Reforming Healthcare Reform

Current scholarship has not addressed the systemic problems that occur in the process of implementing healthcare reform, tending instead to focus on proposing single reform measures to cure specific problems or on constitutional problems related to the Affordable Care Act. 1 To address that gap, this article carefully analyzes a case study of Medicare‘s efforts to control unnecessary hospital admissions over the course of thirty years—efforts that have been subjected to almost universal criticism—and uses this case study to illustrate perennial problems with reform more generally. This article then explores other cultural and regulatory processes that function better than healthcare reform in similar circumstances, specifically the tax regulatory system, and proposes a series of changes to healthcare related regulatory processes.