1. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Chapter 19 Edwards, Wattenberg, and Lineberry Government in America: People, Politics, and Policy Fourteenth Edition Policymaking for Health Care and the Environment

2. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Roots of Health Care Policy  Governments have long advocated for public health.  National health insurance was considered in 1930s.  Failed due American Medical Association lobbied against.  Government’s role has expanded over time.  No universal coverage exists.

3. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Health Care Programs Today  Most people use private insurance  ‘Obamacare’ required  Government provides care for many  Vets, Indians, fed employees (Congress), prisoners  Government funds Medicare (elderly)  Government funds Medicaid (poor)  ’Obamacare’ expands eligibility

4. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. U.S.A. Ranked 37 th by W.H.O. Health: disability-adjusted life expectancy (homicides, obesity*) Responsiveness: speed of service, protection of privacy, and quality of amenities Fair financial contribution (lack of insurance, 37%+ by choice*) * John Stossel criticisms

5. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. HEALTHCARE CONCERNS INCREASING COSTS LACK OF COVERAGE

6. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. The Cost of Health Care Americans spend more than any others ~ 1/7 of GDP (14%) Reasons for high costs High-tech medicine Insurance costs Malpractice lawsuits High ‘End of Life’ phase spending

7. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Global$899 1United States of America$7,164 2Luxembourg$5,996 3Monaco$5,750 4Norway$5,207 5Switzerland$4,815 6Netherlands$4,233 7Malta$4,197 8Austria$4,150 9Belgium$4,096 10Germany$3,922 11Canada$3,867 12France$3,851 13Denmark$3,814 14Ireland$3,796 15San Marino$3,690 16Sweden$3,622 17Iceland$3,583 18Australia$3,365 19Finland$3,299 20United Kingdom$3,222

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13. Source: Organisation for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011). Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates.

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16. The Health of Americans Americans lag behind others Less prenatal care Higher infant mortality rate More lifestyle issues Lower life expectancy and

17. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. PRENATAL CARE

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20. INFANT MORTALITY

21. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. RankCountry or territory Infant mortality rate (deaths/1,000 live births) -World42.09 1 Singapore2.31 2 Bermuda2.46 3 Sweden2.75 4 Japan2.79 5 Hong Kong2.92 6 Macau3.22 7 Iceland3.23 8 France3.33 9 Finland3.47 10 Anguilla3.52 11 Norway3.58 12 Malta3.75 13 Andorra3.76 14 Czech Republic3.79 15 Germany3.99 16 Switzerland4.18 17 Spain4.21 18 Israel4.22 19 Slovenia4.25 20 Liechtenstein4.25 21 South Korea4.26 22 Denmark4.34 43 5.72 44 Cuba5.82 45 Guam6.05 46 United States6.26 European Union

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26. LIFESTYLE ISSUES

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38. LIFE EXPECTANCY

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42. 1 Monaco 89.7 2011 est. 2 Macau 84.4 2011 est. 3 San Marino 83 2011 est. 4 Andorra 82.4 2011 est. 5 Japan 82.3 2011 est. 6 Guernsey 82.2 2011 est. 7 Singapore 82.1 2011 est. 8 Hong Kong 82 2011 est. 9 Australia 81.8 2011 est. 10 Italy 81.8 2011 est. 11 Jersey 81.4 2011 est. 12 Canada 81.4 2011 est. 13 France 81.2 2011 est. 14 Spain 81.2 2011 est. 15 Switzerland 81.1 2011 est. 16 Sweden 81.1 2011 est. 17 Israel 81 2011 est. 18 Iceland 80.9 2011 est. 19 Anguilla 80.9 2011 est. 20 Bermuda 80.7 2011 est. 49 Portugal 78.5 2011 est. 50 United States 78.4 2011 est. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html

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44. http://ucatlas.ucsc.edu/spend.php

45. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Uneven Coverage, Uneven Care 46 million have no health insurance Most insurance is job based Health insurance closely tied to income — Higher income = more insurance

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49. Managed Care Health Maintenance Organization (HMOs) Started by insurance companies Provide care for a yearly fee Designed to reduce costs Limits choice of care providers

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53. The Role of Government in Health Care U.S. Government plays smaller role than governments in other countries National Health Insurance (Phased in 2010- 2018) Compulsory insurance program (“Obamacare”) buy private insurance, Gov’t Insurance or pay fee Medicare (Pay roll tax) Insurance for elderly, disabled Medicaid (State & federal income tax) Public assistance for the poor (state operated)

54. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Map of the Countries That Provide Universal Health Care

55. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Orange countries have some form of universal health care. Yellow countries are in the process of extending universal coverage. Brown are Iraq and Afghanistan (U.S. is supplementing the national health care system). Gray countries have no universal health care

56. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Policymaking for Health Care Interest groups influence health care policy – Elderly – Businesses / Labor groups – Insurance companies – Health providers

57. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Policymaking for Health Care National Healthcare is a POLITICAL ISSUE Democrats generally for Republicans generally against

58. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Three Presidents Three Health Care Plans Clinton – Universal coverage – Paid for by employers – Paid by cigarette tax increases – Complicated plan – Interest groups lobbied against – Plan died in Congress

59. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Three Presidents Three Health Care Plans Bush – Health savings accounts Voluntary non-taxed prepay system – Changed Medicare benefits – Passed in 2003

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63. GUARANTEED ISSUE / Expanded child coverage Everyone eligible even w/ pre-existing conditions EXTENDED AGE (26) AS FAMILY MEMBER OPTION MINIMUM STANDARD POLICIES Essential health benefits INDIVIDUAL MANDATE Must ‘buy’ insurance or pay a ‘tax’ HEALTH INSURANCE EXCHANGES State option or federal option Used to purchase private insurance

64. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. LOW INCOME FEDERAL SUBSIDIES Sliding scale based on income (100% - 400% of poverty level) EXPANDED MEDICAID ELIGIBILITY Optional for states MEDICARE REFORMS To promote greater efficiency EMPLOYER MANDATE Subsidies if under 25 employees Tax penalty of ?? (Depends on wages)

65. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Creating state-operated exchanges Establishing state-federal partnership exchanges Defaulting to federal exchange

66. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Expanding Medicaid Still debating Medicaid expansion Not expanding Medicaid

67. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Most common misconceptions “Death Panels” Nationalizes health insurance Forced contraception Exemption for Congress Benefits to ‘undocumented immigrants’ Implanted microchip

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73. Chapter 19 Environmental Policy

74. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. 3 reasons why environmental policy is controversial… Scientific uncertainty (~90%) Policy creates winners and losers Entrepreneurial politics

75. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. ENTREPRENEURIAL POLITICS BENEFITS TO MANY COSTS TO ONLY A FEW

76. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Environmental policy in America More adversarial than European nations. What is done depends heavily on the states. –Federalism causes conflict Separation of powers causes complications –The 3 Branches of Government

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78. Environmental Protection Agency Created in 1970 Enforces environmental regulations Deals with toxic wastes Largest independent regulatory agency

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82. MAIN GOVERNMENT AGENCY

83. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Clean Air Act of 1970 Goal to limit pollution Reduce automobile emissions Reduce factory emissions Emissions trading allowed 1990 changes

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86. Las Vegas

87. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. THE GROWTH OF BALTIMORE (Urban Sprawl)

88. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. U.S.A. Car Fatalities 1972 = 52, 389 2003 = 42, 884 2004 = 42, 636 2006 = 41, 354 2008 = 31,110 (Jan–Oct)

89. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. TYPES OF ACCIDENTAL DEATHS, USA 2002 PERCENT (1) Motor vehicle (MVA)44.30% (2) Falls17.80% (3) Poison,liq/solid13.00% (4) Drowning3.90% (5) Fires, Burns,Smoke3.40% (6) Medical/Surgical Complication3.10% (7) Other land transport1.50% (8) Firearms0.80% (9) Other (nontransport)17.80%

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91. West Jordan, Utah Population 19502,107 19603,009 19704,221 198027,192 199042,892 200068,336 2009104,915

92. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Dayton, Ohio Population 18302,950— 18406,067105.70% 185010,97780.90% 186020,08182.90% 187030,47351.80% 188038,67826.90% 189061,22058.30% 190085,33339.40% 1910116,57736.60% 1920152,55930.90% 1930200,98231.70% 1940210,7184.80% 1950243,87215.70% 1960262,3327.60% 1970243,601−7.1% 1980193,536−20.6% 1990182,044−5.9% 2000166,179−8.7% 2009153,843−7.4%

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94. Water Pollution Control Act of 1972 Intended to clean up the nation’s rivers, lakes But misses “runoff” pollution from city streets and other areas.

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100. Grand Lake Ohio 2010-11

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102. Retention Ponds Prevent flooding Storm / Displaced water storage

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105. Wilderness Preservation The U.S. is a world leader. National parks / national forests Restrict use for future generations

106. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Endangered Species Act Protect actively endangered species Regardless of economic impact

107. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Superfund Clean up hazardous waste sites Good at limiting dumping of toxic waste Bad at cleaning up existing waste Nuclear waste presents a serious challenge

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109. SUPERFUND CLEANUP SITES Green=Cleaned Yellow=Proposed Red=Identified

110. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Energy Sources 87% coal, oil, and natural gas Coal - the most abundant fuel - also the dirtiest Oil accounts for 40% of our energy, but dependent on foreign sources The most controversial energy source is nuclear

111. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Energy Policy

112. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Energy Policy

113. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. The Global Warming Gridlock Earth to warm 2 -6 degrees by 2100 Total costs could be $5 trillion. United States is leading producer of carbon dioxide States, like California, are reducing emissions

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118. Environmental Politics Environmental clean up is political Pits “public” goods against private concerns Environmental groups formed in 1960s, 1970s Environmental opposition- may hurt economy Policies are controversial and expensive

119. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. The Scope of Government and Health Care and Environmental Policy As citizens want more health care reform, government will grow. Increased environmental protection will also increase the size of government. With party divisions, incremental, not fundamental change is most likely.

120. Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Summary Technology is important to health and environmental policies. Changes in health and environmental will be controversial. Government will continue to grow to address these policy issues.