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For example, those who work in professional or managerial occupations are much more likely to have employer-sponsored insurance than those working in construction, sales or farming.
Similarly, those working in the manufacturing industry are more likely to have coverage than those employed in wholesale and retail trade. Finally, those working for large companies are more likely to have coverage than those who are employed by smaller firms. There are a number of reasons why small employers are less likely to offer health insurance than larger employers.
Second, small employers frequently state that their employees have access to other forms of coverage e. Third, small business owners often argue that many Health care financial accounting 2 essay their employees would never acquire coverage anyway, since turnover rates are relatively high and there is usually a waiting period before benefits kick in for new employees.
As noted above, the central financing mechanism is employer-sponsored private health insurance, supplemented by an array of public insurance and subsidy programs designed to help cover those most likely to lack coverage through an employer in particular the poor and the elderly.
This section of the paper explores the historical development of the employment-based system of health insurance.
In particular, it explains why the U. The institutional evolution of the American health care system is, perhaps, most fruitfully examined in relation to the institutional evolution of American capitalism.
For the history of health care provisioning reveals the myriad of ways in which the system has been shaped by developments within the broader political economy of American society. We therefore begin with an examination of the social, economic and political forces that laid the foundation for the emergence of the modern health care system.
The Failure of National Health Insurance Proposals Throughout the nineteenth century, there was scarcely a market for health insurance in the United States. Family members cared for one another within the home, and there was little reliance on the services of doctors or hospitals.
By the end of the nineteenth century, this was beginning to change. In individual households, sickness now interrupted the flow of income as well as the normal routine of domestic life, and it imposed unforeseen expenses for medical care.
In the economy as a whole, illness had an indirect cost in diminished production as well as a direct cost in medical expenditure Starr,p.
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Acute illnesses were increasingly treated at medical facilities as opposed to homes and hospitals became the centers for surgeries, X-rays and laboratories Thomasson, Along with these advances came an increase in the costs of treating illness and a desire for some form of social protection to replace the traditional relations embedded in the household economy of pre-industrial America.
In response to these and other developments, groups of social reformers arose in the early part of the twentieth century to champion the cause of compulsory national health insurance.
The plan was to be financed by contributions from workers and their employers with additional support from general tax revenues. The program was defended on the grounds of social justice and economic efficiency — the former because it spread the risks of financial ruin and the latter because it mitigated the social costs of illness.
However, the campaign got underway just as support for Progressivism, as a political force, was beginning to wane. It was two decades before there would be another political campaign to increase the involvement of the national government in the management of social welfare.
This time it was President Franklin D. Roosevelt who believed that Americans needed some form of protection against the growing costs of illness and economic insecurity. During the Progressive Era, advocates for social insurance placed health insurance near the top of the agenda.
Although health insurance was no longer considered a top priority, Roosevelt came close to introducing legislation for universal health care coverage after his election in The Moral Accounting Schemes. The general metaphor of Moral Accounting is realized in a small number of basic moral schemes: Reciprocation, Retribution, Restitution, Revenge, Altruism, etc.
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