Crisis in U.S. Health Care: Corporate Power Still Blocks Reform

2017 ◽  
Vol 48 (1) ◽  
pp. 5-27 ◽  
Author(s):  
John Geyman
Keyword(s):  
Health Care ◽  
Insurance Industry ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Public Support ◽  
Universal Coverage ◽  
The United States ◽  
Industrial Complex ◽  
Current Crisis ◽  
The Government

The corporate, largely privatized market-based U.S. health care system is deteriorating in terms of increasing costs, decreasing access, unacceptable quality of care, inequities, and disparities. Reform efforts to establish universal insurance coverage have failed on six occasions over the last century, largely through opposition of corporate stakeholders in the medical-industrial complex. This article provides historical perspective to previous reform attempts, updates the current battle between Republicans and Democrats over repeal of the 2010 Affordable Care Act (ACA), and compares three financing alternatives—continuation of the ACA; its replacement by a Republican plan (the House’s American Health Care Act or its Senate counterpart, the Better Care Reconciliation Act); and single-payer national health insurance (NHI or Medicare for All). Markers are described that reveal the extent of the current crisis in U.S. health care. Evidence is presented that the private insurance industry, increasingly dependent on bailout by the government, is in a “death spiral.” NHI is gaining increasing public support as the only financing alternative to provide universal coverage. Nine lessons that are still unlearned in the United States concerning health care are discussed, together with future prospects to establish universal coverage in this embattled and changing political environment.

scholarly journals Problems of health insurance coverage and health care in the United States: public and private solution strategies

1992 ◽  
Vol 8 (3) ◽  
pp. 270-286
Author(s):  
E. Richard Brown
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Care Financing ◽  
Health Insurance Coverage ◽  
The United States ◽  
Political Debate ◽  
Financing System

A nearly universal consensus has developed in the United States that the current health care financing system is a failure. The system has been unable to control the continuing rapid rise in health care costs (by far, the highest in the world), and it has been unable to stem the growing population that has no health insurance coverage (at least 36 million people). There is nearly universal political agreement that government must provide health insurance to a far greater share of the population than ever before. The political debate now focuses on whether this expanded government role should supplement the private insurance system with an enlarged public program covering those left out of private insurance coverage, or replace private insurance with a universal government health insurance program covering the entire population.

scholarly journals What Counselors Need to Know About Health Care Reform

2010 ◽  
Vol 43 (1) ◽  
Author(s):  
Scott Barstow
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Sector ◽  
The United States ◽  
Care Services ◽  
The Law

More than 60 years after President Truman wrote those words and nearly 100 years since health insurance was proposed by Teddy Roosevelt, the United States has joined the rest of the developed nations in initiating a health care system aimed at establishing universal insurance coverage. President Barack Obama and his colleagues in the House and Senate succeeded where many, many others failed, but just barely. The legislation, described as "similar in scope to Great Society and New Deal programs," was enacted "without the benefit of the congressional majorities of those eras" (Oberlander, 2010). For some health care advocates, the law was a disappointment, as it missed opportunity to establish a "public option" for health insurance, a publicly financed and operated program similar to Medicare to provide broad coverage. For others, the legislation constituted the transformation of the United States into a socialist state, somehow endangering America's "freedoms." The reality is that the new law keeps the predominant role of private insurance coverage and welds it to a new framework of rules, investments in improving the effectiveness and efficiency of care, and a strengthened public health sector to establish a more rational system. The law will have a significant impact oi:i counselors as both consumers and providers of health care services, and its enactment has implications for counselor advocacy.

Capitalizing on Illness: The Health Insurance Industry

1974 ◽  
Vol 4 (4) ◽  
pp. 583-598 ◽  
Author(s):  
Thomas Bodenheimer ◽  
Steven Cummings ◽  
Elizabeth Harding
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Low Income ◽  
Access To Health Care ◽  
Insurance Industry ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
Health Insurance Industry

The private health insurance industry in the United States began as a money-collection mechanism for hospitals and doctors, and has evolved into an important profit-making sector of the economy. Blue Cross is dominated by hospital representatives and serves to channel money into the nation's hospitals. Physicians control Blue Shield and are its principal beneficiaries. And commercial insurance companies are closely linked to banks and industrial corporations through the country's large financial empires. Some effects of this elite control over the health insurance industry have been inadequate and distorted insurance coverage, discrimination against the elderly, the sick, and the poor, and rapidly rising medical costs. In addition, the control of Medicare and Medicaid by private insurance institutions has contributed to the enormous inflation produced by these programs. Though governments, consumers, and even the insurance industry itself are beginning to apply controls to the unprecedented medical inflation of the late 1960s, these controls tend to limit access to health care, especially for low-income people. Unless insurance companies are barred from the health care field and a public financing mechanism based on progressive taxation is introduced, health care will never be an equal right for everyone in the United States.

scholarly journals Impact of Health Insurance Expansion on the Treatment of Colorectal Cancer

2016 ◽  
Vol 34 (34) ◽  
pp. 4110-4115 ◽  
Author(s):  
Andrew P. Loehrer ◽  
Zirui Song ◽  
Alex B. Haynes ◽  
David C. Chang ◽  
Matthew M. Hutter ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care Reform ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
The Third ◽  
Insured Patients ◽  
The Impact ◽  
Privately Insured

Purpose Colorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. Lack of insurance coverage has been associated with more advanced disease at presentation, more emergent admissions at time of colectomy, and lower survival relative to privately insured patients. The 2006 Massachusetts health care reform serves as a unique natural experiment to assess the impact of insurance expansion on colorectal cancer care. Methods We used the Hospital Cost and Utilization Project State Inpatient Databases to identify patients with colorectal cancer with government-subsidized or self-pay (GSSP) or private insurance admitted to a hospital between 2001 and 2011 in Massachusetts (n = 17,499) and three control states (n = 144,253). Difference-in-differences models assessed the impact of the 2006 Massachusetts coverage expansion on resection of colorectal cancer, controlling for confounding factors and secular trends. Results Before the 2006 Massachusetts reform, government-subsidized or self-pay patients had significantly lower rates of resection for colorectal cancer compared with privately insured patients in both Massachusetts and the control states. The Massachusetts insurance expansion was associated with a 44% increased rate of resection (rate ratio = 1.44; 95% CI, 1.23 to 1.68; P < .001), a 6.21 percentage point decreased probability of emergent admission (95% CI, −11.88 to −0.54; P = .032), and an 8.13 percentage point increased probability of an elective admission (95% CI, 1.34 to 14.91; P = .019) compared with the control states. Conclusion The 2006 Massachusetts health care reform, a model for the Affordable Care Act, was associated with increased rates of resection and decreased probability of emergent resection for colorectal cancer. Our findings suggest that insurance expansion may help improve access to care for patients with colorectal cancer.

scholarly journals What Counselors Need to Know About Health Care Reform

2010 ◽  
Vol 43 (1) ◽  
Author(s):  
Scott Barstow
Keyword(s):  
United States ◽  
Health Care ◽  
Health Insurance ◽  
Health Care Services ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Sector ◽  
The United States ◽  
Care Services ◽  
The Law

More than 60 years after President Truman wrote those words and nearly 100 years since health insurance was proposed by Teddy Roosevelt, the United States has joined the rest of the developed nations in initiating a health care system aimed at establishing universal insurance coverage. President Barack Obama and his colleagues in the House and Senate succeeded where many, many others failed, but just barely. The legislation, described as "similar in scope to Great Society and New Deal programs," was enacted "without the benefit of the congressional majorities of those eras" (Oberlander, 2010). For some health care advocates, the law was a disappointment, as it missed opportunity to establish a "public option" for health insurance, a publicly financed and operated program similar to Medicare to provide broad coverage. For others, the legislation constituted the transformation of the United States into a socialist state, somehow endangering America's "freedoms." The reality is that the new law keeps the predominant role of private insurance coverage and welds it to a new framework of rules, investments in improving the effectiveness and efficiency of care, and a strengthened public health sector to establish a more rational system. The law will have a significant impact oi:i counselors as both consumers and providers of health care services, and its enactment has implications for counselor advocacy.

Transformation of the US Healthcare System: Why is change so difficult?

2012 ◽  
Vol 60 (4) ◽  
pp. 415-426 ◽  
Author(s):  
Robert H Blank
Keyword(s):  
Healthcare System ◽  
Political Institutions ◽  
Insurance Industry ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Developed Countries ◽  
The United States ◽  
Economic Forces ◽  
The Us

The United States spends considerably more on medical care than any country in the world but is the only resource-rich country where a substantial portion of its residents lack health insurance coverage. Moreover, the US continues to rank low on most measures of health outcome compared to other developed countries. Therefore, there was considerable incredulity by those unfamiliar with the US as to why a revamping of this obviously broken system was not widely embraced by the American public when in 2009 a popularly elected president made healthcare reform his top priority. This commentary examines this phenomenon and discusses why a meaningful transformation of the US healthcare system has proven so elusive. Among the factors discussed here are political institutions and economic forces, a powerful medical establishment, the dominant private insurance industry, an extensive liability system and a public that is highly suspicious of any government involvement in healthcare.

scholarly journals COVID-19 Has Revealed America’s Broken Health Care System: What Can We Learn?

2021 ◽  
pp. 002073142098564
Author(s):  
John Geyman
Keyword(s):  
Public Health ◽  
Health Care ◽  
Insurance Industry ◽  
International Comparisons ◽  
Economic Downturn ◽  
Industrial Complex ◽  
For Profit ◽  
Urgent Task ◽  
Single Payer ◽  
Health Insurance Industry

The COVID-19 pandemic has exposed long-standing system problems of U. S. health care ranging from access barriers, uncontrolled prices and costs, unacceptable quality, widespread disparities and inequities, and marginalization of public health. All of these have been well documented by international comparisons. Our largely privatized market-based system and medical-industrial complex have been ill equipped to respond effectively to the pandemic. The accompanying economic downturn exacerbates these problems that further reveal the failures of our largely for-profit private health insurance industry, dependent as it is on continued government subsidies while it profiteers on the backs of vulnerable Americans. This article brings historical perspective to these problems, and provides markers of the extent of our unpreparedness and ineffective response to the pandemic. Coherent national health and public health policies are urgently needed based on evidence-based science, not political pressures. Financing reform is necessary, such as through single-payer Medicare for All. Eight takeaway lessons are summarized that can help to inform now best to rebuild U. S. health care and public health, an urgent task for the incoming Biden administration.

Fraud and Abuse: United States ex rel Merena v. SmithKline Beecham Corp.; United States ex rel Spear v. SmithKline Beecham Clinical Lab.; United States ex rel Grossenbacher v. SmithKline Beecham Clinical Lab.

2000 ◽  
Vol 28 (2) ◽  
pp. 191-193 ◽  
Author(s):  
Allyson Behm
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
Laboratory Tests ◽  
The United States ◽  
Care Providers ◽  
Individual Analysis ◽  
Court Of Appeals ◽  
The Third ◽  
The Government

The United States Court of Appeals for the Third Circuit held that when quitam relators file a multi-claim complaint under the Fraudulent Claims Act (FCA), their share of the proceeds must be based on an individual analysis of each claim. More importantly, the court held that relators are not entitled to any portion of the settlement of a specific claim if that claim was subject to dismissal under section 3730(e)(4) Relator Merena filed a quitam suit against his employer, SmithKline Beecham (SKB), claiming, among other things, that SKB defrauded the government by billing for laboratory tests that were not performed, paying illegal kickbacks to health care providers, and participating in an “automated chemistry” scheme. Soon thereafter, additional relators filed suit.

Insurance coverage and care affordability in cancer survivors in 2016-2019.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 1520-1520
Author(s):  
Justin Michael Barnes ◽  
Eric Adjei Boakye ◽  
Mario Schootman ◽  
Evan Michael Graboyes ◽  
Nosayaba Osazuwa-Peters
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
Low Socioeconomic Status ◽  
Private Insurance ◽  
Insurance Coverage ◽  
The United States ◽  
Mediating Effect ◽  
Medicaid Expansion ◽  
Poverty Level ◽  
Linear Probability

1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.

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