This study is dedicated to the political economy of the medical biotechnology industry in the United States. The study combines interviews with more than 150 biotechnology actors with a historical analysis and evidence from publicly available data bases. The ascent of this new industry took place in the United States first and foremost, because there, scientific advancements coincided with the rise of supply-side economics, a policy shift that was part of a larger, neoliberal, ideological shift. Despite free-market rhetoric, specific clusters within the United States became the world’s leading biotechnology clusters because of a history of targeted interventions to stimulate economic competitiveness. And despite much expectation about a ‘biotechnology revolution’, biotechnology became an outsourced sub-industry for research, embedded within the ‘blockbuster drug’ business model of large pharmaceutical companies. This business model benefited from America’s healthcare system, whose fragmentation and domination by private health providers proved to be global drug companies’ most profitable market. To keep the status quo, biotechnology and pharmaceutical industries have successfully engaged in political maneuvering. They have helped preventing or watering down U.S. healthcare reform efforts, not in the least the most recent ones under President Obama.