Policymaking for Health Policymaking for Health Care and the Care and the EnvironmentEnvironment

Chapter 19Chapter 19

Government in America: People, Politics, and PolicyUpdated with 16th Edition

Edwards/Wattenberg/Lineberry

Health Care PolicyHealth Care Policy• The Health of AmericansThe Health of Americans

• Americans generally lag behind other Americans generally lag behind other countries in some key health statistics (life countries in some key health statistics (life expectancy, infant mortality.)expectancy, infant mortality.)

The Cost of Health CareThe Cost of Health Care

• Americans spend more than any other countryAmericans spend more than any other country—$2.9 trillion per year.—$2.9 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 Malpractice lawsuits leads to defensive

medicine, which drives up costs.medicine, which drives up costs.• Overbuilt medical facilitiesOverbuilt medical facilities• Cost containment has taken a back seat to Cost containment has taken a back seat to

technological advancestechnological advances

Access to Health CareAccess to Health Care• Uneven Coverage, Uneven CareUneven Coverage, Uneven Care

• Health InsuranceHealth Insurance• 48 million Americans have no health insurance.48 million Americans have no health insurance.• Most common reason for losing health insurance is Most common reason for losing health insurance is

losing or changing a joblosing or changing a job• Health insurance is closely tied to race and incomeHealth insurance is closely tied to race and income

—higher income means more likely to have —higher income means more likely to have insuranceinsurance

• Managed CareManaged Care• Health Maintenance OrganizationHealth Maintenance Organization (HMO): (HMO):

organization contracted by individuals or insurance organization contracted by individuals or insurance companies to provide health care for a yearly fee—companies to provide health care for a yearly fee—limits choice—covers about 60 percent of Americanslimits choice—covers about 60 percent of Americans

• Designed to reduce costs through oversight and Designed to reduce costs through oversight and limiting patient choiceslimiting patient choices

Access to Health CareAccess to Health Care• The Role of Government in Health CareThe Role of Government in Health Care

• Government in the United States plays smaller Government in the United States plays smaller role than governments in other countriesrole than governments in other countries

• National Health InsuranceNational Health Insurance: a compulsory : a compulsory insurance program for all American that would insurance program for all American that would have the government finance citizens’ medical have the government finance citizens’ medical care—Truman first proposed it, strongly care—Truman first proposed it, strongly opposed by the American Medical Associationopposed by the American Medical Association

• MedicareMedicare: provides hospitalization insurance : provides hospitalization insurance for elderly and optional coverage for other for elderly and optional coverage for other medical expensesmedical expenses• Part A covers hospitalization, Part B Part A covers hospitalization, Part B

(voluntary) covers doctor fees and other (voluntary) covers doctor fees and other expenses, Part D (voluntary) covers expenses, Part D (voluntary) covers prescription drugsprescription drugs

Role of Government in Role of Government in Health CareHealth Care

• MedicaidMedicaid: public assistance program to provide : public assistance program to provide health care for the poor, which is funded by health care for the poor, which is funded by both national and state governmentsboth national and state governments

• CHIP: Children’s Health Insurance Program (1997)CHIP: Children’s Health Insurance Program (1997)

• Program designed to help children and Program designed to help children and pregnant women who don’t qualify for pregnant women who don’t qualify for Medicaid, but they can’t afford private Medicaid, but they can’t afford private health insurancehealth insurance

The UninsuredThe Uninsured

• Most uninsured Americans are full-time Most uninsured Americans are full-time workers and their families who work for low workers and their families who work for low wages with companies who have less than wages with companies who have less than 100 employees100 employees

• Many also have inadequate insuranceMany also have inadequate insurance• In 2012, 25% of households with incomes In 2012, 25% of households with incomes

under $25,000 did not have insuranceunder $25,000 did not have insurance• Hardest hit groups: low income, single Hardest hit groups: low income, single

mother households, Hispanics and African mother households, Hispanics and African AmericansAmericans

Health Care PolicyHealth 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 Interest groups play a major role in health care policy making, leading to health care policy making, leading to uneven government and private health uneven government and private health care policies.care policies.

• ElderlyElderly• BusinessesBusinesses• Insurance companiesInsurance companies

Reform EffortsReform Efforts

•ClintonClinton•Guarantee health care coverage for Guarantee health care coverage for

allall•Paid for by employers who pay a Paid for by employers who pay a

premium into a public fund and tax premium into a public fund and tax increases on cigarettes. Opposed increases on cigarettes. Opposed by business owners and the by business owners and the tobacco industry.tobacco industry.

• Interest groups lobbied hard Interest groups lobbied hard against this bureaucratic and against this bureaucratic and complicated plan which died in complicated plan which died in Congress.Congress.

Reform EffortsReform Efforts• ““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 End discrimination by insurance companies for

pre-existing conditionspre-existing conditions• Cap out of pocket expensesCap out of pocket expenses• Free preventive care (mammograms, flu shots, Free preventive care (mammograms, flu shots,

etc)etc)• People oppose the idea that they HAVE to be People oppose the idea that they HAVE to be

insuredinsured• See it as a government takeover of health careSee it as a government takeover of health care• Pushed through Congress in 2010, but was Pushed through Congress in 2010, but was

challenged at the Supreme Court level. Went challenged at the Supreme Court level. Went into full effect in 2014into full effect in 2014

Environmental PolicyEnvironmental Policy• No one is opposed to cleaning up the environment. No one is opposed to cleaning up the environment.

Political questions arise because of the conflicts Political questions arise because of the conflicts between the environment and economic growth and between the environment and economic growth and jobsjobs

• Environmental Policies in AmericaEnvironmental Policies in America• Environmental Protection AgencyEnvironmental Protection Agency: :

• A federal agency created in 1970 and charged A federal agency created in 1970 and charged with administering all the government’s with administering all the government’s environmental legislationenvironmental legislation

• Administers policies dealing with toxic wastesAdministers policies dealing with toxic wastes• The largest independent regulatory agencyThe largest independent regulatory agency

Environmental PolicyEnvironmental Policy• National Environmental Policy Act National Environmental Policy Act (NEPA)(NEPA)

• Requires the government to file Requires the government to file environmental impact statementsenvironmental impact statements with the with the EPA EPA

• EIS (environmental impact statements)don’t EIS (environmental impact statements)don’t stop building from happening, but can delay it stop building from happening, but can delay it

• Centerpiece of the federal government’s Centerpiece of the federal government’s environmental policyenvironmental policy

• Effective in preventing environmental Effective in preventing environmental despoliationdespoliation

Environmental PolicyEnvironmental Policy• Clean AirClean Air

• Clean Air Act of 1970Clean Air Act of 1970: charged the Department : charged the Department of Transportation with responsibility to reduce of Transportation with responsibility to reduce automobile emissionsautomobile emissions

• 1977 amendments add on non-degradation 1977 amendments add on non-degradation standard, 1990 amendments allowed emissions standard, 1990 amendments allowed emissions tradingtrading

• 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-Carbon monoxide and sulfur dioxide by two-

thirdsthirds• Smaller cars, unleaded gas, higher gas mileage Smaller cars, unleaded gas, higher gas mileage

all came because of this lawall came because of this law

Environmental PolicyEnvironmental Policy

• Clean WaterClean Water• Water Pollution Control Act of 1972Water Pollution Control Act of 1972

• Intended to clean up the nation’s rivers Intended to clean up the nation’s rivers and lakes requiring the use of pollution and lakes requiring the use of pollution control technologycontrol technology

• Has helped reclaim numerous rivers and Has helped reclaim numerous rivers and lakes since its passagelakes since its passage

• But misses “runoff” pollution from city But misses “runoff” pollution from city streets and other areasstreets and other areas

Environmental PolicyEnvironmental 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 The national parks and national forests may

be restricted to keep them for future be restricted to keep them for future generations.generations.

• George W. Bush proposed letting states George W. Bush proposed letting states decide on roads in wilderness areas.decide on roads in wilderness areas.

• Endangered SpeciesEndangered Species• Endangered Species Act Endangered Species Act (1973): federal (1973): federal

government must protect actively endangered government must protect actively endangered species—regardless of economic impactspecies—regardless of economic impact

Environmental PolicyEnvironmental Policy

• Environmental Policies in AmericaEnvironmental Policies in America• Toxic WastesToxic Wastes

• SuperfundSuperfund: created by Congress in 1980 to : created by Congress in 1980 to clean up hazardous waste sites; money once clean up hazardous waste sites; money once came from taxing chemical products, but came from taxing chemical products, but these taxes expired in 1995these taxes expired in 1995

• Has virtually eliminated haphazard dumping Has virtually eliminated haphazard dumping of toxic waste, but less successful in cleaning of toxic waste, but less successful in cleaning up existing wasteup existing waste

Global WarmingGlobal Warming• Caused by the burning of fossil fuelsCaused by the burning of fossil fuels

• Collection of CO2 and other gases causes the Collection of CO2 and other gases causes the “Greenhouse Effect”, which warms the earth“Greenhouse Effect”, which warms the earth

• Earth is warming to between two and six Earth is warming to between two and six degrees by 2100, due to carbon dioxidedegrees by 2100, due to carbon dioxide

• United States is leading producer of carbon United States is leading producer of carbon dioxide, but has not ratified Kyoto treatydioxide, but has not ratified Kyoto treaty• Kyoto requires reduction in greenhouse gas Kyoto requires reduction in greenhouse gas

emissions to 1990 levels by 2010. We never abided emissions to 1990 levels by 2010. We never abided by it.by it.

• States, like California, are reducing emissions.States, like California, are reducing emissions.

Nuclear WasteNuclear Waste

• Nuclear wasteNuclear waste presents a serious challenge—it presents a serious challenge—it takes tens of millions of years for nuclear waste to takes tens of millions of years for nuclear waste to decay to the point at which its safedecay to the point at which its safe

• Yucca Flats in Nevada was designated as home for Yucca Flats in Nevada was designated as home for nuclear waste, but it’s been fought bitterly by nuclear waste, but it’s been fought bitterly by Nevada’s congressional reps. There is currently no Nevada’s congressional reps. There is currently no national storage sitenational storage site

• The problem is that no one wants it where they live The problem is that no one wants it where they live - NIMBY- NIMBY

Energy PolicyEnergy Policy

• Energy Sources and Energy PoliticsEnergy Sources and Energy Politics• 83% of the nation’s energy comes from coal, 83% of the nation’s energy comes from coal,

oil, and natural gas.oil, and natural gas.• Coal is the most abundant fuel—90 percent of Coal is the most abundant fuel—90 percent of

nation’s energy resources—but also the nation’s energy resources—but also the dirtiest.dirtiest.

• Oil accounts for 36% of our energy, but creates Oil accounts for 36% of our energy, but creates a dependence on foreign (especially Middle a dependence on foreign (especially Middle East) sources.East) sources.

• The most controversial energy source is The most controversial energy source is nuclear.nuclear.

Petroleum and Natural Petroleum and Natural GasGas• We import about 1/3 of the oil we use, causing a We import about 1/3 of the oil we use, causing a

large balance of trade deficit, and helping to large balance of trade deficit, and helping to fund potential adversariesfund potential adversaries

• We need to maintain the production of domestic We need to maintain the production of domestic oil, but easy to find oil has already been oil, but easy to find oil has already been recovered – leads to fracking, which can cause recovered – leads to fracking, which can cause ground water contaminationground water contamination

• Offshore drilling has led to enormous oil spillsOffshore drilling has led to enormous oil spills• Current controversy – the Keystone Pipeline Current controversy – the Keystone Pipeline

(Alberta Canada to several destinations in the (Alberta Canada to several destinations in the US)US)

• Message: We need renewable energy sourcesMessage: We need renewable energy sources

Groups, Energy, and the Groups, Energy, and the EnvironmentEnvironment

• Environmental clean up is political since Environmental clean up is political since it puts “public” goods against other it puts “public” goods against other private concerns.private concerns.

• Explosion of groups formed to protect Explosion of groups formed to protect the environment in 1960s and 1970s.the environment in 1960s and 1970s.

• Others oppose strict environmental Others oppose strict environmental laws, claiming it may hurt economy.laws, claiming it may hurt economy.

• Policies will be controversial and Policies will be controversial and expensive.expensive.

Understanding Health Understanding Health Care and Care and

Environmental PolicyEnvironmental Policy• Democracy, Health Care, and Democracy, Health Care, and

Environmental PolicyEnvironmental Policy• The issues involve all levels of The issues involve all levels of

governments.governments.• High-tech issues limit citizens’ High-tech issues limit citizens’

participation.participation.• Relies heavily on group participationRelies heavily on group participation

• Groups, not individuals, have resources Groups, not individuals, have resources needed to afford the research into the science needed to afford the research into the science and policy of the issues.and policy of the issues.

Understanding Health Understanding Health Care and Care and

Environmental PolicyEnvironmental Policy• The Scope of Government and Health The Scope of Government and Health

Care and Environmental PolicyCare and Environmental Policy• As citizens want more health care reform, As citizens want more health care reform,

government will grow.government will grow.• Increased environmental protection will Increased environmental protection will

also increase the size of government.also increase the size of government.• With party divisions, incremental, not With party divisions, incremental, not

fundamental change is most likely.fundamental change is most likely.

SummarySummary

• Technology is important to health and Technology is important to health and environmental policies.environmental policies.• Advances have improved health care but Advances have improved health care but

also increased its cost.also increased its cost.• Advances have improved quality of life, but Advances have improved quality of life, but

reliance on coal and oil as sources of energy reliance on coal and oil as sources of energy have contributed to environmental have contributed to environmental degradation.degradation.

• Government will continue to grow to Government will continue to grow to address these policy issues.address these policy issues.