In moments of idealistic whimsy, conservatives often pay homage to the notion of American Exceptionalism. Tennessee Governor Bill Lee thundered that his state’s students will be taught “unapologetic American Exceptionalism.” That he felt it necessary to thump his chest in defiance gives away a bit of the game. In the 2021, American Exceptionalism largely manifests in bad ways.

Across multiple dimensions of social well being, the United States stands far behind its peer nations. We are the only country experiencing an opioid epidemic, and our obesity rate is almost freakish in comparison to the healthier nations to which we ought to compare ourselves. For example, the Canadian province with the highest obesity rate has a rate of obesity equal to the American state with the lowest obesity rate. In Mississippi, 70% of adults are overweight or obese. Our dubious record on public health carried through to the COVID-19 pandemic, in which we have led the world in total deaths. We have nearly 50% more deaths than India despite India’s population being larger by a factor of greater than three.

Nothing, however, distinguishes the United States like its violence. No other industrialized country lives with a plague of gun violence like our gun-addled society. When in 2011 Anders Behring Brevik murdered 77 people, it was the deadliest event in Norwegian history since the days of World War II. America regularly has mass shootings rivaling Brevik’s atrocity in carnage. When another dozen Americans meet their deaths at the hands of a wicked man with a gun, we respond with thoughts, prayers, sad resignation, and no policy response whatsoever. If you consider gun violence a public health issue–and many scholars do–the firearm epidemic is perhaps our grimmest health problem.

This discussion of America’s lackluster health brings me to the column published this morning by John Hood. Hood, arguably the most influential writer in North Carolina, used the column to make the case–yet again–that Medicaid expansion is “still unwise.” He meanders through a number of policy arguments before reaching his predetermined conclusion, which I’ll quote at length:

“Conservatives should continue to resist expansions of our already gargantuan welfare state. And if they ever regain power in Washington, they should make it a priority this time to pursue practical reforms to reduce its deleterious effects on work, growth, and personal responsibility. That’s the only sustainable way out of this mess.”

It takes only a very dull needle to puncture the conservative bubble in which these assertions make sense. To begin, our welfare state is hardly “gargantuan”–which would be surprising indeed given the harsh Protestant ethic we impose upon the poor but not upon the rich. In reality, the United States spends less than the OECD average on public social spending. We offer nothing in the way of family policy, no childcare, no paid leave, and no permanent child allowance. The only reason our social spending even reaches its anemic level is that healthcare is far more expensive in the U.S. than in any other developed nation.

If our welfare state is not bloated, nor does its meagerness encourage work. The country with the highest labor-force participation rate in the world is Sweden with its immense social spending and cradle-to-grave social supports. Despite our obsession with work, we have a labor-force participation that is below the developed-country average. Yes: we provide a weak safety net yet don’t manage to empower workers to earn a decent living. Part of this owes to our meager welfare state; our female workforce participation is absolutely abysmal, because women are still expected to be primary caregivers and our public policies do almost nothing to support working mothers.

For all that, Hood represents the consensus Republican view of health-insurance policy. Here again it is unique to America, and unique in its cruelty and callousness. To Republicans, healthcare is a consumer purchase just like another that must be earned in the market. If a man dies because he cannot afford a $50 insulin injection (and this did happen), that’s not enough to dislodge right-wing conviction.. Nowhere else in the world does a major party view freedom from pain as a market privilege rather than as decency and justice.

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