In the field of medical sociology, the theoretical perspective of Talcott Parsons is useful in analyzing the social arrangements of a health care system. Parsons and Edward Shils analyze social systems in terms of how they function. They cite the general "tendency toward conformity with a normative pattern" (p. 41), and "a tendency of systems of action to build up and maintain levels of consistency" (Parsons & Shils, 1990, p. 44). But they also say that the "fundamental need for order in a system is the root of the strain which appears when an inconsistent value system is translated into action" (1990, p. 45). Thus not all systems are in order. Indeed, the TennCare health-care system is disordered.
Originally pushed through a majority-Democratic Tennessee legislature by a Democratic governor in the mid-1990s, TennCare has squandered funds and goodwill through mismanagement and enabled inefficiencies to dominate health-care delivery. That describes a dysfunctional system.
According to the nonpartisan Urban Institute, the original objectives of TennCare were "to expand [health-care] coverage to all low-income people in [Tennessee] and to rely on private managed care plans as the mechanism for delivering care to new eligibles and those traditionally covered by Medicaid" (Conover & Davies, 2000, pp. 2-3).
The intent was to save enough money through efficiencies wrought through managed care and by converting federal and state payments made directly to hospitals for indigent care to payments for insurance coverage. These funds, together with some new state tax revenues, were expected to finance the expansion of coverage (Conover & Davies, 2000, p. 2-3).
What actually happened was that money was not saved, that insurers did not receive enough funding to reimburse health-care providers on a timely basis. An important feature of the Urban Institute's report is its citing of reports of adverse selection (Conover & Davies, 2000, p. 4)...