Gaffney Adam
Int J Health Serv. 2015;45(1):33-52. doi: 10.2190/HS.45.1.d.
Leaving millions both uninsured and underinsured, the Affordable Care Act does not create a system of universal health care in the United States. To understand its shortcomings, we have to understand it as part of a historic shift in the political economy of American health care. This "neoliberal turn" began as a reaction against the welfare state as it expanded during the New Deal and post-World War II period. What began as a movement associated with philosophers like Friedrich Hayek ultimately had a powerful impact via the attraction of powerful corporate sponsors and political supporters, and it was to historically transform American health care thought and organization. In health policy circles, for example, it can be seen in a rising emphasis on "moral hazard," overuse, and cost sharing above a concern with universalism and equity. It was likewise manifested by the corporatization of the health maintenance organization and the rise of the "consumer-driven" health care movement. By the time of the health care reform debate, the influence of corporate "stakeholders" was to prove predominant. These developments, however, must be construed as connected parts of a much larger political transformation, reflected in rising inequality and privatization, occurring both domestically and internationally.
《平价医疗法案》让数百万美国人没有保险或保险不足，并未在美国创建一个全民医疗保健体系。要理解其不足之处，我们必须将其视为美国医疗保健政治经济领域历史性转变的一部分。这种“新自由主义转向”始于对福利国家的一种反应，因为福利国家在新政和二战后时期不断扩张。它最初是一场与弗里德里希·哈耶克等哲学家相关的运动，最终通过强大的企业赞助商和政治支持者的吸引力产生了巨大影响，并从历史上改变了美国的医疗保健思想和组织。例如，在卫生政策领域，人们越来越强调“道德风险”、过度使用以及成本分担，而不是普遍主义和公平。健康维护组织的公司化以及“消费者驱动”的医疗保健运动的兴起也体现了这一点。到医疗保健改革辩论之时，企业“利益相关者”的影响力已占据主导地位。然而，这些发展必须被视为一个更大的政治变革的相互关联的部分，这种变革体现在国内外日益加剧的不平等和私有化现象中。
