Overall there is a neoliberal shift in politics

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Overall, there is a “neoliberal” shift (in politics, economy, culture) toward privatization, deregulation, consolidation, and corporatization of healthcare (much like the trend now: privatization of military, schools, local govts, outsourcing; business models for education and health sectors) There is also a cultural shift in academia and the general public re: basic values, perception of profit, etc.
ATTEMPTS TO CONTROL (and LOWER) COSTS… Under President Reagan, Medicare shifts to payment by diagnosis (DRG) instead of by treatment. Private plans quickly follow suit. Growing complaints by insurance companies that the traditional fee-for-service method of payment to doctors was being exploited (and actually it had been!). "Capitation" payments to doctors become more common
THE ROLICKIN’ CLINTON NINETIES… Health care costs rise at double the rate of inflation (roughly 9-12%/yr from 1988-1991). Hillary Clinton spearheads a major health reform attempt but hits a brick wall Managed care is expanded to try to moderate increases in health care costs. (This does reduce the growth rate to 5-6% range, but there are significant human costs and frustration) ONE GOOD THING: Kennedy & Hatch manage to get SCHIP passed in 1997, which provided health insurance to low income children By the end of the decade there are 44 million Americans, 16 % of the nation, with no health insurance at all.
THE TENDER (TRIPPY? TOXIC? TERRIFYING?) 2000s… Health care costs continued to climb (this never stopped) but the rate of growth of costs crept up again, 6%, 7%, 8%, 9+% Medicare seen to be in danger bc unsustainable under the present structure (similar scares about social security) Changing demographics of the workplace lead many to believe the employer-based system of insurance can't last: growth of the “Precariat” who patch together part-time, contingent, contract and temporary labor w/out health or retirement benefits
THUS: There have been multiple attempts at major health care reform over the past century, none successful Did get Medicare and Medicaid in 1965, and later, SCHIP (insurance for children just above the poverty level) These, once in place, have been successful and popular
OUR CURRENT SYSTEM Is a product of those incremental changes meant to solve problems (they solved some, but often created new problems); Has frequently been affected by the advocacy of powerful, wealthy groups that can press for solutions that are of benefit to them Services funded by: mix of private and public entities, with individuals and families covering the balance: multiple billing codes and reimbursement schedules at play Effect is: ݮ a fragmented system, with a greater emphasis on (and higher payment, and thus incentive for) specialist and hospital care (rather that ambulatory and community-based primary care services) ݮ Increasingly untenable costs (for public funding, for employers, and for individuals and families, as evidenced by our appalling medical bankruptcy numbers) ݮ Continued lack of access for millions of people
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