© 2008 delmar cengage learning. chapter 9 privatizing health politics: the origins and enduring...
TRANSCRIPT
© 2008 Delmar Cengage Learning.
Chapter 9Privatizing Health Politics: The Origins and Enduring
Dilemmas of America’s Public-Private Insurance Framework
Jacob S. Hacker
© 2008 Delmar Cengage Learning.
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U.S. Health Spending:More than Meets the Eye
• At first glance, the U.S. (far right), appears to spend far less on health care than (otherwise) comparable nations…
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U.S. Health Spending:More than Meets the Eye
• Once one factors in tax breaks and publicly-regulated/subsidized private benefits, however, U.S. spending levels (again, far right) rise considerably.
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PubliclyRegulated andSubs idizedPrivateSpending
PublicSpending,Including TaxExpenditures
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Rise of Private, Employer-Sponsored Health Coverage
• Early battle by progressives to enact national health insurance drew attention to the need to expand health coverage
• Such groups as AMA, insurance companies championed private coverage as an alternative to government intervention
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• Early treatment of employer contributions to health plans as non-taxable fringe benefits led firms to use employer-sponsored health plans as a means to entice, retain workers
Rise of Private, Employer-Sponsored Health Coverage
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Expansion of Private Health Coverage
• After first successful employer group insurance plan (Baylor Hospital, 1929) arose– Concept caught on across the country during
the 1930s and 1940s
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Expansion of Private Health Coverage
• Following second (failed) attempt to enact national health insurance in association with Social Security– Private insurers redoubled efforts to expand
coverage
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Expansion of Private Health Coverage
• Price/wage controls in wartime made health coverage particularly important as a recruitment tool
• President Eisenhower (1954)– Clarified tax status of private health plans,
confirming their tax-exempt status
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Covering the Consequences: Political Legacy of Private Health Coverage
• Spread of private health coverage gave rise to numerous parties with an interest in defending the status quo– Thus limiting the political “room” to enact
comprehensive reform
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Covering the Consequences: Political Legacy of Private Health Coverage
• Use of private enterprise to serve public goals gives government little leverage over the health care system/industry
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Covering the Consequences: Political Legacy of Private Health Coverage
• Most, though by no means all, receive some form of health insurance under present system, blunting demands for reform
• Costs for switching from largely private to public provision of health insurance would now be monumental
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The Dreamers: Attempting to Develop a System of National Health Insurance
• President Truman famously failed to attain national health insurance in late-1940s
• Passage of Medicare and Medicaid in mid-1960s represents first (and only) broad expansion of public health coverage
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The Dreamers: Attempting to Develop a System of National Health Insurance
• Competing visions of national health insurance in early-1970s withered in the shadow of Watergate
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The Dreamers: Attempting to Develop a System of National Health Insurance
• President Clinton’s attempt to enact national health insurance failed– Private insurers implemented portions of it– Shepherding policyholders into managed care
plans
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Chapter 9 Summary
• U.S. spends greater proportion of income on health care than it initially appears– Once tax breaks and private benefit structures
are taken into account
• Nonetheless, the redistributive aspects of health spending tends to favor the rich
© 2008 Delmar Cengage Learning.
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Chapter 9 Summary
• Though many have, over time, recognized the need for a greater government role in health coverage and spending– The rise of private insurance and its vast
consequences have made national health insurance little more than a perennial fantasy