The Milbank Memorial Fund quarterly. Health and society
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The original and continuing promise of Medicare can be preserved only through a complex package of fiscal reforms. Central to this should be a merger of Hospital Insurance and Supplementary Medical Insurance into a single Medicare trust fund, financed in part through income-related beneficiary premiums. Benefits could be expanded, while improving access and equity.
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Medicare's system of paying physicians is criticized as being costly, inflationary , inefficient, inequitable , and confusing. Yet when alternative methods--to change practice arrangements, units of service, fee levels, and the assignment option--are examined, no one seems ideal. A fee-for-service system combined with a prospective payment schedule may offer the best compromise.
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Medicare is financed principally by taxes--some of which burden the general population and others the elderly beneficiaries. Proposals to adjust these revenue sources are evaluated for equity, efficiency, stability, and administrative costs. A package is offered to redistribute the tax burden among all groups; it may also be good health policy.
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Milbank Mem Fund Q Health Soc · Jan 1984
The politics of ideology vs. the reality of politics: the case of Britain's National Health Service in the 1980s.
In 1979 the British people elected a government that explicitly repudiated the basis of post-war political consensus; Americans did likewise in the following year. New policies, it was expected, would be shaped by a new ideology. Britain's National Health Service offers an opportunity to examine the nature of this relationship. Political, professional, and corporate ideologies about resource allocations are inevitably constrained by the prevailing public philosophy.