First Advisor

Mark S. Kaplan

Date of Publication

Summer 7-30-2014

Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Public Affairs and Policy


Public Affairs and Policy




Health care reform -- United States, National health insurance -- United States, National health insurance -- Europe, National health insurance -- Canada, Social values -- United States, Medical policy -- Economic aspects -- United States



Physical Description

1 online resource (ix, 201 pages)


A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.


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Persistent Identifier

Included in

Health Policy Commons