Paul Krugman assesses the chances that maybe, someday, the United States will join the rest of the First World and provide universal health care for its citizens.

What’s easy about guaranteed health care for all? For one thing, we know that it’s economically feasible: every wealthy country except the United States already has some form of guaranteed health care. The hazards Americans treat as facts of life — the risk of losing your insurance, the risk that you won’t be able to afford necessary care, the chance that you’ll be financially ruined by medical costs — would be considered unthinkable in any other advanced nation.

Most Americans don’t know that these risks would be considered unthinkable in any other advanced nation. As soon as one says “guaranteed health care” in the U.S., someone will say, oh, you mean like in Canada? As if that were the only other nation on earth that provides for health care for its citizens. Occasionally someone will bring up the British system, which has serious problems because for many years the British government has underfunded it.

But in the American public consciousness, the national health care systems of 30 other industrialized nations — most of which provide excellent care, without waiting lists for procedures, at a lower per-capita cost that in the U.S. — do not exist.

I agree with Krugman that if we could get a true national health care system in place that would provide care for all citizens and eliminate the risk of financial ruin, Americans would love it. It would, like Social Security and Medicare, be beyond the reach of the Right to take it apart no matter how hard they try.

That, of course, is what the Right fears.

Krugman points to three hurdles to getting any kind of program in place.

1. Democrats, who have made health care reform the center of the 2008 platform, have to control the White House and Congress.
2. Reformers would have to overcome the public’s fear of change.
3. Once in control of the White House and Congress, the Dems would have to keep their focus and not be distracted by the many other issues screaming for their attention after 8 years of grotesque mismanagement of the government.

Prairie Weather has another one: “Smugness, greed, and ignorance will pull together, forming an army which will fight viciously to keep things just as they are. ”

Ironically, given the “fear of change” issue, McCain’s “health care plan” would change the current system more than Obama’s. This is according to Jonathan Oberlander, a professor of health politics and policy at the University of North Carolina at Chapel Hill. Julie Rovner reports for NPR:

Of the two candidates, McCain is arguably the one whose plan would change the health system the most. Right now, if you get insurance from your employer, you don’t pay taxes on the value of that benefit.

[As alert reader k pointed out, this is not true. My understanding is that the McCain plan would eliminate tax incentives that employers get for offering health benefits to employees. Meaning that most of ’em would drop health benefits. The ideal, in McCainLand, is to shove everyone into one big private market system, which would leave even more people uninsured than there are now. — maha]

But if you have to buy your own insurance and you’re not self-employed, you don’t get any tax help. McCain would change that: He’d make employer-provided insurance taxable, but then give everyone a tax credit.

“Our proposal is to give every family in America a $5,000 refundable tax credit, and they take that tax credit and that money — a refundable tax credit — to go across state lines, to go any place in America, and go online, and pick out the insurance policy they want,” McCain said.

There are lots of questions about McCain’s plan. How hard will it be for people who are already sick to buy insurance? Will people really be able to find policies they can afford when the average family policy now costs more than $13,000? And does the public really want to move away from a system in which employers provide most people’s health insurance to one where most people buy their own?

I still don’t think the “crossing state lines” thing is going to work. There are differences in cost of policies from one state to another, but those costs vary in part according to cost of running a medical practice — more expensive in some states than in others, if only because overall cost of living varies — and how easy or difficult it is in that state for insurance companies to dump “customers” who actually get sick.

McCain’s plan no doubt would cause many employers to dump health benefits for their employees. I think this is something people need to be told. They also need to understand that McCain is making no provision for people with pre-existing conditions or health risk factors to be able to purchase private insurance. I believe his plan would cause millions more Americans to become uninsured and cut off from all but third-world level health care.

My problem with Obama’s plan is that it doesn’t go far enough, and could end up being not much more than a tweak of the current system. If he’s elected, I hope Congress pushes him to go further than what he’s proposed so far.