Health care policy issues and older americans: An introduction

Abstract

In the essay by Jack H. Knott and Robert F. Rich, the authors provide an overview of the unique challenges and problems that face the American health care system. They argue that public policy represents the codification of mainstream values. Consequently, as societal consensus changes over core values, laws and policies also change. Hence, the American health care system is reflective of the values and preferences of interest and professional groups in American society, interacting with expertise and political institutions. These political values and institutions determine who gets what, when and how, and they influence the pace and character of policy change. The essay provides an overview of the development of the privatepublic, segmented health care system in the United States. It then examines what the authors call the "politics of exceptions" as the original fee-for-service model of health insurance was radically altered by the introduction of managed care and other reforms. Knott and Rich examine health policy by analyzing political values and institutions, which allows them to assess the strengths and weaknesses of the health care system and serves as a basis for recommending politically feasible options for reform in the future. In their essay, Richard L. Kaplan and Richard W. Olson examine one of the most important problems in consumer choice in the current health care delivery system: choice of prescription drugs and medications in the recently enacted prescription drug benefits of Medicare. Their essay analyzes the new benefits and what their implications are for consumer choice. The authors conclude that the effect of all of the consumer choices is inevitably consumer confusion. This predicament is made worse when one considers that consumers' future drug needs are not always predictable. Thus, a drug plan--be it in Medicare Part D or one of the alternatives--may be perfectly appropriate today and be totally inadequate in two years, even assuming no structural changes in the plans themselves or in the cost of medications. Clearly, under the new Medicare Part D program, consumer choices will abound. Whether