“In the early 1960s, in the first example of health care "reform," the dominant forces of "Medicine, Inc." played an influential role in championing guaranteed government health care for older Americans. When Medicare was enacted into law in 1965, partially nationalizing medical care for the elderly, the medical-industrial complex had succeeded in getting the Federal Government to bail out a health care delivery system that was already showing signs of severe financial distress. The ensuing three decades have witnessed little actual improvement in the health status of elderly Americans. During the same period, however, profits for the medical business rose markedly (and, driven by Medicare, inflation of everyone's health care costs skyrocketed). (Peter Chowka, 2003)
Paul Starr (1982) documented how, following World War II, organized medicine used its considerable power to strengthen the position of medicine and to increase the dominance of physicians over other health care workers and in the health care system generally. He described well how physicians worked in the legislative arena and in hospitals to solidify and extend their power in the health care system
A related way in which physicians have used their political power to determine who could do what in health care has been to influence reimbursement policy and payment systems. Which clinicians can be reimbursed for providing services clearly has an impact on who performs those services? The federal Medicare payment system uses the Current Procedural Terminology (CPT) classification of payment codes developed and sold by the American Medical Association as the basis for reimbursing providers for services delivered. (Ada Jacox, 1997)
The Health Care delivery system as it existed in the 1960s vs. as it exists today within the context of economics
Today, Americans age 65 and older actually pay more out of pocket for medical care even with Medicare in place, than elderly Americans did in the 1950s before Medicare. And the nation's total annual health care bill is approaching an astronomical $1 trillion -- 14 percent of the Gross National Product. [Note: By 2003, the costs had escalated to $1.5 trillion.]” (Peter Chowka, 2003)
“On one hand, US health consumers continue to demand the highest quality, most accessible care. On the other, cur- rent public policy, expressed as dramatically lower payment for care delivered, has caused academic medical centers and community hospitals alike to hemorrhage financially, putting many institutions on the brink of bankruptcy and patient care at serious risk. Calls for improved economic efficiencies in the American health care system predate early Clinton Administration initiatives. The rise of HMOs was one attempt to use a third party to control costs. But have quality and access been diminished for the sake of controlled economics? The evidence strongly suggests that it have.
Since the mid-1960s, the health care payment system in the United States has undergone major changes. The role of the provider has gradually shifted from price-setter to price-taker. The role of the federal government has changed from being a small participant before the mid-1960s to being a major force in both ...