Impact of Liberal Ideology

Compared with other industrialized nations, the political ethos of the United States emphasizes the importance of the individual rather than the collectivity (see Gosta Esping-Andersen). U.S. political ideas, institutions, and behavior uniquely reflect a virtually unanimous acceptance of the tenets of seventeenth-century English political philosopher John Locke, whose liberal philosophy was in harmony with the laissez-faire economics subsequently propounded by Adam Smith in The Wealth of Nations (2000 [1776]). As Locke propounded in Of Civil Government, Two Treatises (1924 [1690]), the individual should be much more important than the collective, and one of the few important functions of a limited state is to ensure that the wealth that individuals accumulate through the free market is protected. The framers of the U.S. constitution, strongly influenced by the atomistic individualism of Locke's philosophy and his views on the sanctity of private property, took pains to limit the power of government. The constitutional rights they established for American citizens are largely protections for the individual and his property from governmental actions.

This ongoing ideological tradition helps to explain an important distinctive feature of the American political system's approach to health policy. Although U.S. governments intervene a great deal in the health arena, on some matters they are more inclined to rely on the individual and the free market than most other industrialized nations.

Unequal distribution of access to healthcare is a prime example of the effects of this approach. Most industrialized nations, for instance, use the power of government to assure health insurance coverage for virtually 100 percent of their citizens. The rate of government-assured health insurance in the United States, however, is only 33 percent, by far the lowest among industrialized nations (Anderson and Poullier), because the expectation is that most financing of personal healthcare is the responsibility of individuals and their employers (some exceptions are discussed below). Consequently, in 2000, 14 percent of Americans, nearly forty million persons, had no health insurance (U.S. Census Bureau). Lack of insurance, of course, limits access to care, and has been documented by researchers such as David W. Baker, Joseph J. Sudano, Jeffrey M. Albert, et al., (2001) as increasing the risk of poor health.

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