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Health Care. 4/17/2012. Learning Objectives. Accurately describe the social, economic, and political dimension of major problems and dilemmas facing contemporary American society

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Health care

Health Care

4/17/2012


Learning objectives
Learning Objectives

  • Accurately describe the social, economic, and political dimension of major problems and dilemmas facing contemporary American society

  • Use knowledge and analyses of social problems to evaluate public policy, and to suggest policy alternatives, with special reference to questions of social justice, the common good, and public and individual responsibility.


Opportunities to discuss course content
Opportunities to discuss course content

  • Today-11-2

  • Wednesday 10-2


Readings
Readings

Required

  • Health and Welfare (Chapter 5 pp 97-115) Dye

  • American Dilemmas Handbook pp. 27-38

    Optional

  • Health Care: Problems of Physical and Mental Illness (Chapter 10) Kendall



The problems of the system
The Problems of the System

  • Access

  • Cost

  • Quality


Problem 3 cost
Problem 3: Cost

  • Outpacing Inflation

  • Why


Cost labor
Cost- Labor

  • 5.5 People per patient (the old days)

  • Jobs that require skill and education

  • Recession Proof


Cost malpractice
Cost- Malpractice

  • Actually not the suits themselves

  • Defensive medicine

  • High Insurance- just in case


Cost greedy people
Cost- Greedy people

  • We want to get our benefits back

  • We do not realize the actual costs

  • A “Tragedy of the Commons”


Cost an older population
Cost- An Older Population

  • Our last years of life consume much of our health care dollar

  • We are living longer and there are more of us

  • More Care means more $


Cost and prescription drugs
Cost and Prescription Drugs

  • Average cost is $2400

  • 9 in 10 Seniors use a drug

  • Direct to Consumer Ads


Patient protection and affordable care act

The Solution

Patient Protection and Affordable Care Act


What is it
What is it

  • A law that will get health insurance to roughly 30 million Americans

  • Not a single payer system



How will it work expanding federal programs
How will it Work: Expanding Federal Programs

  • Getting those eligible on programs they are eligible for

    • Expanding Medicare Eligibility

    • Expanding COBRA health insurance

    • Expanding SCHIP Program


How will it work making changes to private insurance
How will it Work: Making Changes to Private Insurance

  • Cannot Deny for Pre-Existing Conditions

  • Cannot remove people who use up their coverage

  • The Slackers mandate

  • Subsidies to purchase insurance


How will it work individual mandates
How will it Work: Individual Mandates

  • People will be required to have health insurance

    • Just as we are required to have auto insurance

  • Up to 2.5% of income by 2016


What if i have insurance
What if I have Insurance?

  • In theory it should not change

  • Your employer, however, can just cut you off


When does it start
When does it start

  • Mandates begin in 2014

  • Costs should be lowered over time as people have insurance


How can we afford this
How can we afford this

  • 1 Trillion over first 10 years

    • Tax on Tans

    • Higher Medicare taxes on wealthy and Medicare cuts on providers

    • Taxes on High-end insurance

    • Fees on Health Care Industry


Upwards of 20 million mayremain uninsured
Upwards of 20 million mayRemain Uninsured

  • Illegal Immigrants and non-citizens (10 million)

  • People who do not sign up for eligible programs.

  • People who pay the penalty (mostly younger and single Americans.



Democratic strategy
Democratic Strategy

  • Draw a line on health care and do not let the Republicans cross it

  • Use institutional advantages to delay change

  • Focus on the popular parts of the law

  • Re-Cast the GOP into the Party of No (Part II)


Democratic advantage 1 laws are difficult to repeal
Democratic Advantage 1: Laws are Difficult to Repeal

  • They come in with political support and they retain that support

  • Minor changes and fixes only serve to strengthen the existing law!

  • Prohibition lasted for 13 years



Democratic advantage 3 divided government
Democratic Advantage 3: Divided Government

  • Use Senate Majority to control the Agenda

  • Filibuster when necessary

  • The Presidential Veto as a last resort


Democratic advantage 4 no new taxes in 2011 or 2012
Democratic Advantage 4: No new taxes in 2011 or 2012

  • FSA limits in 2013

  • Medicare tax increase by 0.9% and 3.8% tax on investments income for high-wage earners in 2013

  • Individual mandate in 2014

  • Cadillac Tax in 2018



Repeal the bill through other means

The Republican Strategy

Repeal the bill through other means


Republican strategy
Republican Strategy

  • A straight-up repeal was unsuccessful

  • Continue to push the issue through other political avenues

  • Force this as a campaign issue in 2012


Republican advantage 1 consensus in the party
Republican Advantage 1: Consensus in the Party

  • The Republicans are unified in the support for repeal.

  • Try to exploit Democratic cleavages between those who want to keep the existing law, and those who may want to strengthen it.

  • Try to switch Democrats to their side



Republican advantage 3 the individual mandate
Republican Advantage 3: The Individual Mandate

  • This is key to the success of the bill

  • And one of the least popular portions

  • Expect Heavy Resistance if the GOP tries

  • Which is exactly what the GOP wants



On repeal
On Repeal

Probably For Repeal

Probably Against Repeal

Ruth Bader-Ginsburg

Stephen Breyer

Sonia Sotomayor

Elena Kagan

  • Antonin Scalia

  • Clarence Thomas

  • Samuel Alito


On the fence
On the Fence

Chief Justice Roberts

Justice Anthony Kennedy