The Evolution of the US Health Care System

The previous chapter introduced the subject matter of this book, the environmental factors that influence the United States’ health care policymaking process and reform. The problems facing the health care system, the role of problem definition in policy formulation, including the specification of different alternatives to solve the problems, and the failures of previous reform efforts, were briefly introduced. We ended that chapter by noting that the manner the Constitution disperses power at the federal level of government, the political processes in the country, and the other environmental factors identified in the chapter influence the health care policymaking and reform processes in the country. We further argued that since the factors that influence the health care policymaking system and impede reform evolved over time, it was necessary to devote a chapter of the book to examining how the health care system has been transformed from the early years to the present time. Therefore, this chapter of the book appropriately examines the history of the evolution of the health care system. The chapter is based on the notion of path dependence, in which the past provides useful lessons for the future.