Same as It Ever Was? Persistence and Transformation in US Health Care Policy.

US health care seems stuck in an endless cycle of crisis and failed (or when it does happen, disappointing) reform, the result of weak political institutions, interest group power, cultural aversion to government, and the resilience of a status quo that divides Americans into myriad private and public insurance plans. The United Sates is, as it was 50 years ago, still bedeviled by high costs, a large uninsured population and fragmented, inequitable financing arrangements. Yet the persistence of those problems obscures consequential shifts in US health politics and policy over the past five decades, including the expansion of insurance coverage, the rise of private insurance within public programs, and the advent of government cost control measures as well as major changes in private insurance. This article explores the sources and consequences of these transformations as well as their limits.