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Biomedical subjects

T Bodenheimer

Publications and source records attributed to T Bodenheimer.

At least 37 records · Page 2Linked to original sources
PubMed1994

Paying for long-term care.

Everyone agrees that insurance for long-term care is inadequate in the United States. Disagreement exists, however, on whether such insurance should be provided through the private or public sector. Private insurance generally uses the experience-rating principle that persons with higher risk of illness are charged higher premiums. For private insurance for long-term care, this principle creates a dilemma. Most policies will be purchased by the elderly; yet, because the elderly have a high risk of needing long-term care, only about 20% of them can afford the cost of premiums. A public-private partnership by which the government partially subsidizes private long-term-care insurance is unlikely to resolve this dilemma. Only a social insurance program for long-term care can provide universal, affordable, and equitable coverage.

Health Care Reform↗
PubMed1992

Financing universal health insurance: taxes, premiums, and the lessons of social insurance.

In a society with strong antitax sentiment and large government deficits, the enactment of universal health insurance is blocked by an impasse over financing. The two chief mechanisms for funding universal health insurance are taxes and insurance premiums. Taxes and premiums are not distinct entities; rather, a spectrum of financing methods exists with varying tax-like and premium-like features. Premium-like financing tends to be voluntary and earmarked for health care, with coverage contingent upon making payments and payments going to private insurance firms. Tax-like financing, in contrast, tends to be mandatory and not earmarked for health care, with coverage not dependent upon making payments and payments going to governments. Over the past century, most industrialized nations have developed highly popular social insurance programs to cover periods of retirement, disability, unemployment, and payment for medical care. Social insurance constitutes a blend of tax-like and premium-like features, offering lessons that might assist in breaking the current impasse over universal health insurance financing.

Fees and Charges↗
PubMed1992

Private insurance reform in the 1990s: can it solve the health care crisis?

A number of health insurance reform proposals have surfaced at the state governmental level in the United States. These include Medicaid expansion for the below-poverty or near-poverty uninsured, state subsidy to individuals and/or businesses for the purchases of health insurance, risk pools for the medically uninsurable, insurance industry-initiated reforms within the small group market, the promotion of "stripped down" insurance plans that reduce premium cost, and state mandating of employer-sponsored health insurance for the employed uninsured. All of these insurance reform proposals have serious limitations: (1) they fail to address the inequities of the underwriting principle by which older and sicker people pay more for health insurance than the young and healthy population; (2) they extend the illogical linkage of employment and health insurance; and (3) they do not slow the rate of health cost inflation nor do they contain a mechanism to finance broader health coverage through savings within the health sector. An alternative to insurance reform is the establishment of a social insurance program that brings the entire population into a single risk pool.

Adult↗
PubMed1991

Liberal benefits, conservative spending. The Physicians for a National Health Program proposal.

The Physicians for a National Health Program proposes to cover all Americans under a single, comprehensive public insurance program without copayments or deductibles and with free choice of provider. Such a national health program could reap tens of billions dollars in administrative savings in the initial years, enough to fund generous increases in health care services not only for the uninsured, but for the underinsured as well. We delineate a transitional national health program budget that would hold overall health spending at current levels while accommodating increases in hospital and physician utilization. Future national health program spending would be indexed to the growth in gross national product adjusted for demographic, epidemiologic, and technologic shifts. Financing for the national health program would transfer funds into the public program without disrupting the general pattern of current revenue sources. We suggest a funding package that would augment existing government health spending with earmarked health care taxes. Because these new taxes would replace employer-employee insurance premiums and substantial portions of current out-of-pocket expenditures, they would not increase health costs for the average American.

Budgets↗
PubMed1991

A public health approach to cholesterol. Confronting the 'TV-auto-supermarket society'.

Coronary heart disease has been proved to be associated with a "high-risk" diet and with elevated blood cholesterol levels. The National Cholesterol Education Program has embarked on a campaign based on intensive medical treatment of 60 million Americans with high blood cholesterol levels, but the degree of benefit of dietary change or pharmaceutical intervention or both to reduce blood cholesterol values remains a subject of disagreement within the scientific community. Evidence from comparative international studies suggests that to lower coronary heart disease mortality substantially, dietary alterations and general societal changes must be greater than those possible under the National Cholesterol Education Program's approach of physician-centered patient counseling. The nation's priority to prevent coronary heart disease should be a public policy approach, the goal of which is to reduce for the entire population all coronary disease risk factors. In the dietary area, three proposals to reduce the availability of atherogenic foods are the use of warning labels on atherogenic foods, the prohibition of advertising for such high-risk foods, and the imposition of an excise tax on the same foods. We must confront the "TV-auto-supermarket society" that underlies our nation's high rate of coronary heart disease.

Advertising↗
PubMed1991

National health insurance and the problems of American medicine.

The problems of inequitable access to care, health care inflation, and reduced physician autonomy confront physicians and health care reformers with a dilemma. Piecemeal measures attempting to alleviate one problem in isolation simply exacerbate the others. A logical approach to addressing these problems together is a national health program based on a single payer of health services. By reducing administrative waste and emphasizing global budgetary strategies, the single-payer system could promote more efficient health care spending. While single-payer systems create more explicit political conflict over resource allocation, they also have demonstrated an ability to maintain quality of care and reduce bureaucratic intrusions into clinical practice.

Canada↗
PubMed1990

Should we abolish the private health insurance industry?

Health care financing can be based on one of two conflicting principles: health care as a right versus the insurance principle. The former assures equal access to care for all people regardless of income, while the latter requires each grouping in society to pay its own way. In the United States, health financing has utilized both principles, with employer-sponsored group health insurance approximating health care as a right. However, the insurance principle is increasingly eroding this right. In five major areas, the private health insurance industry has serious flaws: it has contributed to health care inflation; it wastes billions in administrative and marketing costs; it is unfair to many groups in society; it has undermined the positive features of health maintenance organization reform; and it has far too much political and economic power. In order to establish health care as a right as the guiding principle of U.S. health care financing, the private health insurance industry and the insurance principle should be abolished.

Blue Cross Blue Shield Insurance Plans↗