health care 2010
TRANSCRIPT
Uncle Sam, The Beaver and Healthcare:
North American Responses
Dean June [email protected] James Rooney [email protected]
Ruth Writer [email protected]
Overview: Canadian Perspective
Origins of Canadian Health Care Current Status of Nova Scotia Health Care Health Care Funding Health Care examples of challenges & impact on the families What if it’s not covered? Why need to routinely register for Health Care?
U.S. Perspective History of U.S. Health Care Debate Medicare and Medicaid Current Status of U.S. Health Care Health Care Funding Challenges and Impacts on Health Care Current Debate
Major Differences Questions and Answers
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History of U.S. Healthcare DebateRuth Writer [email protected] 1798—Relief of Sick and Disabled Seaman Act 1870s—Patrons of Husbandry Teddy Roosevelt Calvin Coolidge Franklin D. Roosevelt Harry S. Truman John Kennedy Lyndon B. Johnson Richard M. Nixon Ronald Reagan George H.W. Bush Bill Clinton Barack Obama
1798—5th Congress Relief of Sick and Disabled Seaman Act Some argue: Congress mandate proof Purchase of health insurance from private company Imposed tax, collected tax, spent tax Others argue: precedent for Medicare 1798 Act viewed as beginning of creation of U.S.
Public Health Service No order for seamen to buy any form of private
insurance Was precedent of federal involvement in health care
1870s—Grange Movement Helps organize access to health care For farmers in Plains states
Teddy Roosevelt--1912 Aligned with Progressive Movement First attempt to pass universal health
care bill Square Deal
Guaranteed medical coverage All Americans covered
World War I outbreak—derailed plan Followed by Red Scare
Calvin Coolidge--1927 Committee on Cost of Medical Care Investigation of U.S. health care
system Recommendation that private
insurance OR taxes support health care
October 1929—derailed plan
Franklin D. Roosevelt--1935 FDR campaigned on health care platform
Aggressive action called for Major changes to system
Social Security Provided safety for older citizens Provided for sick and disabled
National Health Insurance Program Never seriously considered Nation focused on economic recovery after Great
Depression
Harry S. Truman--1945 Attempt to enact compulsory health
insurance Endorsed Murray-Wagner-Dingell bill Bill failed HST developed plan for 60 days of
free hospital care for Social Security recipients—later part of Medicare/ Medicaid
“The health of American children, like their education, should be recognized as a definite public responsibility.”
--Harry S. Truman 11/19/45 from Truman Library and Museum
Five issues Lack of doctors, dentists, nurses and other
health professionals in rural and low income areas
Lack of quality hospitals—federal funding should be provided
Call for board of doctors and others to create hospital standards
Board responsible for directing federal funds for medical research
NATIONAL HEALTH INSURANCE PLAN Most controversial
National Health Insurance Plan Open to all Americans Remain optional Participants
Pay monthly fees Plan would cover any/all medical costs Cash balance to replace lost wages
Doctors Option to join program
Failed AMA attacked bill as communism and
socialized medicine Forerunner of McCarthy era rhetoric Organized labor supported plan but lost
public goodwill due to strikes Korean War Did publicize issue of health care Blue Cross-Blue Shield did grow
From 28 million policies to 61 million
Kennedy and Johnson JFK platform—medical care benefits Assassination—11/22/63 LBJ—continued health care priority
Medicare Medicaid Coverage for elderly and poor Alliance between medical institutes and
private insurance
Nixon--1973 Health Maintenance Organization Act--Managed health care Intended to reduce cost of health care
economic incentives for physicians and patients to select less costly forms of care;
programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing;
controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; the intensive management of high-cost health care cases
HMOs allowed [now over 75 million Americans in HMOs] Health care on prepaid basis Emphasis on prevention
Allocated funds Grants Loans To fund and expand health organizations
Jimmy Carter--1977 Health Security Plan
Required employers to offer health insurance
Expand Medicare Expand Medicaid
Recession derailed plan Role of Ted Kennedy described in
Carter’s White House Diary
Ronald Reagan--1985 COBRA—Consolidated Omnibus
Reconciliation Act Mandated insurance program
Gave some employees ability to continue health insurance coverage
From workplace after leaving job
George H.W. Bush Americans With Disabilities Act Wide range of protection
Bill Clinton—1990s Offered plan for universal coverage
Due to thousands loosing jobs Thus lost health insurance Universal coverage Managed insurance competition
Opposition from insurance companies killed bill
According to Role of Hillary Clinton
Republican Opposition 1991—Newt Gingrich Predicted the “next great offensive of
the Left…socializing health care.” Declared need for hardline
Clinton 1992 Called for “managed competition” 8 month quest to define his approach July—nominee vowed to “take on
health care profiteers and make health care affordable for every family.”
Voters ranked health care far behind economy as priority
Harry and Louise Ads The iconic 'Harry and Louise' commercials
helped doom the Clinton administration’s health care reform effort. Represent “everyman” in America
Opponents spent $20 millionduring the 1994 debateHealth Insurance Assoc. of Am.
develop alternative planNational Federation of Independent
Business
Clinton laws: Family Medical Leave Act HIPPA—portability and accountability
1996 Even if change jobs Even if preexisting condition
S-CHIP 1997 Expansion of insurance of children 2007—increased by 4 million in middle class
As the 20th Century Neared the End U.S. had the highest health care costs in
the world Only major democracy with a substantial
fraction of the people without basic medical insurance
Each attempt in the 1900s opposed by Physicians Big business Lawmakers of opposition party
--Derek Bok, Harvard University, “The Great Health Care Debate of 1993-1994,” www.upenn.edu
Health Care Costs in U.S. Still climbing in 2008
$2.6 trillion www.closeup.org $8000 for every American 18% of U.S. economy www.CBO.gov 3 times cost of 1990 8 times cost of 1980
Rose 2.4% faster than annual GDP since 1970
Annual growth rate of 4.4% in 2008 Still 50 million were without health care in
2008—cannot afford
How is U.S. health care $$$ spent?
Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group
study done by Pricewaterhouse Coopers on behalf of America’s Health Insurance PLans (AHIP)
What is driving health care costs? Technology and prescription drugs
Leading factor—equipment, training, technicians Research and development
Chronic disease 75% of expenditures
Aging population Baby boomers in Medicare 2011 By 2020 = 16% of population
Administrative costs 7% of costs Marketing, billing Less than 2% in Medicare system
Don’t see bills itemized Uninsured 46 million
Cost due to less preventative care
Who pays? Government = 50% Private
Private insurers For-profit hospitals
Those who cannot afford
Barack Obama Platform Sudden death of Ted Kennedy 8/09 Law passed in 2010 Guaranteed universal coverage Gradual implementation through ‘14
“I suffer no illusions that this will be an easy process. It will be hard. But I also know that nearly a century after Teddy Roosevelt first called for reform, the cost of our health care has weighed down our economy and the conscience of our nation long enough. So let there be no doubt: health care reform cannot wait, it must no wait, and it will not wait another year.” —President Obama 2/24/09
Medicare today Baby boomers entering system 41 million and growing Part A—hospital care Payroll tax of 1.45% Part B—supplemental
80% of doctors, lab fees, etc. Part D—prescription drugs since 2003
Medicaid today 38 million + receive Low incomes Matching state funds Each state sets standards Cost increasing annually
www.pbs.org
Insurance 60% with jobs pay premiums Others buy own Pay part of health care expenses After the fact—submit bills to
insurance Patients pay deductible—up to 20% No comparison shopping
8 principles Reduce long term growth of cost Protect families from bankruptcy Choice of doctors and health care plans Prevention and wellness care Improve safety and quality of care Affordable, quality for all Americans Maintain when change jobs No pre-existing condition issue
--Close Up, --Close Up, Current Issues, 33Current Issues, 33rdrd edition edition, 2009-10, 2009-10
Other concepts to reduce costs: Invest in information Greater use of technology
Electronic medical records (EMR) Improving quality and efficiency Adjusting provider compensation Increasing consumer involvement in purchasing
Health reimbursement accounts (HRA) Greater price transparency
Altering the tax preference for employer-sponsored insurance
www.kaiseredu.org
Big issues: Single payer option Similar to Canada and Australia Eliminate middle man Impact on insurance industry
Some Opponents Now Supporters More groups using ads to push reform Thus gain seat at table Harry and Louise Part II
Paid for by National Federation of Independent Businesses
Pharmaceutical Industry AARP—priority in 2008 American Cancer Society American Hospital Association
Others still opposed Complete overhaul would be catastropic Tamper with best hospitals and doctors Adding uninsured would overwhelm and
cripple system Result in rationing Longer waits Higher taxes
--Close Up, --Close Up, Current Issues, 33Current Issues, 33rdrd edition edition, 2009-10, 2009-10
R.J. Matson, NY, The New York Observer and Roll Call
Comprehensive v. Incremental? Comprehensive
Medicare/Medicaid do not provide full coverage
Must be replaced by universal health care coverage
Better equipped to provide care for all
Incremental Universality not
practical Current system too
cjmplex Inferior care at higher
cost Give employers
incentives to provide catastropic insurance
Give individual tax deductions for insurance
Close Up, Current Issues 33rd edition, 2009-10
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Questions to PonderDo you think the health organizations have caught the Swine Flu outbreak early enough, or do you think it will escalate into a
full-blown pandemic?
What steps should you take to minimize your chance of catching the swine flu?
Do you think the border between Mexico and the United States should be closed down except for essential traffic? What sort of supplies should you have on hand, in case the problem escalates?
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