I get that this is what you think but it comes off, to me, as a projection of how you were… dismissive of @anon61221983 for precisely this reason. As for the rest of this, what I’m hearing from you is my own words coming back to me about what the academic discussion was post-ww2. You miss that it’s been completely ignored in the way the industry is structured. Yes, the ACA was conjured from health policy academia which looks at the medical industry from a larger perspective than the markets for insurance/pharma/providers, except that the ACA itself does not implement that meta-perspective in any important part of the financing, incentives, oversight, cost controls, etc.
This institution which you have studied has been effectively sidelined in this country since the 30s, with Reagan pinning it to the ground in the 80s, and abroad the drumbeat to walk it back to pre-social medicine is taking hold in places like Britain. The public sentiment isn’t shifting so much in those countries, it’s the people in power who see zero value in continuing what they see as a sop to the masses. The entire British establishment, for instance, runs from resigned about cuts to enthusiastically pursuing them.
Perhaps what I was taking as a dismissive tone from you was more a matter of you being primed for a fight about the value of your field. If you view this response as me digging deeper… then you should check that tone again. If you still feel it necessary to be primed for the fight over how socialist the U.S. health care system is, consider that a well-made and monumental academic foundation means little if the foundation still only has one or two small wings on top of it while the institution as a whole is mostly still a sprawling city of mud huts two counties away in a swamp.
Perhaps that bricks and mortar metaphor is too metamophorical. Many of us don’t have the luxury of idealizing the academic underpinnings of something that, for us, does not exist.
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