Pepper Commission Research Articles

Independent Living—In The Jungle Or The Zoo?

I first met Drew Batavia in 1989 when I was a long-term care analyst for the Pepper Commission, a congressional commission charged with exploring health and long-term care reform options that would meet the needs of people of all ages. Our paths crossed again in 1992 when I was leading a work group to design the long-term care component of President Clinton’s health care reform initiative. Drew was one of several disability advocates and experts who advised our group on how to incorporate consumer-directed personal assistance services into our proposed national home and community-based care program. Batavia combined his advocacy and analytical skills with his personal experience as a long-time user of personal care attendants to inform his positions on how to finance and implement an independent-living model for long-term care. He applied these same skills to the writing of this book. Although the independent living concept, the movement, and specific programs have received increasing attention in the academic and policy literature over the past decade, this book represents the first comprehensive review of the evolution of this approach, the nature and scope of programs domestically and internationally, how this model compares with other approaches, and the potential role of this model in the future of long-term care reform. The author aptly borrows from the health economist Victor Fuchs in his introductory description of the current state of long-term care as the “jungle vs. the zoo” for people with disabilities. Batavia highlights the trade-offs between freedom and security, noting that “nowhere are they more stark than in the area of long-term care” (p. 13). He arrays the current range of long-term care settings and providers along a freedom–security continuum with nursing home at one extreme and cash assistance—the ultimate in independent living and consumer direction—at the other. Chapter 3 provides a very useful chronology of the development and maturation of the independent living model, from its roots in the civil rights and consumer rights movements, the pressure to deinstitutionalize people with mental illness and mental retardation, the efforts to “normalize” people with disabilities (including subjecting them to the risks of everyday life), and more recent initiatives to apply the independent-living approach to services for the elderly. This overview emphasizes the importance of grassroots campaigns and how they influenced legislative, judicial, and administrative decisions to foster and encourage independent living options for people with disabilities. One minor gap in Batavia’s chronology is his failure to identify the self-determination movement for people with mental retardation and developmental disabilities as a precursor to the maturation of the independent-living concept. Self-determination programs provide an important subgroup of people with disabilities with budgets and the tools to make important decisions about how they live their lives and use resources to meet their needs. The success of this approach in the mental retardation community has lent credence to the B o o k R e v i e w s

Health policy and craniofacial care: issues in resource allocation.

The distribution of health care services, including craniofacial services in the United States, is examined. The U.S. has a unique health care financing and organizational system in which persons are most commonly covered by health insurance as a benefit of their employment. Current estimates are that nearly 40 million Americans have no health insurance (Himmelstein et al., 1992). Approximately half of the uninsured persons are in low-wage employment that does not provide health insurance benefits nor allow them to qualify for Medicaid (Pepper Commission, 1990). Personal health care costs now exceed 11% of the U.S. gross domestic product, a significantly higher percentage than that found in other industrialized nations (Consumer Reports, 1990b). Within the current system, is health care distributed in a fair or moral manner? What are the effects of the allocation scheme? Possible changes in health care financing and delivery are examined and basic ethical and social issues associated with a changing U.S. health care delivery system are explored.

Health Policy and Craniofacial Care: Issues in Resource Alllocation

The distribution of health care services, including craniofacial services in the United States, is examined. The U.S. has a unique health care financing and organizational system in which persons are most commonly covered by health insurance as a benefit of their employment. Current estimates are that nearly 40 million Americans have no health insurance (Himmelstein et al., 1992). Approximately half of the uninsured persons are in low-wage employment that does not provide health insurance benefits nor allow them to qualify for Medicaid (Pepper Commission, 1990). Personal health care costs now exceed 11% of the U.S. gross domestic product, a significantly higher percentage than that found in other industrialized nations (Consumer Reports, 1990b). Within the current system, is health care distributed in a fair or moral manner? What are the effects of the allocation scheme? Possible changes in health care financing and delivery are examined and basic ethical and social issues associated with a changing U.S. health care delivery system are explored.

Underinsurance in America.

On any given day, an estimated 35 million Americans are without health insurance.1 In addition, at least 20 million people have insurance that could prove inadequate in the event of serious illness.2 Coverage by insurance policies that require large out-of-pocket payments has been termed underinsurance. Lack of Coverage for Catastrophic Medical Expenses According to the 1990 report of the Pepper Commission, a commonly accepted measure of inadequate coverage is health insurance that leaves the person covered at risk of spending more than 10 percent of income on health care in the event of a costly illness. An estimated 13 percent . . .

Research and the politics of decision making: planning services for elders.

Identification of the appropriate measures for determining levels of impairment and disability has emerged as a major challenge for the network on aging. Recommendations from the Pepper Commission as well as recent court decisions will increase pressures on state and area agencies to identify levels of impairment of activities of daily living (ADLs) as a trigger for eligibility for services and as a component of intrastate funding formulas. The use of different descriptors from the Supplement on Aging to the 1984 National Health Interview Survey as a basis for projecting future demand/need for services is discussed. Each scenario presents a different political/decision-making challenge for the network and for individual planners. Planners are encouraged to provide multiple models for decision making to assist the network in making service delivery decisions.

Caring for the Uninsured and Underinsured

To the Editor. —You are to be congratulated for your outstanding edition on universal health insurance (May 15, 1991). It was well-organized and well thought out, and I deeply appreciate your attention to this topic. As one of the few politicians in this country who practices medicine, I'd like to share the following observations. There are two major faults with many of these plans. The first is that a number of them rely on continuation of the Medicare program. Any practicing physician will tell you that the Medicare program is a disaster. It underreimburses the physicians, it undercompensates the insured patients, and its bureaucracy and interference with medical practice are demoralizing. Second, the major shortcoming of many plans (including that of the American Medical Association) is the lack of serious provision for cost containment. That also applies to the Pepper Commission and many of the other plans that rely on

A call for action. The Pepper Commission's blueprint for health care reform

After a year of deliberation and investigation, the Pepper Commission recommended action to ensure that all Americans would have health insurance protection in an efficient, effective health care system. Because it believes that action is urgent, the commission would build universal coverage by securing, improving, and extending the combination of job-based and public coverage we now have. Reform would entail the following elements: a combination of incentives and requirements that would guarantee all workers (with their nonworking dependents) insurance coverage through their jobs; replacement of Medicaid with a new federal program that would cover all those not covered through the workplace and workers whose employers find public coverage more affordable; guaranteed affordable coverage for employers--through reform of private insurance, tax credits for small employers, and the opportunity to purchase public coverage; a minimum benefit standard for private and public plans that would cover preventive and primary services as well as catastrophic care and would include cost sharing, subject to ability to pay; and a combination of public and private sector initiatives to promote quality and contain costs.

Restructuring Health Care in the United States

Nutter, et al. present proposals, developed by the Medical Schools Section of the A.M.A., for reform of the U.S. health care system. The goals of this plan include the definition of appropriate roles for business, government, and the individual; responsible cost containment; simplified administration; quality assurance linked to effective methods of technology assessment; continued public and private support for biomedical research; greater responsiveness by academic medicine to national health care needs in the areas of primary care and geographic distribution; health care payers' shared responsibility for the support of graduate medical education; and the measurement of the restructured system's effectiveness against changes in citizens' health status. Supportive of the Pepper Commission's proposed replacement of Medicaid with a public health plan, the authors also urge the continuation of Medicare, the provision of health benefits by all employers, and subsidized, regional insurance pools for those not covered by other means.

Access to Care--The Problem for the Uninsured and Underinsured: The View From Washington

The fact that some 30% of the US population is uninsured or underinsured underscores the urgency to address the growing problem of many Americans lacking access to health care. The past year has seen some 15 different proposed plans in Congress to deal with the uninsured, plus the Pepper Commission recommendations. The problem of access to health care involves issues of cost, quality of care, and the hassle factor of burdensome administrative paperwork. The problem is being addressed both at the Federal and state levels. The only federal regulation that I am aware of that directly concerns access is the antidumping regulation passed in 1986. This action was designed to prohibit hospitals from refusing treatment to indigent patients with medical emergencies, including women in labor. Changes effective July 1, 1990, tightened requirements and stiffened penalties. The amended regulation requirements basically state that if a Medicare-participating hospital has an emergency room,

Legislative influences on cancer care

Deficit reduction politics was a major force in policymaking in the 1980s and a pervasive fact of life in the development of health policy. The Medicare budget was habitually used to find savings for deficit reduction and reforms, such as how to address the problem of 31 to 37 million uninsured Americans, were postponed. The 101st Congress did produce major physician payment reforms and in the spring of 1990, the Pepper Commission issued its recommendations for access to care and long-term care. Less sweeping but significant proposals affecting cancer care were considered by Congress. For example, positive actions were taken on anti-smoking and food labeling proposals. Funding for the National Institutes of Health was increased, and there was a growing awareness of the threat to biomedical research presented by assaults on animal research facilities.

Pepper Commission Recommends Health Care Overhaul

Pepper Commission Recommends Health Care Overhaul

The Pepper Commission Report on Comprehensive Health Care

Just over two years ago, Congress created the U.S. Bipartisan Commission on Comprehensive Health Care to recommend legislative action to ensure all Americans coverage for health and long-term care. That commission — renamed the Pepper Commission in honor of its creator and first chair, Representative Claude Pepper (D-Fla.) — fulfills its charge with its just-released final report to Congress.* Some may greet the report as a nonevent — just another set of recommendations to sit on the shelf, as the problems of Americans in getting and paying for health care continue to grow. For some, it has become far easier . . .

Job Turnover — A Problem with Employer-Based Health Care

Many proposals for national health care, including that offered by the Commission on Comprehensive Health Care (the Pepper Commission), are based on pressing or requiring employers to purchase heal...

The Pepper Commission's Recommendations: Access to Health Care and Long‐Term Care for All Americans

Journal of the American Academy of Nurse PractitionersVolume 2, Issue 3 p. 127-128 The Pepper Commission's Recommendations: Access to Health Care and Long-Term Care for All Americans First published: July 1990 https://doi.org/10.1111/j.1745-7599.1990.tb00792.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue3July 1990Pages 127-128 RelatedInformation

ANA Applauds Efforts of Pepper Commission

ANA Applauds Efforts of Pepper Commission

Myths & Realities: Why Most of What Everybody Knows about Long-Term Care Is Wrong

The place of long-term care on the national policy agenda has risen dramatically in recent years. Over the past year, Newsweek devoted a cover story to Alzheimer's disease, the New York Times ran a four-part story on long-term care, and Walter Cronkite narrated a special program on financing issues. Several key members of Congress in both houses have introduced legislation to overhaul the financing of long-term care. And long-term care is receiving equal billing with hospital and physician care in major reviews of health policy by the U.S. Bipartisan Commission for Comprehensive Health Care (the Pepper Commission), the White House Domestic Policy Council, and the Social Security Advisory Council. As policymakers have hurriedly educated them selves about chronic disability, nursing homes, and home care, a body of conventional wisdom about long term care has developed. Unfortunately, much of it is simply wrong. Of the many unfounded notions about long-term care currently in circulation, eight myths are especially prevalent. Myth 1: The Long-Term Care Issue Affects Only the Elderly

ANA Applauds Efforts of Pepper Commission, Urges Further Decision-Making to Move the Recommendation Forward

ANA Applauds Efforts of Pepper Commission, Urges Further Decision-Making to Move the Recommendation Forward

ANA Applauds Efforts of Pepper Commission, Urges Further Decision-Making to Move the Recommendations Forward

ANA Applauds Efforts of Pepper Commission, Urges Further Decision-Making to Move the Recommendations Forward