Academic journal article Social Security Bulletin

Section II: Health Care Programs

Academic journal article Social Security Bulletin

Section II: Health Care Programs

Article excerpt

Health and medical care expenditures in the United States, including expenditures for medical research and medical facilities construction, were estimated at $751.8 billion for 1991. This amount constituted 13.2 percent of the gross domestic product (GDP). Fifty-six percent of these expenditures originated in the private sector and 44 percent represented expenditures by Federal, State, and local governments.

More than 70 percent of the public expenditures for health and medical care were for the Medicare and Medicaid programs--39 percent and 32 percent, respectively. Hospital and medical care costs for the Department of Defense and for veterans accounted for 8 percent; workers' compensation payments for 6 percent: and various public health expenditures, medical research, and construction of medical facilities accounted for must of the remainder.

Through the Medicare and Medicaid programs, public health, and medic care expenditures in the United States target two broad population groups. The Medicare program covers persons aged 65 or older who are insured under the Social Security program and also persons who have been receiving Social Security disability benefits for 2 years or more. The Medicaid program covers persons with limited income and resources--for the must part, those individuals receiving assistance under the Aid to Families with Dependent Children (AFDC) or Supplemental Security Income (SSI) programs and those who would be eligible for such assistance if their income or resources were somewhat lower.

The first coordinated efforts to obtain government health insurance in the United States were initiated at the State level between 1915 and 1920. State health insurance programs were envisioned as a complement to the workers' compensation laws that had recently been enacted in the majority of States.

However, these efforts came to naught, in part as a result of changed national priorities and public attitudes in the years following World War I.

Renewed interest in government health insurance surfaced during the 1930's at the Federal level. Again, nothing concrete resulted beyond the limited provisions in the Social Security Act that supported State activities relating to public health and health care services for mothers and children. Broader initiative in health care were crowded out by the programs of public assistance, old-age insurance, and unemployment insurance included in the Social Security Act of 195. One of the concerns was that the health care system would have to be expanded and strengthened before large scale improvements in the provision of health and medical care could be undertaken.

From the late 1930's on, there was broad agreement on the need for some form of health insurance to alleviate the unpredictable and uneven incidence of medic costs for middle-income Americans. The main issue that remained to be resolved was whether health insurance would be privately or publicly financed. Private health insurance, mostly group insurance financed through the employment relationship, ultimately prevailed.

Private health insurance coverage expanded rapidly beginning in World War II as employee fringe benefits were expanded because the Government limited direct wage increases. This tend continued after the war. Concurrently, numerous bills incorporating proposals for national health insurance, financed by payroll taxes, were introduced in the Congress during the 1940's. However, none of these bills was ever brought to a vote.

Instead, Congress acted in 1950 to improve access to medical care for needy persons who were receiving public assistance, including those eligible under the newly enacted program of Aid to the Permanently and Totally Disabled. The resulting legislation, for the first time, permitted Federal participation in the financing of State payments made directly to the providers of medical care for costs incurred by public assistance recipients. …

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