The Dark Side of American Health Care

When I think about bureaucratic politics, I think of the American health care system. I think of the bride-to-be who suddenly had to incur heavy medical expenses. I reflect on where we were in health care policy-making and how we ended up placing power in bureaucratic hands.

The typical American health politics story is one characteristic of lengthy periods of gridlock punctuated by sudden jiffies of reform. These seemingly minute incremental adjustments to the health care system channel into the recent bureaucratic politics. A distinct pattern governing American health care politics is that public authority over medicine has been ceded to individual physicians and other private sector bureaucrats. They now dominate health care legislation on almost every level of government.

Unfortunately, the accountability shift comes at a price. The emerging health politics is increasingly more controlled by the methodology and mindset of self-interested bureaucratic actors. Health care bureaucrats now play a greater role in formulating and implementing legislation with much less deference to the concerns of organized public interests. The much-detested administrative costs of American health care represent not simply a policy problem but also a prevailing political force.

I see “the dark side” of bureaucratic politics when the citizens’ concerns are stifled. With the American health care system, “this dark side” is ever more prominent because the burgeoning private sector authorities can be expected to pursue their own fiscal interests into the future.

-Susan Chen