American Enterprise Institute, Washington, DC, USA.
Health Aff (Millwood). 2010 Jun;29(6):1101-5. doi: 10.1377/hlthaff.2010.0439.
Four dominant political forces drove the process and product of national health reform during the past two years: federal budget constraints; public concerns about the size and reach of the federal government; the time pressure of the congressional calendar; and the political parties' high-stakes, all-or-nothing bets on what became President Barack Obama's defining policy priority. Republican congressional leaders saw little advantage in offering more detailed alternatives. Congressional Democrats calculated that they had even more to lose politically by abandoning health reform legislation than by pushing it through Congress. This essay argues that passage of the legislation merely represents a cease-fire in a long-standing war and that more battles between forces for "implementation" and those for "repeal and replace" are to come.
在过去的两年中，有四大主导政治力量推动了国家医疗改革的进程和结果：联邦预算限制；公众对联邦政府规模和影响力的担忧；国会日程的时间压力；以及两党在成为总统巴拉克·奥巴马的决定性政策重点的问题上孤注一掷。共和党国会领导人认为提供更详细的替代方案没有什么好处。国会民主党人认为，放弃医疗改革立法在政治上的损失比将其推向国会更大。本文认为，立法的通过仅仅代表了一场长期战争的停火，而“实施”和“废除和替代”力量之间的更多战斗即将到来。
