Everything but healthy - A power structure analysis of the U.S. health system

How could it be that the most powerful and richest nation in the world, the United States is discussing about the same failures of the health care system for decades? How a good health care system might look like and what challenges are to be overcome are additional questions this paper seeks to answer.

This paper asks why the US has still not achieved a high quality medical service standard at low costs reaching all citizens, even though there were several attempts for a major structural reform over the last decades.
The hypothesis guiding this paper is therefore that due to power structures and lobbying the U.S. health system has low efficacy (coverage of all citizens in a fair way) and low efficiency (the relation between costs and outcome).

To answer this question one has to put it into context. Since there is an ongoing discussion with ups and downs for more than 70 years the question that comes up first is, how this peculiarity of the US case is possible? What might be the path-dependency that explains why: “The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies.”(Quadango ) This paper argues that the failures of the U.S. health care system, being debated continuously over decades can’t be explained just by referring to “American Exceptionalism”, a culture and history that favours free market regulation. Though this and other popular explanations might play a role, this paper argues that power structures in U.S. society and specifically in the health care sector better explain the current system.