HSCI 305 Lecture Notes - Lecture 11: Underinsured, Health Insurance Mandate, Prescription Drug

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HSCI 305 Lecture 11  US Health Care & Health Systems Comparisons
1. Health Care in the US
2. Overview of Int’l Comparisons: What Are We Comparing?
3. Rhetoric of “Socialized Medicine” (single payer insurance) vs. Business Model of Care
(Michael Moore and SICKO)
1 Health Care in the US
Obama (2009)
-“Now, the truth is that unless you have what’s called a single-payer system in which
everybody is automatically covered, then you’re probably not going to reach every single.”
Quick history US health care reform
-1915, attempted legislation proposes health insurance, fails to pass
-Struggles in: 1943,1945, 1946, 1951, 1965, 1971, 1972, 1973, 1977, 1983, 1985, 1986
-All attempts to enact single payer insurance failed due to resistance from “powerful
interest groups bent on preserving the status quo, demagoguery, fear of socialized medicine,”
a “political culture suspicious of centralized power and enamored of individual responsibility”,
and “the fragmented US (political) system”
What the US got instead…
-Patchwork coverage: mixed public and private
-Private insurance linked to employment with tax deductions to reimburse cost [public
subsidy to private insurance] “the American way” (Oberlander, p 586)
-This still leaves millions uninsured, so “deserving” populations granted public
insurance: medicare and Medicaid (1965)
Medicare Medicaid
Not to be confused with Can. Medicare Means-tested
65+, some younger people with disabilities Non-profit, tax-based, gov’t administered
Non-profit, tax-based, gov’t administered Limited eligibility:
-Very poor and
disabled/pregnant/blind/AIDS T-cell below
200
Covers about ½ health care costs
-Patients pay out-of-pocket or
purchase private insurance for the rest—
long term care, dental, hearing, vision
care, prescriptions, etc
Asset limit
-$2000 in most states
-Forces “spending down” to quality
-5-year “look-back” on
transfers/gifts, can be penalized dollar-
for-dollar
Serious Issues
1. Uninsured or Underinsured
-Not all employers offer insurance. Certain groups remain “bad” risks: pregnant women,
cancer patients, etc; demonstrates the “immoral logic of the individual market”
-Medicare: substantial cost sharing, trouble finding care, long stays, home care not
covered
-Medicaid states slash programs in times of recession, issues finding care, etc
-Eligibility process mired in complexities, “most uninsured children eligible but not
enrolled”
o# people without Health Insurance is equivalent to combined population of 18 states
Who are the Uninsured?
-Perception:
oLazy, unemployed
oYoung, single, healthy  choice
-Reality:
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o79.3% from working families
o70.6% employed full-time
-Choice?
o“choosing” between health insurance and other immediate needs
oMany jobs today offered on contract—not full time “benefited” jobs
What are the consequences of being uninsured?
-Higher prices: hospitals charged uninsured patients 300% of their Medicare-allowable
costs and 250% of the amount private insurers paid for the same services 2004. Why?
-May be required to pay before surgery/treatment: decreases the number of days that
bills remain in receivables
-Safety net hospitals: “ugly stepchild of the American healthcare system” with limited
budgets
-less cancer screening, excess deaths: more likely to be diagnosed with advanced
stage disease, 0.6 times more likely to die within 5 years of diagnosis
What about the Underinsured?
-30 million Americans went underinsured in 2012 in addition to the 55 million with no
insurance at all
-Underinsured if you spent:
o>30% of pre-tax family income on out-of-pocket health expenses
oDeductibles >5% of pre-tax family income
oEg. Family income $60 000: $500/month on medical expenses or deductible of $3000
-29% of those with health insurance coverage report two or more of the following:
oInadequate prescription drug coverage
oForced to postpone treatment due to cost
oHad to use savings to pay for medical bills
oMade job-related decisions based mainly on health care needs
oMedical debts > $5 000
oPostponed home/car repairs due to medical costs
2. Cost
-(2009) $13 375/yr average annual premiums for families enrolled in health insurance
What are the consequences for the US as a nation?
-Ranks last in preventable death rates among 19 industrialized countries
-Fewer health care resources per capita than the int’l average for 30 OECD nations
(Organization for Economic Co-operation and Development)
oFewer doctors, fewer doctor’s visits, fewer nurses, shorter hospital stays
-More patients going without care due to cost
-Lack of attention to preventive care
Patient Protection and Affordable Care Act (ACA aka Obamacare)
-Signed into law March 2010
-Main goals: increase insured citizens; decrease overall costs of health care
ACA Approach to Reform
1. Individual mandate: entice people to buy insurance
2. New regulations over private insurance
3. New requirements for employers
4. State-run health exchanges (aka marketplaces)
5. Expansion of Medicaid
1) Individual Mandate
-Attempt at achieving universality without adopting a single-payer tax-based system
-Fundamentally conservative idea
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Document Summary

Hsci 305 lecture 11 us health care & health systems comparisons. Rhetoric of socialized medicine (single payer insurance) vs. business model of care. Now, the truth is that unless you have what"s called a single-payer system in which everybody is automatically covered, then you"re probably not going to reach every single. 1915, attempted legislation proposes health insurance, fails to pass. Struggles in: 1943,1945, 1946, 1951, 1965, 1971, 1972, 1973, 1977, 1983, 1985, 1986. Private insurance linked to employment with tax deductions to reimburse cost [public subsidy to private insurance] the american way (oberlander, p 586) insurance: medicare and medicaid (1965) This still leaves millions uninsured, so deserving populations granted public. Patients pay out-of-pocket or purchase private insurance for the rest long term care, dental, hearing, vision care, prescriptions, etc. 5-year look-back on transfers/gifts, can be penalized dollar- for-dollar. Medicare: substantial cost sharing, trouble finding care, long stays, home care not.

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