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Health Care
Is it a Legal Right
• No– Not Mentioned in the Constitution
– Not wanted by the States
– It therefore belongs to the people
• We view it, however, as a right
Health Care Has Multiple Goals
• Being Healthy
• Living a Long Life
• Having Good Medical Care
• Making sure Everyone has this
These goals make policy difficult
How Much do We Spend
• 2.2 Trillion Dollars
• 8000 Per person
• 16.2% of the GDP
A Hybrid System of Public and Private
• Modern Health Care is a product of the 1930’s.
• 46% is paid for by the government
• The Rest is from employers, and individuals
Where the Money Comes From
What the Government Covers
• Medicaid
• Medicare
• SCHIP
• Veterans Administration
• Government Employees
Medicaid
• Health Care as Welfare
• Single Largest Welfare program for the poor
• Fraught with problems
Medicare
• Non-Means Tested
• Increasingly Expensive
• Fraught with Problems
Private Insurance
• Fee For Service
• Managed Care- 90% of all private insurance
SCHIP
• Health Care for Children on the Bubble
• Increasingly Expensive
Terms of Health Care
• Premium
• Deductable
• Copayment
How We Get our Health Care
Strengths of the System
• Best Doctors and Hospitals
• Most Advanced Treatment
• Most Research and Development
• People with Health Care are satisfied With it.
The Problems of the System
• Access
• Cost
• Quality
The Problem of Access
The Problem of Access
• It is not “46 Million Americans”, but 46 Million in America
The Problem of Access
The Problem of Access
The Problem of Access
Why People do not have insurance
• Who are they?
• Health Care is an opportunity cost
Options for the Uninsured
• E.R.
• Self Medicate
• Do Nothing
Problem 2 Quality
• Quality is maldistributed
• We focus on sickness, not health
• We are overspecialized
Problem 3: Cost
• Outpacing Inflation
• Why
Cost- Technology
• MRI’s
• Bypass surgery
• Fake Knees and Hips
• These help us live longer
Cost- Labor
• 5.5 People per patient
• Jobs that require skill and education
• Recession Proof
Cost- Malpractice
• Actually not the law-suits themselves
• Defensive medicine
• High Insurance- just in case
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
• 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
• Average cost is $2400
• 9 in 10 Seniors use a drug
• Direct to Consumer Ads
Health Care Reform
• Insuring more people by changing the number
• The 46-47 Million number is gone
Expanding Federal Programs
• Getting those eligible on programs they are eligible for– Expanding Medicare Eligibility– Expanding COBRA health insurance– Expanding SCHIP Program
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
Individual Mandates
• People will be required to have health insurance– Just as we are required to have health
insurance
• This is the tricky part
What if I have Insurance
• In theory it should not change
• Your employer, however, can just you off
When does it start
• Mandates begin in 2014
• Costs should be lowered over time as people have insurance
How can we afford this
• 1 Trillion over first 10 years– Tax on Tans – Higher medicare taxes on wealthy and
Medicare cuts– Taxes on High-end insurance– Fees on Health Care Industry
