Universal Coverage and the American Health Care System in Crisis (Again)

Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died, several old and new issues with the health care system have emerged. First, the number of uninsured Americans rose to 43.6 million in 2002—and the numbers have since increased. Also, the costs for those who do not have insurance are rapidly increasing. In addition health care related problems are one of the leading causes of personal bankruptcy in the United States. Finally, the government’s two primary health insurance programs—Medicare and Medicaid—are experiencing considerable financial strain. Dr. Mayes examines these problems in depth before and revisits President Clinton’s health care reform plan and the reasons it failed. These include: the role of private insurance in covering the uninsured; whether public programs should be expanded to include additional groups; and the commitment of adequate budgetary resources required to assist those who are unable to afford the full cost of health coverage. Mayes concludes that while there are many serious issues in health care that need to be addressed, the health care system has managed to survive even with all of its existing flaws

Universal Coverage: The Elusive Quest for National Health Insurance

Universal health coverage has become the Mount Everest of public policy in the United States: the most daunting challenge on the political landscape. But, despite numerous attempts, all efforts to achieve universal health care have failed. In Universal Coverage, Rick Mayes examines the peculiar and persistent lack of universal health coverage in America, its economic and political origins dating back to the 1930s, and the current consequences of this significant problem.https://scholarship.richmond.edu/bookshelf/1142/thumbnail.jp

Strategies for Health Care Cost Containment (1980s-Present)

The U.S. health care system during the past three decades has been over two interrelated questions: first, who will control the manner in which medical care is paid for, and, second, how much will it cost? Many health care experts believe that Medicare\u27s efforts at cost control, primarily in the form of the program\u27s seminal transition to and continual modification of prospective payment of health care providers, has both triggered and repeatedly intensified the economic restructuring of the U.S. health care system. Medicare is an almost $600 billion public health insurance program for individuals sixty-five years of age and older; individuals under sixty-five with certain disabilities (with eligibility depenqent on the severity of the disability and the resultant consequences for a person\u27s ability to work), and those with end-stage renal disease). With regard to how the program reimburses for care, Medicare sets prospectively the payment amount (rates) providers will receive for most covered products and services, and providers agree to accept them as payment in fun, according to the Medicare Payment Advisory Commission. Thus, in most instances, providers\u27 payments are based on predetermined rates and are unaffected by their costs or posted charges

The Way It Was In Health Policy, And Probably Will Be: Learning Lessons by Rashi Fein (Book Review)

Learning Lessons by Rashi Fein is an enjoyable memoir from a scholar and policy adviser unlike any other. Fein’s influential involvement in health care policy dates back to John F. Kennedy’s administration, and his career as a leading health economist paralleled the significant growth in the political influence of health economists following the enactment of Medicare and Medicaid in 1965. Now an emeritus professor of the economics of medicine at Harvard Medical School, Fein writes here about the lessons he learned in medicine, economics, and public policy. His view of the policy process, as a way of coming to terms with life’s unavoidable trade-offs, has much to offer us, too

The Origins of and Economic Momentum Behind Pay for Performance Reimbursement

Pay for performance, a reimbursement method under which some physicians and hospitals are paid more than others for the same services because they have been deemed to deliver better quality care and their patients appear to have better outcomes, is enormously controversial. Disputes invariably arise over how quality should (or even can) be measured. Nevertheless, differentiating between medical providers, financially, lies at the heart of this new reimbursement innovation developed by insurance companies and employers. Its two main objectives are: (1) to increase the overall quality of health care that patients receive, and (2) to encourage behavioral change on the part of physicians and hospitals that leads to increased efficiency. This article attempts to explain where the momentum for pay for performance reimbursement has come from, why its advocates consider it an improvement upon existing payment systems, and how it can both positively and negatively affect medical providers

Medicare and America\u27s Healthcare System in Transition: From the Death of Managed Care to the Medicare Modernization Act of 2003 and Beyond

This article traces the transition-in Medicare, specifically, and in the American healthcare system, generally-from the aftermath of the Balanced Budget Act of 1997 to the passage of the Medicare Modernization Act of 2003. During this time, restrictive managed care died under an onslaught of resurgent cost pressures, legislative and legal attacks, and a vehement physician and consumer backlash. The subsequent reversion to more generous (and more expensive) health plans coincided with a recession in 2001 to trigger a return to rapidly escalating healthcare spending and yet another in the Nation\u27s series of healthcare crises. Current trends suggest that future policymakers will have no choice but to confront the consequences of rapidly rising rates of healthcare spending

Universal Coverage and the American Health Care System Crisis (Again)

Ten years after President Clinton’s ambitious attempt at comprehensive health care reform died, several old and new issues with the health care system have emerged. First, the number of uninsured Americans rose to 43.6 million in 2002—and the numbers have since increased. Also, the costs for those who do not have insurance are rapidly increasing. In addition health care related problems are one of the leading causes of personal bankruptcy in the United States. Finally, the government’s two primary health insurance programs—Medicare and Medicaid—are experiencing considerable financial strain. Dr. Mayes examines these problems in depth before and revisits President Clinton’s health care reform plan and the reasons it failed. These include: the role of private insurance in covering the uninsured; whether public programs should be expanded to include additional groups; and the commitment of adequate budgetary resources required to assist those who are unable to afford the full cost of health coverage. Mayes concludes that while there are many serious issues in health care that need to be addressed, the health care system has managed to survive even with all of its existing flaws

Postmortems On The Affordable Care Act (Book Review)

Nearly two years after the Affordable Care Act became law, books are appearing by Washington insiders who detail how the legislation came about. The two reviewed here discuss and dissect topics related to the health reform law from decidedly different points of view

An Analysis of Political and Legal Debates Concerning Medicaid Expansion in Virginia

The Supreme Court’s historic June 2012 ruling regarding the Affordable Care Act (ACA) in National Federation of Independent Business v. Sebelius set the stage for a massive federalism battle over Medicaid expansion in the United States. The original language of the Act was intended to nationalize Medicaid by having every state expand their program’s eligibility to all individuals up to 138% of the federal poverty level. This would have significantly reshaped Medicaid, a joint federal-state health insurance program, into a universal entitlement for all low-income citizens. Currently, Medicaid eligibility varies dramatically from state to state. The Court held that the ACA’s Medicaid expansion, and the additional federal financing that would accompany it, would be optional for the states. The decision instigated a series of intense, state-level political battles, especially in Virginia. This article will provide a basic overview of: Medicaid and its significance in Virginia, how and why the Supreme Court’s decision triggered a heated debate over Medicaid expansion, the manner in which the political debate has unfolded in the Commonwealth, and what the major implications are for expanding (and not expanding) the program. This article concludes that Medicaid expansion can be viewed as a valuable investment in the health of vulnerable citizens and the overall healthcare infrastructure of Virginia

Pay-for-Performance Reimbursement in Health Care: Chasing Cost Control and Increased Quality through New and Improved Payment Incentives

Pay-for-performance (P4P) reimbursement has become a popular and growing form of health care payment built on the belief that payment incentives strongly affect medical providers\u27 behavior. By paying more to those providers who are deemed to deliver better care, the goal is to increase quality and, hopefully restrain cost growth. This article provides a brief explanation of: (1) how previous P4P plans in the U.S. have fared, along with their special relationship to primary care, and (2) how England\u27s experience with P4P and newer versions of these kinds of plans being pursued in places such as Massachusetts might provide valuable case studies for how the U.S. and other countries can achieve meaningful reform of health care organization, delivery and finance