A less cynical framing is that the US is a much different culture from European countries, and is massively larger in scale. Depending on the problem, some of their solutions simply can't or don't apply.
The scale argument is thrown around a lot as a justification for why the US couldn't possibly implement universal healthcare. The elephant in the room that I'm always surprises at how rarely it's mentioned in these discussions is Brazil, which is a huge country of comparable size (both territory and population wise), and it manages to make UHC work even though it's also a much poorer country.
It's not perfect by any means, but it's definitely much better than nothing. So the US should absolutely be able to at the very least match that, but really most likely it should be able to do much better. That it doesn't is very much a choice.
The elephant in the room is that in every other sphere, scale is the solution, not the problem. The US should find it easier to implement UHC just because of its scale. More tax dollars, more average outcomes, more resources for outliers, more incremental money for research into rarer conditions. That 10x smaller countries like Canada do it effectively is an indictment of America's inability to do it.
America doesn’t do it for political and cultural reasons. It has absolutely nothing to do with scale, economics, or America’s “inability” to do it. Americans (unfortunately imo) have consistently chosen not to do it by not electing politicians who have pledged to do it.
> I think the US would prefer a UHC if we were starting from a blank slate. The difficulty is mapping a path from what we have now to that.
Do you remember when Republicans went on and on about how "Democrats rammed through the ACA without a single Republican vote"? As if that represented a problem on the Democratic Party side, and not the Republican one? Despite the similarities to models proposed by Republicans in the past, and the relative conservative step it represented from "Byzantine kludge of often poor-to-no-coverage" to "something with a higher floor"? That's how hard it would be to find a Republican to "prefer a UHC if we were starting from a blank slate."
It's important not to underestimate the distrust of government services and regulation of any sort of the Republican base. The conservative media - talk-radio, then cable, then social/podcasts - has been intentionally undermining the credibility of government services at every opportunity for 40 years. And the politicians hamstring and sabotage whenever they get a chance to try to make sure that services offered in the US are sub-par compared to elsewhere.
It's a well-oiled machine running a cycle that keeps people focused on anything else but the services they actually use all the time so that cognitive dissonance can't creep in. (Granted, sometimes, when necessary to acknowledge those things, they'll fall back to making it clear that YOU earned/paid for the things you use, but those other gross poor people are just freeloaders.)
It's like with abortion - for decades "overturning Roe V Wade" was what Republicans said they wanted to do. And people kept trying to convince themselves "oh they don't really mean that, they wouldn't do that actually anymore." Take their word on it about wanting to tear down government services.
> It's important not to underestimate the distrust of government services and regulation of any sort of the Republican base. The conservative media - talk-radio, then cable, then social/podcasts - has been intentionally undermining the credibility of government services at every opportunity for 40 years. And the politicians hamstring and sabotage whenever they get a chance to try to make sure that services offered in the US are sub-par compared to elsewhere.
This is partly what I was getting at when I said the culture of the US is different and the scale is much larger than European countries. It's not just geographically larger, but it's politically and ideologically broader too. If you have a wonderful idea like UHC, you need to make it work with liberals, conservatives, and everyone in between. Like it or not, a universal healthcare or Medicare for all plan is either going to be DoA in Congress, or a considerably watered-down and Americanized version if it has any hope at all of getting enough senators to pass it without first seeing massive electoral college reform in this country first.
That is the scale of the US. You can't assume that an idea that's well-liked and popular in another country is going to be popular and well-liked here.
Considering that Europe is composed of many countries with massively different histories, cultures, economies and languages I find that a very unconvincing argument. The US are much more culturualy homogeneous than Europe. I mean just go across the country and look at the patriotic displays of flags which also transcends political differences. In contrast in Europe you first would be seeing different flags, but also displaying flags has very different acceptance rates in different countries.
Right, but we're not talking about "Europe", we're talking about each individual country. I don't think it's reasonable to say that France, for example, is more culturally diverse than the US.
And the various countries in Europe do have different healthcare systems, sometimes significantly different.
> The difficulty is mapping a path from what we have now to that.
It's difficult, but not as difficult as it's often presented to be, as long as you're okay with giving the finger to a relatively small number of wealthy health industry executives.
That depends on who "you" is. Quite a few people in Congress are ok with doing that, but not anywhere near enough to get anything passed. Look at the GOP side of the aisle and you'll essentially find no one willing to do that. Not to mention they are just simply ideologically opposed to the concept of government-provided universal health care.
And that, is the difficulty. Sure, I agree that it wouldn't be too logistically difficult to implement universal healthcare in the US. But that doesn't matter when more than half the country has been propaganda'd into not even wanting it in the first place.
Hell, I expect that there are a ton of Medicaid and Medicare recipients in the US who would tell you that they think government-provided, single-payer healthcare is a bad idea, when that's essentially what they have, to some degree.
I got a Master's Degree in Education and spent 2 years in Educational Psychology Ph.D. program and absolutely 0 time was spent looking at how other countries do education.
It's baffling how despite numerous other countries outperforming the US in educational outcomes we do not even look at other approaches!
Yes, in the Netherlands we have a culture of moaning about everthing. Youd beter not dare suggest sonething is good enough! This complaining is the only thing we are proud of. lol
(If we had patriotic songs worth remembering im sure i would have)
The problem is this, hoe do you fix something you are proud of? It seems a contradiction?
Agreed, I lives in the Netherlands for a couple years and can agree there isn't much patriotism so much as pragmatism! (I actually mean that as a good thing, I was a very fond of NL and the friends I made there).
Speaking as an American, though, I can both be proud of something and recognize its faults. I'm proud of the core principles that America was based upon, for example, but very much recognize how far we've deviated from them and how much we need to fix.
> I'm proud of the core principles that America was based upon
I think there's never much to gain in being proud of things you have nothing to do with or control over. If you like some principles you would be proud when you uphold them personally. It is when we start feeling proud in the abstract that we start having issues.
Can't help but agree. I would go even further and say that pride itself is problematic. Sure, it can perhaps have some good effects, but pride usually blinds people to faults, even if the do acknowledge there are faults.
"Pride goeth before a fall" is a time-worn saying for good reason.
I'm not a big fan of patriotism in general, but something I noticed about the US patriotism is the tendency to call the US "the best country in the world". This crosses all political differences, e.g. I recall being surprised how Michael Moore was saying it in an interview or movie (when justifying criticising policy, he said he does it because he knows that America is the best country in the world). Even the most patriotic friends I have in other countries would typically not say this.
Yeah, as an American I've always found this cringe-worthy, even kinda icky.
Claiming to be the best (at anything) is just tacky and arrogant. Especially with something as impossible to quantify as "best country". There's no such thing as the best country in the world. Every one has strengths and weaknesses, and you can't really balance and rank them.
What does leftist mean in this context? Sure you could say the "nationalist" movements against monarchies and for more democratic processes were progressive at the time, i.e. they wanted to change the status quo. Calling them leftist in the modern sense (again with a huge caveat about what leftist even mean), doesn't make much sense IMO. Also it's important not to forget that the internationalist movements (which I'd argue fit modern definitions of "left" much more closely) developed quite quickly (in historical timeframes) after, e.g. it was only 50 odd years between the Warburg festival in Germany (generally considered the birth of German nationalism) and the Paris commune.
I guess "the best" is doing a lot of work there, for example the most sung anthem for Denmark "Der er et yndigt land" - there is a lovely land does not explicitly say that Denmark is the best ever, there may indeed be other lovely lands, and in comparison with say America the Beautiful it is downright humble, but on the other hand it is my experience that anthems talk up their country, and if they are talking up their struggle for independence or freedom, like say Il Canto degli Italiani, it will be talking up the martial valor of the people so freed and probably talking about how they aren't going to be put down again, another aspect that America the Beautiful goes into.
The difference between America the Beautiful and other anthems is how much it does, for how long, and making sure it gets everything it can possibly cram in there. It's like a bunch of people standing on a stand at a sporting match shouting "America, America, America" unremittingly, whereas most people might be satisfied to shout "Go {my country}" and be done with it.
Which part here exactly cannot work in the US? I am talking about brushing one's teeth with toothpaste containing fluoride, which sounds as plain simple as possible to me. Is it regular brushing teeth that fails in the US for cultural reasons? Fluoride in the toothpaste? Supervising kids while brushing their teeth to make sure they do not swallow? It is an honest question.
In a word: poverty. People do not have free dental care, and poor people aren't guaranteed to have a toothbrush, toothpaste or sometimes even a sink to brush their teeth in. Fluoridated water is one of the few dental protections available to everyone regardless of their income. It's cheap, minimal and cost-effective cavity protection at scale for the entire country.
> poor people aren't guaranteed to have a toothbrush, toothpaste
There is no person in the world who cannot have a toothbrush and toothpaste if they want to. And if you find one such person, they won't have access to any centrally treated water.
Assuming the "less cynical explanation" you're referring to was my original response talking about the cultural and scale differences between America and most countries, that was not in reference to fluoride or dental care. I was specifically referring to the OP's assertion that "American exceptionalism" is the reason that America doesn't just copy things like universal healthcare and gun control policies from other countries.
I'm not sure what you're getting at here, I think we may have lost the plot. Are you simply implying that you find the cynical answer more appealing and believable than the non-cynical answer? In my opinion, the internet and today's modern zeitgeist has instilled a sense in everyone that if it's cynical, or dark, or depressing, it must be the correct answer. That's usually the laziest and easiest answer too.
The other weird thing in US discourse about other countries is that when it does enter the conversation, the "rest of the world", or at least other developed countries, are often treated as some kind of monolithic entity culturally and politically. For example, a lot of people on both left and right in US believe that the rest of the world is single payer, and generally that "single payer" is synonymous to "public healthcare". Similarly with gun control, there's no recognition of the fact that there are countries in Europe where you can own an AR-15 just fine, and countries (different ones!) where silencers are over the counter items not requiring any special registration.
edit: But I will say it works both ways. Most countries do not know what it takes to keep hundreds of millions of people of various backgrounds together under a common way of life with a certain risk vs entitlement balance. Americans as a whole are more risk tolerant AND accepting of failure and reinventing yourself. In most cultures it's a great shame to quit your job with benefits, start a business and not succeed. In the states it's not shameful. You tried? Awesome.
Yes, that's my point. We are literally different people with different cultures, values and problems. Case in point: the firearm control you mentioned. I won't get in a gun control debate here, I have my own complicated views on the matter, but it's an undisputed fact that Americans have a right to own guns (maybe with limitations, maybe not) and many Americans deeply cherish that right. There is no gun control solution we can take from Europe that you could apply to the US, it's simply not compatible with our culture, not to mention our own Bill of Rights. It's not a bad thing to recognize that.
A lot of people are uncomfortable having an opinion without being able to rationalize it.
I have to assume many, maybe most, people that give reasons like you mention just flat out don't want the policy and reach for a reason to justify it.
I can say I don't want gun control laws. Not because it doesn't work elsewhere or couldn't work here. I just fundamentally disagree with it and don't want to live in a place where the only ones with guns are state officials.
The US isn't several countries put together, region by region. It's one big ass country. I really don't see how taking it region by region somehow eliminates scale issues when you still have to apply it to the entire country.
It's a federal country of many states though. The original design of the US is fairly similar to the design of the EU today, US states used to be offered much more independence.
Sure, I don't disagree that in a vague sense the EU and US are kinda similar in terms of countries and states.
> US states used to be offered much more independence.
But even in your own example with the EU, the EU still mandates many health policies for its member countries: food safety; air and water quality; tobacco, sugar and alcohol regulations; and so on. That's not at all dissimilar to what the federal government does in the US, except our states don't implement those policies/directives themselves because the feds enforce it all.
The comment I was replying to pointed out that the US isn't several countries put together. As you describe, the EU is several countries put together and yet the US actually pushes more power to the states.
> yet the US actually pushes more power to the states.
Doesn’t their comment claim the opposite?
Unlike the US Federal government EU has very limited direct means of imposing any if its laws or regulations on member states of they chose not to comply with them.
There shouldn't be a scale issue with regards to fluoride in the water. It is either scientifically shown to be beneficial or it isn't, scale and geography likely have nothing to do with it.
Does it not depend on the chemical composition of local water? The US is vast, geologically diverse, and water quality varies hugely across it. Denmark can likely make a decision that's good for the entire country.
Actually, what most countries seem to do (according to other comments I’ve seen here), is just delegate to local bodies, so country size is a complete non-issue.
You're not wrong in that our culture is different, but that cultural difference is chiefly a self fulfilling prophecy of "the government can't do it," promoted by billionaire owned media, so that those same billionaires can run for-profit industries like healthcare and transportation.
The cultural difference is that our rich people are too rich, our media is too centralized, and none of those in power want to enrich and empower the country, when they could enrich and empower themselves.
This is the excuse all American use about literally every single issue anytime anybody points out that other do things better. Most often without actually having thought about it beyond 'muhuhu US BIGGG! USA! USA! USA!'.
If you want to make that argument, actually make it, because if you try, 99% of the time its not actually true, its simply ignorance.
The point is that flouride has the same effect on your teeth no matter how many hectares of lifeless desert happen to be controlled by your government.
Interesting, though I think you may have missed a good deal of my own point. Regardless, I wasn't actually commenting on the fluoride situation, I was commenting on the belief that American exceptionalism is the reason we don't look at Europe and other countries for a slew of solutions that won't work here. It had nothing to do with fluoride, so I think your comment and hostility are a bit off the mark.
My point is that those that continually point out 'but some things don't apply to the US because X and Y' are mostly themselves just falling into the same trap and almost never actually explain why X and Y change anything, making their 'defense' just more of the same.
I feel like this always comes up in these sorts of arguments, that the US is so unique that solutions that work elsewhere can't work here. And yet this point is always hand-waved in, without and specifics discussed, and is just presented as a given.
I really don't buy it, at least not as a general statement.
If you focus only on the scale part of my argument, sure. But I think the culture part of my argument is more than enough of an answer for insurance and healthcare:
Maybe it's just me, but I find the argument that "Americans won't do X cool thing that Europeans/the rest of the world do because they [are dumb/are corrupt/love money/hate each other/believe in American exceptionalism]" to be a very cynical and lazy argument. Note that the person I was replying to was talking about policies and goals like UHC and High Speed Rail, not specifically about fluoridated water – that was the context in which I was replying.
The simply reality is, culture matters. And if your culture has a strong believe in exceptionalism pointing out how others are better at something often creates backlash and an increase in opposition rather then a decrease.
And this is known by people who do professional advocacy work, on topic I am familiarly with, such as city design and transportation. They take great care to make sure all the examples are from the US, even if those examples aren't nearly as good as others. Because they know, when speaking to American audiences, you lose the audience if you suggest in X town, they should do Y that is done in Europe. In the US selling something as domestic innovation is usually the best, "if people in Indiana can do it, you can do it even better".
To just ignore any explanation that points out that culture matters, and believing that only 'hard' factors matter, is incredibly foolish. Cultural believes, such as exceptionalism absolutely do a play a huge role in determining what happens in the real world. To point that out, is not cynical or lazy.
And this does not just apply to the US, it many countries have different forms of that.
