Det var doktorerna som en gång såg till att USA inte fick ett allmänt, nationellt sjukförsäkringssystem

2009-04-24
Nyckelord: Politiskt generade problem, Vårdens finansiering, Vårdsystem

Paul Krugman, förra årets Nobelpristagare i ekonomi, kom 2007 med en personlig och tankeväckande bok om den moderna USAs politisk-ekonomiska historia (Krugman, P. , 2007, The Conscience of a Liberal, Norton & Company, New York). Han beskriver där hur det kom sig att Harry Truman, USAs president åren efter andra världskriget, inte lyckades driva igenom sin sjukvårdsreform, i praktiken ett ”single payer”-system liknande det som idag finns i bland annat Kanada. Så här beskriver Krugman tilldragelsen:

In 1946 Truman proposed a system of national health insurance that would have created a single-payer system comparable to the Canadian system today. His chances of pushing the plan through initially looked good. Indeed, it would have been much easier to establish national health insurance in the 1940s than it would today. Total spending on health care in 1946 was only 4.1 percent of GDP, compared with more than 16 percent of GDP now. Also, since private health insurance was still a relatively undeveloped industry in the forties, insurance companies weren’t the powerful interest group they are now. The pharmaceutical lobby wouldn’t become a major force until the 1980s. Meanwhile public opinion in 1946 was strongly in favor of guaranteed health insurance.

But Truman’s effort failed. Much of the responsibility for that failure lies with the American Medical Association, which spent $5 million opposing Truman’s plan; adjusting for the size of the economy, that’s equivalent to $200 million today. In a blatant abuse the doctor-patient relationship, the AMA enlisted family doc to speak to their patients in its effort to block national insurance ostracized doctors who supported Truman’s plan, even to the extent of urging that they be denied hospital privileges. It’s shocking even now to read how doctors were told to lecture their patients on evils of ‘socialized medicine.’  (s 67-68)

Historien talar bra för sig själv.

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