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Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Chapter 19
Edwards, Wattenberg, and LineberryGovernment in America: People, Politics, and
PolicyFourteenth Edition
Policymaking for Health Care
and the Environment
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Roots of Health Care Policy Governments have long advocated for
public health.
National health insurance was considered in
1930s.
Failed due to lobbying of American Medical
Association.
Government’s role has expanded over time.
No universal coverage exists.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Health Care Programs Today Government provides care for veterans and
Indians.
Sponsors research at National Institutes of Health.
Most people use single-payer private healthcare
system.
Costs are rapidly increasing.
Government funds Medicare and Medicaid.
Also plays a major role in public health
management.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011).
Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Global $899
1 United States of America $7,164
2 Luxembourg $5,996
3 Monaco $5,750
4 Norway $5,207
5 Switzerland $4,815
6 Netherlands $4,233
7 Malta $4,197
8 Austria $4,150
9 Belgium $4,096
10 Germany $3,922
11 Canada $3,867
12 France $3,851
13 Denmark $3,814
14 Ireland $3,796
15 San Marino $3,690
16 Sweden $3,622
17 Iceland $3,583
18 Australia $3,365
19 Finland $3,299
20 United Kingdom $3,222
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Health Care PolicyThe Health of Americans
Americans generally lag behind other countries Lower life expectancy and higher infant mortality rate
The Cost of Health CareAmericans spend more than any other country—
$2.3 trillion and one-seventh of GDP.Reasons for high costs:
High-tech medicineInsurance pays for health care.Malpractice lawsuits leads to defensive medicine,
which drives up costs.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Uneven Coverage, Uneven Care
Health Insurance facts46 million have no insurance.
Most common reason for no insurance is losing or changing a job.
Health insurance closely tied to income —Higher income = more insurance
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Managed Care
Health Maintenance Organization (HMO): organization contracted by individuals or insurance companies to provide health care for a yearly fee.
Designed to reduce costs through oversight and limiting patient choices.
Limits choice of health care providers
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1 Monaco 89.7 2011 est.
2 Macau 84.4 2011 est.
3 San Marino 83 2011 est.
4 Andorra 82.4 2011 est.
5 Japan 82.3 2011 est.
6 Guernsey 82.2 2011 est.
7 Singapore 82.1 2011 est.
8 Hong Kong 82 2011 est.
9 Australia 81.8 2011 est.
10 Italy 81.8 2011 est.
11 Jersey 81.4 2011 est.
12 Canada 81.4 2011 est.
13 France 81.2 2011 est.
14 Spain 81.2 2011 est.
15 Switzerland 81.1 2011 est.
16 Sweden 81.1 2011 est.
17 Israel 81 2011 est.
18 Iceland 80.9 2011 est.
19 Anguilla 80.9 2011 est.
20 Bermuda 80.7 2011 est.
49 Portugal 78.5 2011 est.
50 United States 78.4 2011 est.
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html
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Rank Country or territory
Infant mortality rate
(deaths/1,000 live births)
- World 42.09
1 Singapore 2.31
2 Bermuda 2.46
3 Sweden 2.75
4 Japan 2.79
5 Hong Kong 2.92
6 Macau 3.22
7 Iceland 3.23
8 France 3.33
9 Finland 3.47
10 Anguilla 3.52
11 Norway 3.58
12 Malta 3.75
13 Andorra 3.76
14 Czech Republic 3.79
15 Germany 3.99
16 Switzerland 4.18
17 Spain 4.21
18 Israel 4.22
19 Slovenia 4.25
20 Liechtenstein 4.25
21 South Korea 4.26
22 Denmark 4.34
43 5.72
44 Cuba 5.82
45 Guam 6.05
46 United States 6.26
European Union
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The Role of Government in Health Care
Government in the United States plays smaller role than governments in other countries
National Health Insurance: a compulsory insurance program for all American that would have the government finance citizens’ medical care. Current plan (“Obamacare”)- Private insurance or Gov’t Insurance. Phased in 2010-2018.
Medicare: provides hospitalization insurance for elderly and optional coverage for other medical expenses
Medicaid: public assistance program to provide health care for the poor, which is funded by both national and state governments
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Policymaking for Health Care
Interest groups play a major role in health care policy making, leading to uneven government and private health care policies.
– Elderly– Businesses / Labor groups– Insurance companies– Health providers
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Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
http://ucatlas.ucsc.edu/spend.php
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Two Presidents, Two Health Care Plans
Clinton •Guarantee health care coverage for all•Paid for by employers who pay a premium
into a public fund and tax increases on cigarettes
• Interest groups lobbied hard against this bureaucratic and complicated plan which died in Congress.
Bush•Health savings accounts•Drug benefits for elderly through Medicare
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The Health Policy Issues Ahead
Nothing suggests health care will become cheaper.
Health Policy Controversies– Stem cell research
•Limits on federal funding and research, but states spending more
– Is medical rationing the solution to high health care costs?
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U.S.A. Ranked 37th by W.H.O.
Health (50%) : disability-adjusted life expectancy (homicides, obesity*)
Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities
Fair financial contribution 25% (lack of insurance, 37%+ by choice*)
* John Stossel criticisms
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Chapter 19
Environmental Policy
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3 reasons why environmental policy is
controversial…Policy creates winners and losersScientific uncertaintyEntrepreneurial politics
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ENTREPRENEURIAL POLITICS
BENEFITS TO MANY
COSTS TO ONLY A FEW
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Environmental policy in America
More adversarial than most European nations.
What is done depends heavily on the states.– Federalism causes conflict
• Different Levels of Government
– Separation of powers causes complications• The 3 Branches of Government
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Environmental Policies in America
Environmental Protection Agency: A federal agency created in 1970 and
charged with administering all the government’s environmental legislation
Administers policies dealing with toxic wastes
The largest independent regulatory agency
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MAIN GOVERNMENT AGENCY
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Environmental Policies in America
Clean AirClean Air Act of 1970
Charged the Department of Transportation with responsibility to reduce automobile emissions.
1990 amendments allowed emissions trading
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Las Vegas
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THE GROWTH OF BALTIMORE(Urban Sprawl)
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U.S.A. Car Fatalities1972 = 52, 3892003 = 42, 884 2004 = 42, 6362006 = 41, 3542008 = 31,110 (Jan–Oct)
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
TYPES OF ACCIDENTAL DEATHS, USA 2002
PERCENT
(1) Motor vehicle (MVA) 44.30%
(2) Falls 17.80%
(3) Poison,liq/solid 13.00%
(4) Drowning 3.90%
(5) Fires, Burns,Smoke 3.40%
(6) Medical/Surgical Complication 3.10%
(7) Other land transport 1.50%
(8) Firearms 0.80%
(9) Other (nontransport) 17.80%
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
West Jordan, Utah Population1950 2,1071960 3,0091970 4,2211980 27,1921990 42,8922000 68,3362009 104,915
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Dayton, Ohio Population
1830 2,950 —
1840 6,067 105.70%
1850 10,977 80.90%
1860 20,081 82.90%
1870 30,473 51.80%
1880 38,678 26.90%
1890 61,220 58.30%
1900 85,333 39.40%
1910 116,577 36.60%
1920 152,559 30.90%
1930 200,982 31.70%
1940 210,718 4.80%
1950 243,872 15.70%
1960 262,332 7.60%
1970 243,601 −7.1%
1980 193,536 −20.6%
1990 182,044 −5.9%
2000 166,179 −8.7%
2009 153,843 −7.4%
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Environmental Policies in America
Clean WaterWater Pollution Control Act of 1972
Intended to clean up the nation’s rivers and lakes requiring the use of pollution control technology.
Has helped reclaim numerous rivers and lakes since its passage
But misses “runoff” pollution from city streets and other areas.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Grand Lake Ohio 2010-11
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Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Retention Ponds
Prevent floodingStorm /
Displaced water storage
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Environmental Policies in America
Wilderness PreservationThe U.S. is a world leader.National parks / national forests restrict use to
keep them for future generations.
George W. Bush proposed letting states decide on roads in wilderness areas.
Endangered SpeciesEndangered Species Act: federal government
must protect actively endangered species—regardless of economic impact
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Environmental Policies in America
Toxic WastesSuperfund: created by Congress in 1980 to clean
up hazardous waste sites; money comes from taxing chemical products
Has virtually eliminated haphazard dumping of toxic waste, but less successful in cleaning up existing waste
Nuclear waste presents a serious challengeYucca Flats, Nevada as home for nuclear waste
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SUPERFUND CLEANUP SITES
Green=Cleaned Yellow=Proposed Red=Identified
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Energy Sources and Energy Politics
87% of the nation’s energy comes from coal, oil, and natural gas.
Coal is the most abundant fuel—90 percent of nation’s energy resources—but also the dirtiest.
Oil accounts for 40% of our energy, but creates a dependence on foreign (especially Middle East) sources.
The most controversial energy source is nuclear.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Energy Policy
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Energy Policy
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The Global Warming Gridlock
Earth is expected to warm between two and six degrees by 2100 due to carbon dioxide.
Total costs could be $5 trillion.
United States is leading producer of carbon dioxide, but has not ratified Kyoto treatyKyoto requires reduction in greenhouse gas.
States, like California, are reducing emissions.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Groups, Energy, and the Environment
Environmental clean up is political since it puts “public” goods against other private concerns.
Explosion of groups formed to protect the environment in 1960s and 1970s.
Opposition to strict environmental laws, claiming it may hurt economy.
Policies will be controversial and expensive.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Democracy, Health Care, and Environmental Policy
The issues involve all levels of governments.
High-tech issues limit citizens’ participation.
Relies heavily on group participationGroups, not individuals, have resources
needed to afford the research into the science and policy of the issues.
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The Scope of Government and Health Care and Environmental
PolicyAs citizens want more health care
reform, government will grow.
Increased environmental protection will also increase the size of government.
With party divisions, incremental, not fundamental change is most likely.
Copyright © 2009 Pearson Education, Inc. Publishing as Longman.
Summary
Technology is important to health and environmental policies.– Advances have improved health care but
also increased its cost.– Advances have improved quality of life,
but reliance on coal and oil as sources of energy have contributed to environmental degradation.
Government will continue to grow to address these policy issues.