American Exceptionalism and the Healthcare Reform Debate (Annual Federalist Society National Student Symposium‪)‬

Two generations ago, discussion of "American exceptionalism"--at least among social scientists--came down to one great question: Why no socialism in America? (1) By the 1980s, however, even self-described socialists in Western Europe had embraced the benefits of markets and privatization. (2) Soon after, the Soviet empire collapsed and full-scale socialism was largely discredited. (3) America no longer looked particularly unusual in its broader economic patterns. So the "exceptionalism" question dwindled down to: Why no national healthcare in America? (4) The Obama administration tried to give an answer: Yes, we can! (5) Then we did--enact the Patient Protection and Affordable Care Act of 2010 (ACA). (6) The public reaction was: Maybe not. Public opinion polls have shown that a persistent majority of Americans do not favor ACA. (7) So the question about American exceptionalism can now be rephrased: Why is national health insurance still so controversial in America? I want to offer an answer in three parts, looking successively at background political culture, constitutional architecture, and constitutional culture.