Would reforming healthcare strengthen U.S. global power?
A new RAND Corporation analysis of great powers in history provides clues that it might.
This blog has warned that uncontrolled healthcare spending is squeezing public and private budgets, incurring wasted-opportunity costs, cutting into military spending, and increasing the national debt. These financial strains on our economy and defense threaten to weaken us as a nation, so goes its argument.
But this RAND study claims that “[h]istory offers a different lesson. . . [I]t is not military or economic might that makes the crucial difference but the fundamental qualities of a society: the characteristics of a nation that generate economic productivity, technological innovation, social cohesion, and national will.”
Let’s look at the seven factors identified by RAND Corporation inside great powers that give them advantages on the world stage. The RAND researchers gleaned these insights by drawing on case studies ranging from fifth century B.C. Athens to Italian Renaissance city-states, Meiji Japan, and the British Empire. And let’s reflect on how the factors connect to U.S. healthcare reform.
Seven National Factors for Global Success
- National ambition and will
This is the national drive for success in every domain – science, business, industry, arts. And, not least, healthcare. The U.S. has been a leader in healthcare science and technology, but has lagged in universal delivery and in public health. The U.S. has no shortage of ideas for fulfilling the promise of universal access. And political will for it is growing. Regarding the promise of public health, the pandemic has stirred a national conversation. Americans are seeing through the “folk libertarian” fallacy of pitting the individual good against the common good – rather, what goes around in the community eventually comes around to each individual, one way or another, especially in healthcare.
- Unified national identity
The most successful nations have commanded pride and loyalty among their citizenry. Their national identity is undergirded by a shared historical narrative. Americans have always treasured an idealized version of their shared story. Currently, it is no secret that American history is being enriched – though some say degraded! – with vibrant stories that stretch back to our beginnings depicting unrepresented groups like Black-, Native- and Asian-Americans. Flaws and failings are being added, too, with the hope for healing and reconciliation. Healthcare is a thread in that rich history, and can be a source of shared identity and mutual solidarity.
- Shared opportunity
Successful societies offer many routes to achievement, and they draw on the talents from all their members. Businesses small and large in the U.S. are increasingly recognizing that giving economic opportunity to all is pro-growth. They now realize that race- and gender-based wealth gaps hinder growth. What’s good for workers is good for business and good for America. Trapping workers in unproductive jobs just to keep their employer-based health insurance stifles productivity. Depriving some of careers in healthcare, of quality care, and even of full longevity undermines the social contract between workers and society. Healthy workers with healthy benefits are productive, and they make a healthy society.
- An active state
Competitive societies cultivate a vibrant relationship between government and private sector research, education, finance, and novel technologies. United States history gives us vivid examples of such successful joint ventures, ranging from the first turnpikes and canals to railroads to the Internet. U.S. healthcare is already largely a joint public-private enterprise. In the opinion of this blog, healthcare could presently benefit from even more state actions to counteract market failures, such as obstacles to insurance and exorbitant prices of drugs and services.
- Effective institutions
Nimble societies are populated by nimble institutions – civic, commercial, cultural — that are at once stable but also adaptive, innovative, and effective. In so being, they enjoy legitimacy and support. They serve the public good, not corrupt special interests. Healthcare institutions and professions enjoy considerable respect, but need to be rid of creeping monopolistic practices, protectionism, and cronyism.
- A learning and adaptive society
Resilient public and private institutions in thriving societies display a dynamic balance between an innovative spirit, learning, and agility along with stability and continuity. U.S. healthcare has a proud spirit of innovation and curiosity, but has at times been plagued by monetary incentives that pervert scientific integrity. Healthcare reform should incentivize science for its own sake and for the sake of health, not for unbridled profits.
- Competitive diversity and pluralism
This factor refers not just to demographic diversity but also to cultural backgrounds and intellectual viewpoints. Healthcare has generally welcomed innovators and leaders of all backgrounds. But among patients served it has not always attended to social determinants of health – healthcare access, poverty, racial discrimination. There is a growing recognition of the impact of this blind spot and a growing sense of duty for a remedy.
Four Other Ingredients for Success
Great powers show four other characteristics. First, they prudently constrain the seven factors. For example, unchecked ambition can lead to overreach, and unchecked diversity can fragment social cohesion. Second, they pursue all factors in combination, not in isolation, so as to resonate with each other. For instance, well-educated and creative students, from diverse backgrounds, need to have opportunity to rise within fulfilling public and private workplaces of choice. Third, these great powers display a spirit that combines curiosity, self-confidence, and drive, which they term a “Renaissance spirit.” And, fourth, they are led by respected public-spirited leaders devoted to the public interest, not merely to the leaders’ own power and self-interest.
Michael J. Mazarr, the Senior Political Scientist who led the RAND study, writes that currently,
The primary threat to U.S. dynamism and competitive standing comes not from without but from within: from changes in the character of American society. The next great challenge for the United States will be to stimulate a new era of competitive advantage, one that can revive the qualities that powered the country’s rise in the last century as well as sustain them into the next. . . [T]he ultimate question is not one of understanding or of capacity to tackle such an undertaking. The question is one of will: whether the United States has the reservoirs of creative determination, national solidarity, and political resolve to meet this weighty challenge.
This blog agrees with Mazarr that America does have the necessary knowledge and skills to reform healthcare and, along with it, to reform society of which it is a part. This blog discerns that a new American idealism is being rekindled that will reinvigorate the national will. And it proposes that healthcare reform is a good place to start.
The reader can fan this flame by taking action.
Title: “We Shall Overcome” at LBJ Library, Austin, TX 2014
By: Marsha Miller
Note from the Blog Author: I will be taking a break from blogging for several months in order to concentrate on a local civic project.