Tom Miller of the American Enterprise Institute surveys the post-reform health policy landscape and comments on how the political and policy battle lines have become what they are today. According to Miller, the most fervent supporters of the ACA are banking not on great successes but rather on policy inertia to keep the programs in place long enough for some benefits to be realized. The longer the law is in place, the more likely it is that it will persist. In response, a new reality in healthcare has emerged featuring narrow networks, high cost sharing, "regulation-induced innovation" and other new trends. Miller sees organizations attempting to survive health reform by gaining leverage through mergers and acquisitions. Miller predicts that the ACA will not inexorably lead to single-payer healthcare, but rather that U.S. healthcare will "muddle along," becoming increasingly bureaucratized along the way.
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