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• Health Care Policy (U.S.)

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The Accidental System: Health Care Policy in America

by Michael D. Reagan. 176 pgs.

Contributors:

   Michael D. Reagan

Publisher:

   Westview Press

Place of Publication:

  Boulder, CO  

Publication Year:

  1999

Subjects:

Medical Policy--United States, Medical Care--United States

	Contents
	List of Tables and Photos	xi
	List of Acronyms	xiii
1	The Basic Dilemma: Is Health Care a Right or a Market Commodity?	1
	What's Wrong with the Market Model?	5
	Is There an Ethical "Right" to Health Care?	12
2	The Accidental System	17
	The Early Years ,	19
	HMOs and Prospective Payment ,	21
	The Public Sector: Niche Health Care ,	24
	Where Are Current Trends Leading?	28
3	The Stakeholders and the Policy Process	31
	The Clinton Health Plan Debacle and Its Aftermath ,	33
	Federalism Is Alive and Well in Health Care ,	40
	The Cast of Characters and Their Strategies ,	45
4	Beneath the Dilemmas, the Trilemma	57
	How Do We Define Quality Care?	59
	Health Care Costs: How High the Moon?	64
	Is the Insured Population Increasing? No ,	66
	So, What's the Trilemma?	68
5	Medicare and Medicaid: The Entitlement Dilemmas	73
	What Does Medicare Cost the Taxpayers? The Seniors?	76
	Medicare: The Policy Dilemmas ,	81
	Medicaid: Medicare's Poor Relation ,	86
6	Good Health at Lower Cost: How Do Other Nations Do It?	89
	Canada: Mixed Funding and Provincial Responsibility ,	91
	United Kingdom: Socialism with Private Beds ,	96
	Germany: Public Framework, Private Operation ,	101
	To Each Its Own ,	105
7	Managed Care: Boon or Bane? Both! 107
	A Managed Care Profile ,	110
	The Case for Managed Care ,	116
	The Case Against Managed Care ,	120
	The Bottom Line? A Mixed Verdict ,	125
8	Controlling Costs: Mission Impossible?	127
	Cost Cutting--Business Style ,	130
	Better Treatments Lead to Lower Costs ,	131
	Can the United States Change Its Culture of Medicine?	142
	9 A Sensible Wild Idea: Universalize Medicare	147
	Americans Will Live with the Dilemma--But Not Forever ,	150
	Light at the End of the Health Care Tunnel?	158
	A Simple Idea: Universalize Medicare ,	158
	Notes	163
	Index	171
	Tables
	4.1 Health status indicators, 1995	60
	4.2 Health expenditures, selected nations, 1996	64
	4.3 National health expenditures, 1960 - 1996	65
	5.1 Medicare coverage (fee-for-service)	77
	5.2 Medicare costs to patient ( 1998 )	78
	5.3 Rates of use per 10,000 elderly persons, selected procedures	79
	5.4 Annual percentage growth rate of Medicaid expenditures, 1980 - 1996	88
	Photos
	Robert Young , portraying Marcus Welby , examines a patient in a scene from Marcus Welby ,	2
	Emergency department nurses' station	18
	Bill Clinton holds up a proposed health security identification card	32
	CAT scanner	58
	Baden Medical Services rural clinic	74
	Nurse with mother and newborn baby in Germany 90 Medicine, pre- and post-nurseries	108
	Still life--the high cost of health care	128
	More than 20,000 people crowd the start line for the annual "Race for the Cure"	148

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