The debate over the role of markets in public services rages most fiercely in the health sector. Health services affect people at all points in their life, are provided by professionals with strong organized interests, and have experienced faster growth than almost all other economic sectors. Consequently, citizens using the health care sector, the large and growing health care workforce, and taxpayers who foot the bill for public expenditure, all have a major stake in health care reform. The question of what markets offer to patients, workers, and taxpayers, takes on a particular urgency, as health services can be literally a “life or death” matter.

This chapter shows that despite using a common language of markets, left- and right-wing parties have built qualitatively different markets. In England and the Netherlands, conservative reformers increased private responsibility for financing somewhat, while more dramatically expanding competition through clearly developed contracting. These Austerity Markets increased the power of the state and insurers as purchasers of services, while undercutting doctors and offering little to patients. By contrast, in recent years, Britain's Labour party modified the English health care market, increasing public financing and competition around individual choice. These reforms built on the early experience of Swedish health care reform, where policymakers on the Left also introduced competition among hospitals for patients. These Consumer-Controlled markets had dramatically different outcomes than the Austerity Markets – reorienting care around patients and reducing waiting times, albeit at the expense of financial control by the state.