Controversial Issues in Health Care Policy
Publication Year: 1993
Experts agree–the U.S. has achieved the most technologically advanced medical care system in the world and it provides the highest quality, most comprehensive medical education available. Can we conclude that our health care system is one of America's success stories? It appears–we cannot. However, amid growing concern over our health care system, there is far less agreement on what to do about it. Jennie Kronenfeld addresses major health care controversies confronting American society, health care professionals, and policymakers. This intriguing book focuses on the overlapping area between policy sciences and health care studies, particularly the cost, access, and quality of health care. Kronenfeld discusses whether our system can solve its problems, or whether we have a health care “system” at all. Do we have a ...
- Front Matter
- Back Matter
- Subject Index
- Chapter 1: Introduction to Health Care Policy Issues
- Is there a National Health Care System and National Health Care Policy?
- Chapter 2: Disease Patterns, Physical Health, and AIDS
- Health Status in the Past and Now
- Trends and Differentials in Health Status for Special Population Groups
- Year 2000 Health Promotion and Disease Prevention Objectives: How do we Move beyond Goal Setting?
- Chapter 3: Mental Health Concerns and Behavioral Health
- History of Mental Health Treatment in the United States
- Homelessness: Is it a Mental Health Policy Issue?
- Drugs and Alcohol as a Health Policy Issue
- Modem Attempts to Control Alcohol Usage: Is it a Disease?
- An Alternative Approach—The Public Health Model for Alcohol and Drug Control
- Chapter 4: Reproductive Health Concerns and Abortion
- Prior Policy on Birth Control and Its Use
- Prior Policy about Abortion and Its Use
- Major New Controversies Related to Reproductive Health Policy
- Policies over New Reproductive Technologies
- Abortion Controversy
- Chapter 5: Aging and Long-Term Care
- Trends in the Aging of the U.S. Population
- The Relationship between High Health Care Costs and Aging
- The Array of Elderly Services: Where should they be Provided?
- The Right to Die Controversy
- Generational Equity Issues
- Chapter 6: Providers of Care: Health Professions and Health Facilities
- Health Professions and Health Personnel
- Stratification within Health Care Professions
- Current Major Policy Issues
- Nursing and Supply of Personnel
- Allied Health Fields
- Settings of Care
- Ambulatory Care, Managed Care, and HMOs
- Current Policy Issues in Hospitals
- Financing Issues and the Economic Health of Hospitals
- The Changing Hospital Role
- Special Problems of Rural Settings
- Chapter 7: Costs of Health Care
- Trends in Health Care Expenditures
- Trends in Types of Health Care Expenditures and Sources of Funds
- Major Policy Issues in the Cost Arena
- Controlling Costs within the Major Government Programs
- Controlling the Costs to States of the Medicaid Program
- Overall Cost Containment
- Chapter 8: Quality of Health Care Technology
- Basic Components of Quality Assessment: Structure, Process, and Outcome
- Total Quality Management or TQM
- The PORTs Effort and Related Background
- The Institute of Medicine Critique, MOS Studies, and Suggestions for Change
- Chapter 9: Access to Health Care Services and Suggestions for Health Care Reform
- Equity and a Right to Care
- Prior Attempts to Pass National Health Insurance and Ensure Access to Care
- Current Differentials in Access to Care and Health Insurance
- Lessons to Be Learned: State Reforms, Past Efforts, and International Comparisons
- Lessons from Medicare
- International Comparisons
- Comprehensive Proposals to Reform the U.S. System
- Mandated Approaches and Managed Competition
- Pay or Play
- Universal Payors
- Will the United States Ever Enact Fundamental Health Care System Reform?
- Views of the Public
- Fundamental Reform: When Might It Occur?
Controversial Issues in Public Policy[Page ii]
Dennis Palumbo and Rita Mae Kelly
Arizona State University
- Volume 1 CONTROVERSIAL ISSUES IN ENVIRONMENTAL POLICY
Science vs. Economics vs. Politics
KENT E. PORTNEY
- Volume 2 CONTROVERSIAL ISSUES IN ENERGY POLICY
ALFRED A. MARCUS
- Volume 3 CONTROVERSIAL ISSUES IN SOCIAL WELFARE POLICY
Government and the Pursuit of Happiness
CARL P. CHELF
- Volume 4 CONTROVERSIAL ISSUES IN EDUCATIONAL POLICY
LOUANN A. BIERLEIN
- Volume 5 CONTROVERSIAL ISSUES IN HEALTH CARE POLICY
JENNIE JACOBS KRONENFELD
- Volume 6 CONTROVERSIAL ISSUES IN ECONOMIC REGULATORY POLICY
MARCIA LYNN WHICKER
Copyright © 1993 by Sage Publications, Inc.
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Library of Congress Cataloging-in-Publication Data
Kronenfeld, Jennie Jacobs
Controversial issues in health care policy / Jennie Jacobs Kronenfeld.
p. cm.—(Controversial issues in public policy; 5)
Includes bibliographical references and index.
ISBN 0-8039-4877-8.—ISBN 0-8039-4878-6 (pbk.)
1. Medical policy—United States. I. Title. II. Series,
94 95 96 10 9 8 7 6 5 4 3
Sage Production Editor: Judith L. Hunter
Series Editors’ Introduction[Page ix]
Public policy controversies escalated during the 1980s and early 1990s. This was partly due to bitter partisan debate between Republicans and Democrats, a “divided” government in which the Republicans controlled the presidency and the Democrats controlled the Congress, and the rise of negative campaigning in the 1988 presidential election. In addition, the past decade was a time when highly controversial issues such as abortion, crime, environmental pollution, affirmative action, and choice in education became prominent on the public policy agenda.
Policy issues in this atmosphere tend to be framed in dichotomous, either/or terms. Abortion is depicted as “murder” on the one hand, or a woman's “self-interested choice” on the other. One is either “tough on crime,” or too much in favor of “defendants’ rights.” Affirmative action is a matter of quotas for correcting the “educational mess,” or the destruction of public education. In such a situation there does not seem to be a middle or common ground where cooler heads can unite.
The shrillness of these policy disputes reduces the emphasis on finding rational, balanced solutions. Political ideology and a zero-sum approach to politics and policy become the order of the day.[Page x]
Certainly, there hasn't been an “end to ideology” over the past decade and a half, as some have believed was occurring in the 1970s. “Reaganomics” contributed to a widening gap between the rich and the poor during the 1980s and this seemed to exacerbate partisan debate and further stymie governmental action. In 1992 controversies over health care—not only lack of coverage for millions but also skyrocketing costs—illustrate the wide gap in the way Republicans and Democrats approach public policy controversies. The Reagan “revolution” was based on a definite and clear ideological preference for a certain approach to public policy in general: eliminate government regulation; reduce taxes; provide tax incentives for business; cut welfare; and privatize the delivery of governmental services. Democrats, of course, did not agree.
This series in Public Policy Controversies is meant to shed more light and less ideological heat on major policy issues in the substantive policy areas. In this volume Kronenfeld covers controversial issues ranging from AIDS to abortion, aging, costs, mental health, and health care providers. She begins by noting that the United States spends more on health care than all other countries, yet we have between 33 and 38 million Americans who have no health insurance. Even though the United States has the most advanced medical technology in the world, it ranks 19th among nations in infant mortality.
In order to answer why this is the case, Kronenfeld first describes the three different health care systems (or non-systems) in the United States and the various controversies associated with them. In order to improve the systems it is necessary to be able to measure and define health, which she addresses in Chapter 2. Of course, no matter how it is measured, health is related to income level and, surprisingly, not necessarily to the availability of medical services. In fact, in the area of mental health, less availability was considered best in the deinstitutionalization movement, when hundreds of thousands of mentally ill patients were released from state and county mental health institutions.
Birth control and abortion are two of the more controversial issues taken up by Kronenfeld, especially as they are related to the epidemic of teenage pregnancies in the United States. These are areas that are extremely emotional and therefore difficult to find adequate remedies for. Another, considered by Kronenfeld in Chapter 5, is aging. As the U.S. population grows older, the cost of health care will inevitably go up because the largest proportion of health care expenditures goes to the elderly. However, in 1992, the United States still did not have a satisfactory policy or program for long-term care for the elderly.[Page xi]
This volume sheds a great deal of light on these and many other crucial issues in health care. This is a policy area that will become increasingly important in the coming years. Readers of this volume will be well equipped to understand and perhaps contribute to solutions for these complex problems.[Page xii]
I would like to thank many people for assistance in writing this book. My department chair, Howard Zuckerman, was particularly helpful at the end in arranging to have the typing of tables completed. Valerie Hedges, my graduate assistant provided by the School of Health Administration and Policy, was very helpful in researching the facts and figures needed for the book. Janet Soter of the College of Public Programs was most helpful in producing the figures for this book. Also, Rita Mae Kelly and Dennis Palumbo were helpful in their roles as series editors.
I would also like to thank my family. My husband, Michael Kronenfeld, was understanding and patient in his personal role about the time needed to write this book. He also helped in his professional role as a librarian with provision of some of the needed materials and tabular data, as well as in reading the entire manuscript. My three children, Shaun, Jeffrey, and Aaron, were patient much of the time as concerns the time demands and very pleased when their mother appeared less frantic since the book was completed to coincide with the occurrence of their summer vacations. Last, I would like to acknowledge my [Page xiv]mother, Bessie Jacobs, whose intellectual stimulation and encouragement have been important at all stages of my career, but especially when I was in high school and college.
- Volume 1 CONTROVERSIAL ISSUES IN ENVIRONMENTAL POLICY
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