Coined by the French historian Alexis de Tocqueville in the early nineteenth century, the term ’American exceptionalism’ refers to the idea that the US is different from other developed nations because of its unique origins, evolution, and institutions. The concept has been debated extensively – whether such a thing indeed exists and, if so, whether it is good or bad for the US and the world.  This Briefing explores the debate over the use of cost-effectiveness analysis (CEA) in the American health care system through the lens of American exceptionalism.  It explores what about the American character creates resistance to using CEA to guide health care decisions and considers whether, when and how that might change.