Study guide for the final, part 5 Flashcards
What main actions were taken for national health insurance?
1917, the American Association of Labor Legislation
-To expand its social agenda by advocating national health insurance
1940s
-Failed bills on national health insurance during Roosevelt presidency
-Harry Truman: 1st US President to propose national health insurance
1992, Clinton proposals
-Congress opposed with a priority in avoiding tax increases over expanding health insurance coverage
What prevented a national health program by blocking various attempts during the 20th century?
Rise of private health insurance, AMA, and related industries
What were the reasons for defeated national health insurance proposals?
Political inexpediency
Institutional dissimilarities
Ideological differences
Tax aversion
How did political inexpediency defeat NHI proposals?
No threat to US political stability, unlike Germany and England where social insurance was a way to get worker loyalty.
US was decentralized
-Insurance matters were left to local and state gov’ts
Entry into WWI
-A final political blow to NHI because of anti-German sentiments
-NHI seen as a menace inconsistent with American values
How did institutional dissimilarities defeat NHI proposals?
Voluntary sickness funds less developed in US
American hospitals mostly private: seen not consistent with national financing and payment mechanisms
Oppositions of stakeholders
Who were the stakeholders opposed to NHI?
Physicians (threat to private practice) and AMA
Insurance industry (fear of lost income)
Pharmaceutical companies (fear of gov’t as a monopoly buyer)
Retail pharmacies (fear of being replaced by gov’t established pharmacies)
American Federation of Labor (AFL) (fear of loss of influence in the workplace)
What are the American beliefs and values that helped defeat NHI proposals?
Based on the principles of market justice
Individualism
Self-determination
Distrust of gov’t
Reliance on the private sector to address social concerns
How did tax aversion defeat NHI proposals?
Middle class support needed for broad reforms
Middle class already insured
Middle class not willing to pay increased taxes to cover for others
Characteristics of Medicare
Title XVIII of the Social Security Act (SSA)
-Part A: hospital and limited nursing home coverage (based on Forand’s bill, 1957)
-Part B: covers physician bills (based on Byrnes’ proposal to share the cost of premiums)
Attached to Social Security
No class distinction
Uniform national standards for eligibility and benefits
Physicians allowed to balance bill
Characteristics of Medicaid
Title XiX of Social Security Act (SSA)
Federal matching funds to the states for the indigent (based on Kerr-Mills Act, 1960)
Expanded to include all age groups, not just the elderly poor
Based on a means test developed by each state
Varying eligibility and benefits by state
Class distinction: means tested leads to stigma of public welfare for Medicaid recipients
Physicians not being able to balance bill leads to limited participation from physicians
To what does corporatization refer?
The phenomenon that HC delivery has become the domain of large orgs or corporations
What are the two main elements of corporatization?
Managed care
Integrated HC organizations
What happened in the corporatization era with individual physicians?
They consolidated into large clinics
Formed partnerships with hospitals
Started own specialty hospitals
What are some state precedents of HC reform?
OR Health Plan of late 1980s
MA Health Plan of 2006
Aspects of OR Health Plan of late 1980s
Expansion of Medicaid with supply side rationing
Medical insurance pool to cover preexisting conditions
Employer mandate
