THE COMPETITION VOGUE AND ITS OUTCOMES

Social security and comprehensive health care financing were developed to protect all citizens and to redistribute money to cover costs. Their inspiration was social solidarity rather than pecuniary self-interest. The United States differed from other countries by continuing a private market in health, with many self-centred and competing providers and insurers; and its prevailing school of health economics deplored the national heath insurance and national health services that were universal in other countries and recommended devices that would eliminate ''market failure'' in health. When health economics grew in Europe during the 1970s and 1980s, the reformers' first presumption was that the voluminous American market-oriented literature must offer answers; but much of it proved superfluous, since European health care systems still had much competition and consumer choice, and they worked better than the reality in the United States. The United States itself has paid a heavy price for turning over health financing policy to the devotees of microeconomics and free markets, and today its serious problems in health are unsolved.So powerful is the pro-competitive ideology that it has now been adopted by the Democratic Clinton Administration, contradicting the heritage of Roosevelt, Truman, and Johnson.