As Europe struggles to push through serious healthcare reforms it is interesting to look at The Rhetoric of Reaction: Perversity, Futility, Jeopardy by Prof Albert Hirschman. He identified three rhetorical reactions to any planned social reform.

The perversity thesis holds that any change will have the opposite effect. Bring in the market to create choice and you bring in capitalists who will cherry pick and seek monopolies. The futility thesis holds that anything we do will not even leave a dent, as demand and costs of healthcare rise. Reformers are left “humiliated” and “in doubt about the meaning and true motive of their endeavours” Third is the jeopardy thesis. Although the reforms may be desirable, the political costs will be too high. Attempts at healthcare reform lead to the collapse of governments.

I hear all three arguments used in every attempt at reform in Europe.

Yet to each of these, there is a counter-argument. For perversity it is that we should have more faith in our ability to regulate. New market-oriented regulatory arrangements may enhance the state's ability to coordinate and control. Introducing choice forces social providers and insurers to be more responsive to patient needs. The futility thesis is challenged by looking at past social reforms, such as Bismarck and Beveridge, and the huge impact they had. The jeopardy thesis is countered by arguing that unless we act the system will eventually collapse. What is striking about healthcare reform in Europe (and the USA) is how frequently we hear the rhetoric of reaction and how rare it is to hear politicians mouth the counter-arguments. Yet, unless healthcare is to swallow 20% plus of GDP within a couple of decades action needs to be taken.