Document Type
Article
Publication Date
12-2016
Journal Title
Journal of Law, Medicine and Ethics
ISSN
1073-1105
DOI
10.1177/1073110516684787
Abstract
Tracing the evolution of political conversations about health care spending and their relationship to the formation of policy is a valuable exercise. Health care spending is about science and ethics, markets and government, freedom and community. By the late 1980s the unique upward trajectory of post-Medicare U.S. health care spending had been established, recessions and tax cuts were eroding federal and state budgets, and efforts to harness market forces to serve policy goals were accelerating. From the initial writings on “managed competition,” through the failed Clinton health reform effort in the early 1990s, to the passage of the Affordable Care Act in 2010, the policy narrative of health spending acquired a superficial consistency. On closer examination, however, it becomes apparent that the cost problem has been repeatedly reframed in political discourse even during this relatively brief period. The clearest transition has been from a narrative centered on rationing necessary care to one committed to reducing wasteful care – although the role of accumulated law and regulation in perpetuating waste remains largely unrecognized and the recently articulated commitment to population health seems an imperfect proxy for explicitly developing social solidarity with respect to health and health care in the United States.
First Page
559
Last Page
568
Num Pages
10
Volume Number
44
Issue Number
4
Publisher
Cambridge University Press
Recommended Citation
William M. Sage,
Minding Ps and Qs: The Political and Policy Questions Framing Health Care Spending,
44
J.L. Med. & Ethics
559
(2016).
Available at:
https://scholarship.law.tamu.edu/facscholar/1598