The more things stay the same the more they change: The odd interplay between government and ideology in the recent political history of the U.S. health-care system

Disentangling continuity from change in U.S. health-care policy is no task for those who crave instant intellectual gratification. The system is, of course, (in)famously stable: ever inclined to equate specialization and technology with quality, loath to impose planning on the independent institutional fragments of the "supply side state" (Jacobs 1995), unwilling to discard an employerbased approach to medical coverage, unable to acknowledge medical coverage as a right and to make such coverage universal and affordable, and quick to reject every real reform as a formula for "too much government.".