Through a Distant Mirror: Reflections, Projections, and the Multiple Logics of Cross-national Comparisons

摘要

Scholars have long recognized the importance of comparisons for envisioning, formulating, and implementing new public policies. But cross-national comparisons of health systems and policies can prove challenging—sometimes potentially misleading—unless one carefully attends to the nature of comparative reasoning and the inferences that it allows. This article explores the distinctive logics of two forms of comparison: analogies and metaphors. Each offers potentially important insights regarding the performance of the US health care system and appropriate aspirations for American health policy. But they do so in very different ways, each form of comparison singling out particular other countries, policies, and health outcomes as the most appropriate or meaningful comparators. These patterns are illustrated with examples drawn from the articles and commentaries in this special issue. These explorations of comparative reasoning also highlight some gaps in the topics addressed in these other contributions—gaps that merit attention in future research.