This chapter details the development of health care policy in the United States and focuses on contemporary health care policies and the issues that surround them. Beginning with the early efforts to improve health care through public health agencies like the FDA; the chapter moves on to describe more modern efforts to manage care through policies like the recent Affordable Care Act, the long-standing Medicare and Medicaid, and more specialized programs like the State Children’s Health Insurance Program (SCHIP) and the Veterans Health Care System, including the related military’s health plan known as TriCare. These policies have often been massive political undertakings, and while their features are lengthy and complicated, this chapter breaks down policies and explains in detail several of their important features.
In addition to covering major health care policies in the United States, this chapter details many of the often complicated intricacies of health care policy. Broad policy approaches to health care, such as single-payer insurance, national health insurance, and the competing views on health care as an issue that should be considered a merit good or left to market forces, are clarified. The evolution of these approaches over time in the United States, such as a shift from fee-for-service health care to managed care and preventative care is a focus of the latter half of the chapter, clarifying the move to third-party payers and management approaches such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). This chapter also addresses a few of the concerns that have arisen through the development of health care policy, including ethical issues like patients’ rights and the concern many employees have over the portability of their insurance programs.