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    SATISFACTION In all 4 nations, citizens record high (though not unreserved or uncritical) satisfaction with their health care systems online auto insurance reviews. No one views national health insurance as a big mistake and wants to start over. The vices of the US system—40 million uninsured people, an additional (and sizable) number with inadequate coverage, wide disparities in access and quality—are thought to overwhelm such modest and distinctive virtues as more extensive integration of services and more advanced analytic capacity. The foreign systems’ costs are routinely and rhetorically said to be in “crisis.” The systems themselves are not. American public opinion voices no small dissatisfaction with the US system and considerable support for major, even fundamental, changes in it.

    Despite years of intense opinion polling, policymakers remain unsure precisely what people are upset about (beyond the impossibility of enjoying ready access to fine care at minimal cost) and what they think would work better. Nor is this so odd after all: the same political leaders who quietly pushed arcane payment reforms in public programs have generally declined to launch searching public discussions of the big and touchy redistributive and regulatory issues and tradeoffs on which health reform turns. Bill Clinton’s unavailing and politically painful effort to break the pattern reaffirmed it instead. A perplexed public has therefore come to view health care reform as something like shopping for shoes: “We think we are in the mood to buy a health care reform today but not style or fit, so keep showing us others.” The technical opacity of the debate, not to mention continuing skepticism of anything “made in Washington,” inhibit grassroots mobilization, citizen education, and other key concomitants of vigorous pluralist politics.

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