Chapter Thirty-Two: The For-Profit Insurance Companies Take Over
The American Medical Association https://www.referenceforbusiness.com/history2/76/American-Medical-Association.html
Is health care a commodity?
https://www.theberylinstitute.org/blogpost/947424/215160/Thoughts-from-a-Commodity
https://www.enttoday.org/article/health-care-as-a-commodity-competition-should-be-focus-of-health-reform-lecturer-says/ https://journals.lww.com/annalsplasticsurgery/Citation/2009/01000/Is_Health_Care_a_Commodity_.1.aspx
The British NHS
https://www.historic-uk.com/HistoryUK/HistoryofBritain/Birth-of-the-NHS/
https://www.newyorker.com/magazine/2009/01/26/getting-there-from-here
French health care
https://www.french-property.com/guides/france/public-services/health/system-overview
https://healthmanagement.org/c/it/issuearticle/overview-of-the-french-healthcare-system
Universal health care was almost part of the original Social Security Act of 1935
https://timeline.com/social-security-universal-health-care-efe875bbda93
khruschev meets castro
Medicae and hospitals are integrated “The Power to Heal: Civil Rights, Medicare, and the Struggle to transform America’s Health Care System” by David Barton Smith, Vanderbilt University Press, 2016
An American Sickness by Elizabeth Rosenthal. Penguin Press. 2017.
https://www.newyorker.com/magazine/2009/01/26/getting-there-from-here
Did Blue Cross’ Mission Stray When Plans Became For-Profit?
https://www.npr.org/templates/story/story.php?storyId=124807720
Deadly Spin, book by Wendell Potter, Bloomsbury Press, 2010
https://www.managedcaremag.com/archives/1996/6/what-profit-trend-health-care-really-means ——Managed Care Magazine June 1996: “In June 1994, a little-known event occurred behind closed doors in Washington, D.C., that opened the path for any of the 63 Blues plans to switch. The Blue Cross and Blue Shield Association’s board of directors gathered to discuss, among other things, changing the association’s bylaws to allow its affiliates to operate as for-profit companies. It wasn’t the first time the board discussed the hotly-debated issue, but this time the measure had enough supporters to enact the proposed reform by a narrow margin. Until then, the board only allowed its plans to operate for-profit subsidiaries, while the parent company using the Blue Cross and Blue Shield name had to remain nonprofit.”…”Whatever its implications for that “social value,” the market — employers, government and patients themselves — is clearly calling the shots in health care today. In most places, it seems to be saying that for-profit plans are the wave of the future.”
How the cost of care affects treatment
https://www.gsb.stanford.edu/insights/kate-bundorf-what-really-drives-medical-treatment-decisions
https://www.congress.gov/bill/103rd-congress/house-bill/3600/text
‘Hillary’ on Hulu
The Hillary Clinton Health care proposal (abridged.) The health plans they proposed had to cover: hospital services; health professionals; emergency and ambulatory medical and surgical services; clinical preventive services; mental illness and substance abuse services; family planning and services for pregnant women; hospice and home health care. extended care and ambulance services outpatient laboratory, radiology, and diagnostic services; outpatient prescription drugs and biological; outpatient rehabilitation services durable medical equipment; prosthetic and orthotic devices; vision care; dental care; health education classes; investigational treatments;
The items and services provided could not be subject to any duration, scope limitation, deductible, copayment, or coinsurance.
The legislative proposal included a “low” cost sharing schedule: no deductibles; An annual individual out-of-pocket limit on cost sharing of $1500; and (B) an annual family out-of-pocket limit on cost sharing of $3000;
High cost packages which (with a few exceptions) had an annual individual general deductible of $200 and an annual family general deductible of $400.
Individuals had to pay for the first day of care for each episode of inpatient and residential mental illness and substance abuse, and for each episode of intensive nonresidential mental illness and substance abuse treatment. And patients were responsible for the first $250 for outpatient prescription drugs and biological. Then the plan provided benefits.
To keep costs from going through the roof there was a regional target. If the projected cost of care was exceeded there were: automatic, mandatory, nondiscretionary reductions in payments to health care providers.
For out of network emergency and urgent care, individuals had to pay “a percentage of fee set by the alliance.
The items and services provided could not be subject to any duration, scope limitation, deductible, copayment, or coinsurance.
The legislative proposal included a “low” cost sharing schedule: no deductibles; An annual individual out-of-pocket limit on cost sharing of $1500; and (B) an annual family out-of-pocket limit on cost sharing of $3000;
Balanced billing was prohibited: A provider was not allowed to charge or collect money in excess of the fee schedule. And they couldn’t directly bill the patient.
They also recommended caps on health insurance premiums. Companies who wanted to charge more would now have to come before a commission and explain where the money was going and why it was needed.
Chapter Thirty-Three: Obamacare—the Affordable Care Act
Frontline TV
OBAMA’S ORGANIZING YEARS https://www.nytimes.com/2008/07/07/us/politics/07community.html
McCain’s deciding vote on the Affordable Care Act
https://www.pbs.org/video/thumbs-down-6wiayp/
In 2014, as part of the Affordable Care Act, members of congress and their staff members lost the ability to purchase insurance through the FEHB. So they established a new way to buy highly subsidized care. They are using the DC health care exchange, and the government still
kicks in 72% of the cost of the premium—for those who chose a gold plan. https://www.npr.org/sections/health-shots/2017/04/12/523335954/what-happens-to-a-congressmans-health-insurance-if-obamacare-goes-down
Why some dislike Obamacare