Morone James A
Brown University.
J Health Polit Policy Law. 2016 Aug;41(4):827-46. doi: 10.1215/03616878-3620965. Epub 2016 Apr 28.
Partisan politics snarled both the passage and the implementation of the Affordable Care Act (ACA). This essay examines partisanship's effects on health policy and asks whether the ACA experience was an exception or the new political normal. Partisanship itself has been essential for American democracy, but American institutions were not designed to handle its current form-ideologically pure, racially sorted, closely matched parties playing by "Gingrich rules" before a partisan media. The new partisanship injects three far-reaching changes into national health policy: an unprecedented lack of closure, a decline in the traditional political arts of compromise and bargaining, and a failure to define and debate alternative health policies. We can get a better sense of how far partisanship reaches by turning to state health policies. The highly charged national debate has migrated into some of the states; others retain the traditional politics of compromise and problem solving. There are preliminary indications that the difference lies in the dynamics of race and ethnicity.
党派政治使《平价医疗法案》（ACA）的通过与实施都陷入了困境。本文探讨党派之争对卫生政策的影响，并追问《平价医疗法案》的经历是个例外还是新的政治常态。党派之争本身对美国民主至关重要，但美国的制度并非为应对其当前形式而设计——意识形态纯粹、按种族分类、在党派媒体面前遵循“金里奇规则”的势均力敌的政党。新的党派之争给国家卫生政策带来了三个影响深远的变化：前所未有的缺乏定论、传统的妥协与讨价还价政治艺术的衰退，以及未能界定和辩论替代性卫生政策。通过转向州卫生政策，我们可以更好地了解党派之争的影响范围。激烈的全国性辩论已经蔓延到一些州；其他州则保留了传统的妥协与解决问题的政治方式。初步迹象表明，差异在于种族和民族动态。
