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Page 1019 J. B. Case Western Reserve University Who would have predicted at the time of the Arrow article in 1963 the growth in assets invested in health care that we have seen1 fueled by an unprecedented use of tax-exempt debt, retained earnings, and new stock? Enfranchisement of the formerly uninsured through Medicaid and Medicare plus the continued growth of private health insurance have given marginal providers the cash ï¬ow that allowed this dynamic growth in capital investment while substantial subsidies lowered their ï¬nancing cost. Yet it is not clear whether access to new sources of funds precipitated the restructuring of health care or the demand for capital2 was simply the result of fundamental need. Irresponsible investments by managers certainly have occurred.3 Yet once the industry embraced capitalismâs largess, This essay was supported by Grant No. 28665 from the Robert Wood Johnson Foundationâs Investigator Awards in Health Policy Research Program. The opinions and conclusions expressed in this article are solely those of the author and do not necessarily reï¬ect those of the foundation. 1. The Bureau of Economic Analysis, U.S. Department of Commerce (www.bea.doc.gov), reports that net ï¬xed assets have grown to a level ï¬ve times higher proportionally
Journal of Health Politics, Policy and Law – Duke University Press
Published: Oct 1, 2001
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