ABSTRACT
This contribution takes a comparative perspective of health care reforms in the United States (US) and Western Europe in the broader context of the welfare state changes of the last quarter of the twentieth century. The widespread claim that the modern welfare states and health care had become unaffordable and ungovernable fuelled a movement of ideas across borders that met, we argue, with too little evaluative scrutiny. We summarise key features of health care in the US and Europe and discuss the main elements of the 2010 health care legislation enacted by the Obama administration. We next turn to two central questions: is the US health domain ‘unique’ – and if so, is that uniqueness related to US federalism? While federal states have formal delegation of fiscal and social policy making to regional levels of government based on constitutional division of powers, there are tensions between central governments and regional and local authorities over health policy decisions everywhere. Our brief answer to the first question is yes, to some extent, and to the second one, no.
