The pathologies of the United States health care regime

When compared to peer countries, the United States’ approach to health care provision yields systematically higher costs and worse outcomes for most of the population. Understanding these outcomes requires attention not to individual health policies, but to the broader U.S. health policy regime. Our chapter provides a field guide to this regime. What emerges from our analysis is an image of several institutional pathologies. Fragmented institutions laden with veto points that impede systemic reform and advantage well-organized groups. The absence of mass parties ensures that “preference outliers” dominate the policy arena. An anti-statist political culture, reinforced by policies that do not evidently advantage the median voter, tends to weaken public support for state intervention. Yet while these pathologies appear to impede comprehensive reforms, they also produce internal contradictions that threaten to destabilize the policy regime. These contradictions and vulnerabilities, we conclude, warrant greater attention from scholars of health policy.