The Hidden Costs of Health Care Cost-cutting: toward a Postneoliberal Health-reform Agenda

Neoliberals advocate for “marketization,” but the transition to markets in pervasively regulated fields like health, defense, and education is complex. There is no way out but through. The state itself must capitulate to (and coordinate) its subjects’ purported emancipation from it. Thus a paradox threatens the coherence of the thought of neoliberals. Wealth accumulation up to now, they assert, has been distorted by various ill-considered or malicious state interventions. Reform is imperative. But the past maldistribution of wealth biases the present political playing field: tycoons who won crony capitalist favors in the past are going to use those gains to influence future elections, and in particular the future terms of marketization. So the neoliberal doubles down publicly: as the contemporary political economist of laissez-faire, he insists that legislative, regulatory, and cognitive capture just prove that the state needs to be shrunk. Left un(or less) spoken are the more critical questions: What parts of the state are to shrink? And what is to be maintained, or grown, as the