title: Policy reform as creative destruction: political and administrative challenges in preserving the public-private mix.
abstract: As political pressure for affordable universal coverage intensifies, various proposals have been crafted to improve the system without sacrificing the role of the private sector. Some analysts view the preservation of a mixed public-private system as an exercise in incrementalism, avoiding disquieting departures from familiar arrangements. A review of the political and administrative challenges of several main options--market innovation, tax credits, play or pay, and Medicaid expansion--suggests that the path to true reform is a slippery slope. Over time, changes in particular sectors, such as insurance, employers, government, and providers, will very likely implicate the others too. Although redefining the public-private mix may be more incremental than (say) adoption of a Canadian model, it will also entail considerable "creative destruction" of existing patterns and cannot fail to disturb the institutional status quo substantially.
authors.affiliation: Division of Health Policy and Management, School of Public Health, Columbia University, New York, NY 10032.
authors.forename: L D
authors.initials: LD
authors.lastname: Brown
mesh_terms: D005380:Financing, Government / Q000191:economics; D006291:Health Policy / Q000639:trends*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000592:standards*; D017054:Insurance, Medigap / Q000191:economics; D007373:Interinstitutional Relations; D008389:Marketing of Health Services / Q000191:economics; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured; D009310:National Health Insurance, United States / Q000191:economics / Q000592:standards*; D011057:Politics; D013660:Taxes; D014481:United States