Social Health Insurance in the United States The Politics and History of Medicare.
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Transcript of Social Health Insurance in the United States The Politics and History of Medicare.
![Page 1: Social Health Insurance in the United States The Politics and History of Medicare.](https://reader036.fdocuments.us/reader036/viewer/2022062801/56649e595503460f94b53510/html5/thumbnails/1.jpg)
Social Health Insurance in the United States
The Politics and History of Medicare
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Government Health Insurance Options in the US
• Medicare• Medicaid• Child Health
Insurance Protection• State programs
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What is Medicare?
• Government managed health care for seniors over the age of 65 and people with disabilities.
• Signed into law in 1965 by President Lyndon B. Johnson (Great Society)
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How many people does Medicare reach?
• In 1966, 19 million people (approximately 10% of the population)
• In 2008, 45 million people (approximately 15% of the population-12% are elderly, 3% are disabled)
• In 2030, it will reach 79 million people• Almost half of those covered live in 10 states:
California, Florida, Illinois, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania and Texas
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What Does Medicare Cover?
• Part A: Hospital Insurance
• Part B: Out-patient care, doctors visits and preventative health measures
• Part C: Medicare Advantage-privately run
• Part D: Prescription Drugs
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Coverage changes over time
• Disability-1972
• Prospective payment for DRGs (1983)
• Hospice Care-1986
• Preventive care, Pap smears and Mammograms (late 1980s)
• Price controls for physicians-1992
• Prescription Drugs-2005
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Detailed Medicare Spending
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How is Medicare Funded?
• Payroll taxes (7.5%)• General Revenue support of
$179 billion dollars in 2007• Monthly Premium Payments
– $423 for hospital, $96.40 (up to $238.4) for outpatient
– In 1965, the premium for outpatient was $3, in 2000 it was $45.40
– Hospital premium free if you worked at least ten years in the US and paid taxes
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Money, Money
• Medicare expenditures are expected to hit $486 billion in 2009, accounting for roughly 14 percent of the federal budget. Expenses are rising much faster than overall inflation and are on track to hit $887 billion by 2018.
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Money, Money
• “The Federal Government is the biggest purchaser of health care services and a primary determinant of the cost of health care services in major segments of the US health care market” Charlotte Twight, Medicare’s Origin, Cato Journal
• In 2004, Fed Government spent $486 billion for Defense and $473 billion for Medicare and Medicaid
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But Consumers still pay
• 20% co-pay on many items
• 50% co-pay on mental health
• Dentures, glasses not covered
• Up to $8,704 for a long (90 day +) illness in hospital (out of pocket)
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Medicare is not Enough
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Who Administers it?
• US Department of Health and Human Services– Center for Medicare
and Medicaid– Office of Medicare
Hearings and Appeals
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The Politics
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Politics
• “Medicare politics is now transparently a battle of ideas about the role of markets and governments in public policy…… As a consequence, after 37 years of policy innovations, political upheaval, changing economic circumstances and a radically altered health care system, Medicare politics is back where it started” Oberlander
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Short History
• 1934- Franklin D. Roosevelt says health insurance plan would be forthcoming
• 1945-Harry Truman asks for a national health insurance plan
• 1966-Lyndon Johnson signs Medicare into Law
• 1970s- cost control, health inflation of 17%
• 1980s-Ronald Reagan equates Medicare to Socialism
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More History
• 1993- Clinton tries to reform health care in the US.
• 1994, William Kristol convinced Republicans not to work with the Clinton White House to reach a compromise on health care reform
• “the long term political effects of a successful Clinton health care bill would revive the reputation of the party . . . as the generous protector of middle-class interests. “
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More History
• 2003- Bush signs Medicare reform bill for prescription drugs:– “the greatest advance in
health care coverage for America's seniors since the founding of Medicare.”
• Bush vetoed a Medicare bill and Congress revolted, only 41 legislators approved the veto
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Current Events• “The cost of our health
care has weighed down our economy and the conscience of our nation long enough, so let there be no doubt: health care reform cannot wait.”– President Obama,
2009
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How did we get here?
• Post World War I backlash against Germans who started government national insurance plans
• World War II incentives to get people working centered around employer-based insurance (142 million covered by 1950)
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How did we get here?
• AMA opposition to national insurance: denounced it as “socialized medicine”
• Historic American suspicion of “Big Government”
• Republican domination of White House and Congress
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Socialized Medicine?
• “There is nothing in this bill which tells a doctor whom to treat and when to treat him….by which the Government would control the hospital and as I understand socialism, it is Government control” HEW Secretary Celebrezze 1965
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Current Issues in Medicare
• Aging population, 79 million enrollees by 2030, double that of 2000
• Shrinking work force contributions
• Rising costs of health care
• Physician opting out
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Current Issues
• “Medicare is totally unsustainable”
• “the country cannot afford Medicare as it is currently provided”
• “you’ve got a political battle when you try to control the costs of Medicare and even a bigger fight if you try to back track and take it away, its too politically popular.”
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Political Action
• Protest• Advocacy• Legislation• Voting
representatives out of office if they don’t support Medicare
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Political Actions
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The Future
Obama’s proposed reforms• Requiring employers, except small businesses,
to provide health insurance to their employees or contribute to the cost.
• Requiring that all children have health insurance. • Expanding Medicaid and the State Children's
Health Insurance Program (SCHIP). • Creating a National Health Insurance Exchange
to pool risk and give people the choice of competing private or public health plans.