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Biomedical subjects

T R Marmor

Publications and source records attributed to T R Marmor.

At least 37 records · Page 2Linked to original sources
PubMed1991

New York's Blue Cross and Blue Shield, 1934-1990: the complicated politics of nonprofit regulation.

The story of New York Blue Cross is one of complex interaction with state and federal regulators and also with hospitals, the medical profession, commercial insurers, and the public, who make up the regulatory environment. Negotiation, cooperation, and adaptation among parties whose goals and assumptions were partly parallel characterize the relationships. As we can see from New York Blue Cross's origins and its role in the development and administration of certificate-of-need legislation, Medicare, insurance practice and regulation, and hospital rate setting, this story does not represent the capture of government by a special interest, nor the gradual souring of a public interest organization, nor disinterested and distant government regulation.

Blue Cross Blue Shield Insurance Plans↗
PubMed1990

American health politics, 1970 to the present: some comments.

This article reviews the attempts of the 1970s and 1980s to rationalize health care provision in the United States. It critically discusses the contorted debate between competition and regulation as a means of controlling health care costs. The second part of the article takes up Eli Ginzberg's contentions about American health care. We agree that the United States has not been able to control medical inflation because it lacks the necessary condition of concentrated finance. But we present evidence from public opinion polls in the 1970s and the 1980s that challenges Professor Ginzberg's contention that "there is no evidence that the American people want to change [their] system" of medical care.

Attitude to Health↗
PubMed1989

The political and economic context of mental health care in the United States.

Since the mid-1970s, the mental health treatment system in the U.S. has faced budgetary famine. This is in stark contrast to the growing cornucopia of fiscal resources enjoyed by the overall health care system. This paper explores the complex reasons for this disproportionate allocation in health spending. On the one hand, mental health may suffer from the perception that its diagnoses are largely "subjective" and its treatments do not fit the traditional "medical model" that can be defined precisely and paid for by third-party insurers. But more importantly, the death of mental health resources can be attributed to the peculiar nature and characteristics inherent in American politics. This paper describes the American political environment, from both a historical and a contemporary perspective, to give some insight into the development of policies affecting the mental health system in the U.S. Given the current climate of fiscal conservatism in this country toward any increases in social spending, it is likely that the profound mismatch in need and spending for mental health programs will continue indefinitely.

Civil Rights↗
PubMed1988

Reflections on Medicare.

At its inception, the Medicare program was seen as a way to bring the elderly into the mainstream of American medicine. The program after twenty years is increasingly viewed as an instrumentality to influence the nature and costs of American medicine. The first part of this article reviews the origins, history, and evolution of the Medicare program in order to explain how and why this change has come about. In the concluding section, the article explores further the implications of the program's concentration on the aged, its uncertain notion of entitlement, and the bewildering character of the current claims of generational inequity allegedly imposed by Medicare's present outlays of +70 billion and its persistingly high rate of cost increases.

Aged↗
PubMed1987

Nonprofit and for-profit medical care: shifting roles and implications for health policy.

The contemporary expansion of investor-owned health care facilities has stimulated much controversy but little response from policymakers. We believe this results from the apparently ambiguous relationship between ownership and socially valued outcomes. In our assessment, this ambiguity occurs largely because the effects of ownership are mediated in complex ways by characteristics of the services being delivered and the training of health care providers. Reviewing both the history and current performance of nonprofit and for-profit health care facilities, we identify some of the more important of these mediating factors. Taking these into account, there is a consistent influence of ownership on the delivery of health services. On the basis of this analysis, we discuss appropriate policy responses to the future growth of investor-owned health care organizations.

Cost Control↗
PubMed1986

American medical policy and the "crisis" of the welfare state: a comparative perspective.

Health policy debates rarely include broad review of cross-national experiences with related social policies. This article addresses the connection between medical policy concerns and the development of welfare states in the advanced industrial democracies following the oil crisis of 1973-74. After examining the evidence about what actually occurred during the "crisis" years of the welfare state, the article relates the debates about the welfare state's crisis to American concerns about medical care in the 1980s. The distinctive American response to the fiscal strains of stagflation-more severe cuts in social spending than necessary based on the country's economic strength, threats of bankruptcy to produce small adjustments to large programs, and inability to address the problems of medical care as anything other than budgetary strain--is linked to American dissensus about the purposes of the welfare state.

Costs and Cost Analysis↗
PubMed1986

Cost vs. care: American's health care dilemma wrongly considered.

The state dilemma of American medical care is rapidly increasing costs that threaten both quality of care and equal access to care. A frequently cited example of what the United States can expect as the crunch between cost and care gets worse is rationing, as used in the British National Health Service. The introduction of the British National Health Service, according to this analysis, is inappropriate and clouds the relevant issues. The example of national health insurance in Canada--a country much more similar to the United States in size, geography, and governmental and social structure--is a much more appropriate model to examine. Canada, comparably large, wealthy, and socially heterogeneous, spends approximately 20% less of its GNP on medicine, yet has both universal national health insurance and no serious rationing problem. Their example is reason to question the stark dilemma of cost vs. care in American medicine.

Canada↗
PubMed1982

The new health policy: promises and pitfalls.

Our past health care policies--policies relating to provision of services, development of medical resources, public financing of care, and regulation--constitute a legacy greatly affecting our future. A new health policy must accommodate the political, social, and economic manifestations of that legacy. In the coming decade, the health care policy debate will be dominated by the reinvigorated champions of "competition." The banner of pro-competitive reform could be used to cloak changes in programs that give at best nominal help to alternative practice forms, and at worst simply force consumers to bear greater proportions of the cost of care.

Economic Competition↗