New Directions in Public Health Care

This volume is a revised edition of The Institute for Contemporary Study's report on national health insurance (NHI). The debate on the NHI program has broadened in recent years as a greatly intensified public consciousness about costs has been faced with an enormous drain on public budgets from greatly underestimated cost estimates for Medicare and Medicaid. As budget limitations reduced prospects for a full, comprehensive plan, the policy debate broadened. The Carter administration began to emphasize its program for hospital cost containment, focusing on that medical sector which had shown greatest cost increases. Moreover, other proposals began to make their way through congressional committees to change in a fundamental way the incentives governing medical markets. These new approaches-which seek, fundamentally, to increase competition among providers of medical care-have appeared at a time when it is becoming clear that more conventional regulatory efforts at cost control have not been successful in other countries, such as West Germany.

This edition includes an analysis of legislation currently before Congress, an examination of hospital cost increases and cost containment, an investigation of the politics of the NHI that asks if any major interest group involved in health care wants increased competition, new research on both the NHS in Britain and Canada's relatively recent experiments with full NHI, a discussion of the subsidy of health care, and an analysis of the market for medical care and the effects of an NHI on the market for physicians.