The Politics of Cost Control and Regulatory Policy

Abstract

One of the most widespread criticisms of the Patient Protection and Affordable Care Act (ACA) is that it does little to contain health care costs. While some economists argue that the ACA will “bend the cost curve,” Jonathan Oberlander and Thomas Rice contend that the provisions will not control costs substantially any time soon. As the essays in this section attest, this lack of cost control is surprising given the vast number of cost-containment provisions included in the bill. As a result, the final essays in this section focus on specific regulatory or cost-containment provisions, exploring the promise of particular initiatives. Harold S. Luft considers the likelihood that accountable care organizations will take hold in the U.S. delivery system. Michael K. Gusmano examines the politics of cost-effectiveness research and its potential to improve care and control costs. Timothy Stoltzfus Jost examines the benefits and dangers of increased agency discretion under the development of new independent commissions under the ACA, such as an independent Medicare commission, an innovations center, and an Institute of Medicine commission. Finally, Miriam J. Laugesen focuses on the American Medical Association's role in the politics of Medicare physician payment reform and considers how Medicare payment reforms have impacted the entire politics of health care reform.