Chapter 15 : The Elusive Ideal of Market Competition in United States' Health Care

This chapter, in the book Health Care and EU Law (TMC Asser Press 2011), explores how market competition has both driven and (somewhat ironically) undermined U.S. health reform efforts over the past few decades. More than its peers, the U.S. health care system looks to market-inspired theories and policy instruments, even in public programs like Medicare. But decades of promoting market ideals has not given Americans the health care system we desire. Still, the market question remains the basic dividing line in U.S. health policy. This chapter explores how the U.S. health care system remains an international outlier, exploring American exceptionalism in health care. Although many EU member states have embraced market mechanisms in recent health reform initiatives, they do so from a baseline of universal coverage and social solidarity. The U.S. system, in contrast, organizes itself (using the term "organizes" very loosely) around market-based principles, without a baseline of universal coverage or solidarity. Market-based interventions thus may work in EU member states but exacerbate problems in the United States, given these different baselines. The chapter concludes by considering the appropriate role for market competition in health care, given its limitations, highlighting market-based theories embodied in the Patient Protection and Affordable Care Act of 2010