The not quite united States

The operative noun in the name of the country is "States." The adjective describes them as united, but there's been tension from the beginning.
The states existed before the union. Over the years their number has gone from 13 to 50, and they have become more united, but not entirely.
Also important in understand the big country is the individualism in its culture, and the prominence of race in its history..
Major steps in the direction away from states rights and toward centralization occurred with the creation of the FDA in the administration of the first Roosevelt. There was an even greater leap under the heading of New Deal in the administration of the second Roosevelt, another uptick with Lyndon Johnson's War on Poverty, then a more gradual continuation of the regulatory state headquartered in Washington, with periodic campaigns to "deregulate." Now that theme is at high volume with Donald Trump cheering himself.
That there is still a lot of life left in the states should be apparent to anyone looking at two fields of public policy that affect a lot of Americans.
Higher education touches all who see it as the road to a good life for themselves and their kids. Most of it comes from state institutions.
Health policies also affect Americans.
And in both health and higher education, what's available and how much it costs reflects not only the federalism that remains important (if less important than in 1789), but also the individualism that has been hardly less important in shaping the culture, politics, and public policies of the United States.
Don't tread on me
and other expressions of "me first" have been with Americans since before there was a United States.
The revolution against Britain emphasized the issue of taxation that continues to be a theme in national, state, and local politics.
Americans claim to be overtaxed, even while they score lower than other western democracies on the most comprehensive measure of taxation as a proportion of national resources. At 26 percent of GDP, the United States scores below all countries of Western Europe.
That measure of tax burden comes from before Donald Trump's effort to reduce Americans' burdens even more.
The developed country whose overall taxes are closest to those of the US is Ireland at 30.8 percent of GDP. Prominent non-European democracies tax at overall rates of 34.3 percent (Australia), 34.5 percent (New Zealand),35.9 percent (Japan), 36.8 percent (Israel), and 39.8 percent (Canada). Scandinavians tax themselves most heavily, with Norway, Finland, Sweden, and Denmark above 50 percent of GDP.
Indications of the individualism also appear in the political importance of choice and private health insurance, the continued roles of private colleges and universities, and the high costs of both higher education and individual health care in the United States compared to other western democracies.
The United States is a leader in expenditures for health care at 17 percent of GDP, while the overall figure for the Euro Zone is 10 percent, and for Israel it's 8 percent.
Results are not in keeping with expenditures.
Overall health measures of longevity and infant mortality show the US with significantly poorer scores than advanced countries that spend much less of their resources on health.
The US most recently scored #31 among countries in longevity. And by some reports the life expectancy of its people is getting shorter. It scored #56 on a recent measure of infant mortality (deaths within one year per 1,000 live births).
In contrast, the US scored #11 on a conventional measure of economic resources (GDP per capita).
Among the explanations for poor health scores are American individualism, with high spending going disproportionately for the care of the well-off, who can afford the best insurance and get their care in up-scale hospitals and clinics.
The tuition and fees charged by private colleges and universities are off the charts when compared to students' costs where national governments invest more in higher education. The prices at the most elite US campuses may be worth something in terms of contacts with the offspring of other elites, which may pay off in their later opportunities. However, those contacts are less likely at high cost private colleges below the top tier. And the teaching at elite schools is not demonstrably better than at state campuses of lesser prestige and much lower cost.
Private colleges boast small classes. However, that means that students spend much of their time listening to other students. Those in state institutions, with larger classes, are likely to learn more from their instructors.
Recent efforts by the US national government to bring higher education and health care into greater conformity--with respect to costs and quality--as other countries have not fared well.
The Affordable Care Act (Obamacare) entailed some 2,200 pages, and was a caricature of various interests loading their detailed preferences via supporters in Congress. More recently, Trump and other Americans asserting increased costs or excessive regulation have sought to undo the entire measure or some of its features, and currently are quarreling as to how successful they have been. Whatever the outcomes, they are not likely to approach the greater clarity and simplicity of single payer systems that prevail elsewhere among western democracies.
There's also been an uptick in national government involvement in procedures that colleges employ in deciding on financial aid, including opportunities for students to finance their education by loans.
It's debatable if the reforms make higher education more affordable for more students, or simply pass on high costs to years of paying off debts that amount to the equivalent of a house mortgage for each former student.
Among the impacts of individualism on higher education are provisions that prevent the forced retirement of aged faculty.
It's not clear what legislation against ageism has produced by way of improved service for students, instructors who carry on beyond when they should, and the clogging of pipelines that limit opportunities for younger, more up-to-date and lively instructors.
Another feature of American higher education reflecting the prominence of individual free enterprise is the growth of profit-making "universities."
They make it easy to gain acceptance and to arrange student loans, but have a high incidence of dropping out, with clients left with debt but no degree. Some have been accused of misleading and more serious frauds, with the failed Trump University getting more attention than others.
Race also been with the United States since before its beginning.
It began with greater reliance on slavery than other countries that became western democracies, continues with a significant underclass that is largely defined by race, and likely to be outside the networks providing decent health care and education (higher and otherwise).
Other developed countries may be heterogeneous by virtue of migrations, but none has a large group of racially defined individuals with rates of births to single mothers, drug use, crime, violence, and incarceration that approach those of African Americans
Race also affected the weight of American federalism, created in part to distinguish states with greater and lesser slave populations. The Civil War, the failure of Reconstruction and the success of Jim Crowe continued the process, ameliorated only partly by actions toward civil rights and affirmative action from the 1960s onward.
Race arguably adds to the weight of American individualism, via the disinclination of White Americans to pay taxes in order to support social services for the less fortunate, the flight of Whites from public schools as a result of integration, as well as the preference of many Americans for private health insurance as opposed to a single payer underwriting a basic program for all citizens.
There are positive features of the United States, associated with its wealth, the size of its population, the policy choices available to state and local authorities, and opportunities for the talented, ambitious, and otherwise fortunate to do well. But more than in other countries, those traits come along with opportunities to ignore those not favored.
Comments welcome
Ira Sharkansky (Emeritus)
Department of Political Science
Hebrew University of Jerusalem