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Among the 19 rich democracies I have studied for the past 40 years, the United States is odd-man-out in its health-care spending, organization, and results. The Obama administration might therefore find lessons from abroad helpful as it moves toward national health insurance. In the past hundred years, with the exception of the U.S., the currently rich democracies have all converged in the broad outlines of health care. They all developed central control of budgets with financing from compulsory individual and employer contributions and/or government revenues. All have permitted the insured to supplement government services with additional care, privately purchased. All, including the United States, have rationed health care. All have experienced a growth in doctor density and the ratio of specialists to primary-care personnel. All evidence a trend toward public funding. Our deviance consists of no national health insurance, a huge private sector, a very high ratio of specialists to primary-care physicians and nurses, and a uniquely expensive (non)system with a poor cost-benefit ratio. The cure: increase the public share to more than 65% from its present level of 45%. In regards to funding the transition cost and the permanent cost of guaranteed universal coverage: no rich democracy has funded national health insurance without relying on mass taxes, especially payroll and consumption taxes. Whatever we do to begin, broad-based taxes will be the outcome. Three explanations of "why no national health insurance in the U.S.?" are examined.

Among the 19 rich democracies I have studied for the past 40 years, the United States is odd-man-out in its health-care spending, organization, and results. The Obama administration might therefore find lessons from abroad helpful as it moves toward national health insurance. In the past hundred years, with the exception of the U.S., the currently rich democracies have all converged in the broad outlines of health care. They all developed central control of budgets with financing from compulsory individual and employer contributions and/or government revenues. All have permitted the insured to supplement government services with additional care, privately purchased. All, including the United States, have rationed health care. All have experienced a growth in doctor density and the ratio of specialists to primary-care personnel. All evidence a trend toward public funding. Our deviance consists of no national health insurance, a huge private sector, a very high ratio of specialists to primary-care physicians and nurses, and a uniquely expensive (non)system with a poor cost-benefit ratio. The cure: increase the public share to more than 65% from its present level of 45%. In regards to funding the transition cost and the permanent cost of guaranteed universal coverage: no rich democracy has funded national health insurance without relying on mass taxes, especially payroll and consumption taxes. Whatever we do to begin, broad-based taxes will be the outcome. Three explanations of "why no national health insurance in the U.S.?" are examined.

Drawing on research analyzing similarities and differences among 19 rich democracies, this article compares the economic performance of big spenders and lean spenders at a similar economic level from 1950 to the late 1990s. Going beyond aggregate public spending, it shows the contrasting effects of particular types of spending and taxing and particular social policies. I highlight the extraordinary continuity of the contrasting institutions and policy directions of these countries. I find that there is not one road to good economic performance, but several. I specify five types of political economy, each with its own costs and gains in people's well-being, both economic and noneconomic. A final summary compares extremes: the confrontational "low road" pursued by the USA and the "high road" pursued by the strongest consensual democracies of Continental Europe, where social partners have negotiated real reforms in expensive social policies while preserving social cohesion.

Although America leads the world in conducting social scientific evaluations of public policies, in the end, social science contributes less to policymaking here than it does in most of Western Europe and Japan. Instead, our research has little bearing on whether a government program lives or dies. Intellectuals typically have tense relationships with men and women of power, but the disconnect between research and policy is most extreme in the United States.

The theory of postindustrial society and postmaterialist culture can explain neither the structural uniformities of modern society captured by convergence theory nor the national differences captured by theories of democratic corporatism and the mass society. Its depiction of structural changes is superficial: the service sector is too heterogeneous to describe occupational and industrial trends; the idea of technocratic dominance is overblown and misses big national differences in the location and role of experts and intellectuals. As for postindustrial values, they apply to a small population, a minority even of college students. That these attitudes fluctuate so much with shifting economic conditions and political agendas casts doubt on the idea of a basic shift toward 'postmaterial values'. The literature documenting such shifts is plagued with problems of survey validity. It goes up against a heavy weight of evidence showing that older issues of security, equality, civic order and crime, economic growth and stability are dominant in the politics and mentality of modern populations; that cohort effects are weak to non-existent; that political generational effects are rare and soon fade away; that family life cycle, if carefully delineated, has an impact across a wide range of attitudes and behavior. Most important, differences in national mobilizing structures shape both mass and elite responses to the dilemmas and problems of modern life. Assessing related images of modern society - 'the information age', the 'high-tech society' - the paper finds these equally misleading. This paper is based on chs. 1 and 4 of H.L. Wilensky, Rich Democracies: Political Economy, Public Policy, and Performance (University of California Press, 2002).

L'auteur a voulu vérifier s'il existe effectivement un lien entre l'" homme de l'organisation " et vine culture extéro-déterminée, concepts que Whyte et Reisman, respectivement, ont rendu populaires. À cette fin, il a choisi trois groupes de professionnels (ingénieurs, avocats et professeurs d'université) qui travaillent dans des entreprises choisies selon qu'elles représentent, de façon décroissante, les caractéristiques de la grande entreprise. Les résultats prouvent qu'il y a correspondance entre le style de vie et le type d'entreprise, un faible niveau de professionnalisme favorisant cette relation. Mais l'homme de l'organisation n'est pas seulement, comme on l'a décrit, un être conformiste, superficiellement attaché à son travail, aux gens et aux idées ; il est aussi un homme qui ne prend aucun risque, ni avec son chef ni avec son Dieu ni avec sa nation. Toutefois, si l'homme extéro-déterminé ne s'est développé qu'en milieu propice et chez une minorité, cette minorité est importante. Son avenir dépend donc des formes que prendront les structures de l'entreprise et des tendances à la professionnalisation. Les structures hiérarchiques centralisées où les postes sont hautement réglementés favoriseront son eclosión, mais la professionnalisation l'atténuera.