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Paper 3 and Health Care
Learning Objectives• Accurately describe the social, economic, and
political dimension of major problems and dilemmas facing contemporary American society;
• Use knowledge and analyses of social problems to evaluate public policy, and to suggest policy alternatives, with special reference to questions of social justice, the common good, and public and individual responsibility.
PAPER 3
About Paper 3• What it Contains
– Revised Paper 2 paper – an argument for your own position (evidence,
moral reasoning, feasibility)– Counter-argumentation– and Conclusion;
• 12-15 TOTAL pages of text - 15 Works Cited
• Rubric
What it Contains: Your Solution
• Pick/develop a solution to the controversial social problem
• For your solution– Provide new reasons or those from paper 2– Provide evidence to support your solution
What it Contains: Counter-argumentation
• identify the weakest aspects of your solution and defend it against your opponents – who is likely to oppose your choice and why
– provide counterargumentation for your solution and defend it against those would oppose your stance.
What it Contains: Your Moral Reasoning
• Support of your position from a Moral Reasoning perspective
• Identify your Obligations, Values, and Consequences in reaching your solution.
• Use the moral reasoning perspective to justify your solution
What it Contains: A conclusion
• Finally, you get to write a conclusion
• Finish with two or three strong paragraphs that summarize the Social Problem, the Controversial Policy Solution, and your decision. Be persuasive.
About Paper 3
• You must submit two copies– in class on the day and time they are due – submitted to turnitin.com via Blackboard by 11:59
PM on the Day they are due.
• I grade the hard copy, and if this is late, you receive a grade of zero for that assignment
What the Government Covers
• Medicaid
• Medicare
• SCHIP
• Veterans Administration
• Government Employees
Medicaid
• Health Care as Welfare
• Single Largest Welfare program for the poor
• Fraught with problems
Medicare
• Non-Means Tested
• Increasingly Expensive
• Fraught with Problems
SCHIP
• Health Care for Children on the Bubble
• Increasingly Expensive
Private Insurance
• Fee For Service
• Managed Care- 90% of all private insurance
Terms of Health Care
• Premium
• Deductable
• Copayment
How We Get our Health Care
Strengths of the System
• Best Doctors and Hospitals
• Most Advanced Treatment
• Most Research and Development
• People with Health Care are satisfied With it.
The Problems of the System
• Access
• Cost
• Quality
The Problem of Access
The Problem of Access
• Not 50 Million Americans
• But 50 million in America
The Problem of Access
Why People do not have insurance
• Health Care is historically been a private choice
• Health Care is an opportunity cost
Options for the Uninsured
• E.R.
• Self Medicate
• Do Nothing
Problem 2 Quality
• Quality is maldistributed
• We focus on sickness, not health
• We are overspecialized
Problem 3: Cost
• Outpacing Inflation
• Why
Cost- Technology
• MRI’s
• Bypass surgery
• Fake Knees and Hips
• These help us live longer
Cost- Labor
• 5.5 People per patient
• Jobs that require skill and education
• Recession Proof
Cost- Malpractice
• Actually not the suits themselves
• Defensive medicine
• High Insurance- just in calse
Cost- Greedy people
• We want to get our benefits back
• We do not realize the actual costs
• A “Tragedy of the Commons”
Cost- An Older Population
• Our last years of life consume much of our health care dollar
• We are living longer and there are more of us
• More Care means more $
Cost and Prescription Drugs
• Average cost is $2400
• 9 in 10 Seniors use a drug
• Direct to Consumer Ads
PATIENT PROTECTION AND AFFORDABLE CARE ACT
The Solution
What is it
• A law that will get health insurance to roughly 30 million Americans
• Not a single payer system
What it looks like
How will it Work: Expanding Federal Programs
• Getting those eligible on programs they are eligible for– Expanding Medicare Eligibility– Expanding COBRA health insurance– Expanding SCHIP Program
How will it Work: Making Changes to Private Insurance
• Cannot Deny for Pre-Existing Conditions
• Cannot remove people who use up their coverage
• The Slackers mandate
• Subsidies to purchase insurance
How will it Work: Individual Mandates
• People will be required to have health insurance– Just as we are required to have health insurance
• Up to 2.5% of income by 2016
• This is the tricky part
What if I have Insurance?
• In theory it should not change
• Your employer, however, can just cut you off
When does it start
• Mandates begin in 2014
• Costs should be lowered over time as people have insurance
How can we afford this
• 1 Trillion over first 10 years– Tax on Tans– Higher Medicare taxes on wealthy and Medicare
cuts on providers– Taxes on High-end insurance– Fees on Health Care Industry
WHERE IT STANDS TODAY
“We will immediately take action to repeal this law.”
Republican “Pledge To America”
H.R. 2: Repealing the Job-Killing Health Care Law Act
S.AMDT 13
Repeal of 1099 Provision: The Compromise
• Would require businesses to report expenditures of more than $600
• Expected to raise 19bn over 10 years
• Bipartisan support for repeal
KEEPING THE LAW The Democrat’s Strategy
Democratic Strategy
• Draw a line on health care and do not let the Republicans cross it
• Use institutional advantages to delay change
• Focus on the popular parts of the law
• Re-Cast the GOP into the Party of No (Part II)
Democratic Advantage 1: Laws are Difficult to Repeal
• They come in with political support and they retain that support
• Minor changes and fixes only serve to strengthen the existing law!
• Prohibition lasted for 13 years
Democratic Advantage 2: Marketing Popular Initiatives
Democratic Advantage 3: Divided Government
• Use Senate Majority to control the Agenda
• Filibuster when necessary
• The Presidential Veto as a last resort
Democratic Advantage 4: No new taxes in 2011 or 2012
• F SA limits in 2013• Medicare tax increase by
0.9% and 3.8% tax on investments income for high-wage earners in 2013
• Individual mandate in 2014
• Cadillac Tax in 2018
Democratic Advantage 5: Debt and Deficits
REPEAL THE BILL THROUGH OTHER MEANS
The Republican Strategy
Republican Strategy
• A straight-up repeal was unsuccessful
• Continue to push the issue through other political avenues
• Force this as a campaign issue in 2012
Republican Advantage 1: Consensus in the Party
• The Republicans are unified in the support for repeal.
• Try to exploit Democratic cleavages between those who want to keep the existing law, and those who may want to strengthen it.
• Try to switch Democrats to their side
Republican Advantage 2: The Power of the Purse
• Tie Health Care to every spending bill beginning with the new funding bill in March
• This risks a government shutdown
• The GOP lost the last shutdown in the 90’s
Republican Advantage 3 Time
• Two years to find avenues to dismantle the bill
• Time to create a GOP alternative for Election Day
• Time to try additional votes on repeal
Republican Advantage 4: The States
• GOP Gains in the state legislatures in 2010 provide a different angle of attack
• 21 states are pressuring for more flexibility
• Idaho is pushing for more
Republican Advantage 5: The Individual Mandate
• This is key to the success of the bill
• And one of the least popular portions
• Expect Heavy Resistance if the GOP tries
• Which is exactly what the GOP wants
A Potential Court Ruling in 2012
On Repeal
Probably For Repeal• Antonin Scalia
• Clarence Thomas
• Samuel Alito
Probably Against Repeal• Ruth Bader-Ginsburg
• Stephen Breyer
• Sonia Sotomayor
• Elena Kagan
On the Fence
Chief Justice Roberts Justice Anthony Kennedy
This Makes the Legal Challenge a 2012 Campaign Issue
Environmental, Social, and Political Problems of Population Change
Two Demographic Truths
1. We are all Born
2. We Will all Die
What we do in between has ramifications for the Environment and Social Policy.
Copyright ©Allyn & Bacon 2009
Population Growth and The Environment
• World Population is growing
Population Moves through stages
Consequences of World Population Growth
• Thomas Malthus
• Carrying Capacity and environmental damage
• Food Shortages
• Depletion of Resources
• Conflict
How to Control Population
• Zero Population Growth
• Family Planning
• Incentives
Demographics and Social Security
How Population Growth and Change influences Policy
What is it?• The Largest Single Federal Program
• A program that everyone loves
• A Program that tracks baby names
Why do we love it?
• Almost everyone gets it
• It has very basic goals that are easy to reach
• The average worker gets $1,164 a month
How Do We pay for it?• Payroll Taxes
– I Pay 4.2% of my salary For 2011– St. Edward’s matches this
• Only the first $106,800 of wages are taxed
• There is an upper limit on taxes… for Now (the most you can pay is $4,485.60 )
• The most you can get in benefits is $2366
SOCIAL SECURITY IS IN FINANCIAL TROUBLE- ALL BECAUSE OF
DEMOGRAPHICS
America is Getting Older
There are Fewer Workers
The Baby Boomers will drain the System
Bankrupt vs. Broke
• Bankrupt- not being able to meet your obligations
• Broke- not having any money
Either way, we need policy change
The Policy of inaction
1995 Prediction 2005 Prediction
Forecasting in 2006
The 2011 Numbers
In 2016 we will begin paying more in benefits than we collect in taxes. Without changes, by 2036 the Social Security Trust Fund will be exhausted* and there will be enough money to pay only about 76 cents for each dollar of scheduled benefits.
How to Solve the Problem
• There are many solutions
• All involve risk and create winners and losers
• Your primary targets are voting constituents
Other Solutions• Raise the age
• Raise Taxes
• Cut Benefits
• Means Test
• Run Public Service announcements
Radical Solutions
• Partial Privatization
• Full Privatization
• Amnesty for all Immigrants
• Abolish Abortion
Social Security
Has it been a success, and what should we do?
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