Michel Grignon; A Democratic Responsiveness Approach to Real Reform: An Exploration of Health Care Systems' Resilience. J Health Polit Policy Law 1 August 2012; 37 (4): 665–676. doi: https://doi.org/10.1215/03616878-1597475
Real reforms attempt to change how health care is financed and how it is rationed. Three main explanations have been offered to explain why such reforms are so difficult: institutional gridlock, path dependency, and societal preferences. The latter posits that choices made regarding the health care system in a given country reflect the broader societal set of values in that country and that as a result public resistance to real reform may more accurately reflect citizens' personal convictions, self-interest, or even active social choices. “Conscientious objectors” may do more to derail reform than previously recognized.