Eli Ginzberg - Critical Issues In U.S. Health Reform

Edited by
Eli Ginzberg

First published 1994 by Westview Press, Inc.

Published 2018 by Routledge
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Copyright 1994 by 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
Critical issues in U.S. health reform / edited by Eli Ginzberg.
p. cm.
Includes bibliographical references.
ISBN 0-8133-8870-8. ISBN 0-8133-8871-6 (pbk.)
1. Medical careFinanceGovernment policyUnited States. 2. Health care reformUnited States. 3. Medical policyUnited States. I. Ginzberg, Eli, 1911
RA395.A3C85 1994
362.1'0973dc20

94-7920
CIP

ISBN 13: 978-0-367-01687-6 (hbk)

Widespread support exists for a substantial restructuring of our health care system. Universal health insurance coverage and containment of health care costs are embraced by Americans across the social, economic, and political spectrum. Yet while these issues have finally been propelled to the top of the domestic policy agenda, the problems leading to the current crisis have evolved over time and provide a record of useful lessons from former initiatives.

This volume acknowledges the value of that history in examining the complexities of reform and the implications of policy choices. Nationally recognized health care researchers who have authored the following chapters bring their insightful knowledge and expertise to analyses of the major issues raised by reform proposals. Each proposal will be defined and differentiated by how it addresses several crucial areas, such as mechanisms for financing and cost control; the responsibilities of federal and state governments, employers, and individuals; and the level of competition, regulation, or new administrative structures required. The fate of public programs and how vulnerable groups will be provided for, as well as the fate of specialty providers, academic health centers, and graduate medical education, are also major concerns. These chapters provide a thorough and careful examination of these difficult issues, in the context of our past and present situations, as a method of reaching agreement on the best way to proceed in achieving our goals.

The daunting scope of this task demands an ongoing, informed dialogue between all parties in the debate to understand the system as it stands now and the ramifications of change. As the debate evolves, information, analysis, and communication are vital. The mission of The Commonwealth Fund's Health Care Reform Program, of which this book is a product, is to illuminate the intricacies of the U.S. health care system and options for its future. To this end, we owe special thanks to the contributing authors of this volume, and to Eli Ginzberg, who in his capacity as editor is uniquely qualified to synthesize the topics discussed here and predict the challenges ahead.

Karen Davis
Executive Vice President, The Commonwealth Fund

This book could riot have been produced in record time without the wholehearted cooperation of the contributors.

The principal responsibility for editing the manuscript was carried by Christopher Zurawsky. Anna Dutka, a long-time member of the staff, assisted.

The principal responsibility for making the manuscript print-ready rested with Shoshana Vasheetz, who once again demonstrated her great skill in staying on top of multiple flows of paper in varying stages of editing. Gregory Grove managed the technical requirements of the tabular materials.

Special thanks go to Matthew Held of Westview Press, who has been a strong ally of ours over many productive years.

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

Eli Ginzberg

The first obligation of the editor is to convey to the reader the reasons for undertaking this collaborative effort and the purposes that it aims to serve. I shall speak to each in turn. The book aims specifically to contribute to the debate on health reform that dominates the political arena in 1994. For the better part of three decades since the passage of Medicare and Medicaid, neither the public nor the Congress paid serious attention to issues of cost, effectiveness, and equity in the financing and delivery of medical services to the American people. However, once the presidential campaign of 1992 got underway and once President Clinton entered the White House, health care reform moved rapidly toward the top of the domestic political agenda. Since many aspects of health care reform have been little studied and less understood, a volume directed to illuminating many of the critical dimensions of the prospective reforms was an inviting challenge, one that has engaged the authors and the editor, with due acknowledgment to The Commonwealth Fund for its interest and support.

Although the chapters that follow have addressed most of the reform agenda, the volume does not presume to cover all of the important issues. Two issues in particular are conspicuous by their absence: the future role of biomedical research and technology; and the multiple adjustments that are needed in the numbers, education and training, and utilization of the 10 million persons who comprise the health care workforce. Further probing could probably identify other elements of reform that would justify more attention than they have received. Nevertheless, the book can claim to address more definitively than any other current source the major issues involved in reforming the health system. We hope it will prove useful to the many parties to the discussion and debate that will shape the legislation Congress is likely to pass by early fall 1994.