Hoffman 6-end
Medicare was passed in 1965
- government run program for those 65 or older
- least likely to have private insurance, because they
were likely to no longer be working
- initial proposals covered hospital costs only
- AMA supported a proposal to provide help only for
the very poor
- Medicare was like insurance--paid for the provider
of your choice
- initially to get political support it did not
include much cost control, though there were limits on
benefits and the patient had to pay 20%
- did not cover drugs until 2003
- has never covered long-term nursing home care
- expanded in 1972 to included disabled people (though
currently there is a 2 year wait to qualify for Medicare
after qualifying for disability)
Medicaid provided health coverage for the poor
- originated in a 1950 program to help welfare
recipients with medical bills in which 28 states
participated
- available only to those poor people seen as
deserving
- family members such as adult children were often
counted in deciding whether someone could pay
- many hospitals and doctors did not accept Medicaid
The civil rights movement in the 1960s led to more
arguments for health care or equal treatment as a right
- 1975 hospitals that received government funds were
for the first time required to spend up to 3% of their
operating costs on care for those who could not pay
- patients began to demand rights such as informed
consent
- health clinics for the poor were sometimes organized
by activist groups
- physician authority was diminished by women's health
activists
- consumers movement drew attention to how insurance
failed some people
- a consensus grew that there were problems with
paying for health care, two solutions were requiring most
employers to provide coverage and the development of the
Health Maintenance Organization (HMO) which provided
preventative care
By the 1980s the problem was getting worse, but without
solutions
- dumping of uninsured patients was increasing
- people who had Medicaid were dying because they
could not get treatment
- 1986 congress passed a requirement that patients be
treated in emergencies even if they could not pay
- 1983 new Medicare payment model--a standard payment
by diagnosis, so if the hospital could treat patients for
less the rest was profit
- 1988 catastrophic coverage (out of pocket limits)
and prescription drugs added to Medicare
- percentage of Americans with private health
insurance has been declining since 1982
- In 1992 President Clinton proposed universal health
care coverage via regulated and subsidized private
insurance, but the insurance industry rejected it because it
would mean much more government regulation
- the proposal failed to get anywhere in Congress
By the early 2000s, the problems of the system were
much more visible
- more people did not have insurance
- more poor people were not eligible for Medicaid
- those with private insurance were getting upset with
limits on coverage
- HMOs limited what doctors patients could see
- insurance set limits on coverage, for example how
long a woman could stay in the hospital after childbirth
- tax free health care savings accounts so people
could pay extra costs themselves were not popular
- new technologies and drugs meant that health care
costs were rapidly increasing
2010 Patient Protection and Affordable Care Act
(Obamacare)
- expanding the availability of insurance by
regulation, requirements and subsidy
- many liberals would have preferred making Medicare
available to everyone, with a monthly fee for those who
could pay
- lower cost plans are high deductible--you have to
pay up to $6,000 a year per person or $12,000 per family
before insurance kicks in
- requires people to buy health insurance
Four different ways of paying for health care
- government pays the doctors and organizes the health
care system (Britain)--you can pay for more if you want
- Medicare: government pays the doctor of your choice
a fixed amount for treating you
- Affordable Care Act: government requires and helps
you buy insurance from a private insurance company that then
pays the doctor
- pay a fixed monthly fee to a medical practice or HMO
to cover all the health care you need