Health Care at Risk: A Critique of the Consumer-Driven Movement - Softcover

Jost, Timothy

Softcover

ISBN 10: 0822341247 ISBN 13: 9780822341246

Verlag: Duke University Press, 2007

Inhaltsangabe

In Health Care at Risk

Timothy Stoltzfus Jost, a leading expert in health law, weighs in on consumer-driven health care (CDHC), which many policymakers and analysts are promoting as the answer to the severe access, cost, and quality problems afflicting the American health care system. The idea behind CDHC is simple: consumers should be encouraged to save for medical care with health savings accounts, rely on these accounts to cover routine medical expenses, and turn to insurance only to cover catastrophic medical events. Advocates of consumer-driven health care believe that if consumers are spending their own money on medical care, they will purchase only services with real value to them. Jost contends that supporters of CDHC rely on oversimplified ideas about health care, health care systems, economics, and human nature.

In this concise, straightforward analysis, Jost challenges the historical and theoretical assumptions on which the consumer-driven health care movement is based and reexamines the empirical evidence that it claims as support. He traces the histories of both private health insurance in the United States and the CDHC movement. The idea animating the drive for consumer-driven health care is that the fundamental problem with the American health care system is what economists call “moral hazard,” the risk that consumers overuse services for which they do not bear the cost. Jost reveals moral hazard as an inadequate explanation of the complex problems plaguing the American health care system, and he points to troubling legal and ethical issues raised by CDHC. He describes how other countries have achieved universal access to high-quality health care at lower cost, without relying extensively on cost sharing, and he concludes with a proposal for how the United States might do the same, incorporating aspects of CDHC while recognizing its limitations.

Über diesen Titel

Über die Autorin bzw. den Autor

Timothy Stoltzfus Jost is the Robert L. Willett Family Professor of Law at the Washington and Lee University School of Law. He is the author of Health Care Coverage Determinations: An International Comparative Study and Disentitlement? The Threats Facing Our Public Health-Care Programs and a Rights-Based Response. He is the editor of Readings in Comparative Health Law and Bioethics and a coauthor of Health Law: Cases, Materials, and Problems, now in its fifth edition.

Von der hinteren Coverseite

"A well-timed, compelling study, written for experts but also, thankfully, understandable by 'consumers.' Timothy Stoltzfus Jost shows why leaving health care decisions to a free market cannot work, even in the United States, while also emphasizing the importance of consumer choice in future policy decisions. Erudite, clearly argued, engaging, and fair."--Rosemary A. Stevens, author of "The Public-Private Health Care State "

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HEALTH CARE AT RISK

A CRITIQUE OF THE CONSUMER-DRIVEN MOVEMENTBy TIMOTHY STOLTZFUS JOST

Duke University Press

Copyright © 2007 Duke University Press
All right reserved.
ISBN: 978-0-8223-4124-6

Contents

Preface........................................................................................................ix1 Our Broken American Health Care System.......................................................................12 The Consumer-Driven Prescription.............................................................................173 Consumer-Driven Health Care Advocates: Who They Are and What They Believe....................................274 Consumer-Driven Health Care the First Time Around............................................................425 The Nonaccidental System.....................................................................................546 The Origins of Consumer-Driven Health Care: A Short History of American Health Economics.....................707 The Theoretical Foundations of Consumer-Driven Health Care...................................................868 But Does It Work? The Evidence for and against Consumer-Driven Health Care...................................1199 Legal, Ethical, and Regulatory Issues Presented by Consumer-Driven Health Care...............................15010 Are Consumers Our Only Hope? How Other Countries Organize Their Health Care Systems.........................16611 How to Fix Our Broken Health Care System: Where Do We Start?................................................189Notes..........................................................................................................205Bibliography...................................................................................................225Index..........................................................................................................253

Chapter One

Our Broken American Health Care System

Criteria to Judge a Health Care System

The consumer-driven movement has been able to gain purchase as a policy initiative because of a widespread consensus that our health care system is in desperate straits and in need of a radical change. This chapter examines the problems plaguing our health care system to which the consumer-driven movement offers a solution. Chapter 2 lays out the consumer-driven solution, and later chapters examine the appropriateness of that solution to our problems. I will revisit the problems examined here in chapter 10, which compares the performance of the American health care system with the systems of other countries. When placed in a comparative light, the performance of the American system is even more distressing. Recognizing that there will be some overlap between these chapters, I begin by considering our own system in isolation.

Most health care policy experts identify three touchstones by which the health care systems of countries should be evaluated: access, cost, and quality (European Economic and Social Committee 2004). First, do all those within the system have access to health care when they need it? Second, is health care available at reasonable cost given the resources of a nation, and are increases in the cost of health care from year to year kept to reasonable levels? Third, is the health care of acceptable quality? Does it achieve the best possible outcomes, and are avoidable errors kept to a minimum?

Judged by each of these standards, the health care system of the United States fails dramatically. First, by one recent count nearly forty-seven million Americans lack health insurance, and the number is growing (DeNavas-Walt, Proctor, and Lee 2006, 20). Of course not all of the uninsured lack access to all necessary health care, but many face severe access limitations. Even many who do have insurance still experience serious difficulties in affording needed health care products and services. Second, the cost of our health care system is now approaching $2 trillion, or 16 percent of our gross domestic product, and is growing at unsustainable rates (Catlin, Cowan, Heffler, Washington, and National Health Accounts Team 2007, 143). Finally, the quality of American health care is seriously deficient. One example is the conclusion by the Institute of Medicine that from 44,000 to 98,000 Americans die every year from medical errors (Institute of Medicine 2001b, 1). In sum, the American health care system is in trouble.

There are other criteria by which a health care system can be judged. One of these, given particular emphasis by CDHC advocates, is freedom of choice. Another criterion might be whether patients are treated with respect; whether, for example, they are allowed to make decisions with respect to their own health care and whether their medical information is kept private. Yet another criterion is whether the system encourages innovative research regarding medical problems, their causes and cures, and whether it stimulates the creation of new medical products and procedures. Judged by some of these criteria the American health care system does reasonably well; judged by others, it scores rather poorly.

This chapter examines the performance of the American health care system with respect to each of these criteria, focusing first on the central concerns of access, cost, and quality. Readers already familiar with the problems of the American health care system may wish to skip this chapter. But because CDHC advocates minimize the seriousness of the problem of access to health care, which they do not convincingly address, and because they only partially address other problems that plague the American health care system, it is necessary to fully explore the seriousness of these problems before moving on to the CDHC prescriptions.

Access: The Forty-six Million Uninsured

In 2005, according to estimates by the Census Bureau, 46.6 million Americans lacked health insurance at some point (DeNavas-Walt, Proctor, and Lee 2006, 20). This number has grown significantly over the past half-decade, as employer-sponsored coverage has declined dramatically and public coverage has not expanded quickly enough to fill the void (Holahan and Cook 2005, W5-499-W5-502). The number of the uninsured is likely to grow to 56 million by 2013 (Gilmer and Kronick 2005, W5-148). This is the most serious problem facing the American health care system, and a problem that CDHC largely ignores.

To get an accurate perspective on the problem of health insurance in the United States, however, one needs a movie, not a snapshot. If one examines the phenomenon of un-insurance over time, one sees that many more people-almost 82 million, or one-third of all non-elderly Americans-were uninsured at some point during 2002 and 2003 (Families USA 2004, 3). One also sees a very dynamic picture-people moving from private to public insurance, from public to private insurance, or among private insurers; people lacking insurance for long periods, perhaps the entire two years; and people uninsured for a single short period, or for repeated short periods (Short and Graefe 2003, 247-49). Most of those uninsured at any one time have been uninsured for a year or more (over 80 percent according to one survey), and many of those currently insured were uninsured during the previous year-sixteen million according to one survey (Collins, Davis, Doty, Kriss, and Holmgren 2006, 4-5).

Although health policy discussions commonly draw a bright line between the insured and the uninsured, the ultimate issue is access to health care, not insurance....

Details zur Ausgabe

• Verlag: Duke University Press
• Erscheinungsdatum: 2007
• Sprache: Englisch
• ISBN 10: 0822341247
• ISBN 13: 9780822341246
• Einband: Taschenbuch
• Anzahl der Seiten: 284
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: preigu; mail@preigu.de; ; Lengericher Landstr. 19; Osnabrück; 49078; Deutschland