University of Pennsylvania.
J Health Polit Policy Law. 2020 Aug 1;45(4):501-515. doi: 10.1215/03616878-8255445.
The Affordable Care Act (ACA) is in many ways a success. Millions more Americans now have access to health care, and the ACA catalyzed advances in health care delivery reform. Simultaneously, it has reinforced and bolstered a problem at the heart of American health policy and regulation: a love affair with choice. The ACA's insurance reforms doubled down on the particularly American obsession with choice. This article describes three ways in which that doubling down is problematic for the future of US health policy. First, pragmatically, health policy theory predicts that choice among health plans will produce tangible benefits that it does not actually produce. Most people do not like choosing among health plan options, and many people-even if well educated and knowledgeable-do not make good choices. Second, creating the regulatory structures to support these choices built and reinforced a massive market bureaucracy. Finally, and most important, philosophically and sociologically the ACA reinforces the idea that the goal of health regulation should be to preserve choice, even when that choice is empty. This vicious cycle seems likely to persist based on the lead up to the 2020 presidential election.
平价医疗法案（ACA）在很多方面都是成功的。现在，有更多的美国人能够获得医疗保健服务，ACA 推动了医疗服务提供改革的进步。与此同时，它也强化并加剧了美国健康政策和监管核心的一个问题：对选择的热爱。ACA 的保险改革进一步强化了美国人对选择的特别关注。本文描述了这种加倍关注对美国健康政策未来的三个问题。首先，从实际情况来看，健康政策理论预测，在健康计划之间进行选择将产生实际的好处，但实际上并没有产生。大多数人不喜欢在健康计划选项之间进行选择，而且许多人，即使受过良好的教育和有知识，也无法做出正确的选择。其次，为支持这些选择而建立的监管结构构建并强化了一个庞大的市场官僚机构。最后，也是最重要的，从哲学和社会学的角度来看，ACA 强化了这样一种观点，即健康监管的目标应该是保留选择，即使这种选择是空洞的。根据 2020 年总统大选的前期情况，这种恶性循环似乎很可能持续下去。
