Search

This article shows that, in the health policy sector, an infrastructure of expertise external to the state has developed in the United States from the 1970s on, representing a reserve of health‐care specialists in many ways comparable to a specialized, high‐level civil service. Decision makers can delve into that pool of experts when looking for advice, or to find loyal and competent managers to fill administrative positions. By identifying this infrastructure as a "peri‐administration," this article links up with a recent line of thinking on the American State that reconsiders the classical interpretative frames proposed by the Weberian model. The article examines the contribution of this category of policy experts to the evolution of the policy framework and shows how they were instrumental in narrowing the alternatives available in U.S. health‐care policy from the 1970s to the Affordable Care Act of 2010. [ABSTRACT FROM AUTHOR]

Context: In the late 2000s, the contention that quality improvements achieved by reforms in the delivery of care would slow the growth of costs throughout the US health care system became the predominant strategy for cost containment in the discourses and programs of all the 2008 presidential candidates. The question that this paper addresses is why, despite all of the critiques of this idea (especially those of the Congressional Budget Office), what the author terms the quality solution has remained credible enough to be a possible argument in policy makers' discourses and programs. To answer this question, the article explores the role of health policy experts--who are expected to provide credibility and legitimacy to proposals defended by policy makers--in supporting and diffusing this quality solution. Methods: The empirical research combines written sources with evidence from 78 interviews. Findings: This article highlights the political factors that explain the rise and growing prominence of the quality solution in the community of policy analysts: the political support for delivery reform--oriented research since the 1980s and also the importance of political calculations for prominent health policy experts. Conclusions: This policy history contributes to works that underscore the political dimension of policy analysis. [ABSTRACT FROM AUTHOR]