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8. Health Care Policy

Study

The focus of Chapter 8 is health care policy, with an emphasis on rising costs and the role that government and citizens can play in reducing expenses while still improving the health of Americans. The text surveys the major government institutions that deal with health care, both historically and currently and indicates the most useful information sources about health care policy. A brief account of the evolution of U.S. health care policy helps explain the unique approach to the issue in the United States, especially the dominant role played by private health insurance companies (through employer-provided health care benefits), and the challenges facing citizens who have no health insurance. The chapter then illustrates the variety of government institutions and programs in the health care arena, giving special attention to the provisions, costs, and criticisms of Medicare, Medicaid, and the veterans health care system and the reforms commonly suggested for each. It also covers other health care issues, such as portability of insurance when individuals change jobs, patients’ rights, the strengths and limitations of health maintenance organizations (HMOs), the quality of U.S. health care, questions of equity in the provision of health care services, and the central role of lifestyle choices and wellness activities in both improving public health and holding down health care costs. The focused discussion deals with the issue of whether there should be a greater emphasis on preventive health care, such as reducing the levels of obesity and cigarette smoking in the United States.