Yale University.
J Health Polit Policy Law. 2021 Aug 1;46(4):535-547. doi: 10.1215/03616878-8970739.
Given the close division of power in Washington, DC, how might health reformers pursue their bolder aims? In particular, how might they pursue the robust public option that was a centerpiece of Joe Biden's health plan during the campaign? This new iteration of the public option-far more ambitious than anything seriously considered during the debate over the ACA-is not in the cards right now. But instead of giving up on it, advocates should recast it in an inspiring vision that can structure immediate initiatives designed to make its achievement more feasible. This strategy, which might be called "building power through policy," would involve using the openings for policy change that are likely to exist in the near term to reshape the political landscape for the long term. Three interim steps in particular could advance the public option's prospects: (1) pursuing immediate improvements in the ACA that are tangible and traceable yet do not work against the eventual creation of a public option, (2) building the necessary foundations for a public option within Medicare while encouraging progressive states to experiment with state public plan models, and (3) seeding and strengthening movements to press for more fundamental reform.
鉴于华盛顿特区权力的密切划分，健康改革者如何追求他们更大胆的目标？特别是，他们如何追求乔·拜登（Joe Biden）在竞选期间的健康计划中的核心——强大的公共选择？目前，这种新型的公共选择——比在 ACA 辩论中认真考虑的任何选择都更具野心——是不可能的。但倡导者不应该放弃它，而是应该用一种鼓舞人心的愿景来重塑它，这种愿景可以构建旨在使其更可行的直接倡议。这种策略，也可以称为“通过政策建立权力”，将涉及利用近期可能存在的政策变革机会，为长期重塑政治格局。有三个过渡性步骤可以推进公共选择的前景：（1）在 ACA 中寻求切实可行且可追踪的即时改进，同时不反对最终创建公共选择；（2）在医疗保险中为公共选择奠定必要的基础，同时鼓励进步州试验州公共计划模式；（3）播种和加强争取更根本改革的运动。
