Health Care Turning Point

Health Care Turning Point: Why Single Payer Won't Work

Roger M. Battistella
Copyright Date: 2010
Published by: MIT Press
Pages: 192
https://www.jstor.org/stable/j.ctt5vjrjb
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  • Book Info
    Health Care Turning Point
    Book Description:

    In the battle over health care reform we can try to fashion new policies based on old ideas--or we can acknowledge today's demographic and economic realities. In Health Care Turning Point, health policy expert Roger Battistella argues that the conventional wisdom that dominates health policy debates is out of date. Battistella takes on popular misconceptions about the advantages of single-payer plans, the role of the market, and other health policy issues and outlines a pragmatic new approach. Few would disagree that the current system is broken. But, Battistella asserts provocatively, a government takeover of health insurance patterned after Medicare and Medicaid won't work either. Battistella argues that contrary to popular belief, single-payer coverage will not lower health spending but would encourage overconsumption and drive costs up. If consumers were responsible for buying their own health insurance (as they are for buying their own car and home insurance), he argues, they'd look for value and demand greater price and quality transparency from providers. The economic shibboleth that the principles of market competition don't apply to health care is nonsense, Battistella says. We won't achieve real health care reform until policy makers adjust to this reality and adopt a more pragmatic view.

    eISBN: 978-0-262-26596-6
    Subjects: Public Health, Political Science

Table of Contents

  1. Front Matter
    (pp. i-viii)
  2. Table of Contents
    (pp. ix-x)
  3. Acknowledgments
    (pp. xi-xii)
  4. Introduction
    (pp. xiii-xx)

    This book asserts that the prevailing wisdom guiding health policy thinking is rooted in historical convictions and circumstances that have been overtaken by changes in social and economic development. Important changes in population structure and the global economy, compounded by costly advances in medical innovation and insatiable public demands for health care, underlie a need to re-examine and revise old beliefs and attitudes hampering meaningful health reform. This is apparent in the unsustainability of present rates of health spending and the many deficiencies in the way health care is structured and delivered. The necessity for a new health policy paradigm...

  5. 1 Health Policy: Then and Now
    (pp. 1-18)

    Health policy has undergone a profound transformation in the post–World War II period. Massive growth, both in size and significance, has propelled it to the forefront of national attention. This contrasts sharply with its former status as a distinct component of the national economy. The rate at which already large-sized outlays are now growing stirs concerns about whether the health sector is consuming too large a share of national income at a time when pressures are mounting to expand public spending to support a growing number of uninsured Americans. Political controversy over whether and how to deal with the...

  6. 2 Resistance to Change
    (pp. 19-36)

    If the past is any indication of what can be expected, health reform is a goal more easily discussed than accomplished. Failed attempts to enact national health insurance extend back nearly a century and testify to the power of interests arrayed in support of the status quo (Anderson 1958: 621–28). Today’s proposal goes far beyond universal coverage to encompass an ambitious overhaul of the coverage and deliverance of health care. What is contemplated is nothing less than the modernization of a badly antiquated health care structure. Given the scope and complexity of this undertaking, the confidence exhibited by reform...

  7. 3 Contemporary Challenges
    (pp. 37-58)

    Overcoming resistance to health reform that is embedded in the culture of health care presents a major challenge to the possibility of bringing health spending under control in a manner that reconciles competing demands for economy and social justice. This tension is foremost in decisions that will have to be made regarding the disproportionate share of health expenditures directed to individuals at the extremes of the life cycle. It is inevitable therefore that economy-minded policy makers will focus their attention on the value of resources committed to individuals at the end of life and to newborns requiring expensive intensive neonatal...

  8. 4 Contemporary Realities
    (pp. 59-76)

    National health insurance is an idea whose time has passed. The changes now occurring in employee retirement and health benefits, coupled with the strain of financing similar benefits at all government levels, send a clear signal that the goal of taxpayer-financed universal coverage is unachievable. The visionary principles that have shaped popular conceptualizations of national health insurance remain detached from new realities.

    Health care is far more sophisticated and costly than it was at the time the concept of national health insurance was first formulated at the end of the nineteenth century. What was easily affordable then is becoming less...

  9. 5 Popular Misconceptions
    (pp. 77-108)

    From its inception at the beginning of the twentieth century, the history of national health insurance politics in the United States has been a quest for social equity and justice. Because so much of it is advocacy driven, a surprisingly large amount of health reform thinking has fallen under the influence of emotion in which faith and hope prevail over dispassionate analysis and facts. Values derived from theological and philosophical principles play a large part in this reform movement. Although less pronounced and devoid of the emotional intensity found in the politics of national health insurance, faith nevertheless underlies the...

  10. 6 Health Policy Reconfigured
    (pp. 109-134)

    The escalation of public debt, coupled with the size of unfunded entitlement obligations, signals a need for government restraint and financial responsibility in the undertaking of expensive new programs. Financial constraints on employment-based coverage are perilous to ignore under existing circumstances. Employers can no longer be the main source of protection against the threat of household financial insecurity that results from the high cost of health care. In today’s economic environment employers have far less flexibility to offset higher benefit costs by such traditional practices as raising prices or lowering wages. If still possible in the long term, competitive pressures...

  11. References
    (pp. 135-154)
  12. Index
    (pp. 155-167)