"Health care workers, policy-makers, social scientists, and the general public have much to gain by reading this book". -- Choice (on the first edition)
Health care in the United States at the end of the 20th century occupies a completely different place in the economy, in the public consciousness, and in its impact on government, than it did at the beginning of the century, or even in the early years of the Clinton Administration. Health care is now a multi-billion dollar industry; one that consumes more than 15 percent of the nation's GNP. Citizens now regard health care as essential to the quality of their lives, and a steady stream of new medications and procedures point to ways to extend the lives of our aging population and restore those injured on or off the job. At the same time, the changing patterns of health care have stirred a national debate over the growth of managed care and the role that government can play in providing solid health care standards—a medical safety net—within tightening budgetary restraints. This book explores the role of the federal government in health care policy development from the years of the Founding Fathers to the present.
Kronenfeld reviews the key features of the American health care system, its infrastructure, and federal legislative process and outcomes in the health care arena. The current situation in health care is examined, with particular attention given to the attempt at major reform in the first Clinton administration, and to the modest changes that were ultimately passed. She closes with an examination of the future of health care and the role of government, emphasizing how current health care issues and concerns may set the stage for a changed federal role in funding and delivery of health care services in the next century. This comprehensive examination of the role of government in the health care system will be of great interest to students and researchers of public policy and the social aspects of American health care.
Examines the complex interrelationships that inform the health care system. Health care, like all social systems, is a product of thought. Up to now, our collective thinking has been based on trying to manage parts, not the whole. This book inquires into four age-old questions that shape all health care systems: What is health? What is care? Who is responsible? How much is enough?
Americans have the wealthiest health care system in the world, yet the health status of Americans ranks in the lowest quartile among the world's 25 industrialized nations and 45 million Americans are without health insurance. Today's cost, quality, and access problems are inter-related and can be traced to taken-for-granted assumptions and health care's outmoded organizing concepts: reductionism and materialism. Greater fragmentation of care, an over-dependence on technology, inattention to social and environmental determinants of health, and serious economic and moral dilemmas are some of the results of the last 40 years of piecemeal political and economic reform.
This book has three purposes. The first is to help the reader see healthcare as a complex system—a part in a larger whole—and to show how answers to the questions, What is health? What is care? Who is responsible? How much is enough? implicitly define the purpose, effectiveness, efficiency, and fairness of a health care system. The second is to show that today's access, cost, and quality problems are interrelated, and arise from outmoded concepts, unquestioned assumptions, and a long trail of inconsistent and contradictory answers to the four questions. The third purpose is to acquaint readers with both the personal and societal challenges of finding coherent answers to the four questions raised above and to describe some of the budding experimental solutions that challenge traditional conventions and assumptions.
Bill Clinton's 1993-94 health care reform initiative was one of the most active and sustained presidential campaigns ever undertaken in support of a single social issue, and certainly the boldest attempt to establish national health insurance in the United States. An analysis of the Clinton campaign, therefore, reveals much about the politics of divided government in the late 20th century, the apparent end of the New Deal-Great Society approach to governance and the enduring democratic coalition which supported it, and, of course, the high stakes politics of health care reform. This study attempts to advance our understanding of why national health insurance has proven to be such a potent idea while seemingly impossible to accomplish. The work focuses on the political factors which derailed the Clintons' health care reform initiative, providing a case study of a most significant modern-day political and policy battle.