Elena Padilla, Ph.D.
Scholar in Residence, Saint Barnabas Hospital, Bronx, New York
Professor Emerita, New York University
Summary of Paper:
Matching Health Policy to Community Interest
Presented at
Envisioning Ethical Atlernatives in Health Care
9 December 1996
Summary:
There have been two major turnarounds in American health policy: the first, was the result of a set of
continuing federal initiatives (1950's-1970's) which transformed the health care landscape to improve
the availability and access to health care through increased financing for research and development,
workforce education, capital construction, planning and payment for delivery of services.
The second turnaround followed in the 1980's when the Federal government reordered its health priorities, shifting them to contain steep increases in health care costs:
A government policy of deregulation and market oriented policies put an end to nearly two decades of federal expansion of access to health care delivery and insurance. The outcome of this shift was the expansion of for profit HMO'S and hospital chains. Hospital closures and employee lay-offs followed, health planning disappeared.
The third turn around will come about when a strategic thrust for a single payer system is developed that can assure universal access and is addressed to meet community health needs and improvement of community health status.
Current health policy reflects divisions in American society regarding the responsibility of government and its capacity to address societal problems effectively. This ideological drift raises complex questions for which there is no quick fix in the case of health care. Here is a $1 trillion plus industry that centers on diagnosing, treating, rehabilitating and restoring people to health being turned around as if it were a toy.
There are no true markets in health care delivery, but pseudomarkets or market clones, that mimic the market as they are aided and supplemented by government action. In New York, for instance, a pro-market state government has continued to provide or pay for those tasks that are of no interest to the market and are termed public goods, e.g. uncompensated care (or medical indigency), and part of graduate medical education.
For health care markets to operate effectively, the regulatory environment would have to be minimal or non existent. For this to occur, there has to be a horizontal or co-equal relation of exchange between providers and consumers, which in turn would require a society in which services would be available to the have's and not denied to the havenot's, and where egalitarian values prevail. Lacking that, and given finite resources, it becomes necessary to strengthen public health measures, public access to health care delivery, public based organizational planning, and distribution of resources based on evaluation of community benefits.