ABSTRACT
A powerful force shaping the U.S. health care system is the mode of expenditure control. The current regime (instituted in the 1970s) emerged from contradictory developments in the preceding period and unleashed a wave of consolidation and privatization among purchasers of care, managed care insurers, and the providers of care. These new market relationships have in turn generated a new crisis of reproduction of the health care system: a new cost control regime can be discerned as various fractions of capital (corporate employers, managed care insurers, and increasingly corporatized and consolidated health care providers), and the state (seeking to reduce social expenditures), compete for market share and market power in health care provision and finance.
