In this section Brasfield focuses on the specific institutions of Medicare and Medicaid and each of their respective contributions to the issue of uncontrolled costs. In Ch. 3 he describes the evolution of medicare and how, during the Bush campaign, it was proposed to include prescription drugs. one major issue he chase to highlight was whether the biggest monetary risk should be put on the government or the insurance plans. A compromise, called the doughnut hole, was thought up to solve this issue. It suggests that after a copayment of 25% the person would be fully responsible to pay out-of-pocket and once they reached a certain amount medicare would pay 80% to the enrollee's 5%. This out-of-pocket "doughnut hole" gap was used to bridge the gap between the insurance plan paying the majority in the beginning to the government paying the majority in the end. I found this to be an interesting way for a cost solution to develop, but I feel it still puts too much pressure on the enrollee for them to have to pay completely out of pocket for up to $4550. It was also interesting to see the origin of the social insurance vs. privatization. The premium support system idea on the side of privatization is similar to the current system with the difference of allowing plans to discrimination against unhealthy participants, but is this a thing insurance plans should be prohibited from doing even if it helps them control their costs?
In the next chapter it was interesting to learn at just how huge the medicare program had grown to. A particularly surprising figure was the fact that medicaid funds 4/10 births in the US. With close to half of the births in the US to be from families under medicaid show that a disproportionate amount of people are being born into poverty, and with cases made for the inescapable nature of the American poverty cycle, this could become a major factor in increasing health care costs. This also brings up the recurring issue for the government funding of contraceptive measures. Overall what I gained from this reading, and many of the preceding assignments, is that there are an overwhelming amount of historical and monetary aspects to health reform and these contribute to the ambiguity of the decision making process when a reform is put to a vote.