Hyper-stasis as opposed to hyper-activism: the politics of health policy in the USA set against England
Article first published online: 4 JUN 2013
Copyright © 2013 John Wiley & Sons, Ltd.
The International Journal of Health Planning and Management
Volume 28, Issue 2, pages 216–227, April/June 2013
How to Cite
Paton, C. (2013), Hyper-stasis as opposed to hyper-activism: the politics of health policy in the USA set against England. Int. J. Health Plann. Mgmt., 28: 216–227. doi: 10.1002/hpm.2181
- Issue published online: 4 JUN 2013
- Article first published online: 4 JUN 2013
- Manuscript Accepted: 13 MAR 2013
- Manuscript Revised: 12 MAR 2013
- Manuscript Received: 13 NOV 2012
- Comparing policy;
- US health policy;
- UK health policy
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. Copyright © 2013 John Wiley & Sons, Ltd.