Résumé
Steadily delegitimized by the repetition of economic crises from the first oil shocks of the1970s through the 2008 global financial crisis and explicitly targeted by the rolling out of austerity measures, state elites seem to have become a 'political species’ of their own, now under threat of extinction. The study of the comprehensive reform ofhealth policies in the U.S.during the 1990’s and 2000’s shows that far from disappearing, the influence these elites wield is being strategically reconfigured with a view to defending some sector-specific policies. Similarly to those ‘custodians of policy’ dear to P. Selznick, small groups of elites at the heart of both the executive and legislative branches’ centers of powerare gaining expertise within strategic sectors of public policy. Similar to France, where senior health officials played the role of "gardiens des politiques de l’Etat", U.S.health policy elites have reinvented the role of ‘custodianof the policy state’byinternalizing the need to control public spending, making this their “battle royale” in order to safeguard what they see as the crucial role of the public good.