Ensuring America's Health

Abstract

Ensuring America's Health explains why the US health care system offers world-class medical services to some patients but is also exceedingly costly with fragmented care, poor distribution, and increasingly bureaucratized processes. Based on exhaustive historical research, this work traces how public and private power merged to favor a distinctive economic model that places insurance companies at the center of the system, where they both finance and oversee medical care. Although the insurance company model was created during the 1930s, it continues to drive health care cost and quality problems today. This wide-ranging work not only evaluates the overarching political and economic framework of the medical system but also provides rich narrative detail, examining the political dramas, corporate maneuverings, and forceful personalities that created American health care as we know it. This book breaks new ground in the fields of health care history, organizational studies, and American political economy.

Business Interests and the Shape of the U.S. Welfare State: From the Insurance Company Model to Comprehensive Reform

“…Insurers eyed the AMA's health insurance model warily; understandably, they were apprehensive about funding services for which they could not control or regulate the supply. 11 They, nevertheless, hesitantly entered the field of medical insurance to satisfy business client requests for employee-group coverage and to shield health care from government reform. Physicians and insurers allied to deploy an explicit strategyone that they continually discussed in meetings, conferences, and publications-to quickly grow insurance coverage in order to prove that federal intervention in medicine was unwarranted.…”

“…Thus, the very process of constructing the health care market around the insurance company model was done with political objectives in mind. 12 To understand the significance of the insurance company model, consider alternative designs. Around the turn of the twentieth century, as germ theory breakthroughs propelled medicine into modernity, Americans sought ways to finance increasingly effective and, therefore, valuable medical care.…”

“…Nor had the objective of covering the elderly proven attainable: Even though insurance companies combined their resources to provide seniors with bare-bones hospitalization policies, they still lost money on the programs. 28 How the insurance company model developed in reaction to rising costs created a dynamic between insurers and physicians that would gradually weaken their political partnership. Starting in the 1950s, physicians and insurers began constructing overlapping institutions that, over time, evolved to create a pseudocorporate structure.…”

The Politics of Corporate Social Responsibility in American Health Care and Home Loans

“…Edward S. Mason (Cambridge, Mass., 1959 their medical licenses pulled. 40 Thus, for-profit or commercial insurers hesitantly entered medical underwriting believing that failure to support health care would leave it vulnerable to nationalization. Insurers also wished to assuage business clients who had repeatedly requested health insurance to supplement the life insurance and pension products they already bought as a means of providing employee fringe benefits and discouraging union organizing.…”

“…Union leaders advanced this liberalization by negotiating for generous policy benefits, thereby raising the expectations of all consumers. 59 When Medicare debates gained momentum with the 1957 Forand bill, insurers obtained state enabling legislation that permitted their companies to bypass antitrust laws so that they could pool resources and share administration costs in order to cover the elderly. Between 1958 and 1961, insurers doubled the number of aged citizens with medical policies; almost three-fifths of seniors owned some form of coverage.…”