To meet the twin goals of cost containment and universal coverage, health care legislators in the US will eventually have to come to grips with the concept of ‘compulsion’. This is the main tenet of this paper, which also addresses what compulsion might mean as applied in the context of recent US health care legislation and its implications for the US health care industry. Missing the opportunity to embrace compulsion more fully may lead to cost containment not being achieved, thus threatening the sustainability of the reforms contained in the recently Patient Protection and Affordable Care Act.
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