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Health Reform Ideas in the Primeval Soup
Unformatted Document Text:  16 a global budget and universal coverage. 35 This was a lineal and more detailed descendent of the earlier plans, and resembled in some features the British National Health Service without the direct government ownership and operation of health facilities and employment of physicians. In 1971 Kennedy introduced a bill incorporating the major recommendations of the Committee. Variations of the social insurance proposal continued to be introduced throughout the 1970s, and in modified form again in the early 1990s. Basic Concepts With the social insurance idea every American is to be covered with comprehensive benefits. There is little or no cost sharing at the point of service to avoid penalizing the sick and to encourage preventive care. A global national health budget is employed with the aggregate budget total equal to the total taxes collected for the program. A variety of revenue sources including payroll and income tax are utilized. An individual premium may account for a share of total program revenue. Regional and local health service agencies receive a percapita allocation from the budget to be used to reimburse providers. 36 The plan eliminates private insurance, except for services not covered in the basic package. A hierarchical set of agencies is created at the regional and local level for handling reimbursement of providers with budget allocation to them based on population. Alternatively, in some versions the states might serve this regional administrative function. This would be closer to the Canadian model. Medicare uses private insurance companies as fiscal intermediaries between the federal government and local providers. Most versions of the social insurance model recognize size and complexity of the health system in the United States, and seek to have either an administratively decentralized approach or assign the states significant responsibility for administration at the regional level. 37 Strengths The social insurance model provides health care financial protection to all. By definition there is universal coverage. The benefit structure is comprehensive, with no charge at the point of service. As with Medicare, administrative costs associated with insurance marketing and claims processing are eliminated. The work based insurance system with its uncertainty is eliminated, as health insurance is no longer tied to employment. 35 Quadagno , op cit p.112 36 Department of Health, Education, and Welfare, National Health Insurance Proposals: Provisions of Bills Introduced in the 94 th Congress, 1976, pp 121- 137 37 Judith Feder and John Holahan, “Administrative Choices”, in Conflicting ‘Goals and Policy Choices, ed. Judith Feder, John Holahan, and Theodore Marmor, (Washington: Urban Institute Press, 1980.),pp. 21-72.

Authors: Brasfield, James.
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16
a global budget and universal coverage.
35
This was a lineal and more detailed descendent
of the earlier plans, and resembled in some features the British National Health Service
without the direct government ownership and operation of health facilities and
employment of physicians. In 1971 Kennedy introduced a bill incorporating the major
recommendations of the Committee. Variations of the social insurance proposal
continued to be introduced throughout the 1970s, and in modified form again in the early
1990s.
Basic Concepts
With the social insurance idea every American is to be covered with comprehensive
benefits. There is little or no cost sharing at the point of service to avoid penalizing the
sick and to encourage preventive care. A global national health budget is employed with
the aggregate budget total equal to the total taxes collected for the program. A variety of
revenue sources including payroll and income tax are utilized. An individual premium
may account for a share of total program revenue.
Regional and local health service agencies receive a percapita allocation from the budget
to be used to reimburse providers.
36
The plan eliminates private insurance, except for
services not covered in the basic package. A hierarchical set of agencies is created at the
regional and local level for handling reimbursement of providers with budget allocation
to them based on population. Alternatively, in some versions the states might serve this
regional administrative function. This would be closer to the Canadian model. Medicare
uses private insurance companies as fiscal intermediaries between the federal government
and local providers.
Most versions of the social insurance model recognize size and complexity of the health
system in the United States, and seek to have either an administratively decentralized
approach or assign the states significant responsibility for administration at the regional
level.
37
Strengths
The social insurance model provides health care financial protection to all. By definition
there is universal coverage. The benefit structure is comprehensive, with no charge at the
point of service. As with Medicare, administrative costs associated with insurance
marketing and claims processing are eliminated. The work based insurance system with
its uncertainty is eliminated, as health insurance is no longer tied to employment.
35
Quadagno , op cit p.112
36
Department of Health, Education, and Welfare, National Health Insurance Proposals: Provisions of Bills
Introduced in the 94
th
Congress, 1976, pp 121- 137
37
Judith Feder and John Holahan, “Administrative Choices”, in Conflicting ‘Goals and Policy Choices,
ed. Judith Feder, John Holahan, and Theodore Marmor, (Washington: Urban Institute Press, 1980.),pp. 21-
72.


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