Eli Ginzberg - Medical Gridlock And Health Reform

Medical Gridlock and Health Reform, Eli Ginzberg

Changing U.S. Health Care: A Study of Four Metropolitan Areas, Eli Ginzberg, Howard S. Berliner, and Miriam Ostow, with E. Richard Brown, Hardy D. Loe Jr., and J. Warren Salmon

Young People at Risk: Is Prevention Possible? Eli Ginzberg, Howard S. Berliner, and Miriam Ostow

Strategic Factors in U.S. Health Care: Human Resources, Capital and Technology, Howard S. Berliner

Medicine and Society: Clinical Decisions and Societal Values, edited by Eli Ginzberg

From Physician Shortage to Patient Shortage: The Uncertain Future of Medical Practice, edited by Eli Ginzberg

First published 1994 by Westview Press

Published 2018 by Routledge

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Copyright 1994 The Eisenhower Center for the Conservation of Human Resources, Columbia University

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

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Library of Congress Cataloging-in-Publication Data

Medical gridlock and health reform / Eli Ginzberg.

p. cm. (Eisenhower Center for the Conservation of Human
Resources studies in health policy)

Includes index.

ISBN 0-8133-2040-2

1. Health care reformUnited States. I. Series.

RA395.A3M43 1994

362.10973dc20

93-46403

CIP

ISBN 13: 978-0-367-00951-9 (hbk)

With a few exceptions the chapters that comprise this book have been previously published in health care journals, most of them within the past two years. Accordingly, this volume can be viewed as a follow-up to The Medical Triangle: Physicians, Politicians and the Public , which Harvard University Press first published in 1990 and reprinted in paperback in 1991.

The early 1990s saw the U.S. health care system under intensifying pressures and strains because of steeply rising expenditures, an increase in the number of uninsured persons, and a range of other challenges, including increasingly severe pressures on the government and employers, the principal payers for health care. As a consequence of these and other dysfunctional developments, I was encouraged to explore and assess many of these new developments and to make my findings more broadly available by publishing them in various health policy periodicals. They are here reprinted to enable the interested reader to become acquainted with my assessments of the transformations underway in the financing of U.S. health care and in the delivery of services on the eve of an era of major health care reform.

Except for minor changes in wording and an updating of an occasional statistic, the chapters in this volume do not differ from the articles as they were originally published. However, I want to note explicitly that I am indebted to Miriam Ostow () for agreeing to let me include our joint effort in this collection under my name.

I want to add that my collaboration with Miriam Ostow covers three decades; as head of the health care studies of the Eisenhower Center staff, she has contributed in greater or smaller measure to all of the chapters, not only to the one acknowledged above, and for this collaboration I am deeply in her debt, intellectually and personally.

The Eisenhower Center for the Conservation of Human Resources, Columbia University, which I direct, has been fortunate to have received financial support for research from a number of the nations leading foundations concerned with health policy. I acknowledge with gratitude the support of The Robert Wood Johnson Foundation, The Commonwealth Fund, The Pew Charitable Trust, and The Josiah Macy, Jr., Foundation.

In the assembling and editing of the chapters I was greatly assisted by my long-term associate, Anna Dutka, who assumed most of the responsibility for taking the discrete pieces and helping to transform them into a book.

For their preparation of the original articles for publication and for overseeing the multiple stages of guiding this volume through the press, I want to express once again my deep appreciation for the splendid assistance that I received from Sylvia Leef and Shoshana Vasheetz, long-term mainstays of the Eisenhower Center staff.

Eli Ginzberg , Director The Eisenhower Center for the Conservation of Human Resources Columbia University

About a year ago, Victor Fuchs remarked that from being the nations leading incrementalist, I had become a leading eschatologist. Fuchs was fully justified in pointing out the radical shift that had occurred in my thinking about the changing U.S. health care system as we entered the early 1990s. As a longtime student of the changing health care scene I had observed, or had read about, many forecasts of radical changes looming on the health policy horizon that time had proven wrong.

Every decade or two the passage of national health insurance appeared to be imminentit was part of Theodore Roosevelts platform when he ran for president on the Bull Moose ticket in 1912. Each time the proposal reemerged, the last being in 1976 when Jimmy Carter included it in his successful presidential bid, I was certain that it was no closer to enactment than it had been in 1912, 1935, or the late 1940s.

My reaction to health care cost escalation provided other evidence of my incrementalist approach: In the post-World War II decades, when health care expenditures mounted rapidly, most analysts forecasted that the expenditure trend would inevitably level off once health care outlays, which had amounted to 4.5 percent of gross domestic product (GDP) in 1950, rose to 10 percent, but I saw no reason why such a leveling off should occur. True, President Richard Nixon had issued a national alert in 1969 when current expenditures approached $75 billion (up from $43 billion in 1950 adjusted for inflation) and accounted for 7.5 percent of GDP. In the presidents view, a continuation of such expenditure increases threatened the financial stability of the U.S. health care system and even the effective functioning of the U.S. economy. But it seemed to me that the presidents warning had been premature and exaggerated. In fact, although health care expenditures continued to accelerate, the health care system continued to function and the U.S. economy did not falter. My incrementalism was reinforced when the ratio of total health care outlays to GDP crossed the 10 percent line in the mid-1980s and kept increasing.

I made some rough projections in 1990 that indicated that if the United States remained on its present course, national health care expenditures would exceed the trillion-dollar mark by mid-decade and the 1.5 trillion-dollar mark not too long thereafter. This was a major shock to my incrementalism.