Emily Sieg, Staff Writer
Ideology: Social Democrat | Writing From: Washington, DC

The long and tumultuous strive for  healthcare reform in the United States could prove one of the greatest social experiments in recent time.  The drive to provide basic healthcare coverage to every American citizen has been advocated by humanitarian concerns. Calls for reform have come from every class and has been heavily championed by those  who are already insured.  This call for change hasn’t been driven by war or class conflict, as it has in every other industrialized nation with universal health care; rather, it is coming out of a response to the public voice. This means that if healthcare legislation passes, the United States may demonstrate a unique ability to both overcome the status quo and break away from the path-dependence of bismarkthe private insurer’s market as well as an ability to circumvent the social and economic factors that stimulated healthcare reform in other countries.

Before considering the future, take a look into the past.  The iron chancellor of Germany created essentially the oldest healthcare system in the world, guaranteeing insurance for the working classes back in 1883.  As the original master of Realpolitik, one should not presume that Otto von Bismarck had a heart for the little people.  This was not humanitarian – sensing the growing threat of the Social Democrats and fearful of masses of potentially unruly workers, Bismarck took it upon himself to champion healthcare before other political pressures could force him to do so.  The current healthcare plan in Germany, still known as the Bismarckian Model, is practically just a refined version of the original idea.  Over 125 years various German governments have simply built upon what they have inherited.

This mere adaption of pre-existing conditions is known as path-dependence.   According to path-dependence, an initial invention will bear great influence on future products simply by merit of existing first.  Consider the Qwerty keyboard or the size of DVD boxes.  Our keyboards were first developed because an alphabetical keyboard was more conducive to speedy typing, which in turn was quite conducive to jamming typewriters; hence, a randomly assorted keyboard on a device that cannot be jammed.   Similarly, a DVD box stacks nicely with VHS boxes, even though the actual DVD is significantly smaller and does not require such a large carrying case.  Often in spite of newer and more rational inventions or concepts, path-dependence typically lends itself to the continuation of traditional designs and ways of thinking.

Examining another country, the United Kingdom proposed the NHS in the wake of World War II.  Perhaps one of the most ‘socialist’ systems around, patients in the British system never see a bill and all medical personnel and facilities are paid for, operated and owned by the government.  Yet there are clear historical indicators for the development of the NHS set-up.  During the Blitzkrieg, not only were large numbers of civilians injured and in need of medical care, but many hospitals were either damaged or destroyed.  Owing an immediate service to its people, the British government had to not only fund, but also provide medical care.  In the post-war United Kingdom medical services were already so heavily concentrated in the hands of the government that the declaration of the NHS was practically a formal affirmation of the status quo.

Regarding the British case, universal healthcare was born out of a war effort.  Private institutions were reduced to the point at which they could not function and the government was required to fill the gap.  In the post-war era there was no clamor to restore the old system of private institutions and thus Westminster continued operate publically funded and provided services.

Unlike Germany, which faced potential social uprisings and political turmoil, or the United Kingdom, which was faced with total war, the United States does not shave the same time of threatening force driving healthcare reform. Moreover, without such  economic, social and infrastructural stimuli, path-dependency indicates that that traditional methods of business will prevail, in this case a large network of private insurers. Taking history and human tendencies into account suggests that health care reform in the United States will fail. Yes, the American government now has the opportunity to prove that it needs only sheer public movement, and one quite distant from taking to the streets in strikes or uprisings,  to improve the health care of its citizens.