Global Neoliberal Attack on Public Health Systems

Health care systems around the world have not been immune from the political dynamics of the “neoliberal” era.  Though highly uneven in impact, timing, and geographical scope, a number of what can be considered neoliberal processes have been playing out on the global level in recent decades, including: the privatization of health care facilities, the state-accommodated growth of corporate health care interests (often transnational in reach), a rising emphasis on out-of-pocket “cost sharing” for users of health care, austerity-driven reductions in health care spending, and a rollback of the ideology of health care universalism.  Comparatively examining the heterogeneous historical experiences of particular nations – e.g. the United States, countries of the Eurozone, the United Kingdom, China, and India – sheds some light on how national political dynamics have facilitated or retarded these varied but interconnected processes.   Notably, while health care universalism retreated in some nations, it was simultaneously protected – or even advanced (if only incrementally) – in others, demonstrating that the success of “heath care neoliberalism” is critically dependent on contextual political factors.  These factors include the strength of leftwing political parties and labor movements, the degree of national subordination to international financial bodies, elite perceptions of popular discontent and potential for mobilization, and the relative position and potency of health care capital.  Understanding this global scene may be useful in assessing the possibilities for progress towards a more egalitarian health care system in the United States.