Social Insurance and American Health Care: Principles and Paradoxes.

Social insurance, like commercial insurance, is about protection against financial risk. In the United States, Medicare and the Social Security Administration's programs for retirement, disability, worker's compensation, and worker's life insurance have become dominant features of American public policy, amounting to more than 41 percent of the federal budget. Yet their fiscal centrality does not rest on anything like an understanding of what makes social insurance social-or why that is so important to American political life.

The state of American health care: November 2016 to November 2020, a look forward.

The election of Donald Trump, coupled with the retention of Republican majorities in the US House of Representatives and Senate, raises questions about future of the Patient Protection and Affordable Care Act, the structure and funding of the country's public health insurance programs - Medicare, Medicaid and the Child Health Insurance Program - and the direction of health policy in the United States, more generally. Political scientists are not renowned for their capacity to predict the future and many of those who forecast election results have received criticism in recent weeks for failing to predict the Trump victory. While the future is uncertain, it is possible for social scientists to offer a 'conditional causal analysis' about the future.

Commercial pressures on professionalism in american medical care: from Medicare to the Affordable Care Act.

Since the passage of Medicare, the self-regulation characteristic of professionalism in health care has come under steady assault. While Canadian physicians chose to relinquish financial autonomy, they have enjoyed far greater professional autonomy over their medical judgments than their U.S.

Comparative studies and healthcare policy: learning and mislearning across borders.

This article addresses the vocabulary of cross-national analysis and commentary about health care, health policy and health politics. We conclude there is a large gap between promise and performance in comparative policy commentary and point to major sources of confusion, such as the lack of generally agreed vocabulary, vague language and the use of faddish and misleading terms and aspirational labels (illustrated by a selection of widely used expressions in comparative reports). We next examine the basic purposes of international policy comparison, distinguish three useful and two misleading approaches and frame defensible ground rules for comparative work.

Health care politics and policy: the business of medicine: a course for physician leaders.

This article is a condensed and edited version of a speech delivered to the business of medicine: A Course for Physician Leaders symposium presented by Yale-New Haven Hospital and the Medical Directors Leadership Council at Yale University in November 2012 and drawn from Politics, Health, and Health Care: Selected Essays by Theodore R. Marmor and Rudolf Klein [1]. It faithfully reflects the major argument delivered, but it does not include the typical range of citations in a journal article.

Conceptual frameworks for comparing healthcare politics and policy.

This literature review pursues two main objectives: first, it argues that research on health policy actors and healthcare systems need to be separated more thoroughly. Though there are important interactions between both fields, it is often advisable to separate analytically research on health policy actors and on healthcare systems. Second, concentrating not only on actors and institutions but also on outcomes, we suggest, is theoretically valuable, practically feasible, and policy relevant.

From HMOs to ACOs: the quest for the Holy Grail in U.S. health policy.

The United States has been singularly unsuccessful at controlling health care spending. During the past four decades, American policymakers and analysts have embraced an ever changing array of panaceas to control costs, including managed care, consumer-directed health care, and most recently, delivery system reform and value-based purchasing. Past panaceas have gone through a cycle of excessive hope followed by disappointment at their failure to rein in medical care spending.

Health reform and the obama administration: reflections in mid-2010.

The reforms that finally emerged from the Obama administration's initiative were the result of a year of nasty, demagogic and misleading claims in the US public forum, coupled with the complexities of crafting legislation that stood a chance of passing both the House of Representatives and the Senate. The resulting "hybrid" approach to healthcare reform produced a conservative strategy that ignores the experience of other wealthy democracies. More significantly, its long period of implementation, given a possible change of administration in 2012, increases uncertainty regarding whether and how reforms will be rolled out by 2014 and after.

The Brazilian national health system: an unfulfilled promise?

In 1988, Brazil became one of the first countries in Latin America to frame access to health care as a constitutional right. However, it would be misleading to call Brazil's Unified Health System (Sistema Único de Saúde, or SUS) a public health system that provides universal access and comprehensive care. This paper reveals a strong contradiction between the re-distribution model set out in the Brazilian Constitution and the inadequate level of public spending on health care.

Paying for performance in primary medical care: learning about and learning from "success" and "failure" in England and California.

Paying physicians to hit performance targets is becoming increasingly fashionable, as evidenced by the growing number of "pay-for-performance" programs in the United States and beyond. This article compares pay-for-performance initiatives in two nations--the United Kingdom and the United States. It pays particular attention to the context in which the initiatives were conceived and implemented, factors which are largely neglected in the pay-for-performance literature.

The Obama administration's options for health care cost control: hope versus reality.

Controlling the costs of medical care has long been an elusive goal in U.S. health policy.

Understanding social insurance: fairness, affordability, and the 'modernization' of Social Security and Medicare.

Americans have been urged for several decades to view Social Security and Medicare as political relics--both unaffordable and unfair in light of contemporary demographic and fiscal circumstances and the practices of modern financial markets and modern medicine. Proposals abound for "modernizing" both systems to emphasize choice, competition, and individual ownership. This paper contends that critics of Social Security and Medicare have misanalyzed the problems of both programs and are urging misdirected reforms.

Labor pain management in the United States: understanding patterns and the issue of choice.

We reviewed a considerable body of literature in an attempt to characterize the patterns of managing pain in US childbirth. In doing so, we noted the relatively restricted range of choice most US women have in this situation and the limited amount of information available about what US women prefer, the reasons for their preferences, and what influences them. What is clear is that the range of choice available is substantially narrower than in many of the advanced industrial democracies of Western Europe.