Transcript Health Policy POLS 21: The American Political System “The best doctors in the world are Doctor Diet, Doctor Quiet, and Doctor Merryman.’ —Jonathan Swift A Portrait.

Health Policy
POLS 21: The American Political System
“The best doctors in the world
are Doctor Diet, Doctor Quiet,
and Doctor Merryman.’
—Jonathan Swift
A Portrait of Health Care in America
A Portrait of Health Care in America
Does all of this money buy us better care?
A Portrait of Health Care in America


The infant mortality rate (IMR) is defined as the number
of deaths of children under age 1 per 1,000 live births in
a given year.
Life expectancy
measured
by the average
The UnitedisStates
has improved
on bothnumber of
additional
years a person
of a given
ageper
could
expect to
measures—from
26 infant
deaths
1,000
live if live
current
mortality
to2008;
continue
births
in 1960,trends
to justwere
6.7 in
andfor the
rest offrom
thataperson's
life. It isofmost
cited as
life expectancy
69.9commonly
years in 1960
life expectancy
birth.
to 78.4 in at
2008.
But we still lag behind other western,
industrialized democracies.
The Problem
High cost
 Unsatisfactory
performance
 Inequalities in
coverage

Why Have Health Care
Costs Skyrocketed?
Increase in the number of Americans using health
insurance
 Traditional fee-for-service systems encourage
unnecessary tests
 Demographic changes have led to an aging population
that requires more care
 Malpractice lawsuits pass costs along to patients and
encourage "defensive medicine"
 Technological developments such as MRIs, CAT scans
and heart transplants are expensive, as are prescription
drugs
 Administrative costs account for 7% of total spent

Managed Care
A Health Maintenance
Organization (HMO) is a
group of doctors and
administrators who agree to
provide a full range of health
services to members care for
a fixed monthly fee. In
order to save money,
patients are limited in their
choices. But in return they
pay just a small fee each
time they see a doctor,
encouraging the kind of
preventive care that can
detect and stop diseases
early on.
Managed Care
A Preferred Provider Organization
(PPO) is a network of independent
physicians who are affiliated with a
plan. If a patient wants care from an
"in-network" provider, the PPO will
pay most or all of the cost. If the
patient wants care from an "out-ofnetwork" providers, the PPO will
require the patient to pay a much
larger part of the bill. Unlike HMOs,
PPOs do not require members to
select a primary care physician.
PPOs pay doctors a discounted rate
in exchange for a steady flow of
patients.
The Health Care Reform Dilemma
Assuring
Access
Accomplishing all
three goals
simultaneously is
the true
challenge
Preserving
Quality
Controlling
Cost
Case #1
Bill Clinton, 1993-1994
Whatever Happened to Health
Care Reform?
“This health care system of ours is
badly broken and it is time to fix it.
Our health care is too uncertain
and too expensive, too
bureaucratic and too wasteful. It
has too much fraud and too much
greed. At long last, after decades
of false starts, we must make this
our most urgent priority—giving
every American health security,
health care that can never be taken
away, health care that is always
there. That is what we must do
tonight.”
Bill Clinton presenting his proposed
health care reform legislation to the
Congress, October 27, 1993.
Harry and Louise
Gentle music plays as the camera closes in on a couple sitting at their kitchen
table, surrounded by stacks of bills, an adding machine and yellow pads. The
words “Sometime in the Future” flash across the screen, presumably referring to
a period after a Clinton-health-care bill is passed.
“But this was covered by our old plan,” says Louise, looking at a bill.
“Oh yeah! That was a good one, wasn’t it?” says Harry. Dressed as an everyman
in a flannel shirt, he is trying to make sense of the paperwork spread out on the
table. He punches numbers into the adding machine. He jots down figures and
then crumples up the paper in frustration. A voice-over says: “Things are
changing, and not all for the better. The government may force us to pick from a
few health care plans designed by government bureaucrats.”
“Having choices we don’t like,” says Louise, her brow knotted in concern, “is no
choice at all.”
“They choose,” says Harry.
“We lose,” says Louise.
Case #2
George W. Bush, 2003
Medicare Prescription Drug, Improvement, and Modernization Act
Medicare Prescription Drug, Improvement
and Modernization Act of 2003
“With this law, we're giving older
Americans better choices and more
control over their health care, so they
can receive the modern medical care
they deserve.”
—President Bush, signing the bill into
law December 8, 2003
“There’s no doubt in my mind that the
drug industry got everything it wanted
and more. It perhaps should be called
the ‘Leave-No-Lobbyist-Behind Bill.’”
—Senator John McCain (R-AZ)
The Donut
Hole
Case #3
Barack Obama, 2010
Patient Protection and Affordable Care Act
The Perils of Health Care Reform
Entrenched interests (e.g., business and
interest groups)
 Partisan rancor
 Low levels of trust in government
 Scare tactics and fear mongering

Obama’s strategy: “Fix what’s broken and
build on what works.”
In other words, think smaller.
For the uninsured, what does
health care cost?
“People, for reasons of their own, often fail to do things
that would be good for them or good for society.”
—Chief Justice John Roberts
“Mr. President, this is a big @*%^$&# deal.”
— Vice President Joe Biden
If you already have health
insurance…
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You can add your adult children (up to age 26) to your
existing health insurance plan.
Your insurance company can no long drop you if you
become sick.
It cannot limit the coverage you receive over your
lifetime.
You cannot be denied coverage if you have a preexisting condition.
Insurance companies must spent at least 80% of
premium payments on medical service (instead of
advertising and executive salaries). If they don’t, you will
receive a rebate on the amount you paid.
If you don’t have health
insurance…
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

By 2014, everyone will be required to have health
insurance. This is called the INDIVIDUAL MANDATE. If
you opt not to purchase insurance, you will pay
eventually a penalty of as much as 2.5% of your income.
Next year, just 1% of family income.
You can buy insurance from a federal or state-run
“exchange” that allows you to compare plans.
You may qualify for Medicaid if you income is under
133% of the poverty threshold. Even if you don’t qualify
for Medicaid, you may be eligible for a tax credit if you
income is under 400% of the poverty threshold.
“If you like your health care plan, you will be able to keep
your health care plan, period."
— President Barack Obama
Assuring that people can keep their current plan “makes
reform more palatable politically,” but it “also makes it worse
as policy.”
— Jonathan Cohn
The Health Care Reform Dilemma
Extends coverage for low-income
families, young adults, etc.
Assuring
Access
How well did
Obama and the
Democrats do?
?
Preserving
Quality
Controlling
Cost
Require citizens to
obtain insurance.
Targets waste,
fraud, and abuse.