National health insurance policy in the United States: a case of non-decision-making.
Despite the vast range of commentaries and research on the current health care crisis, little research attention has been focused specifically on the lack of federal response to this crisis. As a way of focusing analysis on the specifics of Congressional inaction, it is suggested that both the range of health care proposals and the current debates in Congress may be seen as part of an ongoing bargaining process over legitimate alternatives for modication of health care delivery. It is argued that the lack of any new health care legislation may be seen as the result of a series of non-decision by conservative Congressional representatives of the dominant medical interest groups. These non-decisions have successfully excluded any challenges to those interests by reliance upon a predominant "mobilization of bias" to effectively define and/or divert these challenges as illegitimate attempts at change. The changes which eventually evolve from Congressional compromise may represent a modification of the prevailing bias concerning legitimate alternatives, but are unlikely to modify the relation of the controlling interests involved.
3
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17
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24
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12
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2
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16
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23
- 10.1111/j.1539-6975.2009.01345.x
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This article provides an overview of the U.S. health care reform debate and legislation, with a focus on health insurance. Following a synopsis of the main problems that confront U.S. health care and insurance, it outlines the health care reform bills in the U.S. House and Senate as of early December 2009, including the key provisions for expanding and regulating health in surance, and projections of the proposals' costs, funding, and impact on the number of people with insurance. The article then discusses (1) the potential effects of the mandate that individuals have health insurance in conjunction with proposed premium subsidies and health insurance underwriting and rating restrictions, (2) the proposed creation of a public health insurance plan and /or nonprofit cooperatives, and (3) provisions that would modify permissible grounds for health policy rescission and repeal the limited an titrust exemption for health and medical liability insurance. It concludes by contrasting the reform bills with market-oriented proposals and with brief perspective on future developments.
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