Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Chapter 19 Edwards, Wattenberg, and...

transcript

Chapter 19

Edwards, Wattenberg, and LineberryGovernment in America: People, Politics, and

PolicyFourteenth Edition

Policymaking for Health Care

and the Environment

Roots of Health Care Policy Governments have long advocated for

public health.

National health insurance was considered in

1930s.

Failed due to lobbying of American Medical

Association.

Government’s role has expanded over time.

No universal coverage exists.

Health Care Programs Today Government provides care for veterans and

Indians.

Sponsors research at National Institutes of Health.

Most people use single-payer private healthcare

system.

Costs are rapidly increasing.

Government funds Medicare and Medicaid.

Also plays a major role in public health

management.

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.

Global $899

1 United States of America $7,164

2 Luxembourg $5,996

3 Monaco $5,750

4 Norway $5,207

5 Switzerland $4,815

6 Netherlands $4,233

7 Malta $4,197

8 Austria $4,150

9 Belgium $4,096

10 Germany $3,922

11 Canada $3,867

12 France $3,851

13 Denmark $3,814

14 Ireland $3,796

15 San Marino $3,690

16 Sweden $3,622

17 Iceland $3,583

18 Australia $3,365

19 Finland $3,299

20 United Kingdom $3,222

Health Care PolicyThe Health of Americans

Americans generally lag behind other countries Lower life expectancy and higher infant mortality rate

The Cost of Health CareAmericans spend more than any other country—

$2.3 trillion and one-seventh of GDP.Reasons for high costs:

High-tech medicineInsurance pays for health care.Malpractice lawsuits leads to defensive medicine,

which drives up costs.

Uneven Coverage, Uneven Care

Health Insurance facts46 million have no insurance.

Most common reason for no insurance is losing or changing a job.

Health insurance closely tied to income —Higher income = more insurance

Managed Care

Health Maintenance Organization (HMO): organization contracted by individuals or insurance companies to provide health care for a yearly fee.

Designed to reduce costs through oversight and limiting patient choices.

Limits choice of health care providers

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

Rank Country or territory

Infant mortality rate

(deaths/1,000 live births)

- World 42.09

1 Singapore 2.31

2 Bermuda 2.46

3 Sweden 2.75

4 Japan 2.79

5 Hong Kong 2.92

6 Macau 3.22

7 Iceland 3.23

8 France 3.33

9 Finland 3.47

10 Anguilla 3.52

11 Norway 3.58

12 Malta 3.75

13 Andorra 3.76

14 Czech Republic 3.79

15 Germany 3.99

16 Switzerland 4.18

17 Spain 4.21

18 Israel 4.22

19 Slovenia 4.25

20 Liechtenstein 4.25

21 South Korea 4.26

22 Denmark 4.34

43 5.72

44 Cuba 5.82

45 Guam 6.05

46 United States 6.26

European Union

The Role of Government in Health Care

Government 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. Current plan (“Obamacare”)- Private insurance or Gov’t Insurance. Phased in 2010-2018.

Medicare: provides hospitalization insurance for elderly and optional coverage for other medical expenses

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

Policymaking for Health Care

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

– Elderly– Businesses / Labor groups– Insurance companies– Health providers

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

Two Presidents, Two Health Care Plans

Clinton •Guarantee health care coverage for all•Paid for by employers who pay a premium

into a public fund and tax increases on cigarettes

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

Bush•Health savings accounts•Drug benefits for elderly through Medicare

The Health Policy Issues Ahead

Nothing suggests health care will become cheaper.

Health Policy Controversies– Stem cell research

•Limits on federal funding and research, but states spending more

– Is medical rationing the solution to high health care costs?

U.S.A. Ranked 37th by W.H.O.

Health (50%) : disability-adjusted life expectancy (homicides, obesity*)

Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities

Fair financial contribution 25% (lack of insurance, 37%+ by choice*)

* John Stossel criticisms

Chapter 19

Environmental Policy

3 reasons why environmental policy is

controversial…Policy creates winners and losersScientific uncertaintyEntrepreneurial politics

ENTREPRENEURIAL POLITICS

BENEFITS TO MANY

COSTS TO ONLY A FEW

Environmental policy in America

More adversarial than most European nations.

What is done depends heavily on the states.– Federalism causes conflict

• Different Levels of Government

– Separation of powers causes complications• The 3 Branches of Government

Environmental Policies in America

Environmental Protection Agency: A federal agency created in 1970 and

charged with administering all the government’s environmental legislation

Administers policies dealing with toxic wastes

The largest independent regulatory agency

MAIN GOVERNMENT AGENCY

Clean AirClean Air Act of 1970

Charged the Department of Transportation with responsibility to reduce automobile emissions.

1990 amendments allowed emissions trading

Las Vegas

THE GROWTH OF BALTIMORE(Urban Sprawl)

U.S.A. Car Fatalities1972 = 52, 3892003 = 42, 884 2004 = 42, 6362006 = 41, 3542008 = 31,110 (Jan–Oct)

TYPES OF ACCIDENTAL DEATHS, USA 2002

PERCENT

(1) Motor vehicle (MVA) 44.30%

(2) Falls 17.80%

(3) Poison,liq/solid 13.00%

(4) Drowning 3.90%

(5) Fires, Burns,Smoke 3.40%

(6) Medical/Surgical Complication 3.10%

(7) Other land transport 1.50%

(8) Firearms 0.80%

(9) Other (nontransport) 17.80%

West Jordan, Utah Population1950 2,1071960 3,0091970 4,2211980 27,1921990 42,8922000 68,3362009 104,915

Dayton, Ohio Population

1830 2,950 —

1840 6,067 105.70%

1850 10,977 80.90%

1860 20,081 82.90%

1870 30,473 51.80%

1880 38,678 26.90%

1890 61,220 58.30%

1900 85,333 39.40%

1910 116,577 36.60%

1920 152,559 30.90%

1930 200,982 31.70%

1940 210,718 4.80%

1950 243,872 15.70%

1960 262,332 7.60%

1970 243,601 −7.1%

1980 193,536 −20.6%

1990 182,044 −5.9%

2000 166,179 −8.7%

2009 153,843 −7.4%

Clean WaterWater Pollution Control Act of 1972

Intended 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 passage

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

Grand Lake Ohio 2010-11

Retention Ponds

Prevent floodingStorm /

Displaced water storage

Wilderness PreservationThe U.S. is a world leader.National parks / national forests restrict use to

keep them for future generations.

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

Endangered SpeciesEndangered Species Act: federal government

must protect actively endangered species—regardless of economic impact

Toxic WastesSuperfund: created by Congress in 1980 to clean

up hazardous waste sites; money comes from taxing chemical products

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

Nuclear waste presents a serious challengeYucca Flats, Nevada as home for nuclear waste

SUPERFUND CLEANUP SITES

Green=Cleaned Yellow=Proposed Red=Identified

Energy Sources and Energy Politics

87% 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.

Oil accounts for 40% of our energy, but creates a dependence on foreign (especially Middle East) sources.

The most controversial energy source is nuclear.

Energy Policy

The Global Warming Gridlock

Earth is expected to warm between two and six degrees by 2100 due to carbon dioxide.

Total costs could be $5 trillion.

United States is leading producer of carbon dioxide, but has not ratified Kyoto treatyKyoto requires reduction in greenhouse gas.

States, like California, are reducing emissions.

Groups, Energy, and the Environment

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.

Opposition to strict environmental laws, claiming it may hurt economy.

Policies will be controversial and expensive.

Democracy, Health Care, and Environmental Policy

The issues involve all levels of governments.

High-tech issues limit citizens’ participation.

Relies heavily on group participationGroups, not individuals, have resources

needed to afford the research into the science and policy of the issues.

The Scope of Government and Health Care and Environmental

PolicyAs 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.

Summary

Technology is important to health and environmental policies.– 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.

Government will continue to grow to address these policy issues.

Copyright © 2009 Pearson Education, Inc. Publishing as Longman. Chapter 19 Edwards, Wattenberg, and...

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