Chapter 7: The Mirage of Reform

a. I was surprised to learn that the original function of health insurance was income stabilization. Sick pay was provided first, and then payment for medical care came after. In our current system, sick pay and health insurance are separate entities. I was also surprised to learn that during a period of expansions in subsidization of medical care by many European countries in the early 1900s, the United States took no action, and ignored the concept entirely. While it is obvious that no compulsory insurance exists today, I was surprised to learn that such a thing was never even pursued, during a time when other developed countries were actively doing so. The author goes on to explain the different political situations, institutions, and beliefs which prevented a government sponsored program from coming to fruition, which was interesting to learn about as well.

b. I agree with the author's position that the expansion of the role of the state in health care both brought more freedom and more restriction. For example, employer provided medical care and sick pay brings freedom, in that employees are able to maintain their standard of living and keep their job during times of brief illness, but it also brings more restriction, in that they are more bound to their current company in loyalty. Starr also discusses restriction in the form of limiting the practitioners policy holders are able to use, and intrusion by the state.

c. In the last sentence of the chapter, Starr mentions that the increase in government financing did not threaten professional sovereignty. I disagree with this because the government has financed many intermediary organizations such as Medicare and Medicaid, which interfere with sovereignty of medical professionals. For example, the government determines the rates at which physicians will be reimbursed for their services. Because such programs comprise a large percentage of health coverage in the U.S., many physicians are forced to accept it. Starr does mention that sovereignty wasn't immediately threatened.

d. One aspect of this chapter that I have experienced in my own life is that of loyalty towards companies and employers due to health care. For instance, many people find their physicians through their employer-sponsored health care plan. Likewise, "good benefits," including paid sick time, and medical and dental insurance are often seen as powerful bargaining tools by employers and employees alike. Most employees consider good benefits extremely important when finding and keeping a job.

e. One aspect of this chapter that I am interested in learning more about is how illness and medical expenses affect the economy. Starr mentions the indirect costs of illness to society. While these concerns were undoubtedly important during the turn of the last century, they have become even more so recently, and will continue to do so.