Pre-Existing Conditions How Lobbying Makes American Health Care More Expensive

By: Alex Garlick, Assistant Professor of Political Science Alex Garlick

Published by Oxford University Press, 2025-10-15

Health care inflation is a major problem in the United States. Policymakers claim to be working to slow the growth of health care spending, but these efforts are sorely lacking in most states.

This book shows that lobbying from the health care industry is responsible for the runaway cost of health care in many states. Lobbyists are not all powerful, but Garlick argues that cost containment policy is debated under the precise circumstances where lobbyists have the most leverage over legislators --- such as when they are trying to protect the status quo, working on non-salient matters, when lobbyists hold information that legislators do not, and when their clients have structural power in the state economy. The book uses a mix of interviews with legislators and lobbyists, massive quantitative datasets, and in-depth investigations of state policy debates to find that in states with a stronger health care industry lobby, legislators consider fewer bills to regulate the state's health care sector, bills to regulate the industry are more likely to be defeated or diminished, and consumers spend more money on health care.