Paul Krugman: How to Fix Our Health Care Mess

As progressives rejoice in their Obamacare victory, they are beginning to look further—at Medicaid-for-all. But if progressives do take back Congress in 2018, they should look beyond the single-payer system that has become a “litmus test for Democratic candidates.”


In his Monday New York Times column, Paul Krugman suggests we look to other countries for advice on how to proceed toward universal health care.

Take the Netherlands, where “individuals are required to buy coverage from regulated premium services.” But unlike Obamacare, these regulations allow for subsidies that keep premiums down and people happy. The Dutch system “suggests that a lot could be accomplished via incremental improvements in the A.C.A., rather than radical change,” Krugman says. This is further proven by states that put in the effort to work with Obamacare’s imperfections, such as New York, where only 5.4 percent of the population is uninsured.

It is essential that we avoid “disruption to the 156 million people who currently get insurance through their employers, and are largely satisfied with their coverage.” Moving straight to a single-payer system means taking away coverage and imposing new taxes, and a hefty amount of hard work toward convincing the insured not only that the savings in premiums would outweigh the increase in taxes but that new coverage would be just as good as the old. This can be accomplished by enhancing the ACA rather than replacing it, which perhaps could be an eventual pathway to a single-payer system.

Ultimately, Krugman feels progressives should direct their attention to more than one cause, in particular the U.S. social welfare system:

When you compare the U.S. social welfare system with those of other wealthy countries, what really stands out now is our neglect of children. Other countries provide new parents with extensive paid leave, provide high-quality, subsidized day care for children with working parents and make pre-K available to everyone or almost everyone; we do none of these things. Our spending on families is a third of the advanced-country average, putting us down there with Mexico and Turkey.

In his estimation, building upon the existing ACA is a far wiser choice than ripping it to bits. Why head down the same path as Republicans? If it were possible to start fresh, Krugman too would support a single-payer system. But realistically, “idealists need to set priorities, and Medicare-for-all shouldn’t be at the top of the list.”

Read the entire column at the New York Times.

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