American Exceptionalism and the Healthcare Reform Debate

By Rabkin, Jeremy | Harvard Journal of Law & Public Policy, Winter 2012 | Go to article overview

American Exceptionalism and the Healthcare Reform Debate


Rabkin, Jeremy, Harvard Journal of Law & Public Policy


Two generations ago, discussion of "American exceptionalism"--at least among social scientists--came down to one great question: Why no socialism in America? (1) By the 1980s, however, even self-described socialists in Western Europe had embraced the benefits of markets and privatization. (2) Soon after, the Soviet empire collapsed and full-scale socialism was largely discredited. (3) America no longer looked particularly unusual in its broader economic patterns. So the "exceptionalism" question dwindled down to: Why no national healthcare in America? (4)

The Obama administration tried to give an answer: Yes, we can! (5) Then we did--enact the Patient Protection and Affordable Care Act of 2010 (ACA). (6) The public reaction was: Maybe not. Public opinion polls have shown that a persistent majority of Americans do not favor ACA. (7) So the question about American exceptionalism can now be rephrased: Why is national health insurance still so controversial in America? I want to offer an answer in three parts, looking successively at background political culture, constitutional architecture, and constitutional culture.

One way to capture the distinctiveness of American political culture is to look at survey responses. The Pew Global Attitudes Project has tracked differences in outlook among peoples in various countries. (8) A few years ago, they asked respondents in a survey whether "success in life is pretty much determined by forces outside our control." (9) In every major country in Western Europe where they asked this question, the answer was (often by more than two to one): yes, success is determined by forces outside our control. (10) In the United States, people rejected that answer by nearly two to one. (11) The United States is one of the great outliers. It is one of the only two Western countries where an overwhelming majority insists that individual success in life mostly depends on the personal effort of the individual. (12)

That poll does not seem to be an anomaly. It tracks with a number of other findings. Even Europeans in these surveys acknowledge that Americans seem to work harder than people in other countries. (13) Americans believe this about themselves. (14) It is what you would expect of people who think their success depends on their own efforts.

Americans also are inclined to express a good deal of pride in their country--certainly far more than Europeans and, by some surveys, even more than people in developing countries. (15) Whereas sociologists often interpret "nationalism" as a response to feelings of insecurity, (16) that observation does not seem to be the pattern in the United States.

Perhaps this result, too, fits with the larger pattern of American self-confidence. Americans think they can succeed through their own efforts--and they think the country that assures them the freedom to succeed on their own is a fine country. People in other countries, who place more reliance on state bureaucracies to care for them, usually are disappointed with the results. Then they are more likely to think their government or their whole society is to blame.

Add it up and you might infer that Americans want a healthcare system that helps them make their own choices. The Obama administration seemed to recognize this in its initial characterization of proposed reforms: If you like the private insurance you now have, President Obama promised, "you'll be able to keep [it]." (17) Some part of the resistance to the huge and hugely complicated package of "reforms" Congress enacted seems to reflect the realization that this promise has not been honored: Whatever else it does, the new healthcare law constrains the choices of individuals. (18)

But such broad background attitudes are only one part of the story. Another part of the explanation for our current debates is the actual constitutional architecture of our government, federalism in particular. Here I particularly want to mention federalism. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

American Exceptionalism and the Healthcare Reform Debate
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Author Advanced search

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.