ABSTRACT
This chapter examines the tension between U.S. constitutional commitments to equality and its healthcare sector’s architecture and governance by examining the economic and political notoriously imbalanced power allocations among its market actors. As a few healthcare sector actors dominate and the legal model allows them to ossify the status quo for their benefit, affordable healthcare of quality for all is undermined. The chapter claims that laws and policies play an important role in shaping a heavily industrialized healthcare sector that institutionalizes profit-maximizing environments over social health outcomes. Considering a law and political economy framework and its contributions to the study of market-based health models, the chapter reviews three examples to support its claim: the regulation of U.S. big pharmaceutical companies, healthcare delivery integration in the U.S. market, and the role that the U.S. pharmaceutical model has played in the global COVID-19 vaccine access problem. The chapter concludes that healthcare access has become highly politicized and less constitutionalized, and, thus, the treatment of health dysfunctions as market failures or efficiency problems alone would be a mistake. The U.S. healthcare sector analysis is incomplete without a political approach to health market economies, a necessary account for health law and policymaking in order to de-commodify health and observe the state of formal constitutionally guaranteed equality.
