Health Care Policy in the United States

This book offers a systematic review of major issues and trends in health care policy, including those related to physical health and disease trends, mental and behavioral health concerns, reorganizing the U.S. health system, and managed care and health care personnel. Kronenfeld addresses the problems, challenges, issues and trends in the policies that determine the role and future of health care in the United States.

How can we have received so many benefits while still being as worried as ever about our health and the health care system established to ensure and extend those benefits? The historical perspective provided by the essays in this volume helps answer this question by identifying two points of significant change in health care policy. Beginning in the 1950s there emerged a subtle yet critical reconceptualization as the individual rather than the group came to figure prominently as the central policy-making unit. Then in the late 1960s, a palpable sense of limits rendered the individualism of the previous decade into a Malthusian formulation: the greater the access or benefits that any one person received, the less access and fewer benefits others could get. Besides tracing these patterns in health care development, the essays also show how traditional notions of expertise have been affected by the changes.

In this impassioned and often vitriolic book _ a follow-up to the author's bestselling Bleeding Edge: The Business of Health Care in the New Century _ U.S. health care industry expert J.D. Kleinke offers an unflinching look at our broken health care system. Throughout the book, Kleinke-who was once a vocal advocate of the managed health care system-explains what went wrong and attempts to answer such perplexing questions as Who's in charge of the American health care system? How does managed care work . . . or not work? Why have hospitals become so complex? What are the prospects for reform? Does the Internet change anything? Can we solve the growing problem of the uninsured?

This completely new edition of a best-selling text for practitioners and policy analysts alike tracks the increasingly important role of the states in U.S. health care policy reform and the experience that policy-innovating states have accumulated to date. The first part of the book deals with health issues common to all states. Chapter 1 shows how the states have, by default and design, become the "laboratories" of health care reform and reviews the challenges faced by the states in dealing with rising health care costs, declining insurance coverage of the population (about 35 million uninsured), and the transfer of programmatic responsibility in health policy from the federal to the state level. Chapters 2-5 deal with the states' policy competence and capacity and their role in managed care; health insurance market reform; and Medicaid. Chapters 6-10 examine the successes and failures of notable health policy reform efforts in Hawaii, Minnesota, Oregon, Vermont, and Kansas.

"Health care workers, policy-makers, social scientists, and the general public have much to gain by reading this book". -- Choice (on the first edition)

This book focuses on the problems in America's health care system that have developed over the past 30 years and that will be with us for the next 30 years. It goes beyond mind-numbing quantitative data to probe the underlying causes of the nation's difficulties. Three broad questions are addressed: Why are health care costs in the United States higher than elsewhere? What needs to be done to bring down costs without lowering quality? Is America doing enough about research, prevention, and public information?

The devastating and politically consequential defeat of President Clinton's comprehensive health plan in Congress has unleashed a torrent of speculation over "who or what killed reform." One class of explanation deals with the institutional arrangements by which policy is made in the United States and, more specifically, with the rules and organization of Congress. This volume weighs the importance of Congress in the failure to enact health reform by examining more broadly how Congress shapes health policy--on matters ranging from ambitious plans to achieve universal health insurance coverage to annual appropriations for public health agencies. Part One examines how Congress has organized and equipped itself to make health policy. Individual chapters consider how committee jurisdictions, budgeting procedures, information, and oversight influence health policymaking. Part Two uses recent health policy episodes--the 1988-89 adoption and repeal of Medicare catastrophic coverage and the 1993-94 failure to pass national health reform--to generalize about how process shapes policy. This book is a product of the Renewing Congress Project, a joint undertaking of the Brookings Institution and the American Enterprise Institute. The contributors include C. Lawrence Evans, College of William and Mary; Mark Nadel, General Accounting Office; Julie Rovner, freelance health policy writer; and Allen Schick and Joseph White, Brookings. Copublished with the American Enterprise Institute

Health care in the United States at the end of the 20th century occupies a completely different place in the economy, in the public consciousness, and in its impact on government, than it did at the beginning of the century, or even in the early years of the Clinton Administration. Health care is now a multi-billion dollar industry; one that consumes more than 15 percent of the nation's GNP. Citizens now regard health care as essential to the quality of their lives, and a steady stream of new medications and procedures point to ways to extend the lives of our aging population and restore those injured on or off the job. At the same time, the changing patterns of health care have stirred a national debate over the growth of managed care and the role that government can play in providing solid health care standards--a medical safety net--within tightening budgetary restraints. This book explores the role of the federal government in health care policy development from the years of the Founding Fathers to the present.

Tracking the issue of health care reform through the tumultuous 1990s, Politics, Power, and Policy Making opens a window on the changing dynamics of American politics from the Clinton inauguration in January 1993 through the Republican revolution of 1995 and the 1996 presidential race. The book brings the legislative process to life by tracking a single controversial policy issue through the system, effectively linking public policy studies with the study of American political institutions.

This study of US health care describes how its reorganization has been set by developments in the national and international political economies, and shows how these developments have affected the social and economic transformations.

How can America become a healthy nation, Blank asks, when it is beset by poverty, illiteracy, and crime? No new health care system can succeed unless or until the links between social problems and sickness are understood-and addressed. On the national level, Blank calls for a more aggressive redistribution of social and public health resources to the poor and elderly; at the same time, he describes sanctions that would encourage individuals to be more careful about their own health, and limit or change destructive behavior.