1. Health Care Issues Cost – To Society Access Quality Comparative mortality rates in 17 nations

2. Note: U.S. reaches 17% in 2010; U.S Govt. pays ½ the cost in 2010 European govt. pay 83%

6. Health Care Market Competition large number of buyers and sellers Information buyer and seller have full information Externalities third parties do not bear costs or benefits

7. Restrictions on Competition Licenses limit number of suppliers Patents on pharmaceuticals create monopolies Increasing number of health insurance providers limits bargaining power with monopoly suppliers all this increases costs

8. Information Doctors, not patients, have most of the information Doctors (providers) make the major decisions, but do not bear the costs

9. Externalities Socialized costs: Insurance (government and private). Socialized benefits: communicable diseases. Government tax benefits subsidize expensive insurance. Cost of care for uninsured passed on to the insured.

14. Economist New estimate waste 1.2 trillion/ 2.2 trillion

16. Health Care: Europe and US Europe National Health Service, or National Health Insurance  Covers 80-100% of pop  Covers 70-90 of costs United States Medicare (elderly) –A: Hospital –B: Doctor –C: Private Insurance Co. –D: Drugs (Private) Medicaid (poor) Tax exclusion for employer coverage (middle class) Indian Health Services CHIPS (working poor, children) More………….

17. US Programs (continued) Veterans Health Care Black Lung Health Benefits Municipal Hospitals Community Health Clinics Community Mental Health Kidney dialysis program  Covers 45% of pop  Covers 50% of cost (in 2011, excluding tax benefits)

18. History of US Health Care 1912 Teddy Roosevelt: National Insurance (Bull Moose Campaign) 1919: California Health Insurance defeated 1935: Social Security Act: No Health Ins. 1937: National Institute of Health 1946: Hill-Burton Act: Hospital construction 1950: Truman NHI defeated; AMA opposed 1950's AMA supports Blue Cross\Blue Shield Health Insurance Tax deductible 1965: Medicaid and Medicare: (AMA opposed)

19. History (Continued) 1973: Health Maintenance Organizations (tax and regulatory preferences) 1974: National Health Planning and Resources Development Act: {Certificates of Need} 1974: Nixon Proposal (Kennedy, unions defeated it) (employer mandate with subsidies) 1986 (COBRA) – (continue plan after losing job) 1994 Clintons' Health Care Plan defeated 1996: Health Insurance Portability and Accountability Act -- continued coverage pre-existing conditions 1997: CHIPS (children’s health insurance)\ Medicare Advantage (Part C) 2003: Health Savings Accounts 2006: Medicare Part D -- drugs

20. M ARKET A PPROACHES HMOs (Nixon 1973, State Medicaid) Health Savings Accounts (2003) Medicare Advantage (1997 Part C) Medicare Prescription Drug Companies (2006) Purchase insurance from other states Small business insurance pools Limit and broaden tax exclusion (i.e. tax “Cadillac” plans, allow individuals to exclude insurance costs) [reform malpractice insurance]

21. A NTI - M ARKET A PPROACHES Certificates of Need (Nixon 1973) Mandate community service ratings (NY, Clinton) Employer mandates (Hawaii, Nixon, Clinton) Personal mandates (Mass, Clinton, Obama) Insurance regulation ( pre-existing conditions, mandated coverage for mental health, autism…) Extend Medicaid and Chips Single-payer plans (most other countries)