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| List of Exhibits | |
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| Preface | |
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| The Rise of Medical Expenditures | |
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| Before Medicare and Medicaid | |
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| The Increasing Role of Government | |
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| Changing Patient and Provider Incentives | |
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| Government Response to Rising Costs | |
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| A Look Ahead | |
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| How Much Should We Spend on Medical Care? | |
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| Consumer Sovereignty | |
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| Economic Efficiency | |
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| Government and Employer Concerns over Rising Medical Expenditures | |
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| Approaches to Limiting Increases in Medical Expenditures | |
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| Do More Medical Expenditures Produce Better Health? | |
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| Medical Services Versus Health | |
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| Health Production Function | |
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| Improving Health Status Cost Effectively | |
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| Relationship of Medical Care to Health over Time | |
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| In Whose Interest Does the Physician Act? | |
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| The Physician as a Perfect Agent for the Patient | |
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| Supplier-Induced Demand | |
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| Increase in Physician Supply | |
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| Insurers' Response to Demand Inducement | |
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| HMOs | |
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| Informed Purchasers | |
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| Rationing Medical Services | |
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| Government Rationing | |
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| Rationing by Ability to Pay | |
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| Decision Making by Consumers of Medical Services | |
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| Marginal Benefit Curve | |
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| Price Sensitivity | |
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| How Much Health Insurance Should Everyone Have? | |
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| Definitions of Insurance Terms | |
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| Insurance-Purchase Decision Making | |
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| Tax-Free, Employer-Paid Health Insurance | |
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| Why Are Those Who Most Need Health Insurance Least Able to Buy It? | |
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| Medical Loss Ratios | |
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| How Health Insurance Markets Work | |
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| Additional Legislative Changes Affecting the Health Insurance Market | |
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| Medicare | |
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| The Current State of Medicare | |
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| (HI) | |
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| (SMI) | |
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| Medicare Advantage Plans | |
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| Outpatient Prescription Drugs | |
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| Medigap Supplementary insurance | |
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| Concerns About the Current Medicare System | |
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| The Impending Bankruptcy of Medicare | |
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| Proposals for Medicare Reform | |
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| Politics of Medicare Reform | |
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| Medicaid | |
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| An Illustration of Medicaid Eligibility | |
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| State Children's Health Insurance Program (SCHIP) | |
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| Medicaid Beneficiaries and Medicaid Expenditures | |
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| The Patient Protection and Affordable Care Act (PPACA) | |
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| Medicaid Policy Issues | |
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| Medicaid Managed Care | |
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| Reforming Medicaid | |
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| How Does Medicare Pay Physicians? | |
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| Previous Medicare Physician Payment System | |
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| Reasons for Adopting the New Payment System | |
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| Components of the New Payment System | |
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| Effects of Medicare's Payment System | |
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| Is There an Impending Shortage of Physicians? | |
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| Definitions of a Physician Shortage or Surplus | |
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| Consequences of an Imbalance in the Supply and Demand for Physicians | |
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| Economic Evidence on Trends in Physician Demand and Supply | |
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| Longer-Term Outlook for Physicians | |
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| The Changing Practice of Medicine | |
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| Types of Medical Groups | |
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| Changes in the Size of Medical Groups | |
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| Reversal of Fortunes of Large Multispecialty Groups | |
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| Outlook for Medical Group Practices | |
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| Recurrent Malpractice Crises | |
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| Explanations for the Rise in Malpractice Premiums | |
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| Objectives of the Malpractice System | |
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| Proposed Changes to the Malpractice System | |
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| Enterprise Liability | |
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| The Effects of Various Tort Reforms | |
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| Do Nonprofit Hospitals Behave Differently than For-Profit Hospitals? | |
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| Why Are Hospitals Predominately Nonprofit? | |
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| Performance of Nonprofit and For-Profit Hospitals | |
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| The Question of Tax-Exempt Status | |
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| Competition Among Hospitals: Does It Raise or Lower Costs? | |
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| Origins of Non-price Competition | |
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| Transition to Price Competition | |
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| Price Competition in Theory | |
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| Price Competition in Practice | |
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| The Future Role of Hospitals | |
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| From Medicare to the Present | |
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| The Hospital Outlook | |
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| Hospital Revenues | |
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| Potential Hospital Threats | |
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| Alternative Hospital Scenarios | |
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| Cost Shifting | |
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| Setting Prices to Maximize Profits | |
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| Origins of Claims of Cost Shifting | |
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| Price Discrimination | |
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| Conditions Under Which Cost Shifting Can Occur | |
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| The Direction of Causality | |
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| Can Price Controls Limit Medical Expenditure Increases? | |
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| Effect of Price Controls in Theory | |
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| Effect of Price Controls in Practice | |
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| Global Budgets | |
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| The Evolution of Managed Care | |
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| Why Managed Care Came About | |
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| What Is Managed Care? | |
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| Types of Managed Care Plans | |
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| How Has Managed Care Performed? | |
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| One-Time Versus Continual Cost Savings | |
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| The Change in Managed Care | |
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| Recent Developments in Managed Care | |
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| Consumer-Driven Health Care | |
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| Accountable Care Organizations | |
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| Has Competition Been Tried-and Has It Failed-to Improve the US Healthcare System? | |
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| Criteria for Judging Performance of a Country's Medical Sector | |
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| How Medical Markets Differ from Competitive Markets | |
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| Demand-Side Market Failures | |
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| Supply-Side Market Failures | |
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| How Can Medical Markets Be More Competitive? | |
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| What Might Competitive Medical Markets Look Like? | |
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| Are the Poor Disadvantaged in a Competitive Market? | |
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| Comparative Effectiveness Research | |
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| CER and the Role of Government | |
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| Concerns over How CER Will Be Used | |
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| Cost-Effectiveness Analysis | |
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| Quality-Adjusted Life Years | |
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| The National Institute for Health and Clinical Excellence | |
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| US Competitiveness and Rising Health Costs | |
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| Who Pays for Higher Employee Medical Costs? | |
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| Who Pays for Retiree Medical Costs? | |
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| Possible Adverse Effects of Rising Medical Costs on the US Economy | |
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| Why Is Getting into Medical School So Difficult? | |
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| The Market for Medical Education in Theory | |
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| The Market for Medical Education in Practice | |
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| Accreditation for Medical Schools | |
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| Recommended Changes | |
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| The Shortage of Nurses | |
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| Measuring Nursing Shortages | |
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| Nursing Shortages in Theory | |
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| Nursing Shortages in Practice | |
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| Federal Subsidies to Nursing Schools and Students | |
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| The High Price of Prescription Drugs | |
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| Reasons for the Increase in Pharmaceutical Expenditures | |
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| Pricing Practices of US Pharmaceutical Companies | |
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| Ensuring Safety and Efficacy of New Drugs: Too Much of a Good Thing? | |
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| History of Regulation of Prescription Drugs | |
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| FDA's Stringent Guidelines for Safety and Efficacy | |
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| Why Are Prescription Drugs Less Expensive Overseas? | |
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| Accuracy of Studies on International Variations in Drug Prices | |
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| Why Prescription Drugs Are Expected to Be Priced Lower Overseas | |
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| Public Policy Issues | |
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| The Pharmaceutical Industry: A Public Policy Dilemma | |
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| Public Policy Dilemma | |
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| Structure of the Pharmaceutical Industry | |
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| Development of New Drugs by the US Pharmaceutical Industry | |
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| The Political Attractiveness of Price Controls on Prescription Drugs | |
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| Consequences of Price Controls on Prescription Drugs | |
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| Should Kidneys and Other Organs Be Bought and Sold? | |
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| Sources of Organs for Transplant | |
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| Donor Compensation Proposals | |
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| Opposition to Financial Incentives to Organ Donation | |
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| Additional Considerations | |
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| The Role of Government in Medical Care | |
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| Public-Interest View of Government | |
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| Economic Theory of Regulation | |
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| Medical Research, Medical Education, Alcohol Consumption, and Pollution: Who Should Pay? | |
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| External Costs and Benefits | |
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| Government Policies When Externalities Exist | |
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| Divergence between Theoretical and Actual Government Policy | |
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| The Canadian Healthcare System | |
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| Higher Life Expectancy and Lower Infant Mortality Rate | |
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| Universal Coverage | |
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| Controlling Healthcare Costs in Canada | |
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| Consequences of Strict Limits on Per Capita Costs | |
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| Is Canada Abandoning its Single-Payer System? | |
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| Should the United States Adopt the Canadian System? | |
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| Employer-Mandated National Health Insurance | |
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| The Uninsured | |
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| Why the Uninsured Do Not Have Health Insurance | |
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| Consequences of Employer-Mandated Health Insurance | |
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| Political Consequences of Employer-Mandated Health Insurance | |
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| National Health Insurance: Which Approach and Why? | |
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| Criteria for National Health Insurance | |
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| National Health Insurance Proposals | |
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| Refundable Tax Credits: An Income-Related Proposal | |
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| Financing Long-Term Care | |
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| The Nature of Long-Term Care | |
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| Current State of Long-Term Care Financing | |
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| Why Do So Few Aged Buy Long-Term Care Insurance? | |
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| Approaches to Financing Long-Term Care | |
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| The Politics of Healthcare Reform | |
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| Differing Goals of Healthcare Reform | |
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| The Need for Visible Benefits to the Middle Class and Aged | |
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| Groups with a Concentrated Interest in Healthcare Reform | |
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| The Legislative Process | |
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| The Administration's Objective for Healthcare Reform: A Hypothesis | |
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| The Years Ahead | |
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| Brief Summary of the Patient Protection and Affordable Care Act (PPACA) of 2010 | |
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| Glossary | |
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| References | |
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| Index | |
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| About the Author | |