America's Hidden Health Care State

项目总结/文摘:

Project Summary/Abstract: America's Hidden Health Care State presents a simple argument with enormous implications. It addresses four important questions: (1) Why is the U.S. health care system repeatedly described as predominately private when public funds have long paid for a higher proportion of national health expenditures than have private insurance funds? (2) Why is hospital ownership repeatedly described as private when the majority of hospitals are not-for-profit and receive substantial government subsides --for over a century-- in the form of tax exemptions, but also –and more importantly—in the form of direct public reimbursement for treatment and public grants for capital investments and development? (3) Why are public health expenditures in the U.S. repeatedly described as a meager 3% of total health expenditures when their reach is (and has been for a long time) much more substantial than this figure suggests? What are the consequences of hiding the true extent of public investment in the US health care system? Although the U.S. health care system is often described as exceptional and rooted in classic American liberal ideology, in reality the state has invested quite substantially in public health prevention services, the building of hospitals and clinics, and in reimbursing health care providers for services rendered. Despite this reality, a unique ideology of American “inverted liberalism” allows the state to invest heavily in the health care system and still call it predominately private. As a result, the role of the state is largely hidden and stakeholders successfully present the illusion of minimal government. The consequences of this illusion are crucially important: because the state's is hidden, the distributional effects are highly unequal, and accountability for such inequities is extremely difficult to locate. The timeline of the book largely covers developments in the 20th century. Chapter one begins by detailing the development of local and state boards of public health just before the turn of the 19th Century and the book concludes by showing the relevance of the argument to understanding what is behind current—and likely ongoing—debates about health care reform and the role of government across the American states.