicit government involvement in health care financing, which is largely left up to the insurers, which are called “sickness funds,” there is a great deal of government oversight and direction, particularly on the supply side. Further complicating matters is that health systems change, sometimes fairly rapidly. Both Great Britain and the Netherlands, for example, went from fairly non- marketlike systems to ones relying much more on competition; while Britain has stepped back somewhat, the Netherlands has continued its trends toward markets through the use of private insurance. • Although cross-national measures of access and costs are reasonably good, little is known about the quality of care provided in different countries.

Ultimately, we should see markets and regulation as tools that can be combined in very different ways. Each choice involves complicated tradeoffs between different values such as equality, efficiency, freedom, solidarity, fairness, and the acquisition of wealth. Health services researchers perform a vital function by developing empirical comparisons of the performance of countries that rely on alternative mixes of markets and regulation. But, in the end, basic health system choices involve more than evidence and computation. They require nations to make judgments about their own ideals.

Please read the essay prompt questions located at the bottom of this post.

Answer/address each question in at least 650 words or more.

DO NOT COPY/ PLAGIARIZE any other source so that I can UPVOTE. THANK YOU!


What government decisions resulted in our current employer-based health insurance system? How do employers feel about rising health insurance costs? Is health insurance offered by employers of all types? What are potential problems for employers of expanding Medicaid?


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