Abstract

Health care governance constitutes the central domestic problem in the U.S. from both a socio-political and an economic viewpoint. Compared with other post-industrial countries, it is inefficient, ineffective and characterized by an inequitable "particularism" in dealing with different classes of citizens. This article firstly discusses why there is no compulsory universal insurance in the U.S.; secondly, it shows that 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.