1. Copyright © 2011 Pearson Education, Inc. Publishing as Longman

3. Chapter 19: Policymaking for Health Care, the Environment, and Energy Health Care Policy Environmental Policy Energy Policy Understanding Health Care, Environmental, and Energy Policy Summary

4. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Chapter Outline and Learning Objectives Health Care Policy LO 19.1: Outline the problems of health care in America and the role of government in health care. Environmental Policy LO 19.2: Analyze the conflicts between economic growth and environmental protection and identify the major national environmental protection policies.

5. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Chapter Outline and Learning Objectives Energy Policy LO 19.3: Evaluate the advantages and disadvantages of each of the principal sources of energy in the United States.

6. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Chapter Outline and Learning Objectives Understanding Health Care, Environmental, and Energy Policy Understanding Health Care, Environmental, and Energy Policy LO 19.4: Assess the role of democratic politics in making health care, environmental and energy policy and the effect of these policies on the scope of government.

7. The Costs and Benefits of Health Care The US spends a far larger share of its national income on health than any industrialized country. The US is far from having the healthiest population, as indicated by life expectancy and the infant mortality rate. To Learning Objectives Health Care Policy LO 19.1: Outline the problems of health care in America and the role of government in health care. Copyright © 2011 Pearson Education, Inc. Publishing as Longman

8. LO 19.1 To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman

9. Health Care Policy The Cost of Health Care Access to Health Care The Role of Government In Health Care Reform Efforts To Learning Objectives LO 19.1

10. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy The Cost of Health Care (cont.) Americans now spend over $2.5 trillion a year on health care. In 2009, health expenditures were over one-sixth (17%) of the gross domestic product (GDP). Nearly one-fourth of all federal expenditures go to health care. To Learning Objectives LO 19.1

11. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy The Cost of Health Care (cont.) Factors behind costs – Too many medical care facilities; new technologies, drugs, and procedures; no one has primary responsibility for paying or controlling health care costs; defensive medicine; and higher insurance premiums. To Learning Objectives LO 19.1

12. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy The Cost of Health Care (cont.) Costs rising rapidly – Likely be spending 19% of GDP for health care by 2019. Cost of premiums for employer based insurance has increased by over 100% since 2000. Medicare and Medicaid could amount to 22% of GDP by 2050. To Learning Objectives LO 19.1

13. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.1

14. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Access to Health Care ⅔ of Americans – Private health insurance obtained individually or from employers (58% insured). Health Maintenance Organizations (HMOs) provide health care for yearly fee, and limit choice of doctors and treatments. Enrolled in HMOs – More than 50% of Americans and ¾ of doctors. To Learning Objectives LO 19.1

15. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Access to Health Care (cont.) Medicare – Covers nearly everyone age 65 and older. Medicaid – 43 million people with low incomes are covered. Children’s Health Insurance Program covers many children. More than 46 million people (15%) have no health insurance. To Learning Objectives LO 19.1

16. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Access to Health Care (cont.) Uninsured – 7 million under age 18; 29% age 18-24; 25% household with incomes less than $25,000; 31% Hispanics; 19% African Americans; and 15% Whites. Lack health insurance means lack of access to a family doctor or someone to administer prenatal and neonatal care. To Learning Objectives LO 19.1

17. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.1

18. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.1

19. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy The Role of Government In Health Care Pay 42% of total cost of health services and supplies, give $171 billion to employers providing health insurance in tax breaks, and employ 20,000 physicians. Hospitals connected to public universities and government financed medical research. To Learning Objectives LO 19.1

20. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Medicare (created in 1965) Hospital insurance for elderly allows purchase of inexpensive coverage for doctor fees and other medical expenses. Covers 43 million people (14%). Costs $500 billion (13% budget). To save money – Cut back on fees it pays doctors and hospitals. To Learning Objectives LO 19.1

21. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Medicaid (created in 1965) (cont.) Health care for poor Americans and funded by both the states and the national government. Covers 43 million people (14%). Costs $300 billion (7.8% budget). To save money – Cut fees and now fewer providers accept Medicaid patients like with Medicare. To Learning Objectives LO 19.1

22. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Children’s Health Insurance Program (created in 1978) Uninsured children and pregnant women with family incomes too high to qualify for Medicaid. Covers 11 million children and states determine eligibility parameters, benefit packages, payment levels for coverage, and administrative procedures. To Learning Objectives LO 19.1

23. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Reform Efforts National Health Insurance – A compulsory insurance program for all Americans that would have the government finance citizens’ medical care. National Health Insurance was 1 st proposed by President Harry Truman more than 60 years ago. To Learning Objectives LO 19.1

24. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Reform Efforts (Bill Clinton) Health Security Act proposal in 1993 to provide health care coverage for all Americans. Required employers to provide health insurance for their employees or pay a premium into a public fund; raised taxes on cigarettes; and imposed a small tax on other large companies. To Learning Objectives LO 19.1

25. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Reform Efforts (Barack Obama) Insure people with preexisting conditions; no dropping coverage when people became sick; cap out-of-pocket expenses; no extra charges for preventive care; close the gap in Medicare’s coverage for prescription drugs; and increase the number of people with health insurance. To Learning Objectives LO 19.1

26. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health Care Policy Reform Efforts (Barack Obama) (cont.) Insurance price competition. Tax credits to help people and small businesses buy insurance. Public health insurance option provides coverage to uninsured. Large employers cover employees. Bill passed in 2010, but without the public option. To Learning Objectives LO 19.1

27. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.1

28. Environmental Policy LO 19.2: Analyze the conflicts between economic growth and environmental protection, and identify the major national environmental protection policies. Economic Growth and the Environment Environmental Policies in America Global Warming To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman

29. Environmental Policy Economic Growth and the Environment Environmental interest groups exploded in both size and number during the 1960s and 1970s. Today, conflicts are apparent between economic growth and environmental goals. LO 19.2 To Learning Objectives

30. LO 19.2

31. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America Environmental Protection Agency (EPA) is the largest federal independent regulatory agency, created in 1970 to administer much of U.S. environmental protection policy. To Learning Objectives LO 19.2

32. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America (cont.) National Environmental Policy Act (1969) – Agencies must file environmental impact statements with EPA, which detail proposed policy’s environmental effects. To Learning Objectives LO 19.2

33. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America (cont.) Clean Air Act of 1970 – Combats air pollution, by charging the EPA with protecting and improving the quality of air. Air pollution from toxic organic compounds and sulfur dioxide has decreased since 1970. To Learning Objectives LO 19.2

34. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.2

35. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America (cont.) Clean Water Pollution Control Act of 1972 – A law intended to clean up the nation’s rivers and lakes, by enabling regulation of point sources of pollution. ⅔ of U.S. lakes and rivers are safe for fishing and drinking. To Learning Objectives LO 19.2

36. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America (cont.) Wilderness Preservation – New in 1916 with National Park System. There are now 378 national parks and 155 national forests. About 4% of the land in the U.S. is designated as wilderness and half of that is in Alaska. To Learning Objectives LO 19.2

37. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America (cont.) Endangered Species Act of 1973 is a law requiring the federal government (U.S. Fish and Wildlife Service) to protect all species listed as endangered. As of 2009, the endangered species list included 1,215 animal and 752 plant species. To Learning Objectives LO 19.2

38. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America (cont.) Superfund (1980) – Carried out by the EPA to clean up hazardous waste sites, and about 1,100 sites have been cleaned. Resource Conservation and Recovery Act (1977) – Requires the tracking of use, transit, and disposal of chemicals. To Learning Objectives LO 19.2

39. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Environmental Policies in America (cont.) Nuclear Waste – In 1987 Congress designated the NV Yucca Mountain as the site to consolidate and permanently bury nuclear fuel. NV congressional delegation have delayed implementation of plan due to safety and cost issues. To Learning Objectives LO 19.2

40. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Global Warming The increase in the earth’s temperatures that, according to most scientists, is occurring as a result of the carbon dioxide that is produced when fossil fuels are burned collecting in the atmosphere and trapping energy from the sun. To Learning Objectives LO 19.2

41. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Global Warming (cont.) Scientists – Earth is warming at a rapid rate; by 2100 will be between 2 and 6 degrees warmer; seas will rise; severe droughts, rainstorms, heat waves, and floods will be common; and major climatic and agricultural zones will shift causing pestilence, famine, and disease. To Learning Objectives LO 19.2

42. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.2

43. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Environmental Policy Global Warming (cont.) 4% of world’s population live in the U.S., but the U.S. produces more than 20% of the gases that cause global warming. Sulphur dioxide trading system under the Acid Rain Program of Clean Air Act has reduced emissions by 50% since 1980, and many states have emissions trading systems. To Learning Objectives LO 19.2

44. Energy Policy LO 19.3: Evaluate the advantages and disadvantages of each of the principal sources of energy in the United States. America’s Energy Usage Energy use is tied to emission of pollutants and greenhouse gases. We use to use wood, animals, water, and people power for energy. Today 83% of the energy comes from coal (22%), oil (37%), and natural gas (24%). To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman

45. LO 19.3 To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman

46. Energy Policy Coal Petroleum and Natural Gas Nuclear Energy Renewable Sources of Energy To Learning Objectives LO 19.3

47. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Energy Policy Coal 90% of the country’s energy resources are in coal deposits. Coal accounts for 22% of the energy Americans use, and it produces 48% of its electricity. Coal contributes to global warming, smog, and acid rain. To Learning Objectives LO 19.3

48. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Energy Policy Petroleum and Natural Gas Oil supplies 37% of our energy. Natural gas – 24% of energy and produces 21% of our electricity. Natural gas and oil contribute to global warming, transporting oil can result in spills, and refining oil pollutes the air. 57% of oil we use is imported. To Learning Objectives LO 19.3

49. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.3

50. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.3

51. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Energy Policy Nuclear Energy Nuclear electric power accounts for 9% of our total energy. 21% of our electricity is produced by nuclear energy. Concerns – Radiation leaks; use of atomic fuel; and disposal. Since 1978, no new nuclear power plants and many are abandoned. To Learning Objectives LO 19.3

52. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Energy Policy Renewable Sources of Energy Renewable sources (7% of energy) are water (6% of electricity), wind (1% of electricity), sun, geothermal sources, hydrogen, and biomass (3% of energy). Biomass power – Plants and plant derived materials used to produce electricity (biopower) and liquid fuels (biofuels). To Learning Objectives LO 19.3

53. To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.3

54. Understanding Health Care, Environmental, and Energy Policy LO 19.4: Assess the role of democratic politics in making health care, environmental and energy policy and the effect of these policies on the scope of government. Democracy, Health Care, and Environmental Policy The Scope of Government and Health Care, Environmental, and Energy Policy To Learning Objectives Copyright © 2011 Pearson Education, Inc. Publishing as Longman

55. Understanding Health Care, Environmental, and Energy Policy Democracy, Health Care, and Environmental Policy The public takes a stand when the president proposes complex health care reform. Public opinions are heard when tradeoffs are needed between economic growth and clean air. LO 19.4 To Learning Objectives

56. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Understanding Health Care, Environmental, and Energy Policy Democracy, Health Care, and Environmental Policy (cont.) Public relies on interest groups to help with technical issues. Interest groups play a role in making the complicated decisions affecting us and help translate public opinion into policy. To Learning Objectives LO 19.4

57. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Understanding Health Care, Environmental, and Energy Policy The Scope of Government and Health Care, Environmental, and Energy Policy Scope of federal government has grown in area of health care. Environmental protection has placed additional demands on the federal government. To Learning Objectives LO 19.4

58. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Understanding Health Care, Environmental, and Energy Policy The Scope of Government and Health Care, Environmental, and Energy Policy (cont.) Developing and protecting energy sources require government subsidies and sometimes war. The public expects government to act on these policy demands. To Learning Objectives LO 19.4

59. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.1 Summary Health Care Policy America’s health costs are both extremely high and increasing at a rapid rate. The health care system provides few incentives for controlling costs and Americans who can afford it demand the most advanced care. To Learning Objectives

60. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.1 Summary Health Care Policy (cont.) There are inequalities in health care and health in America. Insurance is mainly obtainable as a benefit from employers. Many poor and working-class Americans are uninsured or underinsured and have been relegated to an inferior health care system. To Learning Objectives

61. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.1 Summary Health Care Policy (cont.) The government provides health care for the elderly and the poor, through Medicare and Medicaid, and since the reforms of 2010, intended to increase access and help control costs, it provides subsidies for health insurance to small businesses and individuals. To Learning Objectives

62. Copyright © 2011 Pearson Education, Inc. Publishing as Longman is funded by both the states and the national government. A.Medicare B.Medicaid C.National Health Insurance D.All of the above LO 19.1 To Learning Objectives

63. Copyright © 2011 Pearson Education, Inc. Publishing as Longman is funded by both the states and the national government. A.Medicare B.Medicaid C.National Health Insurance D.All of the above To Learning Objectives LO 19.1

64. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.2 Summary Environmental Policy Environmental concerns often conflict with equally legitimate concerns about economic growth and jobs. Interest groups advocating environmental protection now play a critical role in environmental policymaking. To Learning Objectives

65. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.2 Summary Environmental Policy (cont.) The Environmental Protection Agency is charged with administering policies dealing with land use, air and water quality, and wilderness and wildlife preservation. To Learning Objectives

66. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.2 Summary Environmental Policy (cont.) The National Environmental Policy Act requires the federal government to file an environmental impact statement with the EPA every time it proposes to undertake a policy that is potentially disruptive to the environment. To Learning Objectives

67. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.2 Summary Environmental Policy (cont.) Clean Air Act charges the EPA with protecting and improving the quality of the nation’s air. Water Pollution Control Act aims to clean the nation’s water. Endangered Species Act seeks to preserve wilderness areas and wildlife. To Learning Objectives

68. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.2 Summary Environmental Policy (cont.) Disposal of toxic and nuclear wastes is a challenge, but the Superfund has helped to clean up toxic waste sites. Global warming issue – Not an agreement over the role of carbon emissions in warming the earth and no agreed upon approach to controlling them. To Learning Objectives

69. Copyright © 2011 Pearson Education, Inc. Publishing as Longman National Environmental Policy Act requires to file environmental impact statements. A.interest groups B.businesses C.agencies D.all of the above LO 19.2 To Learning Objectives

70. Copyright © 2011 Pearson Education, Inc. Publishing as Longman National Environmental Policy Act requires to file environmental impact statements. A.interest groups B.businesses C.agencies D.all of the above To Learning Objectives LO 19.2

71. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.3 Summary Energy Policy Coal is America’s most abundant fuel and produces nearly half our electricity, but it is the dirtiest source of energy. Petroleum supplies most of our motor fuel, and natural gas produces over a fifth of our electricity. To Learning Objectives

72. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.3 Summary Energy Policy (cont.) Oil and natural gas are somewhat cleaner than coal, they both contribute to global warming and drilling, transporting, and refining of oil and gas are also sources of pollution. Moreover, the United States is dependent on other nations to supply much of its oil and gas. To Learning Objectives

73. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.3 Summary Energy Policy (cont.) Nuclear power is clean and provides more than a fifth of our electricity. However, many question its safety and the storage of nuclear waste has proven to be an intractable problem. To Learning Objectives

74. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.3 Summary Energy Policy (cont.) Renewable energy sources, including water, wind, solar, geothermal, hydrogen, and biomass will probably play an important role at some point, but for the foreseeable future, their contribution to America’s energy supply is likely to remain small. To Learning Objectives

75. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Which of the following does not contribute to global warming? A.coal B.natural gas C.petroleum D.nuclear power LO 19.3 To Learning Objectives

76. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Which of the following does not contribute to global warming? A.coal B.natural gas C.petroleum D.nuclear power To Learning Objectives LO 19.3

77. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.4 Summary Understanding Health Care, Environmental, and Energy Policy High-tech issues strain limits of public participation, but most people do not leave these issues to experts to decide. The public often relies on group representation to help them out with technical issues. To Learning Objectives

78. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.4 Summary Understanding Health Care, Environmental, and Energy Policy (cont.) Scope of government has grown as it has provided health care for elderly and poor, and those who cannot afford health insurance. Health is most rapidly growing public policy and poses a long-term challenge for budgeters. To Learning Objectives

79. Copyright © 2011 Pearson Education, Inc. Publishing as Longman LO 19.4 Summary Understanding Health Care, Environmental, and Energy Policy (cont.) Environmental protection placed more demands on government, increasing its regulatory reach. The public expects government to ensure a sufficient supply of energy and to deal with its polluting byproducts. To Learning Objectives

80. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health care, environmental, and energy policies in recent years have the scope of government. A.decreased B.increased C.had not impact D.limited LO 19.4 To Learning Objectives

81. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Health care, environmental, and energy policies in recent years have the scope of government. A.decreased B.increased C.had not impact D.limited To Learning Objectives LO 19.4

82. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Text Credits World Health Organization, 2009. Centers for Medicare and Medicaid Services, 2010. Annie E. Casey Foundation, Kids Count, 2010. Energy Information Administration, 2010.

83. Copyright © 2011 Pearson Education, Inc. Publishing as Longman Photo Credits 546: AP Photos 547T: AP Photos 547TC: Corbis Images 547TB: Getty Images 547B: AP Photos 554: Corbis Images 556: AP Photos 558: Corbis Images 559: Getty Images 563: Getty Images 566: Chris Britt and Creators Syndicate 567: AP Photos