1. Chapter 19

2. Providing Affordable Health Care for All  Health care a central theme of Barack Obama's presidential campaign  About 16 percent of U.S. 2007 GDP spent on health care ($8,000 per person/$4,000 per person in the second highest nation)  Health care costs doubled every decade for the last 30 years  Over 60 percent of all personal bankruptcies due to medical costs  2012 50 million Americans lacked insurance  Many denied due to arbitrary definition of pre-existing condition  47,000 deaths per year due to consequences of lack of insurance  Ranked 37 th in the world in outcomes 2

3. Health Care  U.S. only major industrialized nation without universal health care (Germany first in 1870s)  Many programs exist, providing a patchwork quilt of care  Medicare-elderly 1960s  Medicaid-poor1960s  Children’s Health Insurance Program (SCHIP)-  And now, President Obama’s health care bill 3

4. Many parts of the program founded in Republican ideas  Teddy Roosevelt calls for major reform  Richard Nixon Comprehensive Health Care Program  Individual mandate-Newt Gingrich and the Heritage Foundation  Medicare Part D-Prescription medication George W. Bush 4

5. Domestic Policy Making  More than half of government expenditures made on Social Security, health care, education, and immigration  Many designed to address economic inequality  To evaluate, must address questions involving conflicts between freedom and order and freedom and equality  State and local governments must also have capacity to carry out national programs 5

6. The Development of the American Welfare State  Most controversial purpose of government promotion of social and economic equality  Conflict between freedom and equality  Most modern nations welfare states  Social welfare policy based on concept governments should provide for basic needs of members 6

7. A Human Tragedy 7

8. The Great Depression  Initiatives related to the New Deal and the Great Society dominated national policy until reforms in 1980s and 1990s  Extended protective role of government  The Great Depression longest and deepest setback of U.S. economy in history  Began with stock market crash Oct. 24 th, 1929 and ended with start of WWII  One in four workers unemployed; more underemployed 8

9. The New Deal  Franklin Delano Roosevelt, accepting nomination at Democratic Presidential Convention: “I pledge you, I pledge myself to a new deal for the American people.”  Were programs imaginative public policy or source of massive government growth without matching benefits? 9

10. The New Deal’s Two Phases  First phase aimed at boosting prices and lowering unemployment  Civilian Conservation Corps (CCC)  Second phase aimed at aiding “forgotten people”  Social Security program  Despite programs, poverty and unemployment persisted until WWII 10

11. The Great Society  President Lyndon B. Johnson re- elected in 1964 with landslide  Used support to promote Great Society programs to combat political, social, and economic inequalities  Vital element was War on Poverty  Economic Opportunity Act (1964) designed to end poverty in 10 years  A hand up, not a handout 11

12. Retrenchment and Reform  Despite Great Society’s programs, poverty declined but did not disappear  Ronald Reagan used presidency in early to mid 1980s to re-examine social welfare policy  Shifted focus from economic equality to economic freedom  Questioned whether government alone should look after less fortunate 12

13. Retrenchment and Reform  President Bill Clinton’s proposals aimed at reforming system while protecting basic fabric of safety net  President George W. Bush’s administration greatly expanded welfare benefits for seniors with Medicare drug program 13

14. Social Security  Government social insurance programs protect individuals from various kinds of loss, regardless of need  First example was workers’ compensation  Social security and Medicare also social insurance programs  These programs examples of entitlements 14

15. Origins of Social Security  Social insurance programs began in Europe as early as 1883  In U.S., needs of elderly and unemployed left to private organizations and individuals until Great Depression  In 1935, President Roosevelt signed Social Security Act 15

16. Social Security Act  Act had three approaches:  Social insurance for elderly and disabled, and unemployment benefits  Grants-in-aid to the states to help destitute  Federal aid to the states to provide health and welfare services 16

17. How Social Security Works  Most people think of retirement benefits when thinking of Social Security  Program provides other services  Contributions not set aside for individuals but used to fund “pay as you go” system  Program began with more paying into fund than taking out (nine workers to one beneficiary)  Today’s program closer to three workers for each beneficiary 17

18. Will Social Security Remain Solvent?  Baby boomers begin to retire in 2010  Current projections show fund exhausted by 2037  Politicians face dilemma: lower benefits or raise taxes to fund program?  Current workers’ benefits will be paid by future participants  Solvency depends on growth of base  What happens when birthrate falls, unemployment rises, mortality declines, and/or economy falters? 18

19. Figure 19.1 Day of Reckoning 19

20. Census Data  49.9 million, or 16.2 percent, of Americans live in poverty  15 million children live in poverty  9.4 percent of people over 65 live in poverty (1954 35% lived in poverty, reduction largely due to Social Security benefits.  One in two poor Americans live in a family with a woman head of household 20

21. Figure 19.2 The Feminization of Poverty 21

22. Welfare Reform  Original poverty programs lacked work incentives  A 1994 poll showed 59 percent of Americans believed welfare recipients taking advantage of system  Personal Responsibility and Opportunity to Work Act reforms enacted in 1996  Designed to “end welfare as we know it”  Abolished Aid to Families with Dependent Children (AFDC)  Replaced AFDC with Temporary Assistance to Needy Families (TANF) 22

23. Figure 19.3 Families on Welfare, 1955-2008 23

24. Figure 19.4 Poverty in the States 24

25. Medicare  Social Security Act amended in 1965 to include Medicare for those over 65  National health insurance first proposed by President Truman in 1945  Medicare program had Four components:  Part A for hospitalization  Part B for physician’s fees  Medicare + Choice Part C  Part D-Prescription drug plan 25

26. Medicaid  Participants fall into four groups:  Children under age 21 (29.8 million, or 48 percent in 2008)  Adults (5 million)  Blind and disabled (6 million)  Aged who are also poor (6.1 million)  Last two categories account for over half of Medicaid expenditures 26

27. Health Care Reform  President Obama signed Patient Protection and Affordable Care Act March 23, 2010  Compromises required to balance goal of equality of access with desire for freedom from government intervention  Notable provisions in bill include protections for coverage despite pre-existing conditions and mandatory participation  Bill includes subsidies and tax credits to help individuals and small businesses pay for coverage 27

28. Health Care Reform  Critics of bill concerned about cost – an estimated $940 billion over 10 years  Some, including Congressional Budget Office, believe bill will pay for itself  Those wary of “big government” troubled by additional regulations and bureaucracy  Is mandating individual coverage Constitutional?  Others anxious about effect of reforms on Medicare 28