2<br >Competition versus Regulation<br >in American Health Policy<br > Evan M. Melhado<br >1，1 the history of federal health policy in the United States， the 1970s<br >appear to mark a major turning point. The decade opened with wide-<br >spread cries of"crisis" in American health care delivery and with a twofold<br >agenda of reform: snbjecting the delivery of health services to intensified<br >planning and regulation and entitling the entire population of the coun-<br >try to comprehensive health benefits under a system of national heahh in-<br >surance (NHI). As the decade ended， that reform agenda stood in disarray.<br >Instead， the leading themes among tormulators of American health poli-<br >cy were competition and market strengthening， dismantling of regulatory<br >apparatus， and acquiescence in a lesser conception of entitlement. This<br >study， a preliminary attempt to characterize and explain this shift， briefly<br >summarizes methods， assumptions， and main themes and then develops its<br > points in detail.<br > METHODS， PRESUPPOSITIONS， AND<br > MAIN LINES OF THE ARGUMENT<br > The approach taken here presents the shift as an episode in the intellec-<br > tual history of pnlicy formulation (cf. Fox 1979). The focus is less on<br > detailed policy prescriptions than on their underlying， fundamental prin-<br > ciples. These princit)les are exhibited through characterizing the ideas<br > shared by exponents of each of the valious policy positions (although the<br > difli:rences among advocates of any given position are necessarily under-<br > stated). The characterizations are not used to assess or judge the relative<br > merits or viability of either the fundamental ideas or the particular<br > proposals derived fiom them; instead， they serve as the refl:rence points<br > for an analysis of policy shift. The analysis attempts to identify a novel<br >