American Exceptionalism and American Health Care : Implications for the US Debate on Cost-Effectiveness Analysis

The term, “American exceptionalism” coined by the French historian Alexis de Tocqueville during a trip to the still young United States in 1835, refers to the idea that the US is different from other developed nations because of its unique origins, evolution, and institutions. Briefly stated and somewhat oversimplified, the idea is that Americans are characterized by their optimism, their religiosity and, above all, their predilection for personal and economic freedoms. The concept of American exceptionalism has been debated extensively in the academic literature – whether there indeed exists such a thing and, if so, whether it is good or bad for the US and the world. The purpose of this paper is to explore the debate over the use of cost-effectiveness analysis in the American health care system through the lens of American exceptionalism