Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

1
National Health Insurance: A Qualitative Assessment of Several Proposals

Robert W. Broyles, Bernard J. Reilly, and Walter J. Jones

The American health industry is in a state of disarray. Despite efforts to control inflationary pressures, spending on health care consumes 11.5 percent of the gross national product (GNP) and, if present trends continue, it is estimated that 15 percent of our output will be committed to health care by the year 2000. Adjusted for inflation, the amount of spending per person increased at an annual rate of 4.0 percent during 1970-80 and 4.6 percent per year during 1980-86 ( U.S. Department of Commerce, 1990; Division of National Cost Estimates, 1987; Schieber and Poullier, 1987). Confronted with the deficit and foreign competition, the growth in health spending represents an increasingly intolerable burden to the federal government and the business community.

Concurrently, recent estimates indicate that approximately 37 million Americans are uninsured and that many others are underinsured. The growing reluctance of employers to offer coverage to employees or their dependents, the emphasis by insurance carriers on enrolling those who are least likely to require care, and the emphasis on provisions that exclude preexisting conditions have contributed to an expanding pool of uninsured and underinsured Americans ( Sulvetta and Swartz, 1986; Wilensky, 1988; Farley , 1985b). Further, inadequacies in coverage and a growing reliance on cost-sharing arrangements not only reduce access to care by those who are in greatest need but also exacerbate inequities in the distribution of service ( Manga and Weller, 1980).

Recently, policy deliberations focused on national health insurance as a mechanism that might control spending, improve access, and reduce ine-

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