Chapter 14: Empowering Health Care Consumers in the United States
Michael H. Fox and Anna Lambertson In welcoming remarks at a ceremony introducing the Obama administration’s new director for health reform in April 2009, representatives of two large consumer-oriented health care organizations likened health care reform to the life cycle of the cicada (Henry J. Kaiser Family Foundation 2009b). Like the homopterous members of the Cicadidae family that emerge from underground every 17 years shrilling loudly, the voices of health care consumerism emerge periodically demanding change. Indeed, in the United States, the rhythm of health care policymaking is cadenced by the periodic outcry of the major stakeholders – consumers, hospitals, employers, insurance companies and physicians. Since the second term of the Truman presidency in 1948, these cries have emerged every 15 to 20 years, leading to a pattern of incrementalism in US health care policy that Paul Starr aptly referred to as the ‘politics of accommodation’ (Starr 1982). Crises develop and are defused through health reform that characteristically modifies existing programmes, or creates new ones on the shoulders of others, until fault lines lead to cracks that lead to chasms that lead to crises, when a renewed outcry for health reform goes out, at which point the cycle begins again. So in the late 1940s crises over access to medical care for the elderly and Second World War veterans led to legislation (known as the Hill-Burton Act) that introduced widespread hospital construction for free medical care to indigent patients, while under parallel legislation (known as the Kerr-Mills Act) state services were...
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