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Show importance must be given to the potential costs and repercussions to our society if the ranks of the medically indigent continue to grow and no cost-effective solutions are found. These developments hold out the promise that health care coverage may improve. None of the options would be as comprehensive as national health insurance, which was on the U.S. legislative agenda in the 1970s and is offered in many other western democracies. However, health care providers and policy makers in this country remain opposed to the idea of a centralized health care system, in which the federal government would regulate access and costs. In the absence of a nationwide system, it will take a variety of programs and options to decrease the vulnerability that far too many Americans face during health care crises. Relieving the Health Care Crisis Because America's health care delivery system is a hodge-podge of public/private providers and insurers, responsibility for relieving the crisis lies in many hands, including those of government officials, hospital administrators, doctors and nurses, private employers and the consumers themselves. Nevertheless, government may continue to be the primary initiator of health care programs for the poor. t)'': . . :· :)h_: .f,~ R ecent federal legislative initiatives have focused on three health care fronts: (1) expanding Medicaid coverage by uncoupling eligibility from AFDC and SSI; (2) developing a catastrophic national health care plan to limit liabilities during health care emergencies; (3) requiring more employers to offer basic health insurance plans to their employees. In addition, Congress is working on a catastrophic health plan for the elderly that would include a cap on out-of-pocket expenses for medication and hospital care but would provide only limited coverage for nursing home care. Meanwhile, state governments have launched a number of new programs designed to spread health care costs among as many parties as possible. One popular plan has been to develop indigent care financing pools, with providers, employers and local governments contributing to the costs. Some states also have established ''risk pools'~financed by surcharges on private insurance plans-to offer coverage to high-risk, uninsurable persons. Other states have allowed small employers to jointly buy affordable group insurance. ~::. ::~_ ~;::;::.1:~;- > ; .,.::_~.:;;_., : - c-, "".~"' ' :' >-:-~;_· I ,c, ,. ~•"v- The Crisis of Responsibility Social welfare policy in the United States has always reflected a kind of national schizophrenia about both the causes and cures for poverty. Americans want to be generous, but not too generous for fear of discouraging initiative and responsibility. Shifting federal policies and priorities, budget constraints and an uncertain economic picture have heightened the social welfare crisis. How we as a nation resolve the crisis of responsibility in meeting basic human needs in the next year or so may well affect social policy-and the quality of life for many people-in the 1990s and beyond. This report was researched and written by Kathleen Smith, Senior Program Analyst, and Nancy Reder, Director of Social. Policy for the League of Women Voters Education Fund. Order from League of Women Voters of the U.S., 1730 M St., NW, Washington, DC, 20036. (202) 429-1965. Pub #838, $1.25 (75C for members) plus shipping and handling. Quantity discounts on request. ISBN 0-89959-404-2. 9 ~13 8 |
