Catastrophic Care Coverage

In 1989, in response to growing public concern about spiraling healthcare costs, and particularly "catastrophic" costs bills for major procedures that could run into the tens or even hundreds of thousands of dollars, potentially bankrupting even welltodo families Congress passed the first substantial social "safetynet" program to be enacted since the Great Society years of the 1960s. The Catastrophic Coverate Act of 1988 called for an expansion of the Medicare publiclyfunded healthcare system to provided senior citizens with protection against catastrophic costs. It was an expansion of benefits for which seniorcitizens' organizations had vigorously lobbied (Longman, 1989).

The public response among the elderly (who alone were covered) was, however, far from enthusiastic. The coverage was funded by an increase in Medicare premiums, particularly for the relatively affluent, and the tax was levied at the "front end" before the benefits actually began to be paid out. The result, in the conservative and antitax atmosphere of the late 1980s, was a political firestorm. The welltodo elderly, who were hit hardest (though not particularly hard) by the tax, rose in rebellion. The elderly of more modest means, who would most benefit from the expanded coverage, were largely silent. They were less wellorganized than their betteroff contemporaries. Moreover, since the benefits had not yet come "on line," the potential beneficiaries had stake in a pr

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upply of doctors without having much effect on prices or on health results. (Marmor, Mashaw, and Harvey, 1990: 188) How many of us, in short, can seriously resist any procedure that is recommended to us, if by any direct or indirect means we can pay for it? Above all, how many of us are qualified to judge the "cost effectiveness" of medical interventions? The institutional changes in medicine in the last twenty years have curtailed the independence of doctors as selfemployed professionals; most are now "employees" of medical groups or other organizations, and the traditional family doctor has largely vanished but their incomes have continued to rise. Since "competition" was failing to hold down medical costs, including Medicarecompensated costs, recourse was had to more direct measures. President Jimmy Carter attempted to impose controls on hospital costs, but most Republicans and some Democrats in Congress combined to thwart him. In 1982, however, the Department of Health and Human Services made a study of "prospective payment" as a costcontrol measure, and this led to the adoption of the system of DiagnosisRelated Groups, or DRGs, to regulate and limit Medicare compens

Category: Medical - C