Document Type


Publication Title

Louisiana Law Review

Publication Date

Spring 2010


The Article begins in Part II with a summary of the nation's failure, over nearly eight decades of trying, to create a health care system providing broad access to care. It then reviews several political and economic explanations for that failure. Next, Part II describes disparities in health and in health care in the United States as compared with other nations.

Parts III provides background information. It describes the SCHIP program and unsuccessful efforts in 2007 and 2008 to renew and expand the program. The story of these efforts illustrates the Article's central claim—that implicit class competition played a significant part in undermining efforts to create a system of universal health care coverage in the United States. Part IV links opposition to SCHIP's expansion with class competition by examining a wide set of responses—especially negative responses—to the proposed expansion of SCHEP. These responses illustrate the intensity of class competition—for both health care access and, less openly, for signs of health presumably provided by access to health care—underlying opposition to SCHIP's expansion.

Finally, Part V, again invoking the failed efforts to expand SCHIP in 2007 and 2008 as an illustration, suggests that, the nation's opposition to universal health care notwithstanding, the United States has been moving for several years toward the sort of moment referred to as a "tipping point"—and thus toward the sort of significant health care reform that became manifest in 2009. That seemed to be the case before the economic downturn of 2008 and was, ironically perhaps, even more the case after the start of the Great Recession.



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