Social Justice and Health-Care Policy

1. Social Justice and Health-Care Policy

2. Commonly Accepted Goals? • 1. Universal Access • 2. Cost controls • 3. Comprehensiveness of Benefits • 4. Freedom of Choice • 5. Freedom from hassle for patients • 6. Quality of Care

3. Justice, Rights, and Societal Obligations • Does society have a moral obligation of health care to all citizens? • Is universal access to health care morally sound? • If so, what level of care is appropriate?

4. Key Concepts • Liberty Personal Freedom, Less Government • Equality Government should guarantee that all people should be treated equal

5. 3 Concepts of Social Justice • Libertarianism • Socialism • Liberalism

6. Libertarian Concept of Justice • Individuals have moral rights to life, liberty and property • The sole function of government is to protect these rights • Individuals have the right to the fruit of their labor (their money)

7. Libertarian Concept of Justice • To take taxes to pay for universal health care would infringe on those rights • It is the individual’s responsibility to provide for their own health care costs • Government should be as small as possible

8. Socialist Concept of Justice • Social equality is the most important goal • Limitations on liberty to achieve social / economic equality is morally right • It is government’s job to insure equality among citizens

9. Socialist Concept of Justice • Those who have more than enough should help those who do not have enough • Government should guarantee the basic needs of its people • Health Care is a basic need

10. Liberal Conception of Justice • Tries to find middle ground between the Libertarian and Socialist concept • Restraint of some liberty is justified to achieve more equality • The extent of restraint differs among liberals

11. Income Tax Rates • http://www.bankrate.com/finance/taxes/tax-brackets.aspx • http://taxfoundation.org/comparing-2016-presidential-tax-reform-proposals • What’s your plan?

12. Trump’s Tax Plan • Up to $30,000, you pay 1% • From $30,000 to $100,000, you pay 5% • From $100,000 to $1 million, you pay 10% • On $1 million or above, you pay 15%

13. Apply to Health Care? • Which view do you agree with?

14. Medicaid • Gov’t program that provides health care to low income families

15. Chargemaster • Hospital computer that determines what you are charged for medical services • Has no relationship to cost

16. Non-profit Hospital • Pays no taxes • Has no stockholders • Pays no dividends • Keeps all profit

17. Where does money go? • Back to hospital • To Administration • To new buildings • To new equipment • To doctors and healthcare workers

18. Medicare • Began in 1965 • People over 65

19. Medicare Policy • By law, must pay average sales price plus 6% • Usually pay 80% of cost

20. Main problem of Healthcare • Cost! • Not insurance

21. Four International Perspectives

22. The Canadian System • Single payer system (Federal and Provincial) • Combines insurance and delivery of health-care by province • Coverage differs by province • Physician income set by government

23. The Canadian System • No competition • Providers are paid either: • - Fixed amount for enrolled patients • - Fee-for-service basis • - Government sets fee schedule

24. The Canadian System • Lengthy waits for elective services • Higher taxes to pay for health care • Inadequate range of community-based services and long-term care

25. The Canadian System • Insufficient federal funding leaving too great a burden for provincial governments • 24 hour service not guaranteed • Rural areas not adequately covered

26. 11.3% of GDP is spent on health, or $4,404 per person • In Canada, government spending on health is 70.5% of all health spending - and private is 29.5% of all health spending

27. How does private health break down? • 49.7% of health spending is 'out of pocket' expenses - 43.3% is in private health plans • How big is the medical system? • There are � doctors, which is 19.8 per 10,000 people

28. The German Model

29. Sickness Funds • With the exception of about 2 million permanent civil servants, and the self-employed, • Germans who earn below Euro 3,862 ($5,000) gross salary per month ($60,000 per year) in 2004 • must join one of the 300 statutory sickness funds.

30. Those above the mandatory insurance threshold may opt out of the state system • and buy private insurance instead • but many opt to remain in the state system – • 10 per cent of the population are voluntarily insured.

31. German sickness funds are required to be financially self-sufficient and premiums are set as a percentage of income. • This percentage varies from fund to fund, with an average of 14 per cent The premiums are deducted from pay packets with employer and employee paying half each.

32. The German Model • 1/10 of population opts for more traditional insurance coverage • Civil servants have governmental health care

33. The German Model • Hospital doctors and nurses are salaried • Costs are controlled by Government

34. 11.6% of GDP is spent on health, or $4,332 per person • In Germany, government spending on health is 77.1% of all health spending - and private is 22.9% of all health spending

35. How does private health break down? • 56.6% of health spending is 'out of pocket' expenses - 40.3% is in private health plans • How big is the medical system? • There are 297,835 doctors, which is 36.01 per 10,000 people

36. British Model • Universal health care provided thru taxes • Citizens can also purchase private insurance • Physicians may participate in both public and private insurance

37. British Model • Costs set by government by limiting supply of service and supplies • Limited choice of primary care physicians • Rationed care

38. 9.6% of GDP is spent on health, or $3,480 per person • In United Kingdom, government spending on health is 83.9% of all health spending - and private is 16.1% of all health spending

39. How does private health break down? • 62% of health spending is 'out of pocket' expenses - 6.5% is in private health plans • How big is the medical system? • There are 166,006 doctors, which is 27.43 per 10,000 people

40. Italian Model • Universal health care • Government funded • Delivered thru territorial agencies

41. 9.5% of GDP is spent on health, or $3,022 per person • In Italy, government spending on health is 77.6% of all health spending - and private is 22.4% of all health spending

42. How does private health break down? • 87.6% of health spending is 'out of pocket' expenses - 4.6% is in private health plans • How big is the medical system? • There are 202,866 doctors, which is 34.86 per 10,000 people

43. United States • 17.9% of GDP is spent on health, or $8,362 per person • In United States, government spending on health is 53.1% of all health spending - and private is 46.9% of all health spending

44. How does private health break down? • 25.1% of health spending is 'out of pocket' expenses - 67.8% is in private health plans • How big is the medical system? • There are 749,566 doctors, which is 24.22 per 10,000 people

45. Ideal Health Care Model • What do you think? • Get into your groups and develop the ideal health care model • What are some of the components it should have?