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首页> 外文学位 >The elusive quest for universal health coverage: Social Security as leading asset and a liability.
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The elusive quest for universal health coverage: Social Security as leading asset and a liability.

机译：难以实现全民健康覆盖：将社会保障作为主要资产和负债。

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摘要

What explains the absence of universal health insurance coverage in the United States? There is no one politics of health care or one explanation for the lack of universal coverage; there are, instead, different patterns of politics at different stages of policy development. Yet a unique and critical relationship has existed between Social Security and the development of health insurance. Intimidated by organized medicine in 1935, President Roosevelt excluded universal health insurance coverage from the Social Security Act so that the program could pass in Congress. For the next three decades the American Medical Association (AMA) continued to prevent any public, contributory health insurance scheme from passing, largely due to its superior lobbying. But by the mid 1960s, Social Security had evolved into the best---if not only---vehicle for overcoming the AMA's formidable interest-group opposition and, in the process, incrementally achieving the goal of universal coverage. Medicare's passage in 1965 represented the first major step.; Policy-makers' success with incremental expansion, however, also had detrimental consequences. Specifically, Social Security and Medicare's accumulated costs eventually emerged as a major impediment to the goal of universal coverage. From the mid 1970s on, universal coverage became financially "crowded out," in part by the programs that many envisioned would facilitate its achievement. Once the payroll tax became solely devoted to covering Social Security and Medicare's rapidly increasing costs, policy-makers grew convinced that they could not raise it for any additional commitments. They chose, instead, to pursue alternative financing proposals for increasing health insurance coverage. All of them proved politically futile because any substantial broadening of the government's role in health insurance after the mid-1970s either threatened entrenched, private interests (such as the insurance industry) or risked encouraging employers to discontinue providing coverage for their employees. Essentially, attempts at forging new policy paths became blocked by the constellation of interests surrounding old, institutionalized ones: the private path of tax-subsidized, employer-provided health insurance and the public path of different government programs for targeted segments of the population. With the myriad of elected leaders, interest-groups, and organizations supporting these two paths, political actors have found comprehensive change to be inordinately difficult if not virtually impossible.
机译：是什么解释了美国缺乏全民健康保险的原因？没有任何一种医疗保健政治或缺乏对全民医疗保险的解释；相反，在政策制定的不同阶段存在着不同的政治模式。然而，社会保障与健康保险的发展之间存在着独特而关键的关系。 1935年，罗斯福总统受到有组织医学的恐吓，将《社会保障法》排除了全民健康保险的范围，以便该计划可以在国会通过。在接下来的三十年中，美国医学协会（AMA）继续阻止任何公共的，分担费用的健康保险计划通过，这在很大程度上是由于其较高的游说度。但是到了1960年代中期，社会保障已经发展成为最好的-甚至不仅是）克服AMA强大的利益集团对立的工具，并在此过程中逐步实现了全民覆盖的目标。 1965年Medicare的通过代表了迈出的第一步。但是，决策者在逐步扩展上的成功也带来了不利的后果。具体而言，社会保障和医疗保险的累计费用最终成为阻碍全民医保目标的主要障碍。从1970年代中期开始，全民覆盖在财政上“被挤出了”，部分原因是许多人设想的计划将促进其实现。一旦工资税专门用于支付社会保障和Medicare迅速增加的费用，决策者就逐渐确信他们无法为任何其他承诺提高税收。相反，他们选择了寻求其他融资方案以增加健康保险的覆盖范围。所有这些在政治上都被证明是徒劳的，因为在1970年代中期以后，政府在健康保险中的作用的任何实质性扩大，要么威胁着根深蒂固的私人利益（例如保险业），要么冒着鼓励雇主停止为雇员提供保险的风险。从本质上讲，围绕旧的，制度化的利益的利益格局阻碍了尝试新政策路径的尝试：税收的私人途径，雇主提供的医疗保险以及针对目标人群的不同政府计划的公共途径。在无数的当选领导人，利益集团和组织支持这两种道路的情况下，政治行为者发现全面变革是极其困难的，即使实际上并非不可能。

著录项

  • 作者

    Mayes, Ben Richardson.;

  • 作者单位

    University of Virginia.;

  • 授予单位 University of Virginia.;
  • 学科 History United States.; Political Science General.
  • 学位 Ph.D.
  • 年度 2000
  • 页码 250 p.
  • 总页数 250
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 美洲史;政治理论;
  • 关键词

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