1. Policymaking for Health Care and the Environment Chapter 19 Government in America: People, Politics, and Policy Updated with 15 th Edition Edwards/Wattenberg/Lineberry

2. Health Care Policy The Health of AmericansThe Health of Americans Americans generally lag behind other countries in some key health statistics (life expectancy, infant mortality.)Americans generally lag behind other countries in some key health statistics (life expectancy, infant mortality.)

3. The Cost of Health Care Americans spend more than any other country— $2.5 trillion per year.Americans spend more than any other country— $2.5 trillion per year. ¼ of all federal expenditures¼ of all federal expenditures Reasons for high costs:Reasons for high costs: High-tech medicine (organ transplants, etc.)High-tech medicine (organ transplants, etc.) Insurance pays for health care.Insurance pays for health care. Malpractice lawsuits leads to defensive medicine, which drives up costs.Malpractice lawsuits leads to defensive medicine, which drives up costs. Overbuilt medical facilitiesOverbuilt medical facilities

4. Access to Health Care Uneven Coverage, Uneven CareUneven Coverage, Uneven Care Health InsuranceHealth Insurance 45.8 million Americans have no health insurance.45.8 million Americans have no health insurance. Most common reason for losing health insurance is losing or changing a jobMost common reason for losing health insurance is losing or changing a job Health insurance is closely tied to race and income— higher income means more likely to have insuranceHealth insurance is closely tied to race and income— higher income means more likely to have insurance Managed CareManaged Care Health Maintenance Organization (HMO): organization contracted by individuals or insurance companies to provide health care for a yearly fee—limits choice— covers about 60 percent of AmericansHealth Maintenance Organization (HMO): organization contracted by individuals or insurance companies to provide health care for a yearly fee—limits choice— covers about 60 percent of Americans Designed to reduce costs through oversight and limiting patient choicesDesigned to reduce costs through oversight and limiting patient choices

5. Access to Health Care The Role of Government in Health CareThe Role of Government in Health Care Government in the United States plays smaller role than governments in other countriesGovernment in the United States plays smaller role than governments in other countries National Health Insurance: a compulsory insurance program for all American that would have the government finance citizens’ medical care—Truman first proposed it, strongly opposed by the American Medical AssociationNational Health Insurance: a compulsory insurance program for all American that would have the government finance citizens’ medical care—Truman first proposed it, strongly opposed by the American Medical Association Medicare: provides hospitalization insurance for elderly and optional coverage for other medical expensesMedicare: provides hospitalization insurance for elderly and optional coverage for other medical expenses Part A covers hospitalization, Part B (voluntary) covers doctor fees and other expenses, Part D (voluntary) covers prescription drugsPart A covers hospitalization, Part B (voluntary) covers doctor fees and other expenses, Part D (voluntary) covers prescription drugs Medicaid: public assistance program to provide health care for the poor, which is funded by both national and state governmentsMedicaid: public assistance program to provide health care for the poor, which is funded by both national and state governments

6. Health Care Policy Policymaking for Health CarePolicymaking for Health Care The Politics of Health CareThe Politics of Health Care Interest groups play a major role in health care policy making, leading to uneven government and private health care policies.Interest groups play a major role in health care policy making, leading to uneven government and private health care policies. ElderlyElderly BusinessesBusinesses Insurance companiesInsurance companies

7. Reform Attempts ClintonClinton Guarantee health care coverage for allGuarantee health care coverage for all Paid for by employers who pay a premium into a public fund and tax increases on cigarettes. Opposed by business owners and the tobacco industry.Paid for by employers who pay a premium into a public fund and tax increases on cigarettes. Opposed by business owners and the tobacco industry. Interest groups lobbied hard against this bureaucratic and complicated plan which died in Congress.Interest groups lobbied hard against this bureaucratic and complicated plan which died in Congress.

8. Reform Attempts “Obamacare” – The Affordable Care Act“Obamacare” – The Affordable Care Act Top priority in domestic policyTop priority in domestic policy Wants increased access with lower costsWants increased access with lower costs End discrimination by insurance companies for pre-existing conditionsEnd discrimination by insurance companies for pre-existing conditions Cap out of pocket expensesCap out of pocket expenses Free preventive care (mammograms, flu shots, etc)Free preventive care (mammograms, flu shots, etc) People oppose the idea that they HAVE to be insuredPeople oppose the idea that they HAVE to be insured See it as a government takeover of health careSee it as a government takeover of health care Pushed through Congress in 2010, but was challenged at the Supreme Court level. Goes into full effect in 2014Pushed through Congress in 2010, but was challenged at the Supreme Court level. Goes into full effect in 2014

9. Health Care Policy Policymaking for Health CarePolicymaking for Health Care The Health Policy Issues AheadThe Health Policy Issues Ahead Nothing suggests health care will become cheaper.Nothing suggests health care will become cheaper. Stem cell researchStem cell research Limits on federal funding and research, but states spending more. Obama may change this during his administrationLimits on federal funding and research, but states spending more. Obama may change this during his administration Is medical rationing the solution to high health care costs?Is medical rationing the solution to high health care costs?

10. Environmental Policy Environmental Policies in AmericaEnvironmental Policies in America Environmental Protection Agency:Environmental Protection Agency: A federal agency created in 1970 and charged with administering all the government’s environmental legislationA federal agency created in 1970 and charged with administering all the government’s environmental legislation Administers policies dealing with toxic wastesAdministers policies dealing with toxic wastes The largest independent regulatory agencyThe largest independent regulatory agency

11. Environmental Policy National Environmental Policy Act (NEPA)National Environmental Policy Act (NEPA) Requires the government to file environmental impact statements with the EPARequires the government to file environmental impact statements with the EPA EIS (environmental impact statements)don’t stop building from happening, but can delay itEIS (environmental impact statements)don’t stop building from happening, but can delay it Centerpiece of the federal government’s environmental policyCenterpiece of the federal government’s environmental policy Effective in preventing environmental despoliationEffective in preventing environmental despoliation

12. Environmental Policy Clean AirClean Air Clean Air Act of 1970: charged the Department of Transportation with responsibility to reduce automobile emissionsClean Air Act of 1970: charged the Department of Transportation with responsibility to reduce automobile emissions 1977 amendments add on non-degradation standard1977 amendments add on non-degradation standard 1990 amendments allowed emissions trading1990 amendments allowed emissions trading 2004 EPA data show:2004 EPA data show: Lead has been eliminated from car emissionsLead has been eliminated from car emissions Carbon monoxide and sulfur dioxide by two-thirdsCarbon monoxide and sulfur dioxide by two-thirds

13. Environmental Policy Clean WaterClean Water Water Pollution Control Act of 1972Water Pollution Control Act of 1972 Intended to clean up the nation’s rivers and lakes requiring the use of pollution control technologyIntended to clean up the nation’s rivers and lakes requiring the use of pollution control technology Has helped reclaim numerous rivers and lakes since its passageHas helped reclaim numerous rivers and lakes since its passage But misses “runoff” pollution from city streets and other areasBut misses “runoff” pollution from city streets and other areas

14. Environmental Policy Environmental Policies in AmericaEnvironmental Policies in America Wilderness PreservationWilderness Preservation The U.S. is a world leader.The U.S. is a world leader. The national parks and national forests may be restricted to keep them for future generations.The national parks and national forests may be restricted to keep them for future generations. George W. Bush proposed letting states decide on roads in wilderness areas.George W. Bush proposed letting states decide on roads in wilderness areas. Endangered SpeciesEndangered Species Endangered Species Act (1973): federal government must protect actively endangered species—regardless of economic impactEndangered Species Act (1973): federal government must protect actively endangered species—regardless of economic impact

15. Environmental Policy Environmental Policies in AmericaEnvironmental Policies in America Toxic WastesToxic Wastes Superfund: created by Congress in 1980 to clean up hazardous waste sites; money once came from taxing chemical products, but these taxes expired in 1995Superfund: created by Congress in 1980 to clean up hazardous waste sites; money once came from taxing chemical products, but these taxes expired in 1995 Has virtually eliminated haphazard dumping of toxic waste, but less successful in cleaning up existing wasteHas virtually eliminated haphazard dumping of toxic waste, but less successful in cleaning up existing waste Nuclear waste presents a serious challenge—Yucca Flats in Nevada as home for nuclear wasteNuclear waste presents a serious challenge—Yucca Flats in Nevada as home for nuclear waste

16. Energy Policy Energy Sources and Energy PoliticsEnergy Sources and Energy Politics 83% of the nation’s energy comes from coal, oil, and natural gas.83% of the nation’s energy comes from coal, oil, and natural gas. Coal is the most abundant fuel—90 percent of nation’s energy resources—but also the dirtiest.Coal is the most abundant fuel—90 percent of nation’s energy resources—but also the dirtiest. Oil accounts for 37% of our energy, but creates a dependence on foreign (especially Middle East) sources.Oil accounts for 37% of our energy, but creates a dependence on foreign (especially Middle East) sources. The most controversial energy source is nuclear.The most controversial energy source is nuclear.

17. Energy Policy

18. The Global Warming GridlockThe Global Warming Gridlock Earth is warming to between two and six degrees by 2100, due to carbon dioxideEarth is warming to between two and six degrees by 2100, due to carbon dioxide Total costs could be $5 trillion.Total costs could be $5 trillion. United States is leading producer of carbon dioxide, but has not ratified Kyoto treatyUnited States is leading producer of carbon dioxide, but has not ratified Kyoto treaty Kyoto requires reduction in greenhouse gas emissions to 1990 levels by 2010.Kyoto requires reduction in greenhouse gas emissions to 1990 levels by 2010. States, like California, are reducing emissions.States, like California, are reducing emissions.

19. Groups, Energy, and the Environment Environmental clean up is political since it puts “public” goods against other private concerns.Environmental clean up is political since it puts “public” goods against other private concerns. Explosion of groups formed to protect the environment in 1960s and 1970s.Explosion of groups formed to protect the environment in 1960s and 1970s. Others oppose strict environmental laws, claiming it may hurt economy.Others oppose strict environmental laws, claiming it may hurt economy. Policies will be controversial and expensive.Policies will be controversial and expensive.

20. Understanding Health Care and Environmental Policy Democracy, Health Care, and Environmental PolicyDemocracy, Health Care, and Environmental Policy The issues involve all levels of governments.The issues involve all levels of governments. High-tech issues limit citizens’ participation.High-tech issues limit citizens’ participation. Relies heavily on group participationRelies heavily on group participation Groups, not individuals, have resources needed to afford the research into the science and policy of the issues.Groups, not individuals, have resources needed to afford the research into the science and policy of the issues.

21. Understanding Health Care and Environmental Policy The Scope of Government and Health Care and Environmental PolicyThe Scope of Government and Health Care and Environmental Policy As citizens want more health care reform, government will grow.As citizens want more health care reform, government will grow. Increased environmental protection will also increase the size of government.Increased environmental protection will also increase the size of government. With party divisions, incremental, not fundamental change is most likely.With party divisions, incremental, not fundamental change is most likely.

22. Summary Technology is important to health and environmental policies.Technology is important to health and environmental policies. Advances have improved health care but also increased its cost.Advances have improved health care but also increased its cost. Advances have improved quality of life, but reliance on coal and oil as sources of energy have contributed to environmental degradation.Advances have improved quality of life, but reliance on coal and oil as sources of energy have contributed to environmental degradation. Government will continue to grow to address these policy issues.Government will continue to grow to address these policy issues.