Tag Archives: Medicare

Implementing the Affordable Care Act: Why Is This So Complex?

By Alice M. Rivlin – Governmental complexity goes with being the United States of America for two fundamental reasons.

First, we have a long history of relying on private sector markets and resorting to government regulation and provision of services only where markets fail. This pro-market mindset has given us a high standard of living and brakes on centralized power, but it makes governance inherently and permanently complex.

In the case of health care, our commitment to markets prevented us from adopting a national system to provide or pay for universal health care as most advanced countries did decades ago. That was the simple approach.

Instead, we relied primarily on employers to purchase health coverage for their employees in the private market, with the government filling in the gaps. Two big gaps were filled in 1965 by Medicare for seniors and the disabled and Medicaid for the poor.

The remaining gap—people without employer coverage, but not eligible for Medicare or Medicaid—widened while the political system dithered until the ACA finally became law in 2010. The goal of the legislation was to fill this remaining gap without destabilizing the employer-sponsored coverage on which most people rely. more> http://tinyurl.com/m6dzw8d



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