Explaining America's Spendthrift Health Care System: The Enduring Effects of Public Regulation on Private Competition
Forthcoming 2019 in J. Boertjens et al., eds., Healthcare Finance (Edward Elgar Pub.)
16 Pages Posted: 27 Jul 2018
Date Written: July 25, 2018
The United States is often described as the only developed nation without a public commitment to universal health care. Instead, its health care system is widely considered a product of bio-scientific free enterprise – technologically sophisticated, extremely expensive, but inaccessible to the poor. This chapter offers a contrasting account, refuting the conventional narrative of U.S. health policy as private, competitive, and entrepreneurial. Beginning over 20 years ago, the poor performance of the American health care system has been slowly revealed. For nearly as long, steps that might improve that performance have been identified. But little has changed. Why? The answer, in large part, lies in an accumulation of laws, regulations, self-regulatory practices, and financial subsidies which locks US health care into inefficient, unfair patterns and practices. While most of these provisions were well-intentioned when put into place, this “deep legal architecture” now serves mainly to prevent meaningful competition in medical markets and to distort or limit collective investment in the nation’s health.
Keywords: healthcare, health reform, Affordable Care Act, health law
JEL Classification: I11, I18, K32
Suggested Citation: Suggested Citation