In addition, the seminar ended in a heated discussion about whether certain Affordable Care Act (ACA) provisions on paying for quality, reducing hospital readmissions, and providing for alternative delivery systems are likely to make the Medicare program more sustainable by saving costs by ensuring that beneficiaries get the Medicare-covered services they need, including preventive services.
Increases in cost sharing and out-of-pocket spending place a heavy burden on beneficiaries and can have a negative impact on their health and daily living, chiefly through physical and emotional stress8 The Medicare program faces many challenges as it moves into its second half-century of service.
It will also identify key cost and quality problems facing the program and review solutions included in the recently passed Affordable Care Act (ACA) that might provide solutions.12 I.
The Historical Debate Over Public Health Insurance in the United States Over the past century, paying for health care has been a major concern for American families.13 Prior to the enactment of America’s “Great Society” legislation of 1965, including the Medicare program, families had few options for paying for necessary health care for their old and sick family members.14 Then, and now, health care is prohibitively expensive, with even a hospitalization of a short duration costing thousands of dollars.15 Much of the current structure of the Medicare program stems from a long and public debate about the creation of a social insurance system to address the problems of cost and quality.16 The on-going debate continues to raise questions about the necessary elements of a comprehensive program, including health care financing and accessing the quality of necessary services.17 A.
This debate began in 1906, with the founding of the American Association of Labor Legislation (AALL), a progressive group that began pushing for state-run public insurance in the late 1910s.27 Many have attributed this defeat to the medical profession,28 but to do so is a simplification of the broader debate about government-run health insurance.
The American Medical Association (AMA) was initially a supporter of the bills proposed by the AALL and even sent a three-person committee of AMA members to work with the AALL on the health insurance program.29 The labor unions, in contrast, strongly opposed a national health insurance system, arguing that such a program would amount to government interference in negotiations between unions and employers.30 This opposition was joined in 1912 by serious opposition from the state AMA chapters, which argued strongly against a public program.31 Another factor in the defeat of the bills was the outbreak of World War I in 1917, which resulted in extreme anti-German sentiments.32 Those sentiments enabled opponents, including many physicians, to tie the proposed health insurance programs to similar kinds of health insurance in Germany, issuing brochures describing health insurance as “a dangerous device, invented in Germany.”33 This demonization of health insurance was, in many ways, an early example of the “socialized medicine” propaganda that is still used today.
These challenges collide with major philosophical differences within our legislative and policy making bodies, leading to conflicting notions about how to respond to an expanding demand for services, how to establish sensible cost-containment strategies, and how to provide Medicare services that are comprehensive and of good quality. The likely reason for this shift was an increase in support from reformers, including “organized labor, progressive farmers, and liberal physicians.” Starr, supra n.
Copyright 2013, National Academy of Elder Law Attorneys.
Chiplin Jr., Esq., is a Construction Injury Attorney and managing attorney in the Washington, D. 14, at 279), a position that makes sense given the extensive lobbying push by the AMA during the earlier parts of this debate.
C., office of the Center for Medicare Advocacy, Inc. Chiplin focuses on Medicare coverage and appeals, issues of discharge planning, and quality of care across health care settings.
The AMA and the physician members of the CCMC strong disagreed with the idea of any kind of insurance and several committee members who favored a national public health insurance program issued a dissent to the recommendations.37 Outside forces began to converge, however, with a strong policy argument for a national health insurance system.
Health care costs continued to rise in the 1920s and early 1930s as the market control by licensing boards and new scientific developments (and associated physician education costs) drove up the cost of care.38 The Great Depression compounded these costs in the early 1930s, and health insurance seemed a logical area of focus when President Franklin Roosevelt took office in 1932, due to his support of government programs and significant public demand.39 Initially, the chances of a health insurance proposal seemed likely. Compulsion was contemplated by various plans and was usually in the form of a tax or a penalty for failure to buy or enroll in insurance.
In addition, the costs of providing care continue to rise at a rate that many find unsustainable. Following World War II, he once again had the freedom to focus on domestic social issues.