Serious and Unstable Condition: Financing America's Health Care

by Henry Aaron

Overview

The United States spends more on health care than any other nation in the world, yet millions of Americans cannot afford basic care for acute illnesses, few are insured against the costs of long-term care, and many frequently used medical procedures have never been fully evaluated. The goals of controlling spiraling health care costs and extending insurance coverage or even maintaining current insurance coverage seem to be in conflict. But progress can be made on both goals if they are tacked together. Henry Aaron evaluates these critical issues and explores how adequate care can be provided without fueling inflation. Because the current arrangements for financing America's health care cannot endure, Aaron contends that a major national debate on the restructuring of the U.S. system of financing health care is inescapable, and major legislation is likely. Serious and Unstable Condition offers a guide that is crucial to understanding the reform debate. It explains the important economic issues of health care as a background for evaluating both the current system and proposals for change. Aaron compares the U.S. system of health care financing with certain foreign systems and reviews major options for reform. He cautions that unless the health insurance system is radically changed, the number of uninsured will continue to increase and costs will continue to escalate. He then offers his own comprehensive plan to address these problems.

Product Details

ISBN-13:	9780815700500
Publisher:	Rowman & Littlefield Publishers, Inc.
Publication date:	06/01/1991
Pages:	180
Product dimensions:	6.00(w) x 9.00(h) x 0.41(d)

Table of Contents

1.	What Is the Problem?	1
	Diminishing Support for the Current System	2
	The Inescapable Debate	5
2.	Economic Issues in Health Care	8
	Consumption and Insurance	8
	Production	23
	Competition and the Market for Health Insurance	27
	A Dilemma	37
3.	Organization and Financing	38
	Health Care Expenditures	38
	Sources of Payment	53
	The Role of Government	60
	The Uninsured	73
4.	International Comparisons	78
	Differences in Costs	79
	Measures of Health Status	89
	Differences in Organization	92
	International Competition	94
	Implications of Foreign Experience	101
Appendix A	Intertemporal and International Comparisons of Health Care Expenditures	103
Appendix B	Determinants of Health Care Spending	107
5.	The Terms of the Debate	109
	Voluntary Incrementalism	110
	Mandatory Employment-Based Insurance	119
	Comprehensive Restructuring	128
	The Special Problem of Long-Term Care	134
	State Initiatives	135
	A 1990s Agenda for Health Care Financing	137
	The Universal-Access Single-Payer Health Plan	140
	Index	153
	Tables
	Growth in U.S. Health Care Spending, Selected Years, 1950-90
	Concentration of Health Care Outlays, Selected Countries and Selected Years, 1928-88
	Limits on Coverage among Health Insurance Plans
	Outlays and Recipients of Personal Health Care Expenditures, Selected Years, 1960-89
	Source of Payments to Major Health Care Providers, Selected Years, 1960-89
	Characteristics of the Uninsured
	Total Health Expenditures in Selected Countries, 1987
	Use of Health Care, Selected Countries, 1987
	Mean Length of Hospital Stay for Selected Diseases, Selected Countries
	Reported Admission Rates for Nine Common Surgical Procedures, Selected Countries, 1980
	Life Expectancy in the United States and U.S. Rank among Selected Countries, by Age and Sex
	Public Expenditures as a Share of Health Care Spending, Selected Countries, 1987
	Reimbursement and Planning Arrangements in Selected OECD Countries
	Proposed Health Care Trust Fund, 1991
	Figures
	The Benefits Curve
	Elderly Population in the United States, Selected Years, 1950-2040