Janet Bronstein, Ph.D., UAB professor of Health Care Organization and Policy, offers her thoughts on coming health-care challenges.

Janet Bronstein

“The way we’ve handled health care for low-income people in the past has been to segregate them into separate programs: public hospitals, health department clinics, community health centers, Medicaid. We’re always making sure these programs are separated somehow from mainstream programs, and they have been designed to sort of live off the excess in the system. But as more and more people begin to confront the cost of health care, that excess is going away. So in the short term, the safety net that we’ve carved out is definitely vulnerable.”

Back to Managed Care?

“In the long term, I think the whole health-care system is not really viable the way we’ve been operating it, with employer-based health insurance. It doesn’t make much sense considering the way the new job market is, and it leaves too many gaps for too many people. Once access to health care becomes a “middle-class problem,” then you will see a different kind of public policy response. I think we have to move back to managed care. I think the Kaiser Permanente model is just going to be more and more attractive, both for quality of care and for cost reasons.”

Insurance for All

“We need to build a more viable health-care system and then have some kind of health-insurance scheme that everyone can participate in. We need to have the expectation that people will carry insurance and then provide subsidies to make it affordable.”