Healthcare and Public Policy Continued...
Medicare aimed to give older Americans some security in knowing that their basic medical needs were covered at a time in their lives when earnings were mostly fixed against the cost of care that tended to increase each year.
Medicaid aimed to address the needs of Americans who could not afford medical care. The program has been largely left to the States to administer based on formulas that determine the number of State residents in need and so the amount of Federal funds designated to meet that need.
Jump forward to 1993 when First Lady Hillary Clinton convened an enormous array of stakeholders in the medical care and pharmaceutical industries to determine if a government run program would solve the growing problem of Americans unable to provide healthcare for themselves and their children. In those days public polls found that at least 67% of Americans favored such a program run by the government.
As the Clinton bill made its way to Capitol Hill the healthcare industry response was unified and effective. The bill was dead on arrival as then Senator Bob Dole was attributed to have said. Around the time of the Clinton plan there was a subtle and noticeable difference in the discourse about universal coverage; the idea of everyone having access to medical care was supplanted by the notion that everyone should have access to health care insurance.
The difference in discourse was not insignificant; healthcare in America has come under the control of the health insurance companies, not necessarily the doctors and most certainly not the patients. The primary arguments against the Clinton plan were that the cost was prohibitive, faceless government employees would determine the extent of your coverage (under siege itself for operating under a burdensome bureaucracy, the VA was offered up as an example), and, of course, it was nothing short of Socialism. Socialism, despite it being a term that could accurately describe Medicare and Medicaid, two successful programs that few disputed, came with a stigma born in the 1950s and honed to a sharp political instrument during the Cold War.
Over the years Congress has pumped funds into public programs in an attempt to meet the healthcare needs of the nation. The SCHIP, the State Children’s Health Insurance Program, begun in 1997, aimed to meet the needs of children from low-income families, those families who made too much to qualify for Medicaid but to little to afford private health insurance. It too was distributed on a formula based on the States’ conclusion of individual need. The point of contention with SCHIP has been the formula. It was not unusual for arguments against raising the income caps to cover more children. States recognized that the cost of living in one was higher or lower than in others and one asked for funds based on a higher rate than others. But the opponents tended to leave out that a cap increase had to be approved by the Federal government leaving irate taxpayers with the impression that someone making $80,000 per year was getting taxpayer aid. In some states, $80,000 is a good income even for a family of four, in others it is on the borderline of making ends meet. While most of the caps held, the issue became a successful political tool.
Other programs that utilize taxpayer funds for healthcare include programs for Native Americans, Veterans, and the rural poor.##
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