奥巴马医保和高效政府

伯克利—如果有历史学家回顾2010年奥巴马总统颇有争议的医疗改革——美国患者保护和平价医疗法(Patient Protection and Affordable Care Act,ACA),我们预测他们不会将注意力花在它的规则、它麻烦的保险交易以及它网站的漏洞上。相反,我们认为历史学家会将注意力集中在“奥巴马医保”如何鼓励了逐渐控制一个功能失调的系统的不断上升的成本的创新上,即使它让数百万此前被排除在外的美国人也获得了医疗保险。

创新也许是医疗改革中被讨论最少的话题。但它是“弯曲”医疗成本曲线的关键,因为它能够让高品质医疗以高性价比的方式提供。奥巴马医保为这类创新提供了有力的新激励。

1980—2010年,美国医疗支出速度几乎是经济增长的两倍,占GDP之比从9.2%上升至17.4%。有许多因素促成了这一增幅,但大部分专家都同意,最重要的原因是按服务计费(fee-for-service)制度,该制度鼓励医疗服务提供者尽可能多地提供收费服务,而不是把维持人民健康和有效治疗疾病放在首位。

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