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Background on Health Care


HMOs & MANAGED CARE

  • Comprehensive national health care reform died in Congress in 1994 (after a report by a commission run by Hillary Clinton).
  • 16% of Americans (42 million people) have no health insurance (and hence must pay for health services in full, or receive hospital charity).
  • 14% of Americans receive some form of public health care or health insurance (70% have private health insurance).
  • 20% of Americans are members of Health Maintenance Organizations (HMOs). PATIENT’S BILL OF RIGHTS Congress and the Presidential candidates are debating a ‘Patient’s Bill of Rights’ which would establish rules of dealing with HMO managed care. The buzzwords in this debate are:
  • External Appeal: Patients cannot currently appeal an HMO’s decision to deny coverage, even if the HMO doctor agrees with the patient. The ‘Bill of Rights’ would establish some form of expert appeal board external to the HMO.
  • Medical Necessity: At issue is whether the doctor or the HMO management determines what is necessary. Determination of ‘necessity’ may become subject to expert review as well, or it may become measured against established standards of ‘generally accepted practices.’
  • Legal Liability: Patients would be granted the right to sue HMOs for medical costs and damages, which is not a right under current law. Generally, liberals supoprt the right to sue HMOs while conservatives do not. This is the primary distinction between Republican and Democrat versions of Patient Bill of Rights proposals.
  • Scope of Coverage: Some states regulate HMOs in ways similar to those described here; a ‘Bill of Rights’ could apply to them, to all HMOs, or to all patients.
  • Prevention: Advocating prevention implies support for removing government from health care, or opposition to more federal health care funding or national insurance.
  • Consumer Choice: Advocating consumer choice or reduction in healthcare bureaucracy implies support for removing government from health care, or opposition to national insurance. MEDICAID / MEDICARE
  • Medicare and Medicaid background is covered in theSocial Security section (but quotations are cross-referenced here). EUTHANASIA
  • The Supreme Court ruled unanimously in June 1997 that there is no constitutional right to euthanasia, but that states can allow euthanasia without federal intervention.
  • ‘Euthanasia’ means ‘good death’ in the context of terminal illness. Buzzwords:
  • Passive Euthanasia: Hastening death by withdrawing life support.
  • Active Euthanasia: Causing death in response to a request from that person. The best-known examples are by Dr. Jack Kevorkian, who was found guilty of 2nd degree murder in March 1999.
  • Physician Assisted Suicide: A physician supplies information and/or the means of committing suicide so that a patient can easily terminate their own life.
  • Involuntary Euthanasia: A synonym for murder; used by anti-euthanasia activists.
  • Right to Die: Establishing suicide as a civil right; used by pro-euthanasia activists.
  • The state of Oregon passed a Death With Dignity law, which was active until the federal Department of Justice reversed its enforcement policy in November 2001. TOBACCO SETTLEMENT
  • In Nov. 1998, 46 states settled the cases they had filed against the tobacco companies. (The other 4 states had previously settled, on similar terms)
  • Now, the state legislatures are debating the best use of the settlement funds, which totals $246 billion to be paid over the next 25 years ($5 to $9 billion per year starting in April, 2000).

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    Related issues:

  • Medicare/Medicaid in Social Security
  • Public medical care in Welfare Reform
  • Trust Fund in Budget & Economy MANAGED CARE:
  • Background.
  • HR 2362, Uninsured Act.
  • Against managed care.
  • Against Health Reform.
  • For Health Reform.
  • For National Health.
  • Against National Health.
  • Patient Bill of Rights.
  • Medicare background. EUTHANASIA:
  • Background.
  • Supreme Court case.
  • For Euthanasia.
  • Against Euthanasia.
  • Dr. Jack Kevorkian. TOBACCO DEAL:
  • Background.
  • Settlement, full text.
  • CDC info, federal view.
    Click here for The Forum discussion on Health Care.
    Click here for policy papers on Health Care.
    Other candidates on Health Care: Background on other issues:
    Secy.John Ashcroft
    Pat Buchanan
    President George W. Bush
    Vice President Dick Cheney
    Former Pres.Bill Clinton
    Sen.Hillary Clinton (D,NY)
    Secy.Elizabeth Dole
    Steve Forbes
    Mayor Rudy Giuliani (R,NYC)
    Former V.P.Al Gore
    Ambassador Alan Keyes
    Sen.John McCain (R,AZ)
    Ralph Nader
    Ross Perot
    Secy.Colin Powell
    Gov.Jesse Ventura (I,MN)

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