Sabrina Parrotta and Sopana Selvachandran 

University of Chicago professor Colleen M. Grogan began last week’s talk at the School of Public Policy & Governance by recalling March 23, 2010: the day the Patient Protection and Affordable Care Act (commonly known as ‘Obamacare’) was signed into law by President Barack Obama. While this legislation represents a drastic upheaval in American health care policy, emphasizing specifically a movement towards providing universal coverage, Grogan highlighted that Obama was quick to assuage the concern of Americans that the government would be excessively intervening in health care. As Obama stated in his address: “Long after the debate fades away and the prognostication fades away and the dust settles, what will remain standing is not the government-run system some feared, or the status quo that serves the interests of the insurance industry, but a health care system that incorporates ideas from both parties — a system that works better for the American people.”

From a Canadian public policy perspective, Obama’s depiction of the Affordable Care Act as an alternative to government intervention in health care is puzzling. Why would Americans resent an expansion of health care coverage when it is clearly what the American health care system needs? Grogan’s talk answered this question through a discussion of the U.S. health care state as “hidden” and American support for what Grogran has termed “inverted” liberalism.

Grogran, who is the Chair of the Graduate Program in Health Administration and Policy at the University of Chicago and the Editor of the Journal of Health Politics, Policy and Law, explained that the health care system in the U.S. is much more public than is commonly believed. She revealed that the American government invests in the system substantially through direct funding and subsidies to private businesses as a means of bolstering private provision. Still, to the public, the health care system remains mostly hidden.

The reason for masking this reality is closely connected to what Grogan has termed “inverted liberalism.” Grogan proposed that massive support for a variety of social welfare programs throughout American political history proves that while Americans have a strong desire for public goods such as health care, they largely disapprove of government involvement.

It was evident from the questions that arose following Professor Grogan’s presentation that the audience was unsettled by the notion of hiding the fact that public funding is transferred to private companies who provide health care to American citizens. Canada and the U.S. appear to be two nations on opposite sides of the spectrum when it comes to health care financing and provision: Americans want public goods but do not want their government to provide them, while Canadians celebrate our public health care system.

Professor Grogan explained that while it is problematic that Americans are generally unaware that their tax dollars are being used to fund these initiatives, it is much more dangerous if public funding is made more transparent. Due to the traditional liberalism of American culture, it is likely that Americans would unravel and retrench the current system if they were aware of the funding realities, she argued.

Audience members eager to learn more about Grogan’s perspectives on the U.S. health care system should seek out her forthcoming book, America’s Hidden Health Care State.

Sabrina Parrotta is a 2015 Master of Public Policy candidate at the School of Public Policy and Governance. She also holds an Honours B.A. in Political Science at Brock University. Sabrina is interested in a broad array of public policy fields but is currently focusing her research on health care, social security, and immigration policy.

Sopana Selvachandran is a Master of Public Policy candidate for 2015 at the School of Public Policy and Governance. She previously achieved a Bachelor of Arts (Hons.) in Criminology from York University. Sopana has expressed a keen interest in a wide range of research including, but not limited to social, immigration, criminal justice and environmental policy.