US healthcare and the Affordable Care Act: why the US does not have a UK-style National Health Service

  • Jacque Clinton


In 2010, the United States Congress was entangled in a debate over healthcare reform that divided the nation. Some supporters of healthcare reform questioned why the US failed to emulate the United Kingdom with a National Health Service (NHS) characterized by universal coverage. This paper explores the evolution of healthcare systems in the US and the UK in the first half of the twentieth century to demonstrate the importance of historical institutionalism and path dependency in shaping their present systems. Drawing upon historical analyses of the US and UK systems, this paper then seeks to analyse the passage of the 2010 Affordable Care Act (ACA) under the Obama administration. While the overall ramifications of the ACA remain uncertain, its passage marks a critical moment in the development of the US healthcare system, diverging from a history of failed reforms.


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