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Chapter 9

Chapter 9. Privatizing Health Politics: The Origins and Enduring Dilemmas of America’s Public-Private Insurance Framework Jacob S. Hacker. U.S. Health Spending: More than Meets the Eye.

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Chapter 9

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  1. Chapter 9 Privatizing Health Politics: The Origins and Enduring Dilemmas of America’s Public-Private Insurance Framework Jacob S. Hacker

  2. 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…

  3. 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.

  4. 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

  5. Rise of Private, Employer-Sponsored Health Coverage • 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

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