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Published online by Cambridge University Press: 24 March 2025
Current political divisions are destabilizing existing laws affecting the health field. Major changes in the field of health law have one thing in common: changes in who holds political power ‒ Congress and state legislatures, governors, presidents, judges, and agency officials. The laws that structure financial, economic, educational, and health care systems, environmental conditions, and civil society are primarily the product of elections that populate our political institutions. These structural determinants of health in turn create laws that influence how ‒ and how well ‒ we live and whether our society functions fairly under the rule of law. Thus, who gets elected matters a great deal to the health and safety of Americans. At the same time, changes in health laws resulting from elections may reveal shifts in the structures underlying our legal and economic systems and whether those shifts support or weaken principles of justice and the rule of law.
1 G.K. Chesterton, The Man Who Was Thursday: A Nightmare 82 (Dover Publ’ns 1986) (1908) (quote from protagonist).
2 See generally Anne Case & Angus Deaton, Deaths of Despair and the Future of Capitalism (2020); David Rosner & Gerald Markowitz, Building the Worlds that Kill Us: Disease, Death and Inequality in American History (2024).
3 Jonathan C. Heller et al., Keeping It Political and Powerful: Defining the Structural Determinants of Health, 102 Milbank Q. 351, 357-59 (2024).
4 See generally Why Are Some People Healthy and Others Not? The Determinants of Health of Populations (Roger G. Evans et al. eds., 1994); Nancy E. Adler et al., Socioeconomic Status and Health: The Challenge of the Gradient, 49 Am. Psych. 15 (1994); World Health Org., Social Determinants of Health: The Solid Facts (Michael Marmot & Richard Wilkinson eds., 2d ed. 2003), https://iris.who.int/handle/10665/326568; World Health Org., Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health (2008), https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1; Heller, supra note 3.
5 Ariz. State Legislature v. Ariz. Indep. Redistricting Comm’n, 576 U.S. 787, 824 (2015) (internal quotation marks omitted).
6 Wendy K. Mariner, Toward an Architecture of Health Law, 35(1) Am. J.L. & Med. 67, 69 (2009) (“as health law gained acceptance as a distinct specialty, the legal principles governing much of its subject matter loosened their parochial ties to medicine as the rationale for singular rules” and many health matters became subject to ordinary principles and doctrines.)
7 See, e.g., Steven Levitsky & Daniel Ziblatt, How Democracies Die (2018); Michael Lind, The New Class War: Saving Democracy from the Managerial Elite (2020); Anne Appelbaum, Twilight of Democracy: The Seductive Lure of Authoritarianism (2021) [hereinafter Appelbaum, Twilight of Democracy]; Anne Appelbaum, Autocracy, Inc.: The Dictators Who Want to Run the World (2024).
8 See, e.g., Steven Levitsky & Daniel Ziblatt, Tyranny of the Minority: Why American Democracy Reached the Breaking Point (2023); Rena Steinzor, American Apocalypse: The Six Far-Right Groups Waging War on Democracy (2024) (describing the similar goals and activities of big business, the House Freedom Caucus, the Federalist Society, Fox News, white evangelicals, and armed militias to dismantle national government powers, policies, and programs).
9 See, e.g., Jane Mayer, Dark Money: The Hidden History of the Billionaires Behind the Rise of the Radical Right (2016); Michael J. Graetz & Linda Greenhouse, The Burger Court and the Rise of the Judicial Right (2016).
10 See, e.g., Ari Berman, Minority Rule: The Right-Wing Attack on the Will of the People—and the Fight to Resist It (2024); David Daley, Antidemocratic: Inside the Far Right’s 50-Year Plot to Control American Elections (2024).
11 Steve Benen, Ministry of Truth: Democracy, Reality, and the Republicans’ War on the Recent Past (2024).
12 See Anthony P. Carnevale et al., Geo. Univ. Ctr. on Educ. and the Workforce, The Role of Education in Taming Authoritarian Attitudes (2020), https://cew.georgetown.edu/wp-content/uploads/The-Role-of-Education-in-Taming-Authoritarian-Attitudes-Full-Report.pdf [https://perma.cc/Y4KH-UPV6]; Dariela Sosa, Understanding the Impact of Journalism Inside Authoritarian Regimes, Glob. Investigative Journalism Network (Aug. 9, 2022), https://gijn.org/stories/understanding-the-impact-of-journalism-inside-authoritarian-regimes/ [https://perma.cc/D75V-SXWW].
13 See, e.g., Michael J. Sandel, The Tyranny of Merit: Can We Find the Common Good? (2020) (critiquing merit-based decision making for suggesting that those unable to achieve success must blame themselves).
14 Ana Catalano Weeks & Peter Allen, Backlash Against “Identity Politics”: Far Right Success and Mainstream Party Attention to Identity Groups, 11 Pols. Grps. & Identities 935, 935 (2023).
15 See, e.g., Linda Greenhouse, Justice on the Brink: The Death of Ruth Bader Ginsburg, the Rise of Amy Coney Barrett, and Twelve Months That Transformed the Supreme Court (2021); Larry M. Bartels & Nicholas Carnes, House Republicans Were Rewarded for Supporting Donald Trump’s ‘Stop the Steal’ Efforts, 120 Proc. Nat’l Acad. Scis. art no. e2309072120 (2023); Sheldon Whitehouse with Melanie Wachtell Stinnett, Captured: The Corporate Infiltration of American Democracy (2017) (on corporate capture of regulatory agencies with carefully selected nominees for office).
17 Lilliana Mason, Uncivil Agreement: How Politics Became Our Identity 25 (2018).
18 Id. at 40, 72.
19 Ezra Klein, Why We’re Polarized 13-14 (2020).
20 Id. at 12.
21 See, e.g., John A. Lapp & Dorothy Ketcham, Hospital Law (1926); Emanuel Hayt & Lillian R. Hayt, Legal Guide for American Hospitals (1940); James C. Mohr, Doctors and the Law: Medical Jurisprudence in Nineteenth-Century America (1993).
22 See Charles E. Rosenberg, The Care of Strangers: The Rise of America’s Hospital System (1987).
23 Leonard Berlin, Medical Errors, Malpractice, and Defensive Medicine: An Ill-Fated Triad, 4 Diagnosis 133, 133-34 (2017).
24 See William J. Curran & E. Donald Shapiro, Law, Medicine and Forensic Science (3d ed. 1982).
25 William J. Curran, The Confusion of Titles in the Medicolegal Field: An Historical Analysis and a Proposal for Reform, 15 Med. Sci. and L. 270 (1975). The American Society of Law and Medicine first published its journal, titled Medico-Legal News, in 1973; it continues today under the name Journal of Law, Medicine and Ethics. The Society published its first issue of the American Journal of Law and Medicine in 1975. About Us, Am. Soc’y of L., Med. & Ethics, https://aslme.org/about-us/ [https://perma.cc/9G3X-DP5H].
26 See The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation (George J. Annas & Michael A. Grodin eds., 1992) [hereinafter The Nazi Doctors and the Nuremberg Code].
27 See George J. Annas, Medical Remedies and Human Rights: Why Civil Rights Lawyers Must Become Involved in Medical Decision-Making, 2 Hum. Rts. 151 (1972); Vanessa Burrows & Barbara Berney, Creating Equal Health Opportunity: How the Medical Civil Rights Movement and the Johnson Administration Desegregated U.S. Hospitals, 105 J. Am. Hist. 885 (2019).
28 Rand E. Rosenblatt, The Four Ages of Health Law, 14 Health Matrix 155, 155 (2004) (describing laws governing medical practice from about 1880 to 1960 as deferring to physicians’ expertise in the context of private practice).
29 See Paul Starr, The Social Transformation of American Medicine 338, 378 (updated ed. 2017) (describing the rise and fall of the medical profession’s power, influence, and autonomy).
30 Wendy K. Mariner, Informed Consent in the Post-Modern Era, 13 L. & Soc. Inquiry 385, 391-92 (1988).
31 Salgo v. Leland Stanford Jr. Univ. Bd. of Trs., 317 P.2d 170, 181 (Cal. Dist. Ct. App. 1957); Canterbury v. Spence, 464 F.2d 772, 794 (D.C. Cir. 1972); Cobbs v. Grant, 502 P.2d 1, 13-17 (Cal. 1972); Jay Katz, The Silent World of Doctor and Patient (1984); Ruth R. Faden & Tom L. Beauchamp in collaboration with Nancy M. P. King, A History and Theory of Informed Consent 142 (1986).
32 Superintendent of Belchertown State Sch. v. Saikewicz, 370 N.E.2d 417, 426 (Mass. 1977); In re Quinlan, 355 A.2d 647, 663-64 (N.J. 1976); Cruzan v. Dir., Mo. Dep’t of Health, 497 U.S. 261, 262 (1990).
33 George J. Annas, Health Care Reform in America: Beyond Ideology, 5 Ind. Health L. Rev. 441, 441 (2008) (biographical note); Wendy K. Mariner, Standards of Care and Standard Form Contracts: Distinguishing Patient Rights and Consumer Rights in Managed Care, 15 J. Contemp. Health L. & Pol’y 1, 1 (1998); see generally George J. Annas, The Rights of Hospital Patients (1975); George J. Annas, The Rights of Patients (2d ed., 1989); George J. Annas, The Rights of Patients (3d ed., 2004); George J. Annas et al., The Rights of Doctors, Nurses, and Allied Health Professionals (1981).
34 Americans with Disabilities Act of 1990, 42 U.S.C. §§ 12101–12213.
35 See generally The Nazi Doctors and the Nuremberg Code, supra note 26; George J. Annas et al., Informed Consent to Human Experimentation: The Subject’s Dilemma (1977).
36 See G.A. Res. 217 (III) A, Universal Declaration of Human Rights (Dec. 10, 1948); Sofia Gruskin & Daniel Tarantola, Health and Human Rights in Development, in Perspectives on Health and Human Rights 3, 6-8 (Sofia Gruskin et al. eds., 2005).
37 Of course, law had influenced health long before it found a niche in academia. Before the development of most vaccines, prescription medications, and modern hospitals, public health officials relied on federal and state legislation and municipal ordinances for authority to carry out measures to control infectious diseases. For histories of public health, see, e.g., John Duffy, The Sanitarians: A History of American Public Health (1992); Dorothy Porter, Health, Civilization and the State: A History of Public Health from Ancient to Modern Times (1999); George Rosen, A History of Public Health (Johns Hopkins Univ. Press rev. expanded ed. 2015) (1958). Given the breadth of factors affecting health status, public health law has also struggled to define its boundaries, see, Wendy K. Mariner, George J. Annas, Nicole Huberfeld & Michael R. Ulrich, Public Health Law 17-20 (3d ed., Carolina Acad. Press 2019).
38 See, e.g., Shelby Cnty. v. Holder, 570 U.S. 529 (2013) (ending the Voting Rights Act’s preclearance for changes in certain states’ voting law); 303 Creative v. Elenis LLC, 600 U.S. 570 (2023) (state anti-discrimination law violated free speech of a business).
39 Tandon v. Newsom, 593 U.S. 61 (2021) (free exercise of religion); District of Columbia v. Heller, 554 U.S. 570 (2008) (firearm ownership and possession).
40 Dobbs v. Jackson Women’s Health Org., 597 U.S. 215 (2022).
41 See Sara Rosenbaum & Marybeth Musumeci, Civil Rights, Health Care, and the Struggle for the Soul of Medicine, Milbank Q. (July 22, 2024), https://www.milbank.org/quarterly/opinions/civil-rights-health-care-and-the-struggle-for-the-soul-of-medicine/ [https://perma.cc/FD62-JMTV].
42 Barry R. Furrow, From the Doctor to the System: The New Demands of Health Law, 14 Health Matrix 67, 71-72 (2004).
43 Hospital Survey and Construction (Hill-Burton) Act, Pub. L. No. 79-725, 60 Stat. 1040 (1946) (codified, as amended, at 42 U.S.C. §§ 291–291(o) (1982)). Hill-Burton ended its funding program in 1997, but some facilities still have free/low-cost care obligations. Hill-Burton Free and Reduced-Cost Health Care, Health Res. & Serv. Admin., https://www.hrsa.gov/get-health-care/affordable/hill-burton [https://perma.cc/YX77-UYK9] (last updated Sept. 2023).
44 42 C.F.R. § 124.501 (2024).
45 See H.R. Rep. No. 89-213, pt. 1 (1965).
46 See Barry R. Furrow, Cost Control and the Affordable Care Act: CRAMPing Our Health Care Appetite, 13 Nev. L.J. 822, 828, 832-33 (2013).
47 For histories of health insurance, see Robert Cunningham III & Robert Cunningham, Jr., The Blues: A History of the Blue Cross and Blue Shield System (1997); John E. Murray, Origins of American Health Insurance: A History of Industrial Sickness Funds (2007).
48 See M. Gregg Bloche, Corporate Takeover of Teaching Hospitals, 65 S. Cal. L. Rev. 1035, 1039 & n.11 (1992); David M. Cutler, The Next Wave of Corporate Medicine—How We All Might Benefit, 361 New Eng. J. Med. 549, 549-50 (2009).
49 Daniel R. Waldo et al., National Health Expenditures, 1985, Health Care Fin. Rev., Fall 1986, at 1, 13.
50 Frances H. Miller, Foreword: Following the Money, 36 Am. J.L. & Med. 288, 288 (2010).
51 See Mark S. Freeland & Carol E. Schendler, Health Spending in the 1980’s: Integration of Clinical Practice Patterns with Management, Health Care Fin. Rev., Spring 1984, at 1. The term “costs” is often used generically to mean “prices” as well as costs. Prices are what a buyer, such as an insurer or individual, pays providers for care. Costs are what sellers, like hospitals and insurers, incur to produce a product or service to sell. Vineet Arora et al., The Challenge of Understanding Health Care Costs and Charges, 17 Am. Med. Ass’n J. Ethics 1046, 1046 (2015).
52 Jacqueline A. Fiore et al., National Health Expenditure Projections, 2023-32: Payer Trends Diverge as Pandemic-Related Policies Fade, 43 Health Affs. 910, 911 (2024). In 2023, projected Medicare spending was $1.023 trillion, Medicaid spending was $851.9 billion; and private health insurance spending was $1.433 trillion. The government’s share of total national health expenditures is expected to decline from a high of 51% in 2020 to about 49% in 2032. Private health insurance spending is expected to increase at a higher rate (11.1%) than Medicare (8.4%) and Medicaid (5.7%), but all three are expected to grow at slower rates after 2023. Some of this is likely because of declines in Medicaid enrollment as states disenroll beneficiaries covered by expiring COVID eligibility rules. Id. at 913.
53 See Clark C. Havighurst, Deregulating the Health Care Industry: Planning for Competition 87-88 (1982).
54 See, e.g., Marc A. Rodwin, Exit and Voice in American Health Care, 32 U. Mich. J.L. Reform 1041 (1999).
55 Fiore et al., supra note 52, at 910.
56 Erin C. Fuse Brown & Mark A. Hall, Private Equity and the Corporatization of Health Care, 76 Stan. L. Rev. 527 (2024); Robert Field, Anthony Orlando & Arnold J. Rosoff, The Government Built It, and the Private Sector Came, 51 Am. J.L. & Med. (forthcoming 2025).
57 Allison K. Hoffman, How Power Undermined the Medical Profession, in Rethinking the Lawyer’s Monopoly: Access to Justice and the Future of Legal Services (David Freeman Engstrom & Nora Freeman Engstrom eds., forthcoming 2024), https://ssrn.com/abstract=4836348 (summarizing the trajectory).
58 See, e.g., Ryan Crowley et al., Financial Profit in Medicine: A Position Paper from the American College of Physicians, 174 Annals Internal Med. 1447 (2021).
59 See Eyal Press, The Moral Crisis of America’s Doctors, N.Y. Times (July 14, 2023), https://www.nytimes.com/2023/06/15/magazine/doctors-moral-crises.html.
60 See William Kissick, Medicine’s Dilemmas: Infinite Needs Versus Finite Resources 4-5 (1994) (arguing that the “Iron Triangle” of access, cost, and quality cannot be achieved simultaneously, because improving one often undermines another).
61 See Liran Einav & Amy Finkelstein, We’ve Got You Covered: Rebooting American Health Care (2023) (arguing for such a system).
62 Examples include Social Security, Medicare, and even the Affordable Care Act. See, e.g., John R. Kearney, Social Security and the “D” in OASDI: The History of a Federal Program Insuring Earners Against Disability, Soc. Sec. Bull., 2005/2006, at 1.
63 See Wendy K. Mariner, Health Reform: What’s Insurance Got to Do with It? Recognizing Health Insurance as a Separate Species of Insurance, 36 Am. J.L. & Med. 436, 450 (2010).
64 Wendy K. Mariner, Health Insurance Is Dead; Long Live Health Insurance, 40 Am. J.L. & Med. 195, 195-96, 214 (2014).
65 Michael Marmot, The Health Gap: The Challenge of an Unequal World 26-28 (2015); see also Anne Case & Angus Deaton, False Trials: Poverty, Income, and the Great Recession, in Deaths of Despair and the Future of Capitalism 133 (2020).
66 Raj Chetty et al., Changing Opportunity: Sociological Mechanisms Underlying Growing Class Gaps and Shrinking Race Gaps in Economic Mobility 1-2 (Nat’l Bureau of Econ. Rsch., Working Paper No. 32697, 2024), https://opportunityinsights.org/wp-content/uploads/2024/07/ChangingOpportunity_Paper.pdf.
67 See William G. Gale & Semra Vignaux, The Difference in How the Wealthy Make Money – and Pay Taxes, Brookings (Sept. 7, 2023), https://www.brookings.edu/articles/the-difference-in-how-the-wealthy-make-money-and-pay-taxes/ [https://perma.cc/7AQ4-JBRH]; see also Dorothy A. Brown, The Whiteness of Wealth: How the Tax System Impoverishes Black Americans – and How We Can Fix It (2021) (discussing the black-white wealth gap in America and how the tax system perpetuates the inequalities).
68 Dorothy A. Brown, supra note 67, at 46; Emily A. Benfer, Housing is Health: Prioritizing Health Justice and Equity in the U.S. Eviction System, 22(2) Yale J. Health Pol’y & Ethics 49 (2024).
69 Ana Penman-Aguilar et al., Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity, 22 J. Pub. Health Mgmt. Prac. S33, S34 (2016).
70 See Raj Chetty et al., Race and Economic Opportunity in the United States: An Intergenerational Perspective, 135 Q. J. Econ. 711, 711, 752 (2020).
71 See generally Mary Crossley, Embodied Injustice: Race, Disability, and Health (2022); Dayna Bowen Matthew, Just Health: Treating Structural Racism to Heal America (2022); Ruqaiijah Yearby et al., Structural Racism in Historical and Modern US Health Care Policy, 41 Health Affs. 187 (2022).
72 See Gabriel A. Benavidez et al., Chronic Disease Prevalence in the US: Sociodemographic and Geographic Variations by Zip Code Tabulation Area, Preventing Chronic Disease, Feb. 2024, at 1 (showing that communities with high socioeconomic disadvantages and barriers to health care access had higher prevalences of chronic diseases); Eugene Declercq & Laurie C. Zephyrin, Maternal Mortality in the United States: A Primer, The Commonwealth Fund (Dec. 16, 2020), https://www.commonwealthfund.org/publications/issue-brief-report/2020/dec/maternal-mortality-united-states-primer [https://perma.cc/5MHM-6E28]; see also Ruqaiijah Yearby et al., supra note 71.
73 Consumer Fin. Prot. Bureau, Medical Debt Burden in the United States 4 (2022).
74 See The Price We Pay: Economic and Social Consequences of Inadequate Education (Clive R. Belfield & Henry M. Levin eds., 2007); see also Anne Case & Angus Deaton, Life Expectancy in Adulthood Is Falling for Those Without a BA Degree, but as Educational Gaps Have Widened, Racial Gaps Have Narrowed, 118 Proc. Nat’l Acad. Scis. art no. e2024777118 (2021).
75 Intergovernmental Panel on Climate Change, Climate Change 2023: Synthesis Report 51 (Hoesung Lee et al. eds., 2023).
76 Nicole Huberfeld, Confusion, Chaos, and Conflict in U.S. Law and Health Care after Dobbs, 55 ILCEA 1, 1 (2024).
77 Allison McCann & Amy Schoenfeld Walker, One Year, 61 Clinics: How Dobbs Changed the Abortion Landscape, N.Y. Times (June 22, 2023), https://www.nytimes.com/interactive/2023/06/22/us/abortion-clinics-dobbs-roe-wade.html [https://perma.cc/W7M4-NU3T].
78 Huberfeld, supra note 76, at 2.
79 Id. at 7-9.
80 District of Columbia v. Heller, 554 U.S. 570 (2008); see also, e.g., N.Y. State Rifle & Pistol Ass’n v. Bruen, 597 U.S. 1 (2022) (holding New York violated the Second Amendment of the Constitution when granting public-carry licenses only when the applicant could show a special need for self-defense).
81 Michael Ulrich, Foreword, Finding the Balance in the Fight Against Gun Violence, 51 J.L. Med. & Ethics 7 (2023).
82 See Wendy E. Parmet, Populations, Public Health, and the Law 100-04 (2009).
83 Loper Bright Enters. v. Raimondo, 144 S. Ct. 2244, 2273 (2024).
84 West Virginia v. EPA, 597 U.S. 697, 722-24 (2022); Nat’l Fed’n of Indep. Bus. v. OSHA, 595 U.S. 109, 122 (2022).
85 Alexander Keyssar, The Right to Vote: The Contested History of Democracy in the United States 3-4 (2000).
86 Id.
87 See generally Heather Cox Richardson, To Make Men Free: A History of the Republican Party (2014); Eric Foner, The Second Founding: How the Civil War and Reconstruction Remade the Constitution (2019).
88 See Richard A. Posner, In Defense of Looseness, The New Republic (Aug. 27, 2008), https://newrepublic.com/article/62124/defense-looseness [https://perma.cc/X7LE-6X9J] (“[They were] engaged in what is derisively referred to—the derision is richly deserved—as ‘law office history.’ … [I]t is a simple matter, especially for a skillful rhetorician such as Scalia, to write a plausible historical defense of his position.”); Saul Cornell, Originalism on Trial: The Use and Abuse of History in District of Columbia v. Heller, 69 Ohio St. L.J. 625, 639 (2008) (“The goals of the historian and judge are different.”).
89 Mark Tushnet, In the Balance: Law and Politics on the Roberts Court 164 (2013). The maxim “history doesn’t repeat itself but it often rhymes” has been attributed to Mark Twain, although without credible evidence. Quote Origin: History Does Not Repeat Itself, But It Rhymes, Quote Investigator (Jan. 12, 2014), https://quoteinvestigator.com/2014/01/12/history-rhymes/ [https://perma.cc/GGT5-WRHY]. See also Angela Onwuachi-Willig, Robert’s Revisions: A Narratological Reading of the Affirmative Action Cases, 137 Harv. L. Rev. 192 (2023).
90 Rachel Kleinfeld, Polarization, Democracy, and Political Violence in the United States: What the Research Says 1-3 (Sept. 2023) (unpublished working paper), https://carnegie-production-assets.s3.amazonaws.com/static/files/Kleinfeld_Polarization_final_3.pdf.
91 Id.; see also Upending American Politics: Polarizing Parties, Ideological Elites, and Citizen Activists from the Tea Party to the Anti-Trump Resistance 3-4 (Theda Skocpol & Caroline Tervo eds., 2020).
92 Klein, supra note 19, at 25.
93 Matt Cohen, The Right is Doubling Down on Election Litigation, but Isn’t Winning, Democracy Docket (Sept. 6, 2024), https://www.democracydocket.com/analysis/the-right-is-doubling-down-on-election-litigation-but-they-arent-winning/ [https://perma.cc/UX6J-U9Z9].
94 See Emily Rong Zhang, Voting Rights Lawyering in Crisis, 24 CUNY L. Rev. 123, 125 (2021) (explaining that the “paucity of successful reform litigation coupled with the multitude of obstructionist lawsuits during the pandemic” indicated a major shift in voting rights lawyering).
95 See William Roberts, The US Election Litigation Battlefield, Int’l Bar Ass’n (July 24, 2024), https://www.ibanet.org/The-US-election-litigation-battlefield [https://perma.cc/ZAM6-GHNV].
97 Jon Meacham, The Soul of America: The Battle for Our Better Angels 3-19 (2018).