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The heated nature of the current political debate in the United States upon the subject of healthcare is testimony to the idea that far less than economic numbers, cultural wars govern how healthcare is perceived and administrated. All nations face the problem of cost containment of an increasingly expensive healthcare system. People are living longer, and the nations of the developed world have populations with a far higher median age than in the past. Medical technology is also more expensive. Thus, some form of 'rationing' (as politically unpalatable as the world may be) is required, either based upon need, or based upon who can pay. The United States stresses that individuals can 'choose' to have healthcare or not, and implicit in this assumption is that individuals who can 'merit' better jobs that provide healthcare are making one choice, while Americans who work several jobs that do not offer healthcare -- yet are not poor enough or old enough to qualify for government-assistance plans -- are making another kind of 'choice.'
Thus, the main criticism of Roemer's model is perhaps it gives insufficient attention to politics, at least in its analysis of the developed world. In developing nations, financial...
However, in the developed nations, culture and the sense of whether healthcare is a 'right' versus a 'choice' or a luxury are more important. In the United Kingdom, all citizens are eligible for healthcare, and are approved or not approved for certain procedures based upon universal standards. The UK, although a wealthy and capitalistic nation, acknowledges that capitalism can produce social inequities. In the United States, there is a strong suspicion of government intervention and faith in the marketplace to enable individuals to 'choose' their fate. In the U.S., individuals are seen as deserving of their fate in a 'fair' capitalistic system -- whether that fate provides them with a job offering health insurance or not.
References
Anderson, G .F. & J.P. Poullier. (1999).Health spending, access, and outcomes: trends in industrialized countries. Health Affairs, 18(3):178-192
Creese, Andrew. (1994). Global trends in health care reform. World Health Forum. 15.
Sanders, Jeffrey. Financing global health systems. Current issues facing global health systems.
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