IM_Ch10
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Feb 20, 2024
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T E S T B A N K S E L L E R . C O M
© Springer Publishing Group, LLC
37
C H A P T E R 1 0
HISTORY OF CHANGE FROM 1900 TO 2010: COMPREHENSIVE REFORM SUMMARY Efforts to reform the U.S. health care system comprehensively continued throughout the 20th century. Most of these were efforts to provide NHI. None was successful. It is fascinating that, for the most part, problems identified with the health care system were not the result of a technical or scientific inability to deal with diseases or other health deficits. Nor were the problems caused by a lack of money, as is the case in so many other countries. In the United States, the principal problems, as determined by major system studies done since the 1930s, were as follows: •
As a nation, we spent too much on health care, not too little. •
The rate of increase in health care costs, which moderated somewhat in the late 1990s before gaining momentum again in the early 2000s, had been unaffected by any interventions tried to date. •
The geographic and demographic distribution of health services was highly variable. •
Much that could be done to prevent disease and promote health using available knowledge and techniques was not done. •
Health care was widely misallocated and fragmented. •
Many health care needs were under-met (e.g., not enough home health care for the infirm elderly), whereas others were over-met (e.g., too many hospital beds, too much surgery, too much diagnostic testing). •
Many people had no health care cost coverage of any kind. •
There was an increasing focus on high-tech, increasingly expensive interventions that benefit a relatively small number of people. •
Rationing of access, especially by income, was widespread. •
There were serious problems with the quality of health care.
LEARNING OBJECTIVES After completing this chapter, students will be able to: •
Describe National Health Insurance (NHI) and differentiate it from the current U.S. health care system. •
Identify the attempts to legislate comprehensive health care reform during the 20th century. •
Describe the elements of the Clinton health plan to bring about comprehensive reform of the U.S. health care system. •
Describe some of the arguments against the Clinton health plan.
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T E S T B A N K S E L L E R . C O M
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© Springer Publishing Group, LLC
In short, the problems were not the result of a lack of resources, but rather the misuse and misallocation of resources.
SUGGESTED ANSWERS 1. What is National Health Insurance (NHI)? National Health Insurance (NHI) usually describes a single, countrywide health care financing system run by the government, at one or more jurisdictional levels. NHI programs are usually established by federal legislation and provide everyone in the population with health insurance. NHI may be administered by government or the private sector or a combination of both. NHI may be financed through taxation, private sector or individual contributions, or a combination of these. With varying prominence over time, proposals to create an NHI system have been on the national political agenda of the United States since Teddy Roosevelt made it one of the planks of his Bull Moose Party platform in the presidential election of 1912. 2. What were the main differences between health care systems with NHI and the U.S. system during the 20th century? The United States had no single health care financing system. Rather, health care financing was provided by a variety of public and private entities. The major sources were the federal government (Medicare and the military health insurance system), the federal and state governments (Medicaid and CHIP), and the private health insurance industry with its array of for-profit and nonprofit companies including Blue Cross and Blue Shield, Aetna, and Humana. These sources of financing persist today, as the passage of the Affordable Care Act did not disband the old system, but regulated the entities instead. 3. How wa
s the Clinton Administration’s Health Security Act different from previous U.S. proposals? The proposed American Health Security Act blended free-market competition with federal regulation. There would be a single payer for health care, but private insurance companies would remain. A new series of agencies, called health care alliances
, would have been established by the states. Among other things, they would collect all of the money used to support health services from all sources. They would then contract with provider networks and groups in their region to provide a package of health care services for all persons enrolled. STUDY QUESTIONS 1. What is National Health Insurance (NHI)? 2. What were the main differences between health care systems with NHI and the U.S. system during the 20th century? 3. How was the Clinton Administration’s Health Security Act different from previous U.S. proposals? 4. How did the Health Security Act address the conflict over public and private solutions to health care system problems, as outlined in Chapter 8?
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T E S T B A N K S E L L E R . C O M
© Springer Publishing Group, LLC
39
The alliances would have oversight for all quality-assurance activities. This system would presumably simplify both money flow and paperwork. It would guarantee a choice of plan and a system of quality assurance for the beneficiaries. For the providers, it would reunify authority and responsibility by putting medical decision-making back in the hands of provider groups, along with fiscal responsibility for the viability of the plan. A comprehensive benefit package was laid out, to be subject to fine-tuning and modification over time by the National Health Board. It included virtually all sites of care
—
inpatient, outpatient, short- and long-term facilities, and home based. It encompassed all forms of care
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preventive, diagnostic, treatment, rehabilitative, and follow-up services. The American Health Security Act called for each person to be able to choose from among three types of coverage: • A health maintenance organization (HMO), with no deductible and a copayment of no more than US$10 for each doctor visit • A preferred provider organization (PPO), with no deductible and a US$10 copayment if the patient were to use network providers, deductibles, and higher copayments for the use of physicians outside the PPO (which would be permitted) • A fee-for-service system, allowing completely free choice of doctor, with significant deductibles and copayments. For most businesses, large and small, participation would have been mandatory, which was a major bone of contention. Because employers would have no say in plan choice by their employees, change from plan to plan would be only at the individual’s option—
unless a plan went out of business. Coverage would be portable from job to job and from job to no job. Finally, the American Health Security Act would have linked payment and planning, under public rather than private control. This would have enabled
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although not guaranteed
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significant health care delivery system reform. This was, perhaps, what the opponents of the American Health Security Act were most against. 4. How did the Health Security Act address the conflict over public and private solutions to health care system problems, as outlined in Chapter 8? Although the Health Security Act tried to achieve a balance between public and private sectors, it was perceived as too much government by members of Congress, as well as many groups within the society. TESTBANKSELLER.COM
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