Biomedical subjects
G A Silver
Publications and source records attributed to G A Silver.
Cost containment: medical system rehabilitation or reform.
Cost containment is considered the premier goal for improvement of the medical care system. Before any other steps can be taken to improve availability, accessibility, or quality, or before introduction of any governmental programs for the removal of economic obstacles to obtaining medical care,--in other words, before any effort to make the medical care system more equitable--the rapid hyperinflation of medical care costs must be arrested. It is argued here that the defects of the system as currently operating are such that no cost control effort can be effective without radical change and reorganization of the system itself: methods of practice, methods of reimbursing providers, and methods of assuring accountability and supervision. And it is further argued, that if only cost control measures are instituted, not only will inflation not be stemmed, but it will be further aggravated and at the same time, the poor and minorities now suffering the consequences of an inadequate, ineffective, and unresponsive medical care system will be further deprived.
Specialization and its implications.
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George Rosen: a life in public health.
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Report of the APHA Task Force on Chile.
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Medical politics, health policy. Party health platforms, promise and performance.
Health policy in the United States is a product of medical politics. "Medical politics" includes not only traditional patterns of interest group pressures but traditional political party philosophies and patient expectations as well. Characteristic Republican politics reflects narrower governmental spending and greater emphasis on support of entrepreneurial effort. Desired effects will "trickle down" to the needy. Democratic politics tend to follow a more generous spending line, not neglecting the entrepreneurs, but spreading some of the funds around to the needy themselves. In addition, Republicans tend to distrust salaried officials, placing governmental power (through government funds) into the hands of private agencies or companies. Democrats hesitate less to build bureaucratic structures. On the record, both parties follow roughly similar lines in spite of these philosophic differences, which turn out to be differences in style. Both parties have practiced restraint in financing of medical services, only recently undertaking payment for these, and only recently undertaking to pay for medical education. Research has been a favored federal focus. Rapid and seemingly uncontrollable inflation has forced both parties to take a harder line. Political platforms are not necessarily clear signals of eventual party action. Nevertheless, they underline what the parties consider to be the problems as the voters see them and they express what the parties see as the appropriate response to these problems. This paper suggests what the party platforms will look like for the presidential election this year and also what the parties will probably do thereafter.
Letter: Withdrawal of medicine from society.
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The route to a national health policy lies through the states.
National health program legislation has been becalmed in the Congress for almost 80 years. Despite periodic cries of "crisis," legislation never emerges from committee. Periodically, campaigns have been mounted without success. Tactical efforts to circumvent direct action by legislating bits and pieces of related programs, Medicare and Medicaid, health maintenance organization support, and pre-budgeting, have complicated operation of the medical care system and stimulated intractable cost inflation. For the first 150 years of American history, responsibility for public health and welfare legislation rested with the states. Most public health policies originated in a state or a few states and then later became national legislation. The state efforts were, in effect, natural experiments. After the Depression and the flood of funding from the federal government in subsequent years, the states faded as innovators. It is proposed that funding a few state models to restimulate state initiative in this regard will provide a more effective route to a national health program.
Ordering social objectives: National Health Service and National Health Insurance as policy options in organizing the medical care system.
For many years, a sharp distinction was made between NHS and NHI on the basis of payment and program focus. First, NHS was defined as a program essentially based on Congressional appropriations (general revenues); while NHI would be based on premiums largely derived from the insured. Second, NHS guaranteed service while NHI guaranteed only payment for services rendered.The distinctions were later extended from these definitions to include differences in response to resource needs, changing task descriptions and personnel assignments, more equitable redistribution of manpower, centralized administration and consumer participation.In general, if the goal were equity, NHS seemed more responsive than NHI.However, in recent years, the approach to NHI has been modified in response to criticism as well as increasing recognition of changed needs, and proposals for NHI like the Kennedy-Corman bill have become more like proposals for a NHS. In short, the difference today is largely one of immediate as against eventual transformation of the medical care system into a social instrument aiming to achieve equity. The major disagreement is whether the present medical care system lends itself to modification so as to achieve that end.