Providing Universal and Affordable Health Care (1989) / Chapter Skim
Currently Skimming:
The States' Roles and Responsibilities for Providing Universal and Affordable Health Care to the American People
The States' Roles and Responsibilities for Providing Universal and Affordable Health Care to the American People
Pages 10-27
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 10... ...
Representatives from 172 public and private organizations collaborated on the final document published in early 1987, which recommended 195 major reforms for the future of a United States Health Care system, including a non-mandatory benefits package for the American people and major improvements in the efficiency and equity of Medicare and Medicaid.1 In addressing Medicaid, the HPA recommended that national standards be established that would result in uniform eligibility benefits and payment mechanisms across state boundaries and that Medicaid be extended to Americans who live below the poverty line but are not covered by the present program. HPA's data (prepared in 1988)
|
From page 11... ...
This amount would increase by almost $6.7 billion if the privately insured with income under the poverty level dropped private coverage to enroll in Medicaid, fora total cost of $15.7 billion. Two billion dollars would be deducted for the replacement of current expenditures for uncompensated hospital care, or a final cost estimate for expansion of eligibility of about $13.7 billion.2 Developing cost estimates for the uninsured must be tempered by advice given by one of the actuaries doing the analysis, who said, "no one knows how much it costs to insure the uninsured -- they have never been insured." In the overall scheme of national expenditures those increases in Medicaid coverage are dramatic but certainly feasible in a reshuffling of priorities and the use of political clout.
|
From page 12... ...
I believe, in general terms, that policies which should affect the entire society on a more or less equal basis are appropriately assigned to the federal government. Thus, policies protecting basic rights, such as anti-discrimination laws, and policies requiring burdens on some areas or groups in order to fairly protect or serve others, such as federal environmental goals and income distribution policies, are more appropriately assigned to the national level.
|
From page 13... ...
My position is that the health care access question clearly and convincingly belongs at the federal level. And so, that's where we are going in this address, using the foregoing analysis of federalism as a sextant and taking our bearings not on just the single point of access, but on three points of health care policy -- access, cost, and quality -- in order to arrive at the proper roles for the "different levels of government." 13
|
From page 14... ...
In March of 1983, the President's Commission for the Study of Ethical Problems in Medicine, covering the subject of "securing access to health care," pointed out that in 1952 an earlier commission concluded that "access to the means for the attainment and preservation of health is a basic human right."8 The 1983 commission, however, argued 14
|
From page 15... ...
it is not necessary as a foundation for appropriate governmental actions to secure health care for all. From a strictly legal perspective, neither the Supreme Court nor any appellate court has found a constitutional right to health or health care.
|
From page 16... ...
Americans Lack Adequate Insurance Coverage and States Know It Americans do not have adequate insurance coverage, and the states know that. Look at the report entitled "Policy Options for the Uninsured in New York State" issued in January 1988 by the committee chaired by James R
|
From page 17... ...
Insurance coverage has been the dominant means of financing health care, but the nature and organization of insurance systems have changed in recent years and more and more legal requirements are shaping insurance programs. • Federal policies play a major role in health care financing and delivery, and gaps are national in their impact.
|
From page 18... ...
There are several options for furnishing health care that can reduce the problems: at the state level there are indigency programs, specific conditions programs, catastrophic expenses programs, and subsidization of services programs, such as holding those hospitals that enjoy public subsidies responsible for assisting the poor, which is being done by local governments in Utah while they reconsider property tax exemptions for nonprofit hospitals. Mixed public and private approaches include state risk-sharing pools, mandated employer-based insurance programs, insurance regulation programs, and purchase of prepaid health plans.
|
From page 19... ...
In the first of these Rosenthai Lectures, Senator George Mitchell suggested federal mandating of Medicaid coverage of maternity care, of care for chronic medical conditions, and of various other forms of medical care.20 But this creates a new danger: of one level of government (the federal) reaping the political benefits of assuring services while another level (the states)
|
From page 20... ...
We can expect the states to be most successful where competitive disadvantages are least. For example, the states can encourage privatesector innovation, such as the experiment in Utah in which Intermountain Health Care and the Robert Wood Johnson Foundation are fashioning a less expensive health maintenance organization (HMO)
|
From page 21... ...
Sometimes the federal government can exert useful leverage on the states, for example, in reducing highway speeds. The value of investing in healthful lifestyles now is broadly appreciated by political leaders at all levels, as is evidenced in the program of national priorities set forth two years ago by the national Democratic Policy Commission I chaired.24 States and their political leadership are well positioned to play vital roles in bringing together public health, health care providers, education, business, and the local community in general to campaign for more healthful lifestyles.
|
From page 22... ...
It was a central issue in preparing the report "The Health Policy Agenda for the American People" -- and the central issue behind the establishment of my subcommittee that prepared the "Basic Benefits Package" as 22
|
From page 23... ...
Public and private institutions at the state level have crucial roles in interpreting such information, as in the experiments in Pennsylvania and other states to apply measures of severity of cases in comparing hospital mortality rates. At the system level we need not and cannot responsibly wait for the severity studies before using hospital mortality and other data to measure how we are doing.
|
From page 24... ...
On the other hand, the states are well positioned, in ability, in interest, and in commitment, to take principal and continuing roles in improving lifestyles and in managing the costs and quality of health care -- as well as in helping to share appropriate federal policies and programs. How well we meet the 24
|
From page 25... ...
15. Utah Department of Health, "Report of the Governor's Task Force on Catastrophic Medical Expenses; Analysis and Recommendations for Development of a State Risk Pool for Medically Uninsurable Individuals" (Salt Lake City: Utah Department of Health, March, 1988)
|
From page 26... ...
18. Irene Fraser, Promoting Health Insurance in the Workplace: State and Local Initiatives to Increase Private Coverage (Chicago: American Hospital Association, 1988)
|
From page 27... ...
31. A study mandated by Congress, entitled "Designing a Strategy for Quality Review and Assurance in Medicare," directed by a study committee chaired by Dr.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.