In the middle of a group discussion of health care reform last week, an acquaintance expressed puzzlement that the current debate isn’t more heavily focused on international comparisons. Modulo all the important differences—cultural, institutional, demographic, and so on—between the United States and other developed countries, shouldn’t we be spending most of our time weighing the merits and drawbacks of the huge variety of health care systems that deliver care as good or better than ours at lower cost? Now, I found this a little odd, because to me it seemed as though, if anything, we were hearing a lot more about international comparisons than we normally do in areas where one might think them relevant. But it’s certainly true that, while pundits and writers may make positive reference to other countries’ systems, elected officials almost never do. And the consensus seemed to be that this is because Americans never want to hear that some other country has figured out how to do things better than we have. If you want to use another country’s experience to denigrate a policy by talking about how awful it is over there, by contrast, you’ve got a free pass even if you’re just lying your tuchus off:
Obviously, this is a less-than-optimal state of affairs on face. I don’t expect politicians to start being forthright in ways that turn off voters, but I’m wondering if it there isn’t an opportunity here in the nonprofit space for some institution to start specializing in international policy comparisons, rounding up successful instances of policy entrepreneurship and so on. Annie Lowery, for instance, wrote a useful roundup of the worst health care reforms for Foreign Policy, and it seems like you could do something similar across the board—maybe some kind of biennial roundup of best and worse policy innovations in a whole array of areas.
A few reservations as a small-government type, given that much of the developed world seems to countenance significantly more expansive and intrusive government than we do. First, the benefits of government programs tend to be a lot more obvious than their harmful consequences, and given that you can’t actually run controlled experiments, it’s hard to know how to gauge the way one policy in a vast complex of entangled and interdependent policies affects employment or innovation in an equally complex, and probably quite different, economy. Second, these sorts of comparisons tend to privilege what’s easy to quantify over equally more important but necessarily more nebulous concerns. You can run a regression to estimate whether and to what extent mandatory morning calisthenics reduce obesity or heart disease, whereas the intrinsic disvalue of forcing people to do things isn’t easily rounded to three decimal places, and so tends to drop out of the picture. You can, of course, try running polls to see how unhappy people are about being compelled to do something, but some of us might regard it as even more worrisome if a population ceases to mind being told how many power squats they must perform before breakfast. These concerns notwithstanding, I can’t really bring myself to believe we’re better off for systematically ignoring data: If the rationale for federalism is that we benefit from having 50 “laboratories of democracy,” why stop gathering information at the water’s edge?