Front Cover
Health Policy in the United States: Access, Cost and Quality
Copyright information
Table of Contents
List of tables and boxes
Preface
1 Introduction: Images of American healthcare
Healthcare and medical care
Three images of American healthcare
The jungle
A hierarchy
America has the best healthcare in the world
Politics of health policy
The central trichotomy: access, cost and quality
Conclusion
2 American healthcare in comparative perspective
American healthcare system
A mixed system of finance and delivery

A fragmented and decentralized system
Fee-for-service medicine
A regulated system, with many holes
An unequal system
Comparable healthcare systems
United Kingdom
Sweden
France
Australia
Germany
Switzerland
Conclusion
3 Medicare: public health insurance for the elderly
Coverage and costs
Financing Medicare
Components of Medicare
Part A
Part B
Part C
Part D
Medigap insurance
Subsidies for low-income recipients
Politics of Medicare
Privatization
Public opinion and Medicare
Medicare reform
Conclusion

4 Medicaid and CHIP: medical care for the medically indigent
Medicaid
Eligibility for Medicaid
Medicaid services
The politics of Medicaid
Federalism and Medicaid
Block granting
Waivers
Medicaid and COVID-19
CHIP
Politics of Medicaid and CHIP
Conclusion
5 Affordable Care Act: a major step forward
Background of the Affordable Care Act
Principal provisions of the Affordable Care Act
Individual mandate
Exchanges and insurance
Medicaid expansion
Cost containment
Taxation
Consequences of the Affordable Care Act

Problems with the Affordable Care Act
Subsidy cliff
Family glitch
Reliance on the states
Complexity
Loss of insurers
Costs
Myths about Obamacare
Death panels
Coverage
Affordable Care Act and the Supreme Court
Public opinion and the Affordable Care Act
Repeal of the Affordable Care Act
Conclusion
6 Regulatory policies in healthcare
Regulation of pharmaceuticals
Drug approval process
Current challenges in pharmaceutical regulation
Autonomy
Post-approval controls
Advertising
Orphan drugs
Antibiotics
Dietary supplements
Tobacco

More inclusive testing
Public confidence
Other dimensions of regulation
Certificate of need
Regulating facilities
Regulating health insurance
Regulating the health professions
Conclusion
7 Access to healthcare
Economic barriers
Race
Gender
Geography
Age
Communications for access
Systemic barriers to access
How to improve access? Challenges for the future
8 Healthcare costs and cost containment
Why does healthcare cost so much in the United States?
Drivers of cost in American healthcare
Fragmentation
Price intransparency