America’s Health Care Debate

1. America’s Health Care Debate The Problem The Debate The Solutions?

2. The Problem • The U.S. has been involved in a debate on how to best deliver health care to its citizens for three decades. • The US system is the most expensive in the world • We pay almost twice per person for health care than other industrialized countries. • The US ranks 37 in the world in overall health in the world, between Costa Rica and Slovenia. • The US is the only industrialized country in the world without some form of universal care. • The Effect on Families • Average cost for an employer provided family policy: $12,680 a year. • Workers with employer provided insurance pay up to $4000 for their share of the policy premium. • 47 million Americans are uninsured. • 50% of all personal bankruptcies are partly from medical expenses. • We pay more for less coverage and the average cost increase each year is 4% to 20% • The Effect On Businesses: • Health Care is causing a major economic drag on our businesses, large and small. • Companies are abandoning health insurance as a benefit. Wage increases are eaten up increased costs of premiums. • Health Care costs drive up the cost of goods we buy (adds $1,525 to the price of a GM automobile). • On Government: • Growing problem in covering Medicare and Medicaid spending, both are facing huge deficits. (Medicare may be bankrupt in the next 20 years, maybe) • Government spending on health care has increased 40% and is expected rise, putting huge strains on our budgets.

3. The Debate Crucial Questions: • What is the best way to deliver health care in the least expensive, most effective and efficient way? • Is health care a right in the U.S., like voting, gun rights, freedom of religion, free speech, Or is it a privilege? • What changes can we make to improve our ailing system? Or do we have to start over again? Competing Sides: • Free Market Advocates (Conservatives, Republicans) • Open up health care to the free market: allow competition across state lines • Limit or eliminate malpractice lawsuits • Tax breaks for uninsured families to purchase insurance. • Eliminate waste, fraud, and abuse of Medicare and Medicaid • Universalists (Liberals, Democrats) • Single Payer, Universal Health Care • Promote prevention and wellness with the insured. • Government negotiation for procedures, care and prescription drugs to lower costs. • Eliminate waste and fraud in Medicare and Medicaid

4. American Health Care System Private Insurance System: • Insurance provided by employer or purchased individually from private, for profit insurance companies. • Patients can (theoretically) choose the physician or the specialty physician. • Incentives to researchers for new drugs or new techniques. • Public Insurance for: the Elderly (Medicare), the Poor (Medicaid), the Unemployed (COBRA), and Veterans (VA) • Benefits: • High quality care for those with good insurance. • Leader in medical research, technology, and treatments. • Large number of doctors, hospitals, and clinics. • Choice of doctors, care givers, hospitals (theoretically). • Criticisms: • Insured, Uninsured, Underinsured Americans • 47 million Americans are uninsured (low paying jobs, the unemployed). • Millions of Americans are underinsured (basic coverage or high deductibles) • Health crisis is the largest single reason for personal bankruptcies among insured Americans • World Health Rankings • #1 in the world in cost of health care, #37 in results (37th healthiest nation) • Expensive premiums, co-pays, deductibles, and patient contributions. • Expensive for businesses and families • Causing business/personal bankruptcies • Employers/families dropping health care coverage for financial survival • Premium increases yearly of 5-25%. • Insured Americans Pay for Uninsured Americans • Through unpaid medical bills or through tax-subsidized government programs. • Encourages high tech and expensive care, not primary care or prevention. • Pre-existing Conditions: • Care and/or coverage can be denied because of medical conditions existing prior to coverage.

5. Affordable Care Act Affordable Care Act (2010): aka Obamacare, Health Care Reform Act • Mandated Insurance: • Everyone must be insured, by an employer or individually. • No insurance? you will be fined. ($2,085 by 2016) • Health Exchanges: • A marketplace where insurers will offer affordable health plans to consumers looking to buy insurance. • Financial aid and subsidies will be provided to lower incomes to buy coverage. • Pre-existing Conditions: • Insurers cannot deny you coverage if you have a prior medical condition • Insurers can’t drop you from coverage if you are already insured. • Young Adult Coverage: • Parents can keep their children covered on their policy until they reach age 26. • Small Business Tax Credits: • Small businesses given tax credits for offering insurance to employees. • Preventative Care: • New plans must offer free prevention screenings (mammograms, colonoscopies) free of charge. • Invests in pro-health programs: anti-smoking, obesity, etc… • Medicare/Medicaid: • Closes the “donut hole” ($250 gap) in prescription drug coverage for seniors. • Crack down on health care fraud, including Medicare Fraud. • Provides funds for states to offer Medicaid to more people. • Quality Care: • Steps to improve the quality and affordability of care with standard and best procedures, eliminate unnecessary procedures and scans, providing information on providers and procedures. • More information: http://www.health.gov

6. Universal Health Care Single Payer System: • Universal and comprehensive coverage of all citizens. • Different Delivery Methods: • Socialized Medicine: • Government run. • Private and public doctors/hospitals. • Everyone covered. Example: Great Britain’s National Health Service (NHS) • Social Insurance: • Government is the insurer or private insurance through non-profit insurers. • Private doctors and hospitals. • Everyone is required to be covered through employer or private plans. Ex: Canada, Japan, Switzerland, Germany, Taiwan • Patients choose the providers and doctors. Hospitals are non-profit businesses. • All industrialized countries have some form of universal care (Exception: the U.S.) • Benefits: • Simple and easy to use: • Little paperwork, no fighting with insurance companies • Everyone has the same coverage and benefits. • Employers not burdened with high health care costs. • Smaller premiums and/or no premiums. • Large Bargaining Pool: Cheaper costs • Prices for care/procedures negotiated or set by government (Ex: Great Britain $10 prescriptions) • Supplemental Insurance can be bought for certain procedures but is generally not necessary. • Emphasis on prevention. • Criticisms: • Rationing: • Tight budgets may mean tightening or curbing of benefits or raising taxes. • Waiting: • Depending on the area, wait times for care or procedures can exist from a week to months. • Who Decides: • Critics say government decides who gets care and/or procedures are done. • Sometimes not used enough. • Strain on private doctors and hospitals who aren’t getting business.

7. Other Considerations • Public Option: (Democrat’s Idea) • A government provided , taxpayer funded plan to compete with private plans on the Health Exchange Market • Used to keep insurers honest and offer quality and affordable plans. • Critics believe it will drive private insurers out of business: won’t be able to compete with cheaper government plans. • Critics also believe it’s a slippery-slope: a way to introduce Universal Health Care on the U.S. • Proponents believe its to only way to keep the private honest and affordable. • End Of Life Counseling: • Provisions in the law • Managed Care Plans (HMO’s-Health Maintenance Organization) • Consumers are locked into using specific providers who will charge reduced fees. • Insurance company must approve before benefits are received. • All plans are different in cost and what they offer. • Insurance companies decide how medical care is rationed. • Financial incentives for patients to stay healthy. • Hurts small businesses who can’t afford the high premiums. • Less choice in doctors and providers. Must choose “in network” providers. • Insurance company and policy decide what care is given to whom. • Employers may opt for cost effective plans, rather than good plans. • More Information: http://www.factcheck.org/2009/08/seven-falsehoods-about-health-care/

8. The Assignment: • Choose a side of the issue: How should the US deal with its health care • Research two arguments for the side of the issue that you have chosen. • Places to search: • Think Tanks, Political Parties, Medical or Political Organizations, Political Candidates. • News sites (CNN, FOX News, MSNBC, Time, Newsweek, US News, NY Times, Washington Post, Star Tribune, etc..) • Put together 2 items: • Small Display or PowerPoint showing each argument for or against. • 1 Page opinion paper on what you believe in regards to this issue. What do you think and why. Points: 25 Points • 10 Points for Opinion • 15 Points for Display