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  • Title: Policy reform as creative destruction: political and administrative challenges in preserving the public-private mix.
    Author: Brown LD.
    Journal: Inquiry; 1992; 29(2):188-202. PubMed ID: 1612719.
    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.
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