2.  The U.S. has been involved in a debate on how to best deliver health care to its citizens for three decades. › The US system is the most expensive in the world › We pay almost twice per person for health care than other industrialized countries. › The US ranks 37 in the world in overall health in the world, between Costa Rica and Slovenia. › The US is the only industrialized country in the world without some form of universal care.  The Effect on Families › Average cost for an employer provided family policy: $12,680 a year. › Workers with employer provided insurance pay up to $4000 for their share of the policy premium. › 47 million Americans are uninsured. › 50% of all personal bankruptcies are partly from medical expenses. › We pay more for less coverage and the average cost increase each year is 4% to 20%  The Effect On Businesses: › Health Care is causing a major economic drag on our businesses, large and small. › Companies are abandoning health insurance as a benefit. Wage increases are eaten up increased costs of premiums. › Health Care costs drive up the cost of goods we buy (adds $1,525 to the price of a GM automobile).  On Government: › Growing problem in covering Medicare and Medicaid spending, both are facing huge deficits. (Medicare may be bankrupt in the next 20 years, maybe) › Government spending on health care has increased 40% and is expected rise, putting huge strains on our budgets.

3. Crucial Questions:  What is the best way to deliver health care in the least expensive, most effective and efficient way?  Is health care a right in the U.S., like voting, gun rights, freedom of religion, free speech, Or is it a privilege?  What changes can we make to improve our ailing system? Or do we have to start over again? Competing Sides:  Free Market Advocates (Conservatives, Republicans) › Open up health care to the free market: allow competition across state lines › Limit or eliminate malpractice lawsuits › Tax breaks for uninsured families to purchase insurance. › Eliminate waste, fraud, and abuse of Medicare and Medicaid  Universalists (Liberals, Democrats) › Single Payer, Universal Health Care › Promote prevention and wellness with the insured. › Government negotiation for procedures, care and prescription drugs to lower costs. › Eliminate waste and fraud in Medicare and Medicaid

4. Private Insurance System:  Insurance provided by employer or purchased individually from private, for profit insurance companies.  Patients can (theoretically) choose the physician or the specialty physician.  Incentives to researchers for new drugs or new techniques.  Public Insurance for: the Elderly (Medicare), the Poor (Medicaid), the Unemployed (COBRA), and Veterans (VA)  Benefits: › High quality care for those with good insurance. › Leader in medical research, technology, and treatments. › Large number of doctors, hospitals, and clinics. › Choice of doctors, care givers, hospitals (theoretically).  Criticisms: › Insured, Uninsured, Underinsured Americans  47 million Americans are uninsured (low paying jobs, the unemployed).  Millions of Americans are underinsured (basic coverage or high deductibles)  Health crisis is the largest single reason for personal bankruptcies among insured Americans › World Health Rankings  #1 in the world in cost of health care, #37 in results (37 th healthiest nation) › Expensive premiums, co-pays, deductibles, and patient contributions. › Expensive for businesses and families  Causing business/personal bankruptcies  Employers/families dropping health care coverage for financial survival  Premium increases yearly of 5-25%. › Insured Americans Pay for Uninsured Americans  Through unpaid medical bills or through tax-subsidized government programs. › Encourages high tech and expensive care, not primary care or prevention. › Pre-existing Conditions:  Care and/or coverage can be denied because of medical conditions existing prior to coverage. ›

5. Affordable Care Act (2010): aka Obamacare, Health Care Reform Act  Mandated Insurance: › Everyone must be insured, by an employer or individually. › No insurance? you will be fined. ($2,085 by 2016)  Health Exchanges: › A marketplace where insurers will offer affordable health plans to consumers looking to buy insurance. › Financial aid and subsidies will be provided to lower incomes to buy coverage.  Pre-existing Conditions: › Insurers cannot deny you coverage if you have a prior medical condition › Insurers can’t drop you from coverage if you are already insured.  Young Adult Coverage: › Parents can keep their children covered on their policy until they reach age 26.  Small Business Tax Credits: › Small businesses given tax credits for offering insurance to employees.  Preventative Care: › New plans must offer free prevention screenings (mammograms, colonoscopies) free of charge. › Invests in pro-health programs: anti-smoking, obesity, etc…  Medicare/Medicaid: › Closes the “donut hole” ($250 gap) in prescription drug coverage for seniors. › Crack down on health care fraud, including Medicare Fraud. › Provides funds for states to offer Medicaid to more people.  Quality Care: › Steps to improve the quality and affordability of care with standard and best procedures, eliminate unnecessary procedures and scans, providing information on providers and procedures.  More information: http://www.health.govhttp://www.health.gov

6. Single Payer System:  Universal and comprehensive coverage of all citizens.  Different Delivery Methods: › Socialized Medicine:  Government run.  Private and public doctors/hospitals.  Everyone covered. Example: Great Britain’s National Health Service (NHS) › Social Insurance:  Government is the insurer or private insurance through non-profit insurers.  Private doctors and hospitals.  Everyone is required to be covered through employer or private plans. Ex: Canada, Japan, Switzerland, Germany, Taiwan  Patients choose the providers and doctors. Hospitals are non-profit businesses.  All industrialized countries have some form of universal care (Exception: the U.S.)  Benefits: › Simple and easy to use:  Little paperwork, no fighting with insurance companies  Everyone has the same coverage and benefits. › Employers not burdened with high health care costs.  Smaller premiums and/or no premiums. › Large Bargaining Pool: Cheaper costs  Prices for care/procedures negotiated or set by government (Ex: Great Britain $10 prescriptions) › Supplemental Insurance can be bought for certain procedures but is generally not necessary. › Emphasis on prevention.  Criticisms: › Rationing:  Tight budgets may mean tightening or curbing of benefits or raising taxes. › Waiting:  Depending on the area, wait times for care or procedures can exist from a week to months. › Who Decides:  Critics say government decides who gets care and/or procedures are done. › Sometimes not used enough.  Strain on private doctors and hospitals who aren’t getting business.

7.  Public Option: (Democrat’s Idea) › A government provided, taxpayer funded plan to compete with private plans on the Health Exchange Market › Used to keep insurers honest and offer quality and affordable plans. › Critics believe it will drive private insurers out of business: won’t be able to compete with cheaper government plans. › Critics also believe it’s a slippery-slope: a way to introduce Universal Health Care on the U.S. › Proponents believe its to only way to keep the private honest and affordable.  End Of Life Counseling: › Provisions in the law  Managed Care Plans (HMO’s-Health Maintenance Organization) › Consumers are locked into using specific providers who will charge reduced fees. › Insurance company must approve before benefits are received. › All plans are different in cost and what they offer. › Insurance companies decide how medical care is rationed. › Financial incentives for patients to stay healthy. › Hurts small businesses who can’t afford the high premiums. › Less choice in doctors and providers. Must choose “in network” providers. › Insurance company and policy decide what care is given to whom. › Employers may opt for cost effective plans, rather than good plans. › More Information: http://www.factcheck.org/2009/08/seven-falsehoods-about- health-care/http://www.factcheck.org/2009/08/seven-falsehoods-about- health-care/

8. The Assignment: 1. Choose a side of the issue: How should the US deal with its health care 2. Research two arguments for the side of the issue that you have chosen. › Places to search:  Think Tanks, Political Parties, Medical or Political Organizations, Political Candidates.  News sites (CNN, FOX News, MSNBC, Time, Newsweek, US News, NY Times, Washington Post, Star Tribune, etc..) 3. Put together 2 items: Small Display or PowerPoint showing each argument for or against. 1 Page opinion paper on what you believe in regards to this issue. What do you think and why. Points: 25 Points  10 Points for Opinion  15 Points for Display