Using Taxes to Reform Health Insurance: Pitfalls and Promises

Brookings Institution Press
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Few people realize that one of the nation's largest health programs runs through the tax system. Reformers of all stripes propose to modify current tax rules as part of larger programs to increase coverage and control costs. Is the current system working? Will tax-based reforms achieve their goals? Several of the nation's foremost experts on taxation and health policy address these questions in Using Taxes to Reform Health Insurance, a joint product of the Urban-Brookings Tax Policy Center and the American Tax Policy Institute. Led by respected economists Henry Aaron of the Brookings Institution and Leonard Burman of the Urban Institute, contributors examine the role taxes currently play, the likely effects of recently introduced health savings accounts, the challenges of administering major subsidies for health insurance through the tax system, and options for using the tax system to expand health insurance coverage. No taxpayer or consumer of health care services can afford to ignore these issues.
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About the author

Henry J. Aaron is a senior fellow in Economic Studies at the Brookings Institution, where he holds the Bruce and Virginia MacLaury Chair. Among his many books are Can We Say No? The Challenge of Rationing Health Care, with William B. Schwartz and Melissa Cox (Brookings, 2006), and Reforming Medicare: Options,Tradeoffs, and Opportunities, written with Jeanne Lambrew (Brookings, 2008). Leonard E. Burman is director of the Urban-Brookings Tax Policy Center and a senior fellow at the Urban Institute. He is the author of The Labyrinth of Capital Gains Tax Policy: A Guide for the Perplexed (Brookings, 1999) and coeditor with Henry Aaron and Eugene Steuerle of Taxing Capital Income (Urban Institute, 2007).

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Additional Information

Publisher
Brookings Institution Press
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Published on
Oct 1, 2009
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Pages
282
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ISBN
9780815701972
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Language
English
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Genres
Medical / Health Policy
Political Science / Public Policy / Economic Policy
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Content Protection
This content is DRM protected.
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Academic medical centers provide cutting edge acute care, train tomorrow's physicians, and carry out research that will expand the range of treatable and curable illnesses. But these centers themselves may need urgent care—experts generally agree that many are suffering acute—even life-threatening—financial distress. Many academic medical centers are suffering for several reasons: in-patient admissions are down, as many procedures that once required a hospital stay are now performed on an out-patient basis or in a physician's office ; managed care plans have negotiated discounted fees that cut hospital operating margins; the Balanced Budget Act of 1997 curtailed Medicare reimbursements, lowered margins and pushed some into the red; the revolution in information technology is imposing large new capital costs; and the character of medical education is receiving its most thorough review in decades. While there is a general consensus that medical centers are under pressure, experts disagree about the depth and pervasiveness of the current financial distress. Are they whining about financial pressures other, less-favored sectors find routine; or is the high quality American teaching hospital becoming an endangered species—that could face extinction if nothing is done. Because academic medical centers perform such important jobs, it is critical to determine the true nature and depth of their current financial problems—and then fashion analytically sound and politically sustainable solutions. This book brings together chief executive officers of major medical centers, university presidents, senior members of Congressional and executive office staffs, and leading analysts. These experts address the key issues and prescribe remedies both regulatory and legislative to ensure that the teaching hospital remains a picture of financial health. Contributors include Nancy Kane (Harvard School of Public Health), Jamie Reuter (Institute for Health Care Research Policy, Georgetown University), Peter van Etten (Juvenile Diabetes Foundation), Ralph Muller (University of Chicago Hospitals and Health System), James Robinson (School of Public Health, University of California, Berkeley), David Blumenthal (Institute for Health Policy, Massachusetts General Hospital), Edward Miller (Johns Hopkins University School of Medicine), Spencer Foreman (Montefiore Medical Center), Lawrence Lewin (Lewin Group), Gail Wilensky (Project HOPE), Robert Dickler (American Association of Medical Colleges), and Kenneth Shine (Institute of Medicine).
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A New York Times bestseller/Washington Post Notable Book of 2017/NPR Best Books of 2017/Wall Street Journal Best Books of 2017 

"This book will serve as the definitive guide to the past and future of health care in America.”—Siddhartha Mukherjee, Pulitzer Prize-winning author of The Emperor of All Maladies and The Gene  

At a moment of drastic political upheaval, An American Sickness is a shocking investigation into our dysfunctional healthcare system - and offers practical solutions to its myriad problems.

In these troubled times, perhaps no institution has unraveled more quickly and more completely than American medicine. In only a few decades, the medical system has been overrun by organizations seeking to exploit for profit the trust that vulnerable and sick Americans place in their healthcare. Our politicians have proven themselves either unwilling or incapable of reining in the increasingly outrageous costs faced by patients, and market-based solutions only seem to funnel larger and larger sums of our money into the hands of corporations. Impossibly high insurance premiums and inexplicably large bills have become facts of life; fatalism has set in. Very quickly Americans have been made to accept paying more for less. How did things get so bad so fast?

Breaking down this monolithic business into the individual industries—the hospitals, doctors, insurance companies, and drug manufacturers—that together constitute our healthcare system, Rosenthal exposes the recent evolution of American medicine as never before. How did healthcare, the caring endeavor, become healthcare, the highly profitable industry? Hospital systems, which are managed by business executives, behave like predatory lenders, hounding patients and seizing their homes. Research charities are in bed with big pharmaceutical companies, which surreptitiously profit from the donations made by working people. Patients receive bills in code, from entrepreneurial doctors they never even saw. 

The system is in tatters, but we can fight back. Dr. Elisabeth Rosenthal doesn't just explain the symptoms, she diagnoses and treats the disease itself. In clear and practical terms, she spells out exactly how to decode medical doublespeak, avoid the pitfalls of the pharmaceuticals racket, and get the care you and your family deserve. She takes you inside the doctor-patient relationship and to hospital C-suites, explaining step-by-step the workings of a system badly lacking transparency. This is about what we can do, as individual patients, both to navigate the maze that is American healthcare and also to demand far-reaching reform. An American Sickness is the frontline defense against a healthcare system that no longer has our well-being at heart.
Academic medical centers provide cutting edge acute care, train tomorrow's physicians, and carry out research that will expand the range of treatable and curable illnesses. But these centers themselves may need urgent care—experts generally agree that many are suffering acute—even life-threatening—financial distress. Many academic medical centers are suffering for several reasons: in-patient admissions are down, as many procedures that once required a hospital stay are now performed on an out-patient basis or in a physician's office ; managed care plans have negotiated discounted fees that cut hospital operating margins; the Balanced Budget Act of 1997 curtailed Medicare reimbursements, lowered margins and pushed some into the red; the revolution in information technology is imposing large new capital costs; and the character of medical education is receiving its most thorough review in decades. While there is a general consensus that medical centers are under pressure, experts disagree about the depth and pervasiveness of the current financial distress. Are they whining about financial pressures other, less-favored sectors find routine; or is the high quality American teaching hospital becoming an endangered species—that could face extinction if nothing is done. Because academic medical centers perform such important jobs, it is critical to determine the true nature and depth of their current financial problems—and then fashion analytically sound and politically sustainable solutions. This book brings together chief executive officers of major medical centers, university presidents, senior members of Congressional and executive office staffs, and leading analysts. These experts address the key issues and prescribe remedies both regulatory and legislative to ensure that the teaching hospital remains a picture of financial health. Contributors include Nancy Kane (Harvard School of Public Health), Jamie Reuter (Institute for Health Care Research Policy, Georgetown University), Peter van Etten (Juvenile Diabetes Foundation), Ralph Muller (University of Chicago Hospitals and Health System), James Robinson (School of Public Health, University of California, Berkeley), David Blumenthal (Institute for Health Policy, Massachusetts General Hospital), Edward Miller (Johns Hopkins University School of Medicine), Spencer Foreman (Montefiore Medical Center), Lawrence Lewin (Lewin Group), Gail Wilensky (Project HOPE), Robert Dickler (American Association of Medical Colleges), and Kenneth Shine (Institute of Medicine).
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