Hill B S, Hinckley K A
University of Akron, Ohio, USA.
J Aging Soc Policy. 1991;3(1-2):91-110. doi: 10.1300/J031v03n01_08.
Changes in congressional processes, health agendas, and competitive positions of physician and hospital groups in the 1980s have produced important setbacks for such group interests within Medicare. Though united and successful in opposing Carter's 1977-79 hospital cost-containment proposals, these groups were subjected to severe new limits on hospital reimbursements under the 1982 budget reconciliation act. Thereafter, problems in protecting their interests continued or increased. Disagreements among hospital groups (e.g., the American Hospital Association and the former Federation of American Hospitals) surfaced over the Prospective Payment System introduced in 1983. In 1984, Congress instituted a freeze on physicians' Medicare fees despite AMA opposition. This projected narrow self-interest, thus decreasing the AMA's credibility. Further cost restrictions were imposed in 1985-86 budget acts. The problems of these organizations indicate that if aging groups are to protect their own stake in Medicare in the new political context, they must be particularly concerned with unity, credibility, and long-term perspectives.
20世纪80年代，国会程序、医疗议程以及医师团体和医院团体竞争地位的变化给医疗保险制度下这些团体的利益带来了重大挫折。尽管这些团体团结一致并成功反对了卡特在1977 - 1979年提出的医院成本控制提案，但根据1982年的预算协调法案，它们在医院报销方面受到了严格的新限制。此后，保护自身利益的问题持续存在或有所增加。医院团体（如美国医院协会和前美国医院联合会）在1983年引入的预期支付系统上出现了分歧。1984年，尽管美国医学协会表示反对，国会还是冻结了医师的医疗保险费用。这凸显了狭隘的自身利益，从而降低了美国医学协会的可信度。1985 - 1986年的预算法案进一步实施了成本限制。这些组织面临的问题表明，在新的政治背景下，如果老龄化群体要保护自己在医疗保险制度中的利益，就必须特别关注团结、可信度和长远眼光。
