US health reform and the Stockholm syndrome

Marie Gottschalk


The US healthcare system is exceptional in many ways compared to other developed countries. On average, the United States spends more than twice as much per capita on health care, yet nearly 50 million people are uninsured, and tens of millions more are grossly underinsured. The US ranks near the bottom in major health indicators like life expectancy and infant mortality, and public satisfaction with the healthcare system is extremely low. Heartbreaking stories of people scrambling to find affordable and adequate healthcare coverage while facing down serious, even life threatening, illnesses are common in the media. In the face of these remarkable problems, the leading solution proposed by the Obama administration, top Democrats in Congress, and their supporters was remarkably modest. Time and again, major attempts to reform the US health system fall victim to the ‘Stockholm syndrome’ -- like the famous Swedish bank hostages who became emotionally attached to their captors and even defended them after they were released. Held captive for so long by neoliberal ideas about how best to organise the US economy and society, many advocates of universal health care put competition and consumer choice at the centre of the latest major push for health reform. Dozens of major organisations close to the Democratic Party, including the AFL-CIO (the country’s pre-eminent labour organisation),, and the Children’s Defense Fund, mobilised on behalf of a breathtakingly modest solution: creation of a public health plan -- essentially a nonprofit insurance company -- to compete with the commercial health insurers.  As the problems of the US health system have mounted over the last four decades, the vision of what is possible in healthcare reform continues to shrink. The enthusiasm for creating a nonprofit health insurance company to relieve the country’s healthcare malaise was but the latest example. A closer look at the origins, development, and shortcomings of the Democrats’ competitive public plan solution helps explain why many advocates of universal, affordable, high-quality health care continue to bite off less than they can chew.

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