Out but in. The reconfiguration of American health policy expertise and the advent of a “peri‐administration” (1970–2010)

Abstract

AbstractThis article shows that, in the health policy sector, an infrastructure of expertise external to the state has developed in the United States from the 1970s on, representing a reserve of health‐care 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,” this 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. health‐care policy from the 1970s to the Affordable Care Act of 2010.