Paying for Medicare: Benefits, Budgets, and Wilbur Mills's Policy Legacy
Paying for Medicare: Benefits, Budgets, and Wilbur Mills's Policy Legacy
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支付医疗保险：福利、预算和威尔伯米尔斯的政策遗产
DOI：
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发表时间：
2001
影响因子：
4.2
通讯作者：
J. Zelizer
中科院分区：
文献类型：
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作者：
E. Patashnik;J. Zelizer
医疗保险的融资设计异常复杂。医院保险信托基金支付 Medicare A 部分（住院）的费用，而补充医疗保险信托基金则为 B 部分（看医生、门诊护理和某些家庭健康服务）提供资金。在医疗保险政策引发争论之际，本文对该计划独特的分歧结构的起源和后果进行了新的分析。本文针对美国福利国家历史学家以及当代医疗政策改革者，重点讨论了传奇人物筹款委员会主席威尔伯·米尔斯 (Wilbur Mills) 在 1965 年医疗保险颁布过程中所发挥的关键作用。本文的中心主题是，财政保守主义和对预算限制的承诺构成了医疗保险最初政治理解的重要元素。与认为医疗保险的融资设计产生了“反常”效应的分析人士相反，我们认为，它通过鼓励政策制定者定期面对规模最大、增长最快的联邦计划之一的成本，发挥了宝贵的社会功能。可以说，医疗保险最初的部门需要修改，以整合过去几十年的医疗保健提供变化。然而，至关重要的是，改革者不要忽视政策目标，包括财政诚信，正是这些目标首先推动了医疗保险分叉结构的采用。
Medicare features an unusually complex financing design. The Hospital Insurance Trust Fund pays for Part A of Medicare (hospital stays), while the Supplementary Medical Insurance Trust Fund finances Part B (doctor visits, outpatient care, and certain home health services). At a time when Medicare policy is generating debate, this article takes a new analytical look at the origins and consequences of the program's peculiar bifurcated structure. Addressing historians of the U.S. welfare state as well as contemporary health policy reformers, the article focuses on the crucial role of legendary Ways and Means Committee chair Wilbur Mills in Medicare's enactment in 1965. The central theme of the article is that fiscal conservatism and a commitment to budgetary restraint constitute important elements of Medicare's original political understanding. Contrary to analysts who argue that Medicare's financing design has produced "perverse" effects, we argue that it has served a valuable social function by encouraging policy makers to confront periodically the costs of one of the largest and fastest-growing federal programs. An argument can be made that Medicare's original division requires modification in order to integrate health care delivery changes of the past few decades. It is crucial, however, for reformers not to lose sight of the policy goals, including fiscal rectitude, that motivated the adoption of Medicare's bifurcated structure in the first place.