1. Health Care Issues Cost – To Society Access Quality

2. Cost

3. Access: % without Health Insurance

4. Quality

5. Health Care Market Competition large number of buyers and sellers Information buyer and seller have full information Externalities third parties do not bear costs or benefits

6. Competition Licenses limit number of suppliers Patents on pharmaceuticals create monopolies Increasing number of health insurance providers limits bargaining power all this increases costs

7. Information Doctors, not patients, have most of the information Doctors (providers) make the major decisions, but do not bear the costs

8. Externalities Socialized costs: Insurance (government and private). Socialized benefits: communicable diseases. Government tax benefits subsidize expensive insurance. Cost of care for uninsured passed on to the insured.

10. History of US Health Care U.S. Health Care History 1919: California Health Insurance defeated 1935: Social Security Act: No Health Ins. 1937: National Institute of Health 1946: Hill-Burton Act: Hospital construction 1950: Truman NHI defeated; AMA opposed 1950's AMA supports Blue Cross\Blue Shield Health Insurance Tax deductible

11. History (Continued) 1965: Medicaid and Medicare: (AMA opposed) 1973: Health Maintenance Organizations (tax and regulatory preferences) 1974: National Health Planning and Resources Development Act: {Certificates of Need} 1986 (COBRA) – (continue plan after losing job) 1994 Clintons' Health Care Plan defeated 1996: Health Insurance Portability and Accountability Act -- continued coverage pre- existing conditions 1997: CHIPS (children’s health insurance) 2003: Health Savings Accounts

12. Health Care: Europe and US Europe National Health Service, or National Health Insurance  Covers 80-100% of pop  Covers 70-90 of costs United States Medicare (elderly) {Parts A & B} Medicaid (poor) Tax exclusion for employer coverage (middle class) Indian Health Services CHIPS (working poor, children) Veterans Health Care More………….

13. US Programs (continued) Black Lung Health Benefits Municipal Hospitals Community Health Clinics Community Mental Health Kidney dialysis program  Covers 45% of pop  Covers 45% of cost (excluding tax benefits)