US Health Care Reform after the Defeat of President Clinton's Proposed National Health Insurance in 1994

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  • Noguchi Haruko
    Stanford Institute for Economic Policy Research National Bureau of Economic Research

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  • 米国のヘルスケアリフォーム: その後
  • ベイコク ノ ヘルスケアリフォーム ソノゴ

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Abstract

In 1994, the Congress rejected President Clinton's proposal for health care reform that advocated the introduction of universal insurance system into the US. One of the most important reasons why the US has not had national health insurance is that the goals of politically powerful interest groups are almost always conflicting with each other. On the other hand, in the private sector, managed care plans had been broadly credited with reducing increases in health care costs since 1993 and the first nation-wide efforts to develop moderate measurements of the quality of care had been made.<BR>With the enactment of the Balanced Budget Act (BBA) of 1997, Congress and the Clinton administration approved more aggressi ve adoption of these successful methods elaborated in private markets to public health insurance systems such as Medicare and Medicaid, rather than governmentdominated health care reform. The new Medicare + Choice program was intended to expand the choices among private health plans beyond traditional Medicare feeforservice program and Medicare HMOs that beneficiaries may choose. Further, the BBA's elimination, of the waiver requirement enabled states to make managed care mandatory among Medicaid beneficiaries. In terms of adopting managed care plans to Medicaid, state governments pursue ensuring the accessibility to health care among beneficiaries, making Medicaid more efficient, and controlling rapidly increased Medicaid expenditure. While the heal t h care reform by the US government adopted market solutions to the public sector, the goal of accomplishing national health insurance system have largely faded from public view. Since the American society does not prefer the intervention of“big government”to markets of any goods, in general, it is unlikely for an average American to abandon the market model for medical care and accept a single-payer system with universal coverage, in the short or middle-run. Therefore, the current goals of government should be to develop more effective riskadjustment systems for allocation efficiency; to improve systems for measuring the quality of care for production efficiency; and to provide special protections for marginal people, like poor, elderly, and chronically ill enrollees, who are not qualified to any public health insurance and so who have to pay high cost for purchasing managed-care plans.

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  • Iryo To Shakai

    Iryo To Shakai 9 (3), 15-32, 1999

    The Health Care Science Institute

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