The "Greatest Good": The U.S. Political System and the Uphill Battle for Progressive Health Care Reform

In spite of their relative success in countries as diverse as Sweden, Italy, and England, neither a national health care delivery system nor a single payer plan were ever seriously considered, let alone debated, in the current effort to reform health care in the United States. While this may come as little surprise, at least to American observers, more puzzling is the question of why the country with arguably the least cost-effective health care system in the world, would have such a hard time with the so-called public option. Why, in the midst of a perfect storm of economic need, favorable public opinion, and rigorous support by democratic activists, has the so-called public option been so successfully marginalized? This article attempts to answer this question by looking more in depth at the role of U.S. political culture and the broader structural and institutional forces that have obstructed and continue to obstruct comprehensive public solutions to common socio-economic problems.