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This paper considers health policy-making in the USA with England as comparator. It contrasts policy inertia in US healthcare despite crisis with hyper-activity in perpetual 'reform' in England despite absence of crisis in the NHS. It does so from the standpoint of political science and political economy. I suggest that 'path-dependency', the view that past policy constrains future policy, lacks explanatory power and that wider and deeper explanations must be sought. The USA's apparent path dependency is in fact a story of political economy and power, buttressed by institutions. England's apparent lack of path-dependency in promulgating NHS reform is in fact a story of executive hyper-activism which is oblivious to how implementation will obviate its prescriptions. This failure of 'reform' in the NHS is not a symptom of concealed path-dependency but a sign of pragmatism by those charged with implementation. In the USA, the durability of its various systems of healthcare is by contrast a sign of pragmatism not being adequate to achieve health sector reform. In the USA, a weak state is unable to manage healthcare reform which would actually benefit US capitalism as a whole. In the UK, a strong state has created and developed the NHS to the benefit of capital through the economical provision of healthcare to the workforce. Such an 'investment state' is a testimony to the continuing validity of the neo-Marxist argument that social investment and social expenses are an important and functional component of the capitalist state., (Copyright © 2013 John Wiley & Sons, Ltd.)

Arguably, US and British health-care policies have shown some convergence in recent years, despite vast differences in the two health-care systems. In part, this reflects the incentives common to all systems which must be mobilized to improve efficiency and effectiveness; in part, this reflects the (two-way) trans-Atlantic 'trendiness' of ideas. This article seeks to examine the main context of policy affecting the two health-care systems, the means now used to achieve the systems' goals, and the validity of claims of convergence. The focus is conceptual, although a significant aim is to assess recent policies in a comparative framework.