single predictor of the level of health-care spending is some standard measure of national wealth, such as per capita income. But any examination of the trend line of the distribution point on a graph mapping the health spending/wealth correlation soon make clear that theUnited States is well above the trende: in short, it spends far more on health-care than we should 'expect' given its wealth. The best summary of why this state of affairs obtains links it to the historical development sketched above, and helps explain the twin anomalies of the failure to develop comprehensive health insurance and the unusually high levels spending on health care. It has been offered by Jacobs: the general sequence and form of health policy in the United states diverge form those of all other industrialized nation. The U.S. Government's first and most generous involvement in health care focused on expanding the supply of hospital centered, technologically sophisyicated health care ... . In contrast to the United States, however, other Western countries have made the expansion of access their first and primary priority, governments have acxelerated the expansion of supply in response to widening access and growing demand for care.(1995: 144-5) This quotation catches exactly the important feature. The state in the U.S. has been by no means an unimportant actor in the health-care system. But in terms of the 'three worlds' sketched earlier in this chapter the contents of its interventions have been most heavily shaped by the interests represented by the two linked worlds of health-care surpliers suppliers of professionalised medical care and suppliers of high technology medical care. It has, in summary, been a supply state. That is, it has been dominated by actors in the second and third domains identified in our preceding section, the organised corporate suppliers of care. The mixture of sheer scale and the importance of suppliers of care notably suppliers of high technology medicine - also lies at the base of the third unique feature of the American system noted earlier: its unique global impact, Two remarkable signs of this should be highlighted. First, some of the most important innovations in care, many stimulated by the search for cost containment, have been diffused from the United States. One reason for this is the