Module 5 lecture, part 6 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
What was the insurance system like before Medicare and Medicaid were created in 1965?
Only private insurance widely available
Only for working middle class
The poor and elderly relying on own resources or charity
Private payers charged more to offset charity: “cost shifting” or “cost subsidization”
What occurred with the Social Security Amendments of 1965?
Less opposition for programs targeted at the underprivileged
Medicare and Medicaid created
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
What are prototypes of managed care?
Contract practice
Group practice
Prepaid grp plans
How did contract practice work?
Existed in the form of salary payments for physicians in remote areas (such as railroad, lumber, or mining) or a contract with independent physicians and hospitals at a flat rate per worker per month (capitation)
How did grp practice work?
Brought physicians together with business managers and technicians
-ex Mayo Clinic in MN
-Met with resistance by solo practitioners due to being seen as a threat to general practitioners and specialists in solo practices
How do prepaid grp plans work?
An enrolled pop received comprehensive services for a capitated fee
