Healthcare

Healthcare  America has the “best healthcare system” on earth. But on measures such as life expectancy, infant mortality, and especially cost, the US is worse than nearly all other advanced democracies.

Life Expectancy Per Capita Spending

Healthcare  The US as a whole spends far more than other nations on healthcare, and only here do individuals spend more than the government does.

Healthcare  Health care is not the problem – health insurance is.  Americans get excellent medical care if they are insured, but many do not have adequate insurance.  In most advanced countries the government insures the population directly. Everyone has health insurance so lack of money is not a barrier to getting care.

Healthcare socialized medicine universal health care  In a few countries such as the United Kingdom, the government actually runs the hospitals and employs the doctors. This is socialized medicine. In the US this term is often used to describe a system where the government provides everyone health insurance, but that is more actually universal health care. single-payer health care. This would be like “Medicare for all” and there would be no for-profit insurance companies.  Universal health care can include government-provided insurance or private insurance. When the government directly insures everyone, that is single-payer health care. This would be like “Medicare for all” and there would be no for-profit insurance companies.

Healthcare Reform History  Since the early 1990s, when Bill Clinton’s efforts to reform the healthcare system were defeated, healthcare costs have increased tremendously and a number of Americans lost their insurance when they lost their jobs in various economic downturns.

Healthcare Reform History  There are a couple of government insurance programs, each serving a different population: Medicare, Medicaid, and various military related programs. Medicaid: Medicaid: health insurance for the very poor (less than half of people below the poverty line qualify) Medicare: Medicare: health insurance for people 65 and over As of 2008 (before “Obamacare”) Medicaid and Medicare each covered about 40 million people

Healthcare Reform History There are several programs for the military, including the Department of Veterans Affairs, which is the only example of “socialized medicine” in the US (govt. insurance, VA hospitals, VA doctors). These programs are designed to cover the “most vulnerable” elements of society and veterans. Before 2008 there was little regulation of the private insurance industry, by which most people are insured.

Healthcare Reform History  As of 2008, about 60% of Americans had health insurance through their employer, and less than 10% purchased insurance.  As of 2008, about 50 million Americans lacked health insurance at some point in a given year 1 but less than half of those were “chronically uninsured.” and graph: cps/index.htm

Healthcare Reform History  Despite vociferous opposition, Obama had Democratic majorities in both chambers of Congress and went around the country attempting to sell his plan to the public.  Several plans were introduced in Congress ranging from liberal (“Medicare for all”) to conservative (minimal changes). What emerged was a moderate bill (no single payer, but included a mandate) but it passed with only Democratic votes.  Although the changes are commonly known as health care reform, they are better described as health insurance reform.  Important components of the new law:

2010 Affordable Care Act (“Obamacare”) individual mandate)  Most individuals will be required to have health insurance. ( individual mandate) Anyone who can afford health insurance but chooses not to buy it will pay higher taxes.  There is no “Obamacare” insurance. Health Insurance Exchanges are created to help people find private coverage.  Employers are required to pay fees if they do not offer health insurance for employees (small businesses are exempt).  Health insurers can no longer deny coverage to people who have “pre-existing conditions” nor have annual limits on benefits.  Medicaid will be expanded to cover more people ONLY in states that agree to do so.

2010 Healthcare Reform Law  Legal challenge: A lawsuit was brought by the Attorney General of Florida within hours of the healthcare bill becoming law. Eventually a total of 25 more states joined the suit against the federal government, arguing that various part of the law, especially the individual mandate, are unconstitutional. Lower courts issued contradictory rulings. The Supreme Court narrowly upheld the law as valid because of the federal government’s power to tax but also ruled that states can reject the Medicaid expansion.