title: Hyper-stasis as opposed to hyper-activism: the politics of health policy in the USA set against England.
abstract: This paper considers health policy-making in the USA with England as comparator. It contrasts policy inertia in US healthcare despite crisis with hyper-activity in perpetual 'reform' in England despite absence of crisis in the NHS. It does so from the standpoint of political science and political economy. I suggest that 'path-dependency', the view that past policy constrains future policy, lacks explanatory power and that wider and deeper explanations must be sought. The USA's apparent path dependency is in fact a story of political economy and power, buttressed by institutions. England's apparent lack of path-dependency in promulgating NHS reform is in fact a story of executive hyper-activism which is oblivious to how implementation will obviate its prescriptions. This failure of 'reform' in the NHS is not a symptom of concealed path-dependency but a sign of pragmatism by those charged with implementation. In the USA, the durability of its various systems of healthcare is by contrast a sign of pragmatism not being adequate to achieve health sector reform. In the USA, a weak state is unable to manage healthcare reform which would actually benefit US capitalism as a whole. In the UK, a strong state has created and developed the NHS to the benefit of capital through the economical provision of healthcare to the workforce. Such an 'investment state' is a testimony to the continuing validity of the neo-Marxist argument that social investment and social expenses are an important and functional component of the capitalist state.
authors.affiliation: Keele University, School of Public Policy and Professional Practice, Staffordshire, UK. c.paton@keele.ac.uk
authors.forename: Calum
authors.initials: C
authors.lastname: Paton
mesh_terms: D004739:England; D006291:Health Policy; D011050:Policy Making; D011057:Politics; D013222:State Medicine; D014481:United States