Abstract
In their essay, Jack H. Knott and Robert F. Rich provide an overview of the development of the private-public, 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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Altman, Drew E., and Larry Levitt. “The Sad History of Health Care Cost Containment as Told in One Chart.”Health Affairs (January 23, 2002), available athttp://content.healthaffairs.org/cgi/reprint/hlthaff.w2.83vl.
Arnold, Douglas R. (1979).Congress and the Bureaucracy: A Theory of Influence. New Haven, CT: Yale University Press.
Baumgartner, F. R., and B. D. Jones. (1993).Agendas and Instability in American Politics. Chicago: The University of Chicago Press.
Blendon, Robert J., Mollyann Brodie, J. M. Benson, Drew E. Altman, Larry Levitt, T. Hoff, and L. Hugick. “Understanding the Managed Care Backlash.”Health Affairs 17:4 (1998): 80–94.
Brecher, Charles, and Colin C. Chellman. “Fiscal Federalism: Placing the Clinton Years in Context.” Paper Prepared for Presentation at American Political Science Association Annual Meeting, 2001. San Francisco, CA. August 31, 2001.
Brodie, Mollyann, Lee Ann Brady, and Drew E. Altman. “Media Coverage of Managed Care: Is There a Negative Bias?”Health Affairs 17:1 (1998): 9–25.
Brown, Vickie Yates, and Barbara Reid Hartung. “Managed Care at a Crossroads: Can Managed Care Organizations Survive Government Regulations?”Annals of Health Law 7 (1998): 25–72.
Cooper, Phillip, and Barbara Schone. “More Offers, Fewer Takers for Employment-based Health Insurance: 1987 and 1997.”Health Affairs 16 (1997): 142–149.
Cutler, D. M., and L. Sheiner. (1997). “Managed Care and the Growth of Medical Expenditures.” NBER Working Paper 6140, Cambridge: National Bureau of Economic Research.
Derthick, M., and P. J. Quirk. (1985).The Politics of Deregulation. Washington, DC: The Brookings Institution.
Docteur, E., H. Suppanz, and J. Woo. (2003). “The US Health System: An Assessment and prospective Directions for Reform.” Economics Department Working Papers No. 350, Organization for Economic Cooperation and Development, Paris: OECD.
Draper, Debra A., and Gary Claxton. “Managed Care Redux: Health Plans Shift Responsibilities to Consumers,” Issue Brief, Center for Health System Change, No. 79 (March 2004): 1–4.
Draper, D. A., R. E. Hurley, C. S. Lesser, and B. C. Strunk. “The Changing Face of Managed Care.”Health Affairs 21:1 (2002): 11–23.
Enthoven, A. C., and S. J. Singer. “A Single-Payer System in Jackson Hole Clothing.”Health Affairs 13:1 (1994): 81–95.
Farber, Henry, and Helen Levy. “Recent Trends in Employer-sponsored Health Insurance: Are Bad Jobs Getting Worse?”Journal of Health Economics 19 (1999): 93–119.
Gabel, Jon, Cindy Jajich-Toth, Karen Williams, Sarah Loughran, and Kevin Haugh. “The Commercial Health Insurance Industry in Transition.”Health Affairs (Fall 1987): 46–60.
Gaynor, M., and D. Haas-Wilson. “Change, Consolidation, and Competition in Health Care Markets”Journal of Economic Perspectives 13:1 (1999): 141–164.
Ginsburg, P. B. “RWJF Community Snapshots Study: Introduction and Overview.”Health Affairs 15:2 (1996): 7–20.
Ginsburg, P. B., and C. Lesse. “The View from Communities.”Journal of Health Politics 24:5 (1999): 1005–1013.
Hammond, T. H., and J. H. Knott. (2000). “Congressional Committees and Policy Change: Explaining Legislative Outcomes in Banking, Trucking, Airlines, and Telecommunications Deregulation,” in C. J. Heinrich and L. E. Lynn, Jr., eds.,Governance and Performance: New Perspectives, 199–238. Washington, D C: Georgetown University Press.
Haskins, R. “Just What the Nation Needed: The Welfare Reform Law of 1996.” Public lecture given at the Center for Advanced Studies, University of Illinois, Urbana-Champaign, January 27, 2004.
Health Care Financing Administration. “HCFA Letter to State Medicaid Directors” (August 1997). Available athttp://www.hcfa.gov/
Health Insurance Association of America. “Why Do Health Insurance Premiums Rise?” HIAA Issue Brief, September 2002.
Holahan, John, Joshua M. Weiner, and Amy Westpfahl Lutsky. “Health Policy for Low-income People: States’ Responses to New Challenges.”Health Affairs (May 22, 2002) available athttp://content.healthaffairs.org/cgi/reprint/hlthaff.w2.187v1
Iglehart, J. K. “Health Care Reform—The States.”New England Journal of Medicine 330:1 (1994): 75–79.
Kingdon, J. W. (1984).Agendas, Alternatives, and Public Policies. Boston: Little, Brown.
Knott, Jack H., and Gary J. Miller. (1987).Reforming Bureaucracy: The Politics of Institutional Choice. Englewood Cliffs, NJ: Prentice-Hall.
KPMG Peat Marwick, (1998).Health Benefits in 1998. Washington, DC: KPMG Peat Marwick.
Ladenheim, Kala. “Health Insurance in Transition: The Health Insurance Portability and Accountability Act of 1996.”Publius: The Journal of Federalism 27:2 (Spring 1997): 33–51.
Landa, Amy Snow. “Medicaid Managed Care Rule Ignores Low Doctor Pay.”American Medical News 44 (November 12, 2001): 6.
Leichter, Howard. “State Health Policy Analysis: On the Abuse of Metaphor and the Pathology of Variation.”Journal of Health Politics, Policy & Law 22:3 (June 1997): 897–906.
Lesser, C. S., P. B. Ginsburg, and K. J. Devers. “The End of an Era: What Became of the ‘Managed Care Revolution’ in 2001?”Health Services and Research 38:1 (2003): 337–355.
Levit, K., C. Cowen, B. Braden, J. Stiller, A. Sensenig, and H. Lazenby. “National Health Expenditures in 1997: More Slow Growth.”Health Affairs 17:6 (1998): 99–110.
Litman, Theodor J., and Leonard S. Robins. (1991).Health Politics and Policy, 2nd ed. Albany, NY: Delmar Publishers.
Managed Care National Statistics. (2003). Available athttp://www.cdphp.com/home/news-room/HMO_statistics03.asp (accessed May 6, 2004).
National Conference of State Legislatures. “SCHIP Funds are Redistributed: St. Budget and Tax News.” National Conference of State Legislatures, Washington, DC (Apr. 1, 2001). Available athttp://www.ncsl.org/programs/fiscal/sbtn010401b.htm
Nichols, L. M., and J. L. Blumberg. “A Different Kind of ‘New Federalism’? The Health Insurance Portability and Accountability Act of 1996.”Health Affairs 17:3 (1998): 25–42.
Parmet, Wendy. “Regulation and Federalism: Legal Impediments to State Health Care Reform.”American Journal of Law and Medicine 19 (1993): 121–143.
Pear, Robert, and Robin Toner. “States Face Hard Choices on Medicaid Cuts.”New York Times (January 14, 2002). TheNew York Times on the web athttp:// www.nytimies.com/2002/01/14/national/14MEDI.html visited 1/16/2002.
Reinhardt, Uwe. “Our Obsessive Quest to Gut the Hospital.”Health Affairs 15:2 (1996): 145–154.
Rich, Robert F., L. DeBrock, R. Kaestner, J. H. Knott, A. Patla, C. L. Rice, R. Kaplan, and G. T. Schumock. (2003). “Rising Health Care Costs in the United States: Implications for Public Policy.” Institute of Government and Public Affairs, University of Illinois.
Rich, Robert F. “Health Policy, Health Insurance, and the Social Contract.”Journal of Comparative Labor Law and Policy 21:2 (Winter 2000): 397–421.
Rich, Robert F., and W. D. White. (1996). “Health Care Policy and the American States: Issues of Federalism,” in Robert F. Rich and William D. White, eds.,Health Policy, Federalism and the American States, 3–38. Washington, DC: The Urban Institute Press.
Rich, Robert F. “National Health Care Reform.”Illinois Business Review 51:1 (Spring 1994): 3–6.
Rich, Robert F. “Change and Stability in Mental Health Policy: The Impact of Two Transformations.”American Behavioral Scientist 30:2 (1987): 111–142.
Rodgers, Daniel T., 1998.Atlantic Crossings: Social Politics in a Progressive Age Cambridge, MA: Belknap Press of Harvard University Press.
Rosenblatt, Rand E., Sylvia A. Law, and Sara Rosenbaum. (1997).Law and the American Health Care System Westbury, New York, Foundation Press.
Rosenbaum, Sara, K. Johnson, C. Sonosky, A. Markus, and C. DeGraw “The Children’s Hour: The State Children’s Health Insurance Program”Health Affairs 17:1 (1998): 75–89.
Schattschneider, E. E. (1963).Politics, Pressures, and the Tariff: A Study of Free Private Enterprise in Pressure Politics. As Shown in the 1929–1930 Revision of the Tariff. Connecticut: Archon Books.
Shorthell, S. M., and K. E. Hull. (1996). “The New Organization of Health Care—Managed Care/Integrated Health Systems,” in S. Altman and U. Reinhardt,Strategic Choices for a Changing Healthcare System, 101–48. Chicago: Health Administration Press.
Simon, Carol J., William D. White, Sandy Gamliel, amd Phillip R. Kletke. “The Provision of Primary Care: Does Managed Care Make a Difference?”Health Affairs 16:6 (1997): 89–98.
Smith, Vernon K, Eileen R. Ellis, and Christina Chang. (2001).Eliminating the Medicaid Asset Test for Families: A Review of State Experiences. Washington, DC: Kaiser Commission on Medicaid and the Uninsured.
Starr, Paul. (1982).The Social Transformation of American Medicine. New York: Basic Books.
Weinick, R. M., and J. W. Cohen. “Leveling the Playing Field: Managed Care Enrollment and Hospital Use, 1987–1996.”Health Affairs 19:3 (2000): 178–184.
Wholey, Douglas, Roger Feldman, and John Christianson. “The Effect of Market Structure on HMO Premiums.”Journal of Health Economics 14:1 (1995): 81–105.
Zwanziger, Jack. “Physician Fees and Managed Care Plans.”Inquiry 39 (2002): 184–193.
Additional information
Jack H. Knott, Ph.D. is the director of the Institute of Government and Public Affairs and professor of political science at the University of Illinois. Until 1997, he served as the chair of the Political Science Department and the director of the Institute of Public Policy and Social Research (IPPSR) at Michigan State University. Professor Knott has published widely in the area of public management, government reform, and public policy. His articles have appeared in theJournal of Politics, theJournal of Public Administration Research and Theory, Journal of Public Policy Analysis and Management, Health Affairs, and the Journal of Health Policy, Politics and Law.
Robert F. Rich, Ph.D. is a professor of law, political science, medical humanities and social sciences, community health, and health policy and administration at the University of Illinois at Urbana-Champaign. He is currently director of the J. D. and Elizabeth Epstein Program in Health Law and Policy in the College of Law at the University of Illinois and director of the Office of Public Management within the Institute of Government and Public Affairs. He was the director of the Institute of Government and Public Affairs from 1986 to 1997. In the 2002–3 year, Rich was the Mercator Professor at the Humboldt University in Berlin, Germany, where he has also been appointed as a permanent fellow in the European Center for Comparative Government and Public Policy. In 2004, he was a visiting scholar at the Max Planck Institute for Foreign and International Social Law. He is the author of five books and over fifty articles in the areas of health law and policy, federalism, information policy, and science and technology policy.
Rights and permissions
About this article
Cite this article
Knott, J.H., Rich, R.F. The politics of health and social welfare in the United States. Ageing Int. 31, 96–117 (2006). https://doi.org/10.1007/s12126-006-1007-5
Issue Date:
DOI: https://doi.org/10.1007/s12126-006-1007-5