Department of Psychiatry, Yale University School of Medicine, 300 George St., New Haven, CT 06511, USA.
Psychiatr Serv. 2010 Nov;61(11):1144-5. doi: 10.1176/ps.2010.61.11.1144.
The Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, contains elements of two seemingly contradictory positions: health care as a commodity and as a right. The commodity argument posits that the marketplace should govern demand, supply, and costs of care. The law's establishment of state insurance exchanges reflects this position. The argument that health care is a right posits that it is a need, not a choice, and that government should regulate care standards that may be compromised as insurers attempt to minimize costs. The law's requirement for coverage of mental and substance use disorders reflects this position. This Open Forum examines these arguments in light of current state fiscal crises and impending reforms. Despite the federal government's interest in expanding prevention and treatment of mental illness, states may demonstrate varying levels of commitment, based in part on their perception of health care as a right or a commodity. The federal government should outline clear performance standards, with minimum services specified to maximize state commitments to services.
《患者保护与平价医疗法案》于 2010 年 3 月由奥巴马总统签署成为法律，其中包含了医疗保健作为商品和权利这两个看似矛盾立场的元素。商品论认为，市场应该控制医疗保健的需求、供应和成本。该法律建立州立保险交易所反映了这一立场。医疗保健是一项权利的论点认为，它是一种需求，而不是一种选择，政府应该监管医疗保健标准，因为保险公司试图将成本最小化，这些标准可能会受到影响。该法律要求涵盖精神和物质使用障碍反映了这一立场。本公开论坛根据当前州财政危机和即将进行的改革，审查了这些论点。尽管联邦政府有兴趣扩大对精神疾病的预防和治疗，但各州可能会根据其对医疗保健作为商品或权利的看法，表现出不同程度的承诺。联邦政府应该制定明确的绩效标准，规定最低服务，以最大限度地提高各州对服务的承诺。
