Controversial Issues in Health Care Policy

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Jennie J. Kronenfeld

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  • Controversial Issues in Public Policy

    Series Editors

    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

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    Series Editors’ Introduction

    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.

    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.

    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.

    RitaMaeKelly
    DennisPalumbo

    Acknowledgments

    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 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.

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    Author Index

    • Aday, L., 138
    • Aguirre, B. E., 141
    • Aiken, L. H., 138
    • Alspach, J. G., 92
    • Amidon, R., 104, 115
    • Andersen, M. L., 54
    • Andersen, R., 28
    • Anderson, R., 138
    • Antioch, L., 150
    • Arches, J., 88
    • Aries, N., 83, 92
    • Avom, J., 31
    • Baker, S., 115
    • Ball, J. K., 31, 34
    • Banta, D., 83
    • Baquet, C., 142
    • Barer, M. L., 150, 159
    • Barnett, P. G., 85
    • Bass, D. M., 78
    • Batten, H., 78
    • Bauer, E., 74
    • Bean, G. L., 45
    • Beauchamp, D. E., 47, 48
    • Becker, E., 116
    • Behny, C., 83
    • Beitler, D., 80
    • Beland, F., 78
    • Bennett, A. E., 19
    • Bennett, R. C. X., 55
    • Bergner, M., 19
    • Binstock, R. H., 77, 80
    • Blendon, R. J., 5, 35, 138, 159
    • Bodenheimer, T., 155
    • Boismier, J., 74
    • Bonar, J. W., 56
    • Botehlo, R. J., 2
    • Bowen, O. R., 128
    • Boyd, J. H., 37
    • Braun, P., 116
    • Brook, R. H., 122, 123, 125, 142
    • Brown, E. B., 147, 155, 156
    • Brown, P., 42, 43, 44
    • Burke, J. D., 37
    • Burke, M., 143
    • Burke, T. R., 128
    • Bursh, J. W., 18
    • Butler, A. M., 152
    • Cascardo, D., 7
    • Case, T. W., 79
    • Chen. M. N., 18
    • Chesney, J., 115
    • Christensen, S., 100
    • Christianson, J. B., 94
    • Cleary, P. D., 31
    • Coheii, B. B., 145
    • Cohen, H., 147
    • Cohen, M., 78
    • Cohodes, D. R., 137
    • Colwell, J. M., 88
    • Corey, C. R., 138
    • Cowan, C. A., 106, 108
    • Coward, R. T., 69
    • Curtis, R. E., 7, 93
    • Cutler, S. J., 69
    • Dailey, T., 158
    • Daley, D., 60
    • Danzon, P., 149
    • Davis, K., 133, 142
    • Davis-Avery, A., 122
    • DeGeyndt, W., 123
    • Delevan, S. M., 91
    • DesHarnais, S., 115
    • Devanter, N. V., 31
    • Dienes, C. T., 54
    • Dill, A., 44
    • Dippe, S. E., 129
    • Dobson, S., 115
    • Donabedian, A., 122, 123
    • Donelan, K., 35, 159
    • Donovan, P., 62
    • Dowling, W. L., 94, 96, 103
    • Duncker, A. P., 77
    • Durch, J., 30
    • Eddy, D. M., 146
    • Edwards, J. N., 159
    • Edwards, W. O., 115
    • Enthoven, A., 8, 151, 152, 160
    • Ermann, D. A., 103
    • Estes, C. L., 70
    • Evans, R. G., 150, 159
    • Evashwick, C. J., 75, 77
    • Falk, I. S., 135
    • Fans, L. J., 141
    • Feder, J., 142
    • Fein, R., 161
    • Feldman, S. E., 131
    • Feldstein, M., 88
    • Fell, J., 37
    • Field, M. A., 63
    • Fingaratte, H., 37, 47, 48
    • Fink, S., 147
    • Fischer, G. A., 45
    • Fischer, W. S., 146
    • Fisher, C. R., 115
    • Fleming, G., 138
    • Forrest, J. D., 61
    • Fox, D. M., 146, 147
    • Fraser, I., 118
    • Freeman, H. E., 138
    • Freidson, E., 83
    • Freudenheim, M., 145
    • Fried, M. G., 67
    • Fries, J. L., 73
    • Fuchs, V., 88, 110
    • Gabel, J., 144, 147
    • Gay, G., 115
    • George, L. K., 37
    • Gerstman, B. B., 55
    • Gibson, R. M., 110
    • Ginzberg. E., 120
    • Glaser, W. A., 114, 120
    • Gold, M., 133
    • Gold, R. B., 60
    • Golden, W. E., 126
    • Goldman. H. H., 39
    • Goldstein, L., 58
    • Grannemann, T. W., 146
    • Gray, B., 99, 100
    • Green, L. R., 73
    • Gross, T. P., 55
    • Grumbach, K., 155, 156, 160
    • Guterman, S., 115
    • Haber, L. D., 18
    • Hadley, J., 88, 142
    • Haglund, C., 94, 96, 103
    • Harvey, L., 2
    • Haug, M., 84
    • Hays, R. D., 37
    • Henshaw, S. K., 58, 60
    • Hilts, P. J., 59, 61
    • Himmelstein, D., 113, 114, 155, 156, 161
    • Hing, E., 75
    • Holahan, J., 88
    • Howard, E. F., 77
    • Hoy, E. W., 7, 93
    • Hsiao, W.C., 116
    • Hurst, J. W., 149
    • Hussey, J., 104
    • Hyde, P. S., 45
    • Ingram, W., 79
    • Jensen, G., 144
    • Jillinek, E. M., 47
    • Joffe, C., 64
    • Jogerst, G. J., 129
    • Johnston, M., 19
    • Jonas, S., 105
    • Kamo, M., 37
    • Kasper, J. D., 138
    • Kellie, S. E., 126
    • Kelly, J. T., 126
    • Kemper, P., 76, 78
    • Kenkel, P., 94, 144, 156
    • Kennedy, D. L., 55
    • Kennedy, L., 83, 92
    • Kiesler, C. A., 42
    • Kirchbaum, J., 2
    • Kirkman-Liff, B., 148, 149
    • Kleig, R., 148
    • Kleinman, J. D., 138
    • Klerman, L. V., 39
    • Knickman, J., 74
    • Knowles, J. H., 47
    • Knox, R. A., 35
    • Kobrinski, E., 115
    • Koch, A. L., 115
    • Koff, S. Z., 91
    • Kralovec, P., 118
    • Kramer, M., 37
    • Kravitz, R. L., 130
    • Kronenfeld, J. J., 26, 47, 53, 78, 93, 95, 96, 99, 100, 104, 106, 110, 115, 133, 134
    • Kronick, R., 8, 152, 160
    • Kutner, N. G., 111, 112
    • Ladenheim, K. E., 138, 139, 140, 141, 157
    • LaLonde, M., 26
    • Lamanna, M. A., 65
    • Larson, M. J., 78
    • Lazerby, H., 106, 108
    • Lee, R., 88
    • Leichter, H. M., 146, 147
    • Letsch, S. W., 106, 108
    • Levine, I. S., 45
    • Levine, S., 73
    • Levit, K.R., 106, 108, 110, 111, 112
    • Lewin, T., 65
    • Lewis, D. A., 40
    • Linton, P. B., 64, 66, 67
    • Lo, B., 146
    • Locke, B. Z., 37
    • Logerfo, J. P., 125
    • Lohr, K., 129, 130
    • Lubitz, J., 75
    • Lurie, M., 142
    • Lurigo, A. J., 40
    • Maleac, D., 133
    • Manga, P., 160
    • Manning, W. G., 96, 130
    • Manton, K. G., 70
    • Mayer, D., 91
    • Mayfield,!. A., 128
    • McCall, N., 74
    • McConnell, S., 80
    • McDowell, I., 19
    • Mcllrath, S., 115, 116
    • McKeown, T., 24, 26, 121
    • McKinlay, J. B., 19, 24, 25, 26, 88, 121
    • McKinlay, S. J., 19, 24, 25, 26, 121
    • Mechanic, D., 44, 45
    • Menken, M., 2
    • Midling, J. E., 85
    • Miles, D. L., 18
    • Miller, C. A., 60
    • Mills, D. H., 131
    • Moccia, P., 89, 90
    • Morrissey, J. P., 39
    • Moscovice, I., 82, 90, 103
    • Mosher, W. D., 55, 56
    • Mowll, C. A., 140
    • Moyer, M. E., 139, 140
    • Mullan, F., 133, 158
    • Mullinex, C. F., 138
    • Mullner, R., 28
    • Murtaugh, C., 76
    • Mydans, S., 673
    • Myers, J. K., 37
    • Narcross, J., 118
    • Nelson, E., 130
    • Neuschler, E., 149, 150
    • Newell, C., 19
    • Newschaffer, C. J., 90, 91
    • Noelker, L. S., 78
    • Ory, M. G., 70, 77
    • Patrick, D. L., 18, 19
    • Peck, R., 37
    • Perrine, M., 37
    • Petersdorf, R. G., 88
    • Phillip, R. L., 70
    • Pincus, H. A., 51
    • Pindyck, J., 31
    • Plough, A. L., 111
    • Pollack, R. F., 74
    • Poullier, J. P., 113
    • Pratt, W. F., 55, 56
    • Prihoda, R., 75
    • Probst. J. C., 104
    • Provencher, H., 92
    • Rae, D. S., 37
    • Record, R. G., 24
    • Regier, D. A., 37
    • Reinhardt, U. E., 157, 160
    • Reiman, A., 160
    • Renne, K. S., 19
    • Reverby, S., 84, 89
    • Reynolds, W. J., 18, 19
    • Rice, T., 7, 74, 93, 113, 114, 120, 147
    • Richardson, M., 37, 38, 39, 40
    • Ringman, K., 142
    • Rivas, E. E., 71
    • Robbins, L. N., 37
    • Robinson, J. C., 7
    • Roblin, D. W., 131
    • Rochefort, D., 44, 45
    • Rockefeller, J. D., 152
    • Rodman, H., 56, 63, 64, 66
    • Rog, D. R., 45
    • Rogers, S. W., 130
    • Rogers, T. F, 31
    • Rosenbaum, R., 79
    • Rosenberg, C. E., 95
    • Rosenblatt, R., 66, 67, 103, 130
    • Ross, J. W., 62
    • Rossi, P., 45
    • Roth, D., 45
    • Roth. J. A., 65
    • Rothman, B. K., 63
    • Rothman, D., 38
    • Rothman, M. L., 19
    • Rubin, R. J., 150
    • Rushing, W. A., 18
    • Russell, L. B., 25
    • Ryder, N. B., 55
    • Salive, M. E., 128
    • Sanchez, S. M., 94
    • Sarvis, B., 56
    • Scanlon, W., 88
    • Schieber, G. J., 113
    • Schlenger, W. E., 18
    • Schoeman, J. A., 90, 91
    • Schroeder, S. A., 129, 130
    • Scull, A. T., 38
    • Seekins, S. B., 2
    • Sekscenski, E., 75
    • Shadish, W. R., 40, 42, 43
    • Shapiro, M. F., 142
    • Sheils, J. F., 149
    • Sherlock, D. B., 138
    • Siegel, J. E., 158
    • Singer, E., 31
    • Siu, A., 96
    • Soldo, B., 71
    • Somerville, J., 142
    • Sonnenberg, F. A., 96
    • Spillman, B., 76
    • Sprague, J., 56
    • Stadel, B. V., 55
    • Stahan, G., 75
    • Starfield, B., 149
    • Starr, P., 83, 88
    • Steinberg, E. P., 142
    • Steinbrook, R., 146
    • Stevens, R., 95, 96, 98, 102
    • Stewart, A., 37
    • Stoeckle, J., 88
    • Stone, R., 77
    • Stoto, M., 30
    • Sudman, S., 138
    • Sulloway, A. W., 54
    • Tarlov, A., 130
    • Tell, E. J., 78
    • Thorpe, K. E., 158, 159
    • Todd, J. S., 2
    • Tolchin, M., 156, 160
    • Tomita, D. K., 55
    • Torrens, P. R., 6
    • Torres-Gil, F. M., 71
    • Tresnowski, B. R., 157
    • Turner, B. J., 31, 34
    • Turner, R. D., 24
    • Van Vort, J., 58, 60
    • Waldman, S., 160
    • Waldo, D. R., 106, 110
    • Wann, M., 65
    • Ward, N. B., 142
    • Ware, J. E., 130
    • Warners, H. R., 70
    • Weiner, J., 85
    • Weiss, J. A., 39
    • Weissman, N. W., 128
    • Welch, H. G., 146
    • Welch, W. P., 150
    • Weller, G. R., 160
    • Wells, K. B., 37
    • Wennberg, J. E., 146
    • West, R., 74
    • Westoff, N. B., 55
    • Whicker, M. L., 26, 53, 78, 93, 95, 96, 99, 100, 106, 110, 133, 134
    • White, E. L., 138
    • Wholey, D. R., 94
    • Wildavsky, A., 25
    • Wilems, J., 83
    • Wilensky, G. R., 138, 139, 140, 141, 157
    • Williams, K. N., 122
    • Williams, R. G. A., 19
    • Willis, G., 45
    • Willis, L. A., 19
    • Wilson, R. W., 138
    • Wolinsky, F. D., 141
    • Woolhandler, S., 113, 114, 155, 156, 161
    • Wright, J. D., 45, 46
    • Wyszewianski, L., 122
    • Yntema, D. B., 116
    • Young, G. J., 145, 149
    • Zola, I., 48
    • Zubkoff, M., 130

    About the Author

    Jennie Jacobs Kronenfeld is a Professor in the School of Health Administration and Policy, Arizona State University. She holds a doctorate (1976) and a master's degree (1973) in sociology from Brown University, and a master's degree (1971) in sociology and history from the University of North Carolina. Prior to coming to Arizona, she held faculty positions at the University of Alabama in Birmingham and the University of South Carolina.

    She has published more than 80 articles and book chapters on public health, medicine, health services research, and sociology. She has co-authored four books: on the social and economic impact of coronary artery bypass surgery (1981); on the federal role in health policy (1984); on the impact of technology on sex roles and social change (1986); and on public versus private models of service delivery in several different human services areas, including health (1990). Her current research interests include health policy issues, especially access to health care and reform of the health care system, and research on preventive aspects of health care such as perceptions of risk, childhood injury, and the relationship between social roles and wellness.


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