Roadblocks to Reform: Beyond the Usual Suspects

Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered for why such reforms are so difficult: institutional gridlock, path dependency and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that, as a result, public resistance to real reform may more accurately reflect citizensÕ personal convictions, self-interest or even active social choices. ÒConscientious objectorsÓ may do more to derail reform than previously recognized.