PHP 310 EXAM 1 Content !!!

According to the Mirror, Mirror, 2024 report, which two countries had the lowest health care spending as a share of GDP while also being top-ranked overall.

France and Canada

Australia and Netherlands

U.S. and U.K.

Germany and Sweden

Australia and Netherlands

According to Victor Fuch’s article on trends in US health care since 1950, which of the following is a feature of managed care?

• Fees and prices fo physician services are negotiated beforehand by insurance companies

• patients receive personal assistants to manage their health care services

• free medications

• special advertising privileges for pharmaceutical companies

fees and prices for physician services are negotiated beforehand by insurance companies

True or false: according to the mirror, mirror 2024 report, all countries in the study have achieved universal health coverage, including the US

FALSE

According to “Healthcare Costs are not a simple fix,“ eliminating administrative costs overhead and profit from private insurance would result in major healthcare cost savings. True or False?

False

According to Victor Fuch’s article on trends in the US health care since 1950, which is not one of the effects of increased specialization among physicians?

• Greater health expenditures

• increase in the number of years of required training

• better quality of health care

• restructuring of medical education

better quality health care

which of the following is not a trend discussed in Victor Fuch’s article on trends in US healthcare?

• increased number of women physicians

• decreased number of in-patient hospital stays

• decreased role of the federal government in health

• rising health expenditures

decreased role of the federal government in health

According to “How the national debt affects the U.S.— and you — in 10 charts,“ which programs are examples of mandatory spending?

• defense and homeland security

• social security, medicare, and medicaid

• education and transportation

• veterans affairs and student loans only

social security, medicare, and medicaid

True or False: According to the Mirror, Mirror 2024 report, the U.S. spends more than 16% of its GDP on health care, the highest among the 10 countries studied

True

According to “How the national debt affects the U.S. — and you — in 10 charts,“ what is the current size of the U.S. national debt?

• 26.2 trillion

• 30 trillion

• 36.2 trillion

• 40 trillion

36.2 trillion

According to the Mirror, Mirror 2024 report, which three countries ranked highest overall in health system performance?

• australia, netherlands, and United Kingdom

• canada, germany, and france

• sweden, switzerland, and new zealand

• united states, netherlands, and australia

australia, netherlands, and united kingdom

Which of the following is not a trend discussed in Victor Fuch’s article on trends in US healthcare?

• increased number of women physicians

• decreased number of in-patient hospital stays

• decreased role of the federal government in health

• rising health expenditures

Decreased role of the federal government in health

According to the Mirror, Mirror 2024 report, despite its overall poor performance, the US ranks highly in which domain?

• access to care

• administrative efficiency

• care process

• health outcomes

Care process

True or False: According to Victor Fuch’s article on trends in US health care since 1950, In patient hospital care has significantly increased since 1980, causing massive increases in health expenditures.

False

According to “How the national debt affects the U.S. — and you — in 10 charts,“ in fiscal year 2024, the federal government spend more on interest payments for debt service than on the Defense Department. True or False?

True

According to “Healthcare Costs Are not a Simple Fix,“ what portion of U.S. healthcare spending does private insurance account for?

• 20%

• 29%

• 50%

• 75%

29%

According to the Urban Institute article, true or false: death rates for white, middle-aged Americans are rising. True or False?

True

According to the Shit and Singh textbook reading, what is managed care?

• A system of health care delivery that integrates the four basic functional components of health care (financing, delivery, payment, and insurance)

• A type of insurance that seeks to reduce the amount of time physicians spend on patients

• A type of insurance that systematically inspects doctors for high-efficiency care

• A system of health care delivery that emphasizes alternative/holistic treatment options

A system of health care delivery that integrates the four basic functional components of health care (financing, delivery, payment, and insurance)

According to the Shi and Singh textbook reading, which of the following is not among the four basic functional components of the US health care delivery system?

• financing

• screening

• delivery

• payment

screening

According to the Shit and Singh textbook reading, what is the primary reason employers health insurance plans to provide benefits to their employees?

• to ensure their employees have access to the latest medical technology

• to attract and retain talented workers

• to protect their employees from financial catastrophe due to high medical costs

• to reduce the administrative burden of managing employee health benefits

• to protect their employees from financial catastrophe due to high medical costs

According to the Shi and Singh textbook reading, what is not one of the reasons why the US places great emphasis on medical specialization?

• the proliferation of specialty boards certifying physicians to practice certain types of medicine in the 1930s

• specialists are more cost-effective than primary care doctors

• specialists were automatically given a higher rank in the military during WWII

• Medical schools prefer to hire specialists over generalists

• specialists are more cost-effective than primary care doctors

According to the Ted Talk. “The Problem with Race-Based Medicine“, who is Samuel Cartwright, according to Dorothy Roberts?

• cardiologist who developed the first FDA approved race-specific medicine

• physician who developed the race-specific correction for GFR

• head of the human genome project who alluded to the idea that genetic difference between humans are not related to race

• physician who invented the spirometer to show the presumed deficit in lung capacity in african americans

physician who invented the spirometer to show the presumed deficit in lung capacity in african americans

Based on the Ted Talk by Dorothy Roberts, which of the following is FALSE about BiDil?

• it was marketed only to black patients for commercial reasons

• race was used as a proxy to account for an unknown genetic factor

• it did not gain FDA approval due to poor study design

• the clinical trial only included african-american participants

• more than one of the above

it did not gain FDA approval due to poor study design

According to the Shi and Singh textbook reading, which of the following is NOT a characteristic of the U.S. health care system compared to other countries?

• no central agency governs the system

• access to health care services is based on insurance coverage

• it operates under a free market system

• it provides universal health coverage for all citizens

it provides universal health coverage for all citizens

According to the Shi and Singh textbook reading, what is one of the weaknesses of a social justice perspective on health care?

• proponents of social justice are usually uneducated

• social justice encourages freeloading

• the social justice perspective does not address inequities in health care

• health care entitlement programs are extremely expensive

health care entitlement programs are extremely expensive

According to the Wilson & Clearly article, “Linking Clinical Variables with Health-Related Quality of Life”, which of these patient outcomes is easiest to measure according to the Health Related Quality of Life (HRQL) conceptual model?

• Functional status

• symptom status

• biological and physiological variables

• overall quality of life

biological and physiological variables

According to the Shi and Singh textbook reading, how do market justice and social justice differ in their views on health care?

• market justice views health care as an economic reward whereas social justice views health care as a right

• market justice views health care as an economic reward whereas social justice views health as an individual responsibility

• market justice views health care as a social resource whereas social justice views health care as a right

• market justice views health care as a social resource whereas social justice views health care as a way to ensure the common good

• market justice views health care as an economic reward whereas social justice views health care as a right

 According to the Shi and Singh textbook reading, how should health care be rationed from a market justice vs. social justice perspective?

•  According to social justice, everyone should have access to health care; according to market justice, only those who can afford health care should receive health care

•  According to social justice, only those who deserve health care should receive it; according to market justice, only those who can afford health care should receive health care

•  According to social justice, everyone should have access to health care; according to market justice, only those who have achieved a certain level of education should receive health care

•  According to social justice, only those who deserve health care should receive it, according to market justice, only those who have achieved a certain level of education should receive health care

 

According to social justice, everyone should have access to health care; according to market justice, only those who can afford health care should receive health care

According to the Shi and Singh textbook reading, what did the Hill-Burton Act of 1946 do?

• it created universal health care in the U.S.

• it provided federal funds to construct hospitals across the nation

• it outlawed surgery without anesthesia

• it funded the construction of nursing homes

 

It provided federal funds to construct hospitals across the nation

According to the Ted Talk, “The Problem with Race-Based Medicine,” Race-based medicine is:

• When physicians use race as a crude proxy for genetic factors

• Can perpetuate harmful stereotypes about patients of color

• Addresses both the biological and social factors that contribute to racial inequalities

• A and B

• B and C

A and B

According to “How Systemic Racism Works with Tricia Rose,” what key concept describes the powerful effects produced when interconnected policies reinforce one another beyond the impact of any single policy?

• structural racism

• systemic racism

• meta effects (metaracism)

• institutional racism

meta effects (metaracism)

According to the Urban institute, which of the following factors affects health?

• education level

• race

• income

• all of the above

all of the above

According to the Shi and Singh textbook reading, which is not one of the two main objectives of a healthcare delivery system?

• To enable all citizens to obtain health care services when needed

• To have cost-effective health care services that meet established standards of quality

• To compensate all doctors as much as possible for their services

 

To compensate all doctors as much as possible for their services

According to the Wilson & Clearly article, “Linking Clinical Variables with Health-Related Quality of Life”, what is Health-Related Quality of Life (HRQL)?

• Factors which affect one’s functionality in the workplace

• All economic, political, cultural, and spiritual factors that affect quality of life

• The aspects of quality of life that relate specifically to a person’s health

• All factors which affect function

• The aspects of quality of life that relate specifically to a person’s health

According to the Shi and Singh textbook reading, which of the following accurately describes the evolution of hospitals from 1890 to the present?

• Hospitals were used as housing for the poor and chronically ill; currently hospitals are used to house only those with short-term illnesses

• Hospitals were used as housing for the poor and chronically ill; currently hospitals are well-funded and have the latest treatment technology and specialized interventions to treat many different patients

• Only rich people could afford to use hospitals in the 1890s - now hospitals are accessible to everyone

• Hospital physicians were primarily volunteers in the 1890s – now hospitals only hire salaried physicians

Hospitals were used as housing for the poor and chronically ill; currently hospitals are well-funded and have the latest treatment technology and specialized interventions to treat many different patients

According to the Shi and Singh textbook reading, what is one of the weaknesses of the market justice perspective on health care?

• Market justice ensures that there are no free riders in the healthcare system

• Market justice perpetuates disparities by ensuring that poorer individuals have better access to healthcare than wealthier individuals

• Market justice does not ensure that individuals who are ill will have the care that they need if they cannot afford it, thus individual health issues can spread into the general society through the transmission of contagious diseases

• Proponents of market justice are usually uneducated

Market justice does not ensure that individuals who are ill will have the care that they need if they cannot afford it, thus individual health issues can spread into the general society through the transmission of contagious diseases

According to “How Systemic Racism Works with Tricia Rose,” which metaphor does Tricia Rose prefer for illustrating systemic racism because it highlights how institutions (like gears) interconnect and drive one another?

• a birdcage

• a web

• a series of gears

• a locked door

a series of gears

According to the Shi and Singh textbook reading, what are the four key determinants of health according to the Blum model?

• Environment, nutrition, medical care, heredity

• Environment, lifestyle, heredity, medical care

• Environment, social life, mental health, heredity

• Environment, mental health, level of education, income

Environment, lifestyle, heredity, medical care

According to the Shi and Singh textbook reading, why does cost containment remain an elusive goal in US health services delivery?

• Wide availability of cheap medical technology

• it is difficult to get doctors to cooperate with insurance companies

• general inflation

• the us healthcare system is fragmented and each player seeks to price services at a level that is beneficial to themselves rather than the whole system

the us healthcare system is fragmented and each player seeks to price services at a level that is beneficial to themselves rather than the whole system

According to “How Systemic Racism Works with Tricia Rose,” she argues that structural racism refers to isolated discriminatory actions and does not involve interconnected systems. True or false?

False

According to Atul Gawande’s “Is Health Care a Right?”, there are successful examples of free-market health care systems delivering universal coverage. True or false?

False

According to Chapter 2 of Shi & Singh, the Healthy People initiatives have consistently met their targets for reducing health disparities across the U.S. population.

False

According to Chapter 2 of Shi & Singh, which of the following is NOT listed as a reason for the increased prevalence of chronic conditions in the U.S. population?

• New diagnostic methods and medical procedures

• Increased government funding for chronic disease programs

• Lifestyle choices like poor diet and physical inactivity

• Improved survival rates and longevity

Increased government funding for chronic disease programs

According to Chapter 2 of Shi & Singh, which of the following is a major global health challenge discussed?

• malaria

• tuberculosis

• HIV/AIDS

• All of the above

All of the above

According to Chapter 2 of Shi & Singh, the Global Health Security Index found that no country was fully prepared to handle a global pandemic. True or False?

True

In the NYT article by Lipton and Sack, which lucrative drug did Amgen get a special exclusion for in the “fiscal cliff” bill?

• tylenol

• senispar

• enbrel

• nyquil

sensipar

Which is not one of the reforms Mackey suggests in his article The Whole Foods Alternative to Obama Care?

• Increase the salaries of generalists by 20%

• Repeal state laws preventing insurance companies from competing across state lines

• Make costs transparent so consumers understand what health care treatments cost

• Equalize the tax laws so that employer-provided health insurance and individually-owned health insurance have the same tax benefits

increase the salaries of generalists by 20%

In Krugman’s article, what is one major reason private insurance systems have higher administrative costs than single-payer systems?

• They spend resources on denying claims and avoiding sick patients

• They must pay doctors higher salaries

• They invest more in preventive medicine

• They provide broader benefits than public systems

They spend resources denying claims and avoiding sick patients

According to the Brooks article, why doesn’t health care function like other markets?

•  Health care costs are unpredictable

• Providers (health care deliverers) know much more about medicine than patients (consumers) do

• Payment comes after care, not before

• All of the above

All of the above

According to Chapter 2 of Shi & Singh, what is one major difference between Healthy People 2020 and previous Healthy People Initiatives?

• It places more emphasis on the social determinants of health

• It identifies health priorities for the nation

• It has the goal of improving the quality of life for Americans

• It seeks to involve community partners in health improvement initiatives such as businesses, churches, etc.

It places more emphasis on the social determinants of health

According to Paul Krugman’s article “Why markets can’t cure healthcare”, why can’t health care be sold like bread or TVs?

• Because patients can easily compare prices at different hospitals

• Because most health care is inexpensive and routine

• Because doctors do not want competition between hospitals

• Because health care involves unpredictable, extremely costly needs that require insurance

• Because health care involves unpredictable, extremely costly needs that require insurance

According to the Fuchs article on How and Why US Health Care Differs From That in Other OECD Countries, what is the most important reason why US health care is different from other OECD countries?

• Heterogeneity of the US population

• Distrust of the government in the US

• It is relatively easily for “special interests” to hijack the political system

• Medicare and Medicaid exist

• It is relatively easily for “special interests” to hijack the political system

According to Chapter 2 of Shi & Singh, the COVID-19 pandemic highlighted the United States' strong public health infrastructure and preparedness. True or False?

False

According to Atul Gawande’s “Is Health Care a Right?”, what distinction did James Madison make regarding the rights the government must protect?

• Natural rights vs. civil rights

• Political rights vs. economic rights

• Individual rights vs. collective rights

• Negative rights vs. positive rights

Negative rights vs. positive rights

According to Gawande, how do most Americans view the government’s role in health care, despite disagreements about policy?

• They generally expect government to ensure access to essential care

• They believe government should have no role at all

• They are deeply divided, with no shared expectations

• They only support emergency care as a government responsibility

they generally expect government to ensure access to essential care

What argument do opponents of treating health care as a right often make, according to Gawande?

• That health care costs too little to be considered a right

• That health care requires taking resources from some people to give to others

• That health care is unnecessary in modern society

• That health care is already guaranteed under the Constitution

That health care requires taking resources from some people to give to others

Which country is among the top performers for care delivery process?

United States

Americans have BLANK lives and have the most BLANK deaths

shortest, avoidable

OECD stands for?

Organization of Economic Cooperation and Development

What is the association between wealth and mortality in the United States and Europe?

• The gap in survival between the top and bottom wealth quartiles were wider in the United States than in Europe. Survival among the participants in teh top wealth quartiles in northern and western Europe and southern Europe appeared to be higher than that among the wealthiest Americans. Survival in the wealthiest U.S. quartile appeared to be similar to that in the poorest quartile in northern and western Europe.

The Big Beautiful Bill Act would make how many more people uninsured?

16 million people

What is national debt caused by?

the growing debt is caused by a structural mismatch between spending and revenues

Growth in spending on Medicare is projected to account for more than XYZ percent of the increase in spending on the major health care programs over the next 30 years?

90%

Health is something that is? Health care seeking occurs in a societal context and for many in the US that context is complex…it leads us to ask what XYZ had to do with asking for help, leading to delays

• Health is something that is experienced

• Race, gender

What is the WHO definition of health?

A complete state, of physical, mental, and social well-being, and not merely the absence of disease or infirmity

What are some biological and physiological variables?

• molecular and genetic factors

• function of cells, organs, and organ systems

• diagnoses such as HIV/AIDS, diabetes, lung cancer

• laboratory values such as temperature, white blood count, serum glucose level

• exam findings such as weakness on one side of the body, a skin rash, or a heart murmur

• mental diagnosis like panic disorder

Symptoms focus on the whole? What are some examples of physical and emotional symptoms? Biological variables and symptoms have a ? Symptoms drive? Symptoms are dependent and difficult sometimes because…?

• Focus on the whole organism

• Focus on whole organism 

• Physical symptoms such as pain or itching 

• Emotional or psychological symptoms such as frustration, anxiety, fear 

• Stimulation and hypochondriasis 

• Complicated relationship between biological variables and symptoms 

• Subjective; cultural competent; stigma (case)

• Symptoms drive care seeking and care costs

What is functional status?

Dimensions: physical, emotional, role, social

Complexity: motivation, other contexts

Case: hip pain case

Objective measurement possible

FDA now requires measures of functioning

What are general health perceptions?

• Integration of previous factors

• by definition subjective

• strong empirical predictors of

  • general medical and mental health utilization

  • mortality

What is overall quality of life?

• may not be related to health

• may be related to the economy, religious factors, employment factors, etc.

What did researchers find between income inequality and health?

• researchers found that life expectancy was lower in places with more income inequality. this map shows their measure of inequality for every county in the United States

What is the Whitehall study? Who was the PI? What are the two studies?

• PI = Michael Marmot

• First Whitehall study (1967)

  • 18,000 Men

  • British civil service

  • Mortality related to civil service grade

• Second Whitehall study (1985)

  • civil servants between 35 and 55 years old

  • 2/3 men, 1/3 women

  • still underway

What percentage of health is attributable to medical care?

The best estimates are that about 10% of health is attributable to medical care

What are some determinants of health?

• behaviors

• social circumstances

• environment

• genetics

• medical care

• stress

What are the 9 areas of disadvantage for the US?

1. adverse birth outcomes

2. injuries and homicide

3. adolescent pregnancy and sexually transmitted infections

4. HIV and AIDS

5. Drug related mortality

6. obesity and diabetes

7. heart disease

8. chronic lung disease

9. disability

What do the roberts and rose videos about and assert?

• assertion: you can’t understand health and health care in the US without understanding history

• health and health care disparities will be part of everything that we do in this course

what is a major factor that contributes to health other than health care?

history

there is a widespread agreement and excellent data supporting the assertion that social factors are stronger determinants of health than….XYZ

medical care

Compared to other countries, the US has greater BLANK and worse BLANK

great health risks, and worse health outcomes

virtually every measure of BLANK AND BLANK is strongly associated with health

social or economic status

What is the sensipar case? What are the themes form the Sensipar case?

• sensipar = combats bone disease

  • excluded from bundling in 2010

  • now again in 2013

• inserted into 2013 “fiscal” cliff legislation by Senate finance committee

  • Max Baucus (Democrat, Montana)

  • Orrin Hatch (Republican, Utah)

• increases medicare costs (500M)

• lobbying by interest groups: 74 Amgen lobbyists

• campaign financing

• bipartisan

Themes from sensipar case

• science and drug development

• payment mechanisms:FFS and bundling

• Role of interest groups, $ and lobbying

• politics and health care

• every dollar cut = a dollar of income lost for someone

What are some is the erythropoietin story and the relevance it has to bundling?

• Erythorpoietin story: anemia drug 

  • Fee-for-service payment mechanism 

  • Some is good, too much is harmful 

  • Bundling effectively reversed overuse (bundling, textbook)

What are some beliefs and values that deal with the US healthcare system?

• US is a large and divided nation

• markets and health care

• important history

• fragmented politics and interest groups

The US in size and diversity

• US is geographically large and very diverse

• Diverse is almost every dimension

Market justice and social justice characteristics

Market justice characteristics

• views health care as an economic good

• assumes free-market conditions for health services delivery

• assumes that markets are more efficient in allocating health resources equitably

• production and distribution of health care determine by market-based demand

• access to medical care viewed as an economic reward of personal effort and achievement

Social justice

• views health care as a social resource

• requires active government involvement in health services delivery

• assumes that the government is more efficient in allocating health resources equitably

• medical resource allocation determined by central planning

• ability to pay is inconsequential for receiving medical care

• equal access to medical services viewed as a basic right

What are implications of market justice and social justice?

Market justice

• individual responsibility for health

• benefits based on individual purchasing power

• limited obligation to the collective good

• emphasis on individual well-being

• private solutions to social problems

• rationing based on ability to pay

social justice

• collective responsibility for health

• everyone is entitled to a basic package of benefits

• strong obligation to the collective good

• community well-being supersedes that of the individual

• public solutions to social problems

• planned rationing of health care

what is it really meant for market justice and what is it really meant for social justice?

• market justice: what is really meant is market EFFICIENCY

• social justice: another word for this might be FAIRNESS

• natural tension between efficiency and fairness, but most of us value both of them

Markets don’t work well in healthcare because….according to teh krugman article which is a summary of the arrow article

• you can’t know (in general) if or when you will need care, and when you do it is very expensive

• therefore, you need insurance, but insurance companies make money by NOT paying for health care, so their interests may not be aligned with yours (principal-agent problem)*

• the gamesmanship of trying to cover people who won’t need care, and denying claims is expensive

markets don’t work well in healthcare because

• health care is complicated and you can’t comparison shop or rely on your experience

• even doctors have conflicts of interest because they can get paid for “selling you services that may not help, or may hurt, and that you may not have the knowledge to refuse (again, the principal-agent problem)“

Makey article suggests that markets would work IF ….

• remove the legal obstacles that slow the creation of high deductible health insurance plans and health savings accounts (HSAs)

• equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits

• repeal all state laws which prevent insurance companies from competing across state lines

• repeal government mandates regarding what insurance companies must cover

what was mackey article summaru?

move “towards less government control and more individual empowerment“

what are some market failure examples?

• theory of externalities

  • water pollution

  • movie erin brockovich (CA power plant)

  • carbon taxes (create market for an externality)

• orphan drugs: no company will ever develop drugs with small markets if there is no chance of recovering their investment

• drug safety: why we have the FDA

• public defense: police departments, army/navy, etc.

what are regulatory failure examples?

• markets are imperfect…but so is the alternative: governments and regulation

• extreme case: central planning in the former USSR

  • built sputnik and ICBMs

  • but, shortages of consumer goods and food

  • no contraceptives (2 abortions/live birth)

• the post office, RI registry of motor vehicles

• “…a government staffed by angels could undoubtedly do a better job than markets run by humans“

• but…a few governments are staffed by angels

• US tends to favor market-based solutions, but all countries rely on a combination of market and government solutions in health care

what are the take home messages related to markets in healthcare?

• Americans, generally, have faith in markets

• Try not to think about markets in moral/ethical terms; don’t ask about if they work, think about when they work, and why or why not

• Try not to think about government regulation in moral/ethical terms; think about when regulation is necessary, and how it can be done smartly

• Real issue is how to intelligently combine market and government approaches, which is virtually all countries must do

• Aside: many important problems defy either market or governmental solutions because they are global in nature

• Air pollution

• Acid rain

• Climate change

• Ebola, zika virus, covid-19, etc.

what are some examples of private insurance?

• blue cross - coveres hospital care

• blue shield - covers physician services

• employer based private insurance

• The AMA and Medicare/Medicaid

what are blue cross hospitals? what is the history behind blue cross hospitals?

• in 1929 Baylor University Hospital has an arrangement with dallas school teachers where they provide 21 days of hospital care fo $6 per year

• prepayment idea spread during the Great Depression because of low occupancy rates

• Next: plans sponsored by groups of hospitals

• American Hospital Association (founded 1898) supported and the coordinated these groups

• plans united into blue cross network

• by 1946, 43 blue cross plans with 20M enrollees

what is the history of the blue shield (physicians)?

• Great depression reduced patients’ ability to pay MD fees out of pocket

• in 1939 the california medical association set up first blue shield plan to cover MD expenses

• idea spread nationwide

• controlled by state medical societies

• starting in 1974 blue cross and blue shield (BCBS) plans began to merge

BCBS is provider driven — where as health insurance is … driven?

• health insurance in europe consumer driven

• in the US, provider driven

• thesis: control of this major source of insurance guaranteed that payments would remain high, and that cost control would have a less important role

what is the history behind employer based private insurance?

• WWII price and wage controls (National War Labor Board), 1942

• competition for workers on the basis of fringe benefits (health insurance)

• post-war unions continued this strategy, negotiating for health benefits as part of compensation strategies

• enrollment in group insurance plans grew from 12M (1940) to 142 M (1988)

what is the history behind tax subsidy for health insurance?

• National War Labor Board ruled in 1943 that employer and employee contributions to insurance did not count as wages, and that workers’ health benefits were not taxable 

• IRS issued tax exclusion ruling in 1954 

• “Tax Expenditure”: This an enormous public subsidy of private, employer-based insurance; estimated currently at over $348 B in 2023 

• Regressive: Bigger benefit to individuals in higher tax brackets

what is the history behind the american medical association (AMA) and medicare/medicaid?

• in 1920 stated its opposition “to the institution of any plan embodying the system of compulsory [medical] insurance…controlled or regulated by any state or the federal government“

• social security act (1935) contained a single sentence about studying health insurance … which because of an AMA letter writing campaign had to be dropped for fear that it would endanger the entire bill

• 1948 Truman health insurance program

  • AMA said that supporters of the plan included “all who seriously believe in a socialistic state. every left-wing organization in American…[and] the Communist Party“

  • Pushed voluntary (not compulsory) insurance as the “American way“

• 1958 House Ways and Means Committee consideration of Medicare

AMA response

• unwarranted intrusion of the government into medical practicce

• “the aged as a group are substantially better off on average than younger Americans“

• Warning in teh midst of the cold war that health insurance for the aged was the first step to national socialism

• Medicare/Medicaid did finally pass in 1965

• Physician are professional who have social contract with patients

• BUT, the AMA in the US also behaves as an interest group with its own agenda

• Long history as. avery powerful player health care politics even though only ~25% of physicians are members