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Yes, the American healthcare system has many flaws. But, between 85 and 90 per cent of all Americans are reasonably happy with their own healthcare situation. That percentage, by the way, is high enough to include a large number of uninsured people, people who are uninsured by choice.

It seems from Mr Sinha’s article that it was intended for a non-American audience. That being the case, I’ll make a few observations about Americans that may not be either widely known or widely shared outside the US.

The first of these observations is that for most of the four centuries since Europeans first started coming to this continent in significant numbers, the evolving culture was very much one of self-reliance. It had to be. The continent is huge and to this day is, on average, sparsely populated. Add to that the effective anarchy that existed in much of the American West as recently as only a little over a century ago, and you end up with continuing the strong tradition, in much of the country, of self-reliance.

The result is that there are effectively two Americas — the urban areas of high population density occupying only a very small fraction of the country, and the low density rural areas. The characteristics of people from these two areas are very different.

I moved to the US from Germany in 1959 when I was a young man, and since then have lived in both rural and urban environments.

The problem with the various healthcare reform proposals being offered is that they appeal, for the most part, only to urban America. Rural America, where the traditions of self reliance and personal responsibility are still strong, is, for the most part, averse to any proposal not in keeping with those characteristics. It is not even slightly interested in being forced to pay the medical bills of strangers in distant cities. Urban Americans see this as uncaring; rural Americans have no small measure of contempt for those they perceive as incapable of taking care of themselves.

The US is a large, diverse, country. No “one size fits all” solution to any problem will satisfy everyone. And, as far as I’m concerned, it’s foolish even to try. The diverse character of the country was apparent even in the late 18th century when the US Constitution was written. The authors of that document tried hard to make sure that the country’s diversity would be reflected in its system of laws. To the extent that, over the years, the various American states have lost power to the federal government (or had that power usurped, depending on your point of view), the diversity of the American people is no longer reflected by the diversity of American law.
Had the country evolved the way its founders had intended, there would not, I think, be any national debate at all over healthcare. Each state would make arrangements according to the characteristics of those who live there.

Henry Miller
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