American Exceptionalism and Health Reform

Normally, I am a big fan of American Exceptionalism. For the most part, it has done our country well, and I would argue it may act as a glue that holds our diverse society together. Unfortunately, it also leads to problems, like a flat out ignoring of important facts. Nothing has brought this to my attention more than in the current health care debate.

Today, on Meet the Press Senator Orrin Hatch (R-UT) claimed that the U.S. has the best health care in the world. (On a completely unrelated note, read Jon Cohn's response to the Hatch interview regarding numbers that would appear on the public plan by CBO. Yes Gregory did catch Hatch.).

However, signs show that this is not the case. Most recently the Robert Wood Johnson Foundation worked with the Urban Institute to publish an issue brief that asks if the U.S. has the best health care in the world. (Tip to Ezra Klein).

Here's a bit of a sample:

An analysis from the Urban Institute looks at the evidence on how quality of care in the United States compares to that in other countries and provides implications for health reform. Authors Elizabeth Docteur and Robert Berenson find that international studies of health care quality do not in and of themselves provide a definitive answer to this question.

What they do show is that the evidence for American superiority in quality of care (or lack thereof) is a mixed bag, with the nation doing relatively well in some areas—such as cancer care—and less well in others—such as mortality from treatable and preventable conditions.

And while evidence base is incomplete and suffers from other limitations, it does not provide support for the oft-repeated claim that the “U.S. health care is the best in the world.” In fact, there is no hard evidence that identifies particular areas in which U.S. health care quality is truly exceptional.

This is also not the first study to find this. Indeed, the brief itself is essentially a review of a lot of literature. Everyone has searched to find inklings that the U.S. has the best health care in the world by some measure. Only a few have found it, and it is usually confined to narrow areas and even so it is not overwhelmingly better. Note too that T.R. Reid in his new book and today's Washington Post makes a similar argument.

But, of course, there is this idea of American Exceptionalism that is so deep-seated into our culture that it makes up part of our situational milieu and reaches into our subconscious as part of our situation. It is the idea that America is exceptional. It is a leader in everything, and the best in everything. That cultural idea has roots to John Winthrop's famous "City on a Hill" idea of Boston and the colonies there serving as a new Jerusalem.

Unfortunately for wonks like me, there is really little that studies like this wonderful Urban Institute thing can do. It affects a deeper part of our situation, and the situation as Jon Hanson has often said, is much stronger than the disposition. Furthermore, I think deep down most Americans do find it troubling that we have a system that has so many individuals uninsured and that costs more than the rest of the world. Yet, we have our exceptionalism, and indeed, we have to believe that the world is just and right. The system justification theory then also kicks into the discussion, and the moves arise in this basic way

1. We have a system where millions are uninsured and cannot get coverage, and thus suffer needlessly.
2. We also have a lot of costs.
3. But the world is just, and we are the U.S., an exceptional country.
4. There must then be some sort of a reason for this matter.
5. The reason we have this problem is because people deserve it by not working hard enough and that we must be spending so much and have so much fracture that our system must do something right through innovating.

Now this is likely a poor oversimplification of what is going on, but I think my point is made. Such a sort of illogical conclusion is not something that one can easily get rid of, especially if it is deep-seated.

Unfortunately, health reform seeks to fight this, by pointing to the rest of the world saying we should become like them. That attacks our exceptionalism and that shows that our just world is perhaps not so. This leads then to resistance, and ultimately, a status quo bias.