Out but In. The Reconfiguration of American Health Policy Expertise and the Advent of a "Peri-administration" (1970-2010)
Résumé
This article shows that, in the health policy sector, an infrastructure of expertise external to the state has developed in the U.S. from the 1970s on, representing a reserve of healthcare specialists in many ways comparable to a specialized, high-level civil service. Decision-makers can delve into that pool of experts when looking for advice, or to find loyal and competent managers to fill administrative positions. By identifying this infrastructure as a "peri-administration", the article links up with a recent line of thinking on the American State that reconsiders the classical interpretative frames proposed by the Weberian model. The article examines the contribution of this category of policy experts to the evolution of the policy framework and shows how they were instrumental in narrowing the alternatives available in U.S. healthcare policy from the 1970s to the Affordable Care Act of 2010.
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