It's the Institutions, Stupid! Why Comprehensive National Health Insurance Always Fails in America

Abstract

We argue that the United States does not have comprehensive national health insurance (NHI) because American political institutions are biased against this type of reform. The original design of a fragmented and federated national political system serving an increasingly large and diverse polity has been further fragmented by a series of political reforms beginning with the Progressive era and culminating with the congressional reforms of the mid-1970s. This institutional structure yields enormous power to intransigent interest groups and thus makes efforts by progressive reformers such as President Clinton (and previous reform-minded presidents before him) to mount a successful NHI campaign impossible. We show how this institutional structure has shaped political strategies and political outcomes related to NHI since Franklin D. Roosevelt. Finally, we argue that this institutional structure contributes to the antigovernment attitudes so often observed among Americans.

Payment for Health Care and Perception of the National Health Insurance Scheme in a Rural Area in Southwest Nigeria

“…This political structure played a major role in the long process of establishing a nation-wide health insurance in the United States, which spanned over decades without success despite policy makers and potential beneficiaries interest, until lately when a major progress was achieved with ObamaCare. 41,42 It has taken the United States that long to implement a country-wide health insurance scheme because of the presidential system that allows politicians, as well as sectional, market-related interests groups in the health industry to lobby. Politicians do so mainly for political interests, while health-related interest groups do for economic/fiduciary interests.…”

“…In Nigeria, at present, the difficulty making health insurance mandatory and poor progress achieved in its expansion could be attributed to similar factors that militated against the implementation of a nation-wide scheme in the United States prior to the recent development. 42 Expressing interest in an issue may not necessarily translate to active participation. In the context of this study, the respondents though showed interest to participate in a prepayment scheme such as the health insurance but they also made known their concerns.…”

The Role of States in Controlling the Obesity Epidemic, and a Personal Autonomy to Decide

“…In fact, in a society oriented by liberal values such as the United States of America, where the intervention of the State over the individual is execrated and strongly repudiated [35], it is understandable that individuals will argue and oppose a possible health system in which decisions would be taken solely by "health authorities" and not by the individual [36].…”

DNA, Privacy, and Social Justice: The Policy-making Process in the State of Maryland

“…Of particular importance is the role of the judiciary in the federal system of the United States in the determination of public policy (Choper, 1993). Palley,Bright & Afkinich 3 Institutional factors (March & Olsen, 1984;Okma & Marmor, 2015;Spithoven, 2011;Steinmo & Watts, 1995), such as the Bill of Rights in the U.S. Constitution as well as ideologies, are often expressed in judicial opinions, but also by other stakeholders in the public sphere. Also involved is how decisions in this area are made given the United States' emphasis on separation of powers and division of jurisdictional authority (Krane, 2007;Wright, 1993).…”