Wang Miao
Harbin Institute of Technology, Harbin, China.
Health Care Anal. 2025 Sep 10. doi: 10.1007/s10728-025-00542-1.
The US healthcare system is characterized by a persistent deadlock, where high costs, low efficiency, and inequity resist fundamental reform. This stalemate is rooted in deep ideological divides, political polarization, a fragmented fiscal structure, and the power of entrenched interest groups. This article analyzes how recent trade protectionist policies, specifically tariffs on pharmaceuticals and their inputs, intersect with this domestic gridlock. It posits a central paradox: a political system incapable of enacting major domestic health reform can simultaneously deploy assertive trade interventions in the same sector. The article argues that these tariffs should not be misconstrued as flawed instruments of healthcare reform. Instead, they represent the application of a distinct sovereigntist and protectionist logic, driven by national security concerns. The consequence is not a failed attempt at a solution, but a collision of policy agendas that actively exacerbates the healthcare system's core dysfunctions. By increasing costs, destabilizing supply chains, and creating new arenas for interest group conflict, tariffs intensify partisan strife and further entrench the reform deadlock. This process, marked by the "securitization" of the pharmaceutical industry, signals a critical shift in global health governance, where geopolitical strategy now overrides and complicates the pursuit of domestic public health goals.
美国医疗体系的特点是长期陷入僵局，高昂的成本、低下的效率和不公平现象阻碍了根本性的改革。这种僵局源于深刻的意识形态分歧、政治两极化、分散的财政结构以及根深蒂固的利益集团的影响力。本文分析了近期的贸易保护主义政策，特别是对药品及其投入品征收的关税，是如何与国内的这种僵局相互交织的。文章提出了一个核心悖论：一个无法实施重大国内医疗改革的政治体系，却能在同一领域同时采取强硬的贸易干预措施。文章认为，这些关税不应被误解为有缺陷的医疗改革手段。相反，它们体现了一种独特的主权主义和保护主义逻辑的应用，这种逻辑是由国家安全担忧驱动的。其后果并非是一次失败的解决方案尝试，而是政策议程的冲突，这种冲突积极地加剧了医疗体系的核心功能失调。通过提高成本、破坏供应链稳定以及制造利益集团冲突的新领域，关税加剧了党派纷争，并进一步巩固了改革僵局。这一以制药行业“安全化”为特征的过程，标志着全球卫生治理的一个关键转变，即地缘政治战略现在凌驾于国内公共卫生目标的追求之上，并使其复杂化。
