Throughout its history in the United States. medical care has been on a fee-for-service basis: Patients arc billed individually for each service they receive, ineluding
treatment by doctors. labo atory work. hospital visits. prescriptions, and other health-related e penses. Fee for service is an expensive way to deliver health care because there arc few restrictions on the fees charged by doctors, hospitals. and other medical providers. . There ~re both good and bad sides to the fee-forservice
approach. 111e good side is that ill the “true the Ritz’ hut a 19-room wing ofthe Mt. Sinai Medical Center, one of the nation’s leading hospitals …. Here at Mt. Sinai and a few other top hospitals … sheets are lSD-count cotton, the bathrooms are marble and stocked with toiletries. and there is ample room to accommodate a nice seating group of leather wing chairs and a brocade soia. And here no call button is pressed in vain. Hospital personnel not only come when summoned but arc eagerly waiting to cater to your every need …. On these select floors. multi-tiered food service carts and their clattering. plastic trays are gone. “Room service” is in full force. Meals are presented. often course by course. by bow-tied. black-jacketed waiters from rolling. linen-covered tables. (Winik, 1997).
The additional charges for rooms on floors such as those described above may run from $250 to $1.000 per night more than the cost of the standard private room (Winik. 1997). Obviously. this sort of medical care is not within the budget of most of us. However. the cost of health care per person in the United States rose from SI41 in 1960 to $7.900 (more than fifty times as much) in 2007 (National Coalition on Health Care. 2008) and is still increasing. ~ Figure 18.2 reflects recent cost increases, Keeping in mind the issues that have been raised throughout this text regarding income disparity in the United States. the questions to be considered at this point are “Who pays for medical care. and how?” and “What about the people who simply cannot afford adequate medical care?”