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Through cross-national comparisons, the essays in this section illuminate the key elements of the U.S. approach to health care. When European nations have passed major health care reforms, the leaders of those countries have presented a strong moral argument for reform. Theodore R. Marmor finds that element missing in the U.S. case and ponders its implications. Carolyn Hughes Tuohy provides a comparative framework for understanding different approaches to reform and to understand better the U.S. choice to pursue what she calls a mosaic approach. Finally, as a European observer of U.S. reform and a longtime health policy expert, Kieke G. H. Okma reflects on how Europeans view the U.S. approach to reform.