The horizon is not so far as we can see, but as far as we can imagine

American Exceptionalism: What Works Elsewhere Won’t Work In America

So, an acquaintance just told me that what’s wrong with US healthcare is so unique and complicated that no simple solution would work, and that if a simple solution (like copying another country’s system) would work, it would already have been done.

In one sense, of course, he’s correct.  No other country’s system can happen (as opposed to work) in the US because the US system is so corrupted by special interest monies that no such system can pass.  Likewise, every health care system is experiencing inflation faster than GDP growth.

In another sense, this is simply incorrect, since other systems cost 2/3rds what the US does and provide better care while covering everyone. The American belief that what works elsewhere won’t work in America is just BS. To use just one example, before Canada moved to single payer our per capita costs were higher than America’s. When we moved to single payer, they dropped to about 2/3rds of yours.

Yes, other country’s solutions will work. If you bother to try them rather than coming up with specious reasons why they won’t work. Very simple variations on a few themes have worked in EVERY SINGLE country that has tried them. Yet somehow the US is supposed to be this unique flower which is so different that nothing will work.

Yeah, right. American exceptionalism turned perverse. “We can’t learn from other people because we’re so unique, so we’ll just have to continue writhing hopelessly, letting people die and paying too much.”

The simple truth is that most problems aren’t that complicated.  They really, really aren’t.  There is great confusion between the words hard and complicated, as well as between easy and simple.

It’s simple to stop smoking.  Just don’t smoke anymore.  But it’s bloody hard.  It’s simple enough to get in shape—work out.  But it can be very hard.

America is fucked up in extremes that don’t apply to other nations, simply because it is the heart of the Empire, the Hegemonic Power.  It is the place which is most corrupt.  That makes things a lot harder.  But it does not mean that policy solutions which have worked elsewhere wouldn’t work in the US, it means it is hard to get those policy solutions into effect, and once in effect to protect them from regulatory capture (which, as an aside, is why single payer is superior to a Swiss style system for the US, because it is not nearly as subject to regulatory capture.)

But the fundamental point is simpler.  America and Americans are not some special, unique flower, so different from anyone else that whatever has been done in another place or time won’t work in the US or doesn’t apply to the US.

Grow the fuck up.  The belief that you are a special unique flower unlike anyone else is the illness of adolescents, which they are expected to get over by the end of their sophomore year in college, or after a couple backbreaking humiliating years in shitty jobs.

If you won’t cure yourself of this belief, the world will do so for you.  It’s been trying, with things like the financial crisis, and having your ass whipped by insurgents who don’t spent one millionth what you do on the military, but your heads are very thick.  Rest assured, however, that the world will keep trying.  And if it’s necessary to smash your heads in to get through to you, it will.

Ask the Russians about that…


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  1. CMike

    August 14, 2009
    Belgrade, Montana

    Q I was laid off in January. I am currently uninsured. My two children have Medicaid right now. And my question is, without going into too much detail, can you tell us what you — if you have kind of looked at Canada, England’s system, and sort of — can you pick and choose from those systems that work, that we see there’s some success rate and apply that to what you’re trying to push through right now?

    THE PRESIDENT: Well, let me tell you what happens in other industrialized countries. First of all, I think it’s important for everybody to understand that Americans spend $5,000 to $6,000 per person more than any other advanced nation on earth — $5,000 or $6,000 more than any other person — any other country on earth.

    Now, if you think that — how can that be?…

    So clearly we’ve got a system that isn’t as efficient as it should be because we’re not healthier than these people in these other countries.

    Having said that, most other countries have some form of single-payer system. There are differences — Canada and England have more of what’s called — what people I guess would call a socialized system, in the sense that government owns the hospitals, directly hires doctors — but there are a whole bunch of countries like the Netherlands where what they do is, it’s a single-payer system only in the sense that government pays the bill, but it’s all private folks out there — private doctors, private facilities. So there are a bunch of different ways of doing it.

    Now, what we need to do is come up with a uniquely American way of providing care. (Applause.) So I’m not in favor of a Canadian system, I’m not in favor of a British system, I’m not in a favor of a French system. That’s not what [Sen.] Max [Baucus] is working on. Every one of us, what we’ve said is, let’s find a uniquely American solution because historically here in the United States the majority of people get their health insurance on the job.

    So let’s build on that system that already exists — because for us to completely change that, it would be too disruptive. That’s where suddenly people would lose what they have and they’d have to adjust to an entirely new system. And Max and I agree that’s not the right way to go….

  2. alyosha

    That really is a pathetic form of American exceptionalism. In essence it’s saying “we’re so crippled we cannot save ourselves”, which has a lot of truth to it.

    I saw a show on Frontline, which looked at five countries’ approaches to health care. Among the many interesting points was how the Taiwanese approached the problem. They investigated a number of systems around the world, and went about crafting their own. It’s somewhat analogous to the problem recently liberated Soviet bloc countries had in coming up with a form of government, post-liberation (to my knowledge, all of them passed on the American model).

    Apparently, the Taiwanese approach of 1) surveying the many solutions that have been invented, and 2) either copy or invent something ourselves is beyond the ability of America at this point.

  3. It’s really much simpler than this, especially regarding health care. American exceptionalism is simply the admission that there is a significant segment of the American population—not necessarily anything close to the majority, but for various reasons quite politically weighty—who actually really do think that there are people who should NOT get health care. And they do NOT actually object to the Russian solution to the problem as long as they get theirs and more importantly, the rest DON’T.

    You can extend this to a large number of other issues.

  4. Jeff W

    I never viewed the American exceptionalism “argument” has anything other than Herndon Alliance messaging.

    The “too disruptive” line struck me as about as persuasive as “Because I said so.”

    It actually reminds me of psychologist Ellen Langer’s work as described in the Boston Globe:

    Langer followed this up by looking at the often meaningless factors that determine how people evaluate information. In one study, conducted with Benzion Chanowitz and Arthur Blank, she had experimenters approach people who were using a Xerox machine and ask to cut in to make copies. They found that people were more likely to let someone cut if offered a reason—but, intriguingly, it did not matter if the reason made sense. People were as receptive to a meaningless reason (“to make copies”) as a valid one (“I’m in a rush”).

    Meaningless reasons, it seems, work as well as valid ones (although one critic of that conclusion notes “…the ‘placebic’ request, in this case, was so moronically self-involved that subjects may have been motivated to grant a small favor out of pity, bemusement, or reluctance to argue with an idiot”).

  5. Actually, health care in other industrialized nations costs half to less than half of what it costs in the U.S. And these countries have better outcomes.

    As quoted by Bob Somerby, from a 2003 assessment:

    United States: $5711
    Denmark: $2743
    France: $3048
    Germany: $2983
    Italy: $2314
    Japan: $2249
    United Kingdom: $2317

    Carolyn Kay

  6. Barry

    First I want to endorse what Mandos said. A significant portion of American society is obsessed with making sure that undeserving people don’t get anything they don’t deserve.

    I worked for many years in a highly dysfunctional organization (or rather a highly functional organization with a highly dysfunctional, toxic culture). Over time what I observed was that highly-trained professionals (like architects or engineers or even inventory experts) were the least likely to survive in our organization. The more they knew there were best practices, the more likely they were to leave in disgust or to be driven out as trouble-makers. The weird thing was the organizational incumbents talking down to them (picture Homer Simpson “explaining” something to Lisa Simpson when she clearly knows he doesn’t know what he’s talking about). The professionals, with their standards and procedures, were naive, bookish, academic, not used to working in the “real world”, AND they were too rigid to understand that our organization, within our University, was very exceptional. In short, we KNEW that things couldn’t be done the right way, and THEY were stupid for thinking we should do things according to known, established best practices.

    Over time I saw the organization start to select candidates for jobs more carefully, since we had learned that highly qualified professionals didn’t work out. Thus was our exceptionalism maintained.

    Problems of institutional culture are very hard to correct. Clearly you need a new boss, but unless you are willing to sweep out as many incumbents as needed (up to 100% if necessary); unless you are willing to refuse gradualism utterly; unless you are willing to risk destroying all the routines and functions and relationships with other organizations that DO work in the process of reform; the odds of the new boss making headway are low. The people inside can’t see outside their box, and they eject people who tell them about the world outside the box. Not because they are stupid, but because they have been selected for their ability to fit in and trained and rewarded to see their blindness as a special, important kind of vision.

    This is not a problem just for Washington at this point, but all of America. Most of my friends are intelligent and politically active. Most of them believe that most American voters are too stupid to be trusted with a vote, and yet they also aren’t paying much more attention to how policies get made in Washington than their Moveon and OFA emails. Most Americans have been trained in “the art of the possible”, which means they know not to contemplate options outside the box.

    And everyone in power is rewarded or potentially rewarded for playing well the existing game, whose rules they know very well.

  7. Zach


    Ian if you think Americans are giving up their core identity, you may as well quit the Jeremiad business now.

    Whatever way forward is found, whatever portion of collapse can be staved off, mitigated, softened, or god forbid prevented — it will be done by Americans who believe to their very souls that their/our precious individualism is their/our greatest strength.

    Brits believe in a doughty stiff upper lip. Canadians believe they are funny, pragmatic, clear-sighted. Until they turn out the lights down here there is always going to be an pervasive American Dream of individual triumph over adversity.

    The fact that lots of Americans have found seemingly endless ways to exploit this self concept, ever more speedily, towards the possible doom of the Republic, is a nice tragic/ironic twist, but all achilles heels become the target eventually. You dont replace a national self-concept, any more than you convince people en masse to leave their homes for Sweden or China.

    Whatever is done or is not done, it will be done within some version of this constraint. You dont offer personal photosynthesis as a legitimate alternative to a starving man nor gills to a drowning one. Any help you propose to offer, any change to be made on a national scale — is going to have to come in the form of some extension or revision on this narrative.

    Otherwise, its just venting.

  8. Ian Welsh

    Medicare is single payer.

    End of that argument.

  9. Lex

    Hey, we’re exceptional…exceptionally stubborn, arrogant, ignorant, close-minded and venal. (not all of us, nor all the time…but on the whole what comes through is the preceding list)

  10. Zach

    Reminds me a lot of the way UK and EU viewed Obama for so long, vs the way we could see the campaign / first term from the inside. You miss the key elements, you miss the meaning of the picture. Skews the ability to predict or prescribe.

  11. Ian Welsh

    I predicted Obama’s actions far better than most Americans. American economy too. Certainly I miss some things because I’m an outsider, no question.

    But sometimes being outside is useful. It’s true that the US is opaque (because you’re nuts), but you aren’t some uniquely precious flower that no one else can understand, either. Individualism isn’t relevant, single payer could have been sold to Americans as Medicare for all, which is as American as apple pie and at various points has polled over 50%. What’s keeping America from using other people’s solutions isn’t Americans individualism, it is that American politicians are owned by monied interests, and those politicians use the language of America uber alles to cover their legislative thefts on behalf of their masters. They could just as easily sell something like single payer as an American invention if they wanted to.

    And I ain’t in the jeremiad business. Being in business means making money. I do this for free.

    And while I’ll keep saying what needs to be done, I don’t expect Americans to do any of it until they’ve had their faces stomped into the curb repeatedly by reality. Wish it wasn’t so, but I’ve wasted 6 years of my life, and I’ve learned my lesson.

  12. Lex

    The failure here, at least with specifics and to a very great degree in the general, is on the Left. Quite likely it stems from the Democratic leadership’s moving away from actual people and towards corporations…along with gulping down all that neo-liberal swill.

    But let’s give the Democratic Party the benefit of the doubt and assume that its intentions are good; that it does represent all the stuff it gussies up for campaign brochures. (That is, allow me, for a brief moment, to conflate the Democratic Party and the Left.)

    The messaging is terrible. Just fucking awful. The Party won’t stand for anything; it’s constantly shuffling around looking for approval. When it does muscle up, the action is invariably against malcontents under the Democratic tent. It doesn’t even try to convince the majority of Americans that it has answers, only wages an eternal rear guard action against the nation’s movement to the right…as if that movement couldn’t be reversed.

    It’s like nobody in the Democratic Party gets that the movement to the right is because the GOP (and its surrogates) have been winning the message battles creating movement. If the Democratic Party had someone who could rile up the base, it would shut that person down.

    This is all way off the point of exceptionalism. Ian’s right that we’re nuts, and that we’re not a precious, unique flower…but that conception of ourselves is really all we’ve got. It’s part of the mythology. It gets accentuated because the Right needs it and messages it. The Left falls victim to it too…probably because the Left spends all its time chasing the Right. The Left could promote other portions of the American mythology: progress as a result of solidarity during the labor movement or the civil rights movement. The Left could give grand speeches about how it was they who gave the nation Social Security and Medicare.

    It doesn’t. It never rallies the troops. It never pushes any issue. It (The Democratic Party) is functionally useless…a shapeless blob of malleability, cowering in fear of the scary Right and its effective tactics.

    There’s nothing exceptional in cowardice. Something which the Right has in abundance too; it just blusters better.

  13. Jeff W

    What’s keeping America from using other people’s solutions…is that American politicians are owned by monied interests, and those politicians use the language of America uber alles to cover their legislative thefts on behalf of their masters. They could just as easily sell something like single payer as an American invention if they wanted to.

    And they don’t even need to do that. In what always seemed to me to be a rhetorical slip, President Obama said in his 22 July news conference

    …we know that we’re spending, on average — we here in the United States — are spending about $6,000 more than other advanced countries where they’re just as healthy. And I’ve — I’ve said this before. If you found out that your neighbor had gotten the same car for $6,000 less, you’d want to figure out how to get that deal

    He never again hinted that we might want to find out what other countries do. It didn’t fit in with the talking points.

    Politicians could just as easily sell the eminently sensible approach (followed by Taiwan) of looking at other countries’ health care systems. Instead of playing the nonsensical “uniquely American” card, Obama could have just as easily (and more credibly) said, “We don’t have to reinvent the wheel.” They don’t and he didn’t because of, as Ian says, the moneyed interests in this country.

  14. Barry

    Lex, the Democratic Party behaves the way it does in large part because Dem voters vote the way they do. No matter what Dem voters feel and say they are “for”, at the end of the day they will vote for the Democrat and against the Republican. Meanwhile, the corporate monied interests Ian talks about can impose real punishments and rewards on Democratic politicians. If their voters don’t stand up for anything in any way that counts, how can they really expect the politicians to stand for anything?

  15. Lex

    Barry, that’s a good and fascinating point. Indeed, if the voters won’t punish the Dems but the monied interests will, then it’s clear who the party will follow. Many – i think – vote Democratic regardless out of fear…or, they vote against the Republican Party. The Democratic Party plays that fear pretty well (while working to nominate the most conservative Dems it can find), and it makes sure that Democratic voters don’t have any liberal lightening rods to look to.

    There’s also a strange, American exceptionalism that i’ve heard from Democratic voters: the belief that everything will be ok in the US because everything’s always turned out ok before.

    I wonder where the breaking point is for Democratic voters?

  16. Zach

    individualism isnt relevant

    Again with missing the point. Individualism is the entire point: you call it special-flowerism, cleanly demonstrating the miss. Of course medicare for all would work here, it would work anywhere it could be implemented.

    As you say, simple not the same as easy.

    Your point

    Grow the fuck up. The belief that you are a special unique flower unlike anyone else is the illness of adolescents

    to which I respond, oh for gods sake can you get a grip. All venting aside, please, whatever has to be done to get out of this mess, that will so not to be it. You cannot conveniently go back 200- 400 years and give the US a thousand years of monarchies and couple of on-scene mega scale land wars (Russia, Britain / EU), or long term organized colony status (Canada, Australia) or a handy crushing series of dictators (Argentina) and re-route a national consciousness, just because it happens to be nonfunctional in this crisis.

    Americans believe to their very cognitive cores that the individual can save himself, should save himself, must save himself — however much we may know we cannot, and wish fervently it could be another way.

    Something no Canadian can ever get his blessedly socialized head around. Canadians believe that saving the commons is the commons problem, not the individuals’: is, should be, can be, must be. How nice for you. Americans can only wish they could believe that.

    Youre talking about a fundamental national belief system like it was a character flaw. Fun to do, as a Canadian, but doesnt actually help. Nobody is going to abandon four hundred years of core identity, not in sizeable numbers, not in the short time frame necessary to pull out from this mess. Won’t happen, can’t happen.

    So however we fix this, its with that in mind, not pretending we can all suddenly turn Canadian or Australian or Argentine because it would be sensible.

    Medicare for all has to be framed another way, pushed hard and vehemently into another story, another narrative construct, for it to work. The one we have now has already been tidied off the table by the funded interests as ‘unamerican’. So we find something else, or fail.

    Where on earth you get the idea people are sensible, I cant imagine. Talk about wishful thinking. Americans arent. Canadians arent. Nobody is. We work with the reality you have, not the one we wish we had.

  17. madaha

    Zach –

    I believe this all DOES help – it clarifies our national cognitive dissonance. If you don’t recognize the problem, you can’t even begin to solve it. It helps to read it here, but it should be trumpeted throughout the country and written in the sky.

  18. Ian Welsh

    Again, Zach, you’d be right, if you weren’t, well, wrong. If you were right, then things like Social Security and Medicare would never have occured. Not saying Americans don’t occupy a place farther along on the individualism scale, but they are clearly capable of socialized action.

    Polls showed numbers as high as 70% of the population was for a “public option” they had no idea WTF a public option was, but they were for it because it had the word “public” in it. Perhaps the word “option” also helped, but again, single payor has polled over 50% at times.

    But, as I’ve noted before, if you’re right, that’s great. All that matters is what a man can do and what a man can’t do and if Americans /can’t/ do what is necessary (and yes, it is going to require some version of socialism, whether you sell it as that or not) then so be it.

    I just wish you weren’t on Canada’s border. And I wish we had nukes.

  19. Thank you Zach for articulating what (perhaps as a Canadian myself albeit America-dwelling) could not.

    You see, Ian, you’re operating from the wrong conceptual space when you say:

    Again, Zach, you’d be right, if you weren’t, well, wrong. If you were right, then things like Social Security and Medicare would never have occured. Not saying Americans don’t occupy a place farther along on the individualism scale, but they are clearly capable of socialized action.

    and things like “Medicare is single-payer” or whatever. It doesn’t matter so much what it actually is, but how it’s perceived to be—the political-cognitive model of the voter. And in the political-cognitive model of the mythical Average American Voter, that Medicare is single-payer doesn’t really factor into what happens at the ballot box. A model of “ballot box cognition” is what is required and in this era of mass media, that’s going to involve the tools of market research.

  20. Ian Welsh

    It doesn’t require much fanciness. I myself have said, in the past, to go for Medicare-for-all as an American made approach. I’m not talking at this blog to millions of Americans, I’m talking to about 1,000, all of whom are relatively wonky and understand the point I’m making.

    Rest assured, that if I am ever in charge of a large spread advertising campaign in the US (ie. never), it will not say “Canadians do it, so should Americans”. Because while that would be effective amongst people already convinced it will not convinced deep red types.

    But, again, I’m not talking to them, I’m talking to blue types and trying to convince certain staffers and pols who read my blog that it’s the right thing to do.

    And, y’know, I know what works with blue types and what they’re willing to hear. I have never edited a blog that did not have a significant rise in traffic while I was editor. I have never written for a group blog consistently where I was not one of the most popular bloggers. I know what sells to liberal blog reading audiences.

    However socialism can be sold to other Americans. It is not even all that damn hard, if anyone wants to try. And defeating the “made in America” thing is damn simple. You just turn it on its head, and say whatever you want to do is the American solution and made in America, whether or not you got your inspiration from another country.

    “I can’t climb that mountain” rings awfully false when no one has tried for over thirty years, and the last time people did try (Medicare and Social Security and the GI bill, and so on) they succeeded.

    Maybe the problem isn’t the “American people”, maybe it’s that those who supposedly speak for socialism (call it “making America work for everyone”) don’t even try and haven’t tried for damn near two generations. If one side of the battle quits the field, the other side wins.

    More on this in a post, when I manage to care enough to bother. That may be a while given that Americans have already decided that they “can’t”. I’ve spent 6 years explaining what needs to be done, saying specifically what will happen if it isn’t done, and then watching what I warned would happen, happen. Every blog I write for consistently for gets a traffic bump from my articles or my editing (I have the numbers, this is not opinion but fact), but every year what I can say at a-list blogs becomes more and more limited because even Blue Americans don’t want to look their clusterfuck and failures in the eyes and own them. (Yes, yes, I own my failure to save America and thus limit the blow to my own country as well. Oh well. That’s why I’m moving on to other things.)

    If being “individuals” who do things the “American way” is more important to you than not losing 40% of your standard of living, having an actual population decline and seeing your friends and family die needlessly, then to hell with you. You can’t save people who are determined to destroy themselves.

    As my friend Stirling said back in early 2002. “It’s clear that Americans are determined to ride this bucket all the way down” (to hell). Nothing I’ve seen since has made me think he’s wrong.

    God save you all, no one else can, because you won’t.

  21. Jeff W

    …they are clearly capable of socialized action

    And they are not even that much against “socialized medicine” even when it’s called that. A Harvard study in 2008 found that 49% of Americans thought “socialized medicine” (as the respondent understood that phrase) was better or about the same as what the US has now (as of 2008). And that’s with the mainstream media and political culture strongly aligned against the term.

    A political leader could easily defuse the loaded term “socialized medicine,” as Michael Moore did in his movie SiCKO with the socialized fire department, the socialized police department, the socialized highway system, the socialized Veterans Administration. That’s not to say he or she should—only that it’s arguable that he or she could, given the findings of the Harvard study.

    President Obama, instead of mouthing Herndon Alliance talking points, could have easily made the case for some sort of public or public-private health care system (or, least desirably for the US for the reason Ian gives, a tightly-regulated, private, not-for-profit system as in Switzerland). All he had to do was endlessly point to the numbers given above by Carolyn Kay and the fact that all those other countries outlaw for-profit health insurance or care for most health needs. (President Harry Truman didn’t hesitate to make that case in 1945, without the buttressing of many other working models now present or the widespread acknowledgment of the broken nature of our current health care system.) That Obama didn’t had nothing or very little to do with what Americans would accept and everything to do with corporate influence on our government and the agenda Obama was trying to push.

  22. Ian,

    If all you were doing were offering policy analysis and prescriptions, best practices and all that, I’d agree with you about 95% of the time, I suspect. That’s probably why you are able to drive traffic of like-minded people. But you also spend a lot of time hypothesizing about political mechanics, and that’s where I think your track record is not quite as good. But you seem to want to have it both ways and punt by saying “All that matters is what a man can do and what a man can’t etc”.

    If you’re going to talk about political mechanics—as in, for example, the fact that politicians you seem to like vote for bills you believe are bad—then there’s no consistent way of doing it without drilling deeper into the issue. One can either diagnose what needs to be done politically to move things forward, or decide that there’s no hope because they won’t do things in a particular way. I’m the victim of “learned helplessness” here?

    On the matter of health care, you can get all kinds of people to support things in polls, because people even in the aggregate are not very honest in polls on issues. The entire problem is that people are knowingly not voting for politicians that will give them universal health care, even though they may say they support socialized medicine or whatever.

    That’s why pollsters and market researchers make use of values inventories and other indirect mind tricks to get into the underlying mental model of the voter, rather than merely ask them what they want. They don’t pay Environics the big bucks to lie to them. The biggest reason to doubt the competence of the American single-payer movement was (some of) their mockery of Celinda Lake’s methodology and Environics’ research on the matter, using a social science technique I have seen applied to other domains as well. Kip Sullivan’s rant on the matter is just intellectually lazy.

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