Return to Deadlock? Health-Care Reform in America

Paul Starr

(University of Princeton)

8th February 2010

After nearly a century of failure, the struggle for universal health care in the United States seemed to be on the verge of a breakthrough in December after the Senate and House of Representatives passed separate, though similar, bills that would extend coverage to a projected 95 percent of the population. But the loss of a by-election in Massachusetts in January has probably killed the chances of significant reform. That reform came so close to enactment in 2010—as it did at several earlier times—reaffirms the view that the absence of universal health care in America is not due to deep cultural or structural factors, but to contingent political decisions and the specific developmental path of American institutions. Yet if reform is dead in 2010, it will probably be very dead for a very long time, with the result that inequalities in health care are likely to increase to even higher levels than at present.