hoffman1

Hoffman 1

rationing--limits on medical services

rights--a right to adequate health care or to health security (not being impoverished by illness)

how did the poor get health care in the past?

The depression mean many more people who could not pay, at a time when medicine could do more

doctors didn't want too many charity cases but they also didn't want people who could pay going to free clinics
physicians incomes dropped dramatically during the depression because many patients could not pay
30% of disabling illnesses among people on relief received no medical care (p. 15)
doctors argued that they had the right to be reimbursed for their services so government should help
much relief during the depression came in the form of jobs, not cash, so people who were unable to work were in trouble
still, some people got free health care who had never had access before

Social Security came out of the depression to help the poor who were too old to work

some saw the Depression as proof that something radical had to be done, and there were arguments for a right to health care
but health care was less of a priority than old age pensions and unemployment insurance
concerns that rural people didn't get fair access to health care fit better with New Deal priorities

Blue Cross and Blue Shield

hospitals were more open to insurance plans than doctors were--too many people couldn't pay
Blue Cross covered hospital costs
Blue Shield initially covered doctors fees while in the hospital

World War II

many recruits were in poor health
government covered cost of childbirth for wives of soldiers using an argument of expressing gratitude
doctors resisted the government setting fees
resulted in an increase in hospital births
some doctors experienced group practice first during the war

After the war Truman pushed for national health insurance on the basis of a right to health

Hospitals (and doctors) had the right to refuse treatment

but they were more interested in government money than doctors
so funding to improve medical care tended to go to hospitals
with local control, so segregation continued until it was rule unconstitutional in 1963
if the hospital was funded by a town or city only people living there would be treated if they couldn't pay
turning away people who could not pay was still acceptable

By the 1960s private health insurance was common for middle class people

close to 70% of the population had coverage in 1960, mostly through employers
those not employed in jobs that provided insurance often could not afford to buy coverage
those who did have insurance found it paid for on average 40% of their costs
many plans still covered hospitalization only--in 1968 only 42% of those with insurance had insurance that covered doctor's services outside the hospital
the federal government gave tax breaks to companies that provided insurance
coverage was denied for pre-existing conditions or cancelled when the person turned 65, maternity care was sometimes excluded
alternative approach: Kaiser Permanente started as a group practice, came to offer prepaid medical care using doctors it employed and its own hospitals (what is called today an HMO)
insurers resisted call for more comprehensive coverage
as coverage became broader deductibles and copays were increased