Month: August 2023

A sweeping history of the American health care state that reveals the public has been intentionally misled about the true role of government. The US government has always invested federal, state and local dollars in public health protection and prevention. Despite this public funding, however, Americans typically believe the current system is predominantly comprised of private actors with little government interference. 

In Grow and Hide: The History of America's Health Care State (Oxford UP, 2023), Colleen M. Grogan details the history of the American health care state and argues that the public has been intentionally misled about the true role of government. The US created a publicly financed system while framing it as the opposite in what Grogan terms the "grow-and-hide regime." Today, the state's role is larger than ever, yet it remains largely hidden because stakeholders-namely, private actors and their allies in government-have repeatedly, and successfully, presented the illusion of minimal government involvement. The consequences of this narrative are scarce accountability and a highly unequal distribution of benefits. In the wake of a pandemic that has killed over one million Americans--with the highest death rates among minorities and lower-income people--the time has come for an honest discussion about the health care system. As Grogan reveals, America has never had a system that resembles a competitive, free-market model. Given how much the government already invests in the health care system, means how these funds are distributed and administered are fundamental political questions for the American public, not questions that should be decided by the private sector. If we want to fix care in America, we need to reimagine the way it is organized, prioritized, funded, and, perhaps most importantly, discussed. Grow & Hide is an important contribution to this reimagining.

Stephen Pimpare is a Senior Fellow at the Carsey School of Public Policy at the University of New Hampshire.

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