Civilisation des Etats-Unis-8 Social Protection and Health Care Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France)

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) 1 Social Protection: How It Works - safety net, Democratic presidents  1930s FDR (Franklin D. Roosevelt)  1960s LBJ (Lyndon B. Johnson) A. Social Security for elderly, unemployed, disabled 1935 Social Security Act = entitlements - old-age, disability pensions and unemployment - Medicare for everybody (rich and poor)! B. welfare for poor (no health insurance!) - Medicaid - food stamps ≠ entitlements, temporary measures

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) C Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) C. Employer Coverage 1942 businesses desperate to attract new workers  offer attractive health care packages! Nowadays: - health as a business: average $400 a month  choice of insurance plans (only private insurance?)  risk segmentation: higher premiums - retirement plans based on individual capitalization  pension funds on Wall Street (e.g., Calpers= California Personnel)

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) 2 Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) 2. An Imperfect and Costly Safety Net A. Inadequacies of the System - not covered: part-timers & small firms (less than 10 = 20%) - usually only one plan per firm (no choice) - but quick turnover: you lose job  you lose health insurance!  15%, 48 mio have no health coverage - take a chance on good health (follow TV ads) - postpone treatment

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) - relatively low life expectancy, high infant mortality (!) - until 1999: no government-provided maternity leave - hospital stay for birth = 48h (4-5 days in France) - unpaid leave: 12 weeks for medical reasons But also very sophisticated medicine: many Nobel Prizes!

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) B Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) B. A Costly Business - 17% of GNP to health care - not efficient, costs skyrocketing!  federal govt. foots 45% of bill! (Medicare in 1970: $6 billion; 2012: $500 billion…) - “baby boomers” retire: in 2030: 2 working for one retired - very expensive drugs (price manipulations) - old GM: $1200 per vehicle  bankrupt!

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) C Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) C. HMO (Health Maintenance Organizations)  for-profit organizations run like a business  own doctors, limited list & treatments  primary care provider = “gatekeeper”

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) - PPO (Preferred Provider Organization)  less and less independent doctors - fear of malpractice suit:  high doctor’s insurance = high costs!  tendency to “overtreat” = more expensive! - bad reputation of denial of expensive treatment  “gag rule” for medication, doctors’ moral dilemma! - improve preventive care? D. Obamacare = PPACA (Patient Protection Affordable Care Act)  Republicans against Hilary Clinton’s “socialized medicine”! - passed, but sign-up problems!

Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) 3 Prof. Sämi Ludwig Université de Haute Alsace Mulhouse (France) 3. The Dismantling of the Welfare State generosity vs. self-reliance  responsibility, poor are not victims 1980s: Ronald Reagan on “welfare queens”: reduce benefits! - Social Security stays untouched  lobby of elderly! 1996 welfare reform (Clinton): 1. federal block grants to States  more freedom 2. only welfare if you actively look for jobs  but community service? single moms, care-taking? 3. reduce welfare benefits after 2 years, cut after 5 years 4. immigrants ineligible for welfare  more ask for citizenship! Encouraging employment, but many low-level jobs