Comparative Health Care Federalism by Katherine Fierlbeck & Howard A. Palley

Author:Katherine Fierlbeck & Howard A. Palley [Fierlbeck, Katherine & Palley, Howard A.]
Language: eng
Format: epub
Tags: Comparative Politics, Political Science, Business & Economics, Health, Insurance
ISBN: 9781317163114
Google: 7L21CwAAQBAJ
Goodreads: 29513785
Publisher: Routledge
Published: 2016-03-09T00:00:00+00:00

Conclusions

In many ways, the United States remained exceptional after the introduction of the 2010 Patient Protection and Affordable Care Act (ACA). It still is the only OECD nation without universal or near-universal health insurance, though the ACA seeks to reduce the number of uninsured. The current system is highly fragmented and offers health insurance coverage to different population groups – elderly, (very) poor families, veterans, working families – with widely divergent distributional consequences. By 2012, almost 15 per cent of the population, 45.5 million persons, had no insurance and another 15 per cent or so is underinsured or has been without coverage in the last few years. They have to pay themselves for medical care or depend on charity care and public subsidy. While there is strong public support for Medicare, the social insurance for elderly, and most Americans support the notion of universal health insurance, there is not agreement on the form of such scheme. Moreover, the fragmented political system in the US has created many veto positions that all but block major change. The 2010 mid-term elections brought a Republican majority in the House, and Republican leaders announced that they continue their efforts to repeal all or part of the legislation, and weaken or reverse it in the years ahead. That means that president Obama has faced strong and continuous opposition in the actual implementation of the ACA.

Our overall conclusions are as follows. First, transformative change in public policy is rare, and the health policy domain is no exception. There are not that many ‘windows of opportunity’ for ‘big bang’ reforms (Kingdon 1984). The passage of the 1935 Social Security as well as Medicare and Medicaid (in 1965) in the US, the introduction of the British NHS in 1948, the passage of Holland’s 2006 universal health insurance mandate – these are all examples of major change.

Second, values matter. Over time, dominant social values shape political institutions and policy making. Reversely, once in place, institutions themselves fortify and shape values as well (Marmor, Okma, and Latham 2006). For example, America’s Social Security and Medicare reflect the idea that retired elderly are especially ‘deserving’ of income protection. Over time, both programmes became very popular. Likewise, the British NHS of 1948 expresses support for universal and fair access to health care for all Brits, publicly funded and administered. The NHS itself has added to the sense of common values in the UK, and so has Canada’s medicare. In Europe (as in Canada), strong popular support for universal access to health care without undue financial barriers constrains government efforts to shift costs of medical care to families.

Third, reforming health care is not a one-shot effort (Okma and Crivelli 2010). Unexpected and unwanted side effects, public dissatisfaction and strong opposition by organised stakeholders commonly force governments to change policy or abandon their plans altogether. Actors in the health care arena anticipate policy change and react strategically to gain or defend their market positions. In fact, ‘after-reform maintenance’ seems to be a more or less permanent feature of health reforms.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.