Health Care Reform in the 1990s: An Analysis of the Problems and Three Proposals

By Scuka, Robert F. | Social Work, September 1994 | Go to article overview

Health Care Reform in the 1990s: An Analysis of the Problems and Three Proposals


Scuka, Robert F., Social Work


There is widespread discussion of whether the U.S. health care system is in a state of crisis. A consensus on this has not been reached but appears to be slowly emerging. It perhaps reached a critical breakthrough with the special U.S. Senate election in Pennsylvania in November 1991. Many political analysts regard health care as the single most important issue that crystallized voter preference in that election, and the ensuing public debate during the 1992 presidential election only substantiated the impression that a sufficient critical mass in public opinion would necessitate a positive political response to this public policy problem.

Of course, political events tell nothing about what the response is likely to be or whether the political calculations that inevitably must be made will result in a response that goes beyond stopgap measures and patchwork changes to embrace a comprehensive reform that addresses the underlying problems facing America's health care system. As a consequence, it is important to consider some of the reforms that have been proposed in response to the public concern over the state of health care in America and to identify how well these alternative proposals address the underlying problems. This article does three things: (1) It discusses the problems that constitute the crisis in American health care; (2) it delineates the criteria by which any health care reform proposal should be evaluated; and (3) because the crisis in U.S. health care is as much a political as it is a public policy problem, the article evaluates three proposals for reform considered by the U.S. Congress.

The proposals to be evaluated include the Universal Health Care Act of 1991 (H.R. 1300), proposed by Representative Marty Russo (D-IL), hereinafter referred to as the Russo bill; Senate bill S. 1227, sponsored by Majority Leader George Mitchell (D-ME), hereinafter referred to as the Senate bill; and the Pepper Commission report on Access to Health Care and Long-Term Care for All Americans (U.S. Bipartisan Commission on Comprehensive Health Care, 1990), hereinafter referred to as the Pepper Commission Report. These proposals represented two of the major alternatives in the current policy debate: the "single-payer" model (the Russo bill) and the "play or pay" model (the Senate bill and the Pepper Commission Report).

Factors Contributing to the Health Care Crisis

The crisis in American health care comprises a number of distinct problems, but this article will focus on two fundamental issues: absence of universal access and excessive costs.

Absence of Universal Access

The absence of universal access to health care constitutes for many the number 1 problem in America's health care system. Access is restricted on the basis of employment; ability to pay; current level of health; and, most significantly, ability of certain individuals to obtain health insurance (for example, those with pre-existing conditions). Recent estimates indicate that between 32 million and 37 million Americans are without any health insurance and that another 25 million have only minimal or inadequate health insurance (Cohn, 1991).

Ironically, Medicare contributes to the problem of nonuniversal access by creating a select population guaranteed adequate access and denying other groups such access. Some refer to this as America's two-track system in health care. However, the problem goes deeper. The United States has a multitrack system that includes private employment-based health insurance policies; Medicare for elderly people; Medicaid for poor people; and a grab bag of leftover or no options for those who are unemployed, underemployed, self-employed, or employed by companies that offer no health insurance benefits. The current employment-based system is predicated on the assumption that health insurance is a fringe benefit rather than a fundamental right.

Another factor contributing to the problem of nonuniversal access is the widespread practice by health insurers of restricting or denying coverage to individuals with prior health problems (pre-existing conditions). …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Health Care Reform in the 1990s: An Analysis of the Problems and Three Proposals
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.