ITS THE INSTITUTIONS - STUPID - WHY COMPREHENSIVE NATIONAL-HEALTH INSURANCE ALWAYS FAILS IN AMERICA

We argue that the United States does not have comprehensive national h ealth insurance (NHI) because American political institutions are bias ed against this type of reform. The original design of a fragmented an d federated national political system serving an increasingly large an d diverse polity has been further fragmented by a series of political reforms beginning with the Progressive era and culminating with the co ngressional reforms of the mid-1970s. This institutional structure yie lds enormous power to intransigent interest groups and thus makes effo rts by progressive reformers such as President Clinton (and previous r eform-minded presidents before him) to mount a successful NHI campaign impossible. We show how this institutional structure has shaped polit ical strategies and political outcomes related to NHI since Franklin D . Roosevelt. Finally, we argue that this institutional structure contr ibutes to the antigovernment attitudes so often observed among America ns.