How individualism shapes the US healthcare debate

Of all the activities I expected to be engaged in Saturday night, finding myself at a bar in Switzerland vociferously defending the right to name a child Adolf Hitler was not one of them. But as it happens, this curious discussion about European naming regulations gave way to a very interesting conversation about the healthcare hullabaloo in the US – a debate that has perplexed Europeans over the past eight months.

The two very different attitudes in the conversation about whether the government should get involved in the naming of a baby was symptomatic of a larger divide between the Anglo-Saxon English-speaking world and continental Europe. Being reminded of this vast difference helped me to put into perspective Americans’ huge resistance to increasing healthcare coverage.

Talking about the US, a German friend of mine who lives in Zurich said he thinks it's strange how Americans give their children crazy names like Apple Blossom or Stapler, and such a thing would never happen in Germany. Of course the most extreme example of a bizarre name, widely reported in Germany, was the case of the neo-Nazi man in Pennsylvania who complained when a local supermarket refused to write his son’s legal name (Adolf Hitler) on a birthday cake. In Germany, where it is illegal to use any of the imagery of the Nazi party, people couldn’t believe that the government would allow someone to give their child such a name in the first place.

In Germany, my friend explained, after a birth the local municipality must approve the name you have given your child. If the name is found to be unacceptable, the government has the power to reject it. This is a good policy, my friend opined, because it prevents parents from committing a sort of child abuse by giving their baby a name that would cause them to be tormented or ostracized by other children – such as giving a boy a girl’s name or the name of an embarrassing body part. In Switzerland the policy is even stricter. I’ve been told that when you have a baby in Switzerland you can only choose from a pre-approved list of names when you go to register the birth.

I was there at the bar with my boyfriend (who is British) and he was absolutely horrified by the idea of having to approve names with the government. He is Asian by background and has a Muslim name, and to him the German and Swiss naming system seemed to implicitly discriminate against foreign names. My German friend responded that even if the municipality hadn’t heard of the name it would be approved if the parents could prove that it is a legitimate name in another culture. I noted that this seems to be giving an extraordinary amount of power to some local civil servant, who could be racist or xenophobic and give immigrant parents a hard time. Surely the parents could appeal the decision of the municipal worker, but not after a very hostile message had been sent about whether they are welcome in their host country.

My British boyfriend was perplexed as to how the state could have such a level of intrusion into something as intimate as naming a child. And my German friend couldn’t understand what kind of society would allow parents to give their children a horrible or ridicule-inspiring legal name. “I see we’ve stumbled upon another continental/Anglo-Saxon divide,” I observed. It is a divide I encounter often as an American living in Britain but working in continental Europe – the conflict between collectivism and individualism.

Me or us

In England and the societies it spawned (the United States, Canada, Australia, etc), liberalism (that is, "libertarianism" in Amero-speak) has long been the most cherished ideal – be it in economics or society. The Anglo-Saxon model of individualism, and the laissez-faire government systems that go with it, has been taken to the extreme in the United States. The US is obsessed with the ideals of freedom and individual rights. Individualist societies emphasise independence and self-reliance while opposing external interference upon a person’s choices, whether by society, family or religion.

In continental Europe, however, the idea of individualism never took firm root. Continental European societies are based more around the ideals of collectivism, which prioritise group goals over individual goals. In this type of society (embodied at its extreme in countries like Japan), the whole is greater than the sum of its parts.

Because the countries of continental Europe are more collectivist by nature, their citizens tend to be more receptive to a high degree of state intervention in their lives - because they trust the community that they are in. They are also more willing to sacrifice more of their own labour and earnings for the benefit of the society as a whole (particularly its less fortunate members). Citizens of collective societies are willing to put up with things like having to submit their baby’s name for approval or having to register for a national ID card (the UK is one of the only countries in Europe not to have them) if these things are of a benefit to the society as a whole.

In the case of the naming conventions, a German person would be more likely to acquiesce to the naming conventions if it promotes greater community cohesion and protects the interests of children in making them feel part of the community. The collectivist societies of continental Europe are also focused on a person’s role within the society. They have a tendency to assign career paths to children at a very young age (the first test separating children based on aptitude is around 12 in most continental countries) and education is much more regimented than in the flexible British and American systems.

A perfect example of this came this week, when an American judge granted a German family political asylum in the US, saying their individual freedoms were being violated. The German evangelical Christian family wished to homeschool their children, but homeschooling is not allowed in Germany. The lawyer representing the family argued that Germany's requirement that children attend officially recognised schools is "trying to coerce ideological uniformity in a way that is frighteningly reminiscent of past history," and the Tennessee judge agreed. In America, where an estimated 2 million children are homeschooled (most of them evangelical Christians), there are little to no requirements for homeschooling parents to use standardised lesson plans, and the decision to homeschool does not require approval.

Why Americans resist healthcare expansion

The United States is not by any stretch of the imagination a collectivist society, and this has majorly shaped the development of healthcare in that country. Europeans tend to be shocked that Americans would be ok with a system in which 46 million people have no healthcare. But because the United States is such an individualist culture, there isn’t as much concern with those members of the community who are less fortunate as their would be in a collectivist society. In the harshest version of individualism, those uninsured people should be self-reliant enough to fix their own situation. For many Americans, the benefit of insuring everyone in the society is not worth the cost of increasing the government's role in their life. This was painfully evident when Obama made the decision early on to sell reform by telling Americans it would improve their own individual healthcare, rather than stressing the moral imperative of fixing a broken system that is harming other people in the society. The moral imperative argument was never strongly made, because the administration made the calculation that it just wouldn't sell with Americans.

Of course nobody does individualism like the Americans, but the ethic is also present in the other Anglo-Saxon countries. Of course the UK and the commonwealth countries do have universal healthcare, but their social welfare systems are much weaker than those in continental Europe. While the UK has many collectivist traits compared to the United States (free healthcare, decent unemployment pay and pensions, publicly-funded broadcast media), it also maintains a very individualist social model. These factors include a relatively low tax rate (resulting in a low quality in public services compared to other Western European countries), high levels of crime and anti-social behavior, comparatively widespread feelings of isolation and resistance to bureaucratic measures such as national IDs or mandatory registration of living arrangements.

Individualism can be a double-edged sword. If you just look at its effect on issues such as healthcare and welfare, American societal values sound enormously selfish and dysfunctional. But it’s not all bad. The ideal of individualism (and the corresponding value of ambition) is also one of the things that has made the United States great and given people like me the freedom to live the sort of life we choose. For instance I didn’t decide I wanted to be a journalist until my final year of university. In continental Europe you don’t start university until you know exactly what you want to do, and switching careers after you’ve completed your studies is exceedingly difficult. The rise of individualism has also resulted in a huge number of gay and lesbian people coming out over the past half century, something that was made possible because they no longer depended on community/family/religious ties for survival.

The fact that these community ties are still comparatively much more important in continental European societies result, in my observation, in people feeling less free to “think outside of the box” and live the way they would most like to. I find there to be much more conformity in continental European societies than in the US or UK. This has resulted in the curious incongruity that there are observably less openly gay people in continental European countries with full gay marriage rights than in the US where there are no (federal) marriage rights. Over the years I’ve noted with no small sense of irony that although all Western European countries except Italy and Ireland have some form of gay marriage, gay people I meet on the continent seem much more likely to be closeted than people in the US. Collectivist societies allow much less room to be 'different'. But that’s just my observation.

In any event, I’m still not sure where I come down on this whole collectivism vs individualism question. It frustrates me to no end that Americans are so individualistic that they can’t trust their own society to do anything for the collective good. On the other hand, I also find the bureaucratic nightmare of state intrusion that comes with living on the continent to be hair-pullingly annoying and unnecessary. I’m going to get a full taste of that when I move to Brussels next month. I also find the conformity of continental Europe rather depressing sometimes.

It seems like the UK is maybe the perfect place for me, teetering as it does halfway between the continent and the US. Still, I think collectivist societies have a lot of merit and I want to understand them better. Who knows, perhaps as I get older and live for a longer time in Europe I will develop a more collectivist mindset. As with most things, the best solution is probably somewhere in between.