Health Care as the Central Civic and Political Problem of the United States: A Comparative Perspective

Abstract

Health care governance constitutes the central domestic problem in the US from both a socio-political and an economic viewpoint. Compared with other post-industrial countries, it is inefficient, ineffective and characterised by an inequitable ‘particularism’ in dealing with different classes of citizens. Utilising the cultural theory of American exceptionalism, this article discusses why there is no compulsory universal insurance in the US, by reconstructing the structural developments of the health care system during the last century, and documenting the anti-social medicine ideological positions of the providers. The idea of a balanced combination of rugged individualism and reformist liberalism producing satisfactory collective outcomes does not appear to work in this case. There is a severe imbalance between the interests of the providers and those of a fragmented and stratified public thus far incapable of acting cooperatively in the pursuit of better collective outcomes. President Obama's proposal for a clearly defined and potentially satisfactory collective outcome is confronted by formidable resistance from the vast constellation of providers which will not be easy to dismantle.