This article examines possible reasons based on public choice, voting, and constitutional theory to explain why the United States does not have universal health insurance. It is argued that, compared to countries that have adopted such institutional structures, the current high levels of medical insurance costs and the high proportion of the population insured in the United States help to explain why closing the gap in coverage has not occurred. An interest group model is used to explain why the political equilibrium appears to remain the status quo.
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