Health-Care Politics in the United States

Abstract

Comparative studies of health care in the United States and peer nations often highlight a number of distinct features of the American system including high costs, fragmentation, and health inequities. While unique political factors and institutions in the United States are prominent reasons for these disparities, there are also distinct interactions between American politics and cultural, economic, racial, and social factors. Many comprehensive overviews of American health politics and policy begin in the 20th century highlighting the important influence of global and national historical events, such as World Wars I and II, and social movements, including the civil rights movement. Yet, health-care politics in the United States also continues to be shaped by early American history, government institutions, and systems. To understand health-care policy in the United States, it is also necessary to consider the legacy of other non-health factors and their intersections with health politics, including slavery and ongoing racism, early Protestant notions of mortality and self-reliance, the localized nature of private charity and volunteerism, federalism, a public distrust of federal government, and the evolution of health professions, among other factors. Often these historical events and other cultural, economic, or social factors significantly shape public opinion, political participation, and health-care inequities, and in some cases, provide a window of opportunity to advance important health-care reforms. The structure of American government institutions, political parties and growing polarization, unique attributes of elected leaders or policy entrepreneurs, and the power of interest groups, particularly private actors in the health care delivery system, are all significant factors that shape health-care politics in the United States. Contemporary American public health policy literature focuses on efforts to reduce health inequities and improve access to health care as well as the politics of recent reform ideas that promote government regulation and investments in non-health factors such as the environment and social services to reduce population health inequities.