Introduction
There is a common and perhaps understandable perception that the US is an international laggard when it comes to health policy. The US famously spends far more per capita than other countries, despite middling performance on key population health metrics. The country’s political system and cultural traditions make it challenging at the national level to advance sweeping social policy of any kind, including health policy. The US was the last industrialized nation to enact a comprehensive health insurance plan for its citizens, for example, and implementation of that law, the 2010 Affordable Care Act (ACA), continues to be deeply controversial. The American health care system has historically been decentralized and fragmented and heavily influenced by interest groups.
Yet it would be a misconception to infer that the US is lagging in health policy innovation. Indeed, a quiet transformation is occurring in the country in terms of new organizational arrangements, incentive-based programs, and an orientation in research towards “patient-centeredness.” As in foreign policy, where the US has been characterized as “leading from behind” on flashpoints from Libya to Syria, one might conceive of US health policy in somewhat similar fashion.