1. Policymaking for Health Care and the Environment Chapter 19

2. Preview How does your family get and pay for health care? How does health care policy in the US compare to other countries? How does the quality of health care in the US compare to other countries? What are the biggest problems and greatest strengths of health care policy in the US?

3. America in Perspective Countryper % of GDP Life IMR capita $ expectancy U.S.$4887 13.9% 77.3 9 Canada$2163 9.5% 79.8 6 France$2109 9.6 79.7 5 Germany $2412 10.8 78.7 5 Italy$1584 8.4 79.7 5 Japan $2627 8.0 81.9 4 UK$1835 7.6 78.2 7

4. Health Care Policy The Health of Americans – Americans generally lag behind in some key health statistics – Specifically a lower life expectancy and higher infant mortality rate. The Cost of Health Care – Americans spend more than any other country. – Reasons for high costs: private insurance pays much of the cost, emphasis on new and expensive technology, increase in malpractice suits results in “defensive medicine.”

5. Health Care Policy Uneven Coverage, Uneven Care – Health Insurance About 43 million Americans have no health insurance. Often linked to having a job - lose the job, lose the health insurance. Health insurance is closely tied to race and income.

6. Health Care Policy The Role of Government in Health Care – Medicare: provides hospitalization insurance for elderly and optional coverage for other medical expenses. – Medicaid: public assistance program to provide health care for the poor. Paid for by national and state governments.

7. Figure 19.2 Health Care Policy

8. Who pays? Most get insurance through their jobs Accessibility is unequal by race and income Government pays 50% of health care costs Insurance companies pay about 30% Individuals pay about 20%

9. The Affordable Health Care Act (aka Obamacare) Provisions – Bring insurance coverage to previously uninsured Americans – Eliminate co-pays for immunizations and other preventative care (cancer screenings) – Eliminate lifetime caps for those needing major medical care

10. The Affordable Health Care Act (aka Obamacare What’s the Controversy? – Requires all Americans to buy health insurance – Is that constitutional?

11. Health Care Debrief One of the most controversial aspects of the Affordable Health Care Act (Obamacare) is the required individual mandate and whether it is constitutional. – Make an argument that it is constitutional for Congress to require this. – Make an argument that it is NOT constitutional for Congress to require this.

12. Environmental Policy Americans want their air, water and land protected but disagree on government’s role and regulations Environmental protection became prominent in the 1960’s and 1970’s

13. Environmental Policy Environmental Policies in America – NEPA / National Environmental Policy Act Requires Environmental Impact Statements: report that specifies likely environmental impact of a proposed action - filed with the EPA. Used by environmental groups to challenge and delay projects they object to. – Environmental Protection Agency (EPA), 1970 Carries out environmental laws passed by Congress Enforces all regulations and laws

14. Clean Air Act, 1970 Originated to reduce auto and industry pollution. Auto makers battled its requirements but many prevailed and cars run much cleaner The Act was revised in 1990 Amendments allowed emissions trading—buying and trading rights to pollute on the open market

15. Clean Water – Clean Water Act 1970 and Water Pollution Control Act of 1972 – Passed to clean up the nation’s rivers and lakes – Requires the use of pollution control technology. Water quality has benefited greatly from the Act But it misses “runoff” pollution from agriculture, city streets and other areas.

16. Environmental Policies in America – Wilderness Preservation The U.S. is a world leader in wilderness preservation. The national parks and national forests may be restricted to keep them for future generations. – Endangered Species Government protects those species listed as endangered - regardless of costs (Endangered Species Act, 1973). Exceptions may be made in some instances. Very controversial

17. Environmental Policies in America – Superfund, 1980: Superfund was created by Congress in 1980 to clean up hazardous waste sites. Has virtually eliminated haphazard dumping of toxic waste, Less successful in cleaning up existing waste. Nuclear waste presents a serious challenge.

18. Figure 19.3 Energy Policy Sources of America’s Energy (Figure 19.2)

19. Energy Policy Energy Sources and Energy Politics – 87% of the nation’s energy comes from coal, oil and natural gas. – Coal is the most abundant fuel, but also the dirtiest. – Oil accounts for 40% of our energy, but creates a dependence on foreign (especially Middle East) sources. – Most controversial energy source is nuclear.

20. Energy Policy

21. The Global Warming Debate Heats Up – Scientists argue about the effects of accumulations of carbon dioxide in the atmosphere. – The only way to reduce the problem is to reduce the amount produced. – The costs to do this are immediate, but the effects won’t be visible for decades, if ever.