Abstract
My goal in this chapter is to help people understand what makes healthcare so complex and contentious. To do so, one first needs to have a basic understanding of how the US system compares with those of other countries, and how it has evolved from a “fee for service” model of compensation to a system of managed care, in which people pay for bundled services. It is also important to grasp the reasons many doctors and patients are critical of managed care, especially health maintenance organizations (HMOs), while many healthcare analysts contend the system saves money and does not compromise health. The chapter also reviews the attempt to implement universal coverage during the Clinton administration and then takes up the controversy surrounding Obamacare and Republican opposition to it.
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Notes
- 1.
CNNPolitics.com, February 28, 2017.
- 2.
See The Commonwealth Fund, The US Heath Care System, 2014.
- 3.
See 2015 International Profile of Health Care Systems, edited by Elias Mossialos and Marton Wenzel of the London School of Economics and Robin Osborn and Dana Sarnak of The Commonwealth Fund, January 2016.
- 4.
Ibid.
- 5.
This analogy is depicted in David Dranove’s book, Code Red: An Economist Explains How to Revive the Healthcare System without Destroying It, Princeton University Press, 2008.
- 6.
See Stephanie Kelton, cFEPS, “An Introduction to the Health Care Crisis in America; How Did We Get Here?” September 2007.
- 7.
For a discussion of the goals of the legislation see B.A. Meyers, “Health Maintenance Organizations: Objectives and Issues,” HSMHA Health Rep. July 1971, pp. 585–591.
- 8.
See Institutes of Medicine, “Too Err is Human: Building a Safer Health System,” November 1999.
- 9.
David M. Cutler , Your Money or Your Life, Oxford University press, 2004.
- 10.
Ibid, p. 94.
- 11.
See Kelton, op. cit.
- 12.
Bill Clinton , Address to Joint Session of Congress, September 22, 1993.
- 13.
Ironically, the concept is linked to The Heritage Foundation , a conservative think tank, and to Republican senators who were seeking a market-based approach to healthcare reform in the early 1990s. In the wake of the Clinton administration ’s plan for universal coverage, the Republicans countered with an alternative, the Health Equity and Access Reform Today Act (HEART Act) that included an individual mandate provision. It was not until the Affordable Care Act was enacted that the Republicans challenged the individual mandate as being unconstitutional.
- 14.
See Robert J. Samuelson, “How to Get Medicaid under Control,” The Washington Post, March 20, 2017.
- 15.
Ibid.
- 16.
Danove, op. cit., p. 5.
- 17.
Cutler, op. cit., p. 122.
- 18.
Kenneth Arrow , American Economic Review, Vol. 53, Issue 5, (Dec. 1963).
- 19.
See Megan McCardle, “Liberals Are Wrong: Free Market Health Care is Possible,” theatalantic.com, March 18, 2012.
- 20.
See Paul Krugman’s blog, “Why markets can’t cure healthcare,” July 2, 2009.
- 21.
Ibid.
- 22.
See David Danove and Graig Garthwaite, “Here’s A Republican Response to Obama’s Call for Ideas to Reform the Health Care System,” Business Insider, February 4, 2014.
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Sargen, N.P. (2018). What Makes Healthcare Reform So Complex: A Primer. In: Investing in the Trump Era. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-76045-2_4
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