Pamela Behan, Solving the Health Care Problem: How Other Nations Succeeded and Why the United States Has Not

Journal of Sociology and Social Welfare, Dec, 2007 by Krista Drescher Burke

Pamela Behan, Solving the Health Care Problem: How Other Nations Succeeded and Why the United States Has Not. Albany, NY: State University of New York Press, 2006. $60.00 hardcover.

Health care in the United States has received varying amounts of attention since the beginning of the 20th century. With a presidential election looming, a winning candidate will almost certainly have to offer a feasible plan to control the health care system, whose costs are rising while millions of Americans still lack insurance. Almost 16% of the population of the United States, or almost 47 million individuals, lack insurance. Health care accounts for about 16% of gross domestic product, but, as is well known, the United States is the only western nation that does not have a comprehensive plan that provides health care to all citizens.

Interest group opposition, especially representing the medical field, is commonly cited as one of the main differences between the United States and other nations, and as the reason the United States does not have a comprehensive health care plan. As Behan explains, however, other nations have also faced opposition from interest groups in the development of national health insurance, but they have overcome that opposition to implement a health care plan.

Behan's book explores the history of Australia, Canada, and the United States, and she explains how governmental infrastructure is the true culprit in the lack of national health insurance in the United States. Canada and Australia have similar interest groups that opposed national health insurance before its formation to those in the United States, but the United States legislative process is set up in such a way that interest groups, which usually represent small but powerful and wealthy minorities, wield disproportionate power in the legislative process. Wealthy interest groups opposed to national health insurance are in a unique position to influence policy in the United States in that they can contribute substantially to politicians', usually Republicans', campaigns, and in return, they can expect policy that favors their interests when their candidate is elected. Groups lacking insurance and those favoring a national health care plan are not in a similar position to donate, and their interests are therefore not considered. Behan asserts that there is a need for a class-based political party representing the voice of working class Americans, who are disproportionately uninsured. Other nations have an active political party representing Labor, which has traditionally been the party that advances the national health insurance agenda. Labor in the United States, on the other hand, has relied primarily on the Democratic Party, which also has traditionally represented southern White elites, who have frequently been opposed to national health insurance.

Solving the Health Care Problem uses a systematic analysis to compare three nations, demonstrating that lack of national health insurance in the United States is far from simple or straightforward. Behan's book offers no suggestions for how to provide insurance to more Americans quickly, but instead points to major system changes as necessary for change; for national health insurance to become a reality, there must be either significant Labor party power or a lack of veto points, meaning there must be a reduced number of places where proposed legislation can be defeated. Currently, the United States does not satisfy either of these conditions so the likely successful approach to provide health insurance to more Americans will depend on expansion of existing programs.

Krista Drescher Burke, University of California, Berkeley