1. Current Legal and Ethical Controversies in American Health Care
Health Reform—Achieving Access to Affordable Health Care

2. Goals of HC System
Access
Affordability
Quality

3. Where Are We Now? Conglomeration of public and private sectors
Public Sector
Providers (federal, state, local)
Payers (Medicare, Medicaid)
Private Sector
Providers (for-profit and not-for-profit)
Insurance
Employer-supported
Individual or group policies

4. “The people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies. Why? Because they’re not organized. They don’t have any bargaining power with insurance companies. And they’re getting whacked. So you’ve got this crazy system where all of a sudden 25 million more people have health care, and then people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half…

5. “It’s the craziest thing in the world.”
Former President Bill Clinton
October 3, 2016

6. Fundamental Questions
Does insurance=access=health?
Purpose of insurance?
Is health a “right”? Define
Is health care a “right”? A “right” to what (e.g., contraceptives)? Corresponding “duty”?
Alternative conceptions of health care?
Market good
Something people should have

7. Alternative Approaches
Federal v. State approaches
Nationalized health system (e.g., VA)
Single payer system
Free market
Consumer choice with subsidies and incentives
Regulated competition

8. HC Financing and Older Americans
Should there be a separate program?
Alternatives for saving/restoring/preserving Medicare?
Status quo
Repeal
Change eligibility criteria
Age
Means test at front end
Means test at back end (differential premiums)

9. Change provider reimbursement
Change benefits
Change provider reimbursement
Methods
Amounts
Change program structure to voucher/premium support
Medicare Advantage precedent
Medicare Part D precedent

10. Paying for Long-Term Care
Medicare
Medicaid
Benefits planning techniques
Private pay
Private LTC Insurance
Adverse selection
Paying family caregivers?
Moral hazard (“Woodwork effect”)

11. International Comparisons
Different goals (Quality of life)
Compare apples to apples