Health Care
Health Care: Introduction
The Social Problems of Health Care in America
The rapidly rising costs of health care, the aging of the population,
and dramatic increases in the rates of obesity have brought
discussions of health care quality and delivery to the forefront of
American political and social discourse.
This presentation focuses on four health care issues facing
America at the dawn of the 21st century:
• Health Care Costs
• Health Care Politics
• Obesity
• Euthanasia
Health Care
• Costs
• Politics
• Health Care Reform
Health Care: Costs
Grace Budrys, Health Care Costs and Cost Containment
Three goals guide the health care delivery system in America:
• Quality
• Access
• Cost Containment
You can have any two, but not all three.
In America, access seems to be third down on the list.
Although the United States spends more as a proportion of gross
national product on health care than any other country, over 45
million Americans of ages infant to 65 (17% of persons in this age
range) do not have health insurance and therefore have severely
limited access to health services. All American citizens have
access to free health care after age 65 through Medicare.
Health Care: Costs
Increasing Needs for Affordable Health Care
Although costs continue to rise and rates of uninsured continue to
increase, Americans face a growing need for affordable, high
quality health care.
• The age structure of the U.S. population is increasing.
• Americans are becoming increasingly obese.
• Real wages for middle-class Americans are remaining stable
or declining, depending upon the industrial sector of their
employment.
Health Care: Costs
Proposed Solutions to Improving Health Care
1. Increase the quality of health care.
This is an expensive proposal because of:
• Greater demand for health care (aging population).
• Greater demand for “exceptional” health care.
• Greater regulatory control over health care.
2. Increase access to health care (universal health care).
This proposal will be difficult to implement because:
• The functional needs of society require a competitive
marketplace.
• Powerful segments of the economy have a vested interest in
maintaining the status quo.
• Cultural expectations favor self-sufficiency.
Health Care: Costs
Proposed Solutions to Improving Health Care
3. Reduce the costs of health care by:
• Reducing services to patients.
• People are demanding more, not fewer services.
• Instituting cuts in the prices we pay for health services.
• This option sounds popular to the public, but is the least
promising approach to cutting costs.
• If profits to pharmaceutical companies were reduced by
50 percent, for example, health care expenditures
would decrease by less than 1 percent because
expenditures for medicines, although very high,
represent a small percentage of total health care costs.
• It would be difficult to lower salaries for physicians,
nurses, technicians, and other highly trained staff.
Health Care: Costs
Proposed Solutions to Improving Health Care
3. Reduce the costs of health care by:
• Implementing a single payer system.
• Approximately 25% of health care costs are
administrative expenses.
• Much of these costs are related to completing paperwork
needed for health insurance.
• Many different health care plans and insurance
companies require that clerks at health-care providers
must be knowledgeable about many different rules.
• Because companies often change their plans and forms,
clerks often make mistakes, which cost money to correct.
• The single payer system is proposed as a means of reducing
administrative costs.
Health Care: Costs
The Single Payer System
The Single Payer System (SPS)
• Single set of forms.
• Single set of rules.
• Single reimbursement schedule.
• The federal government would be the single payer and
everyone would be covered by a single health-care plan, with
multiple options for coverage as are available already with
private plans.
Basically, SPS is a government-sponsored health care insurance
company.
This system might effectively reduce health-care costs, but it raises
issues related to ethics, economics, and politics.
Health Care: Terminology
Terminology
1. Universal health care: The government provides health care to
everyone.
2. Socialized medicine: The government controls the health care
industry.
• The single payer system (SPS) is a form of socialized
medicine. That is, hospitals and clinics, whether private or
public, profit or not-for-profit, as well as private physicians,
provide health care. The government is the “insurance
company.”
• Because Americans have strong objections to “socialism,”
(read: Communism), opponents of the single payer system
call it “socialized medicine” and associate it closely with
universal health care. Proponents, on the other hand,
emphasize that the health care is provided by the physicians
and the insurance is provided by the government.
Health Care: Politics
Health Care Philosophy
Right to Health Care
Do people have a fundamental right to health care?
• Yes: The good society will provide its citizens with health care.
• No: Universal health care violates individual rights because is a
non-essential form of wealth redistribution (i.e., unnecessary
welfare).
Government Involvement
Should the government get involved in health care?
• Yes: Government intervention can improve health care.
• No: The government is not qualified to provide health care.
Health Care: Politics
Rationale for a Single Payer System
• Those who would otherwise go without care receive it.
• People are more likely to seek preventative care, which costs
less in the long run.
• Death rates are lower in societies with socialized medicine.
• Because doctors do not have to worry about paperwork, they
can concentrate more on treating patients.
• Socialized medicine reduces waste in the delivery of medical
care.
Health Care: Politics
Critiques of the Single Payer System
• Government-sponsored programs do not encourage
competition and the development of new technologies.
• SPS is a payment system; not a health-care delivery
system.
• SPS is “socialized medicine.”
• SPS is not universal health care; it is a governmentsponsored administrative system.
• The government, not doctors, would be in the business of
making health care decisions.
• Business managers already dictate health care guidelines
for providers as part of private health care plans (i.e.,
Health Maintenance Organizations: HMO’s).
• Insurance companies would be hurt financially.
• Society often sacrifices industries for progress.
Health Care: Health Care Reform
The debate over health care reform in the United States:
• whether there is a fundamental right to health care,
• who should have access to health care and under what
circumstances,
• who should be required to contribute toward the costs of
providing health care in a society,
• whether the government should support health care commerce
by forcing citizens to buy insurance or pay a tax,
• the quality achieved for the sums spent,
• the sustainability of expenditures that have been rising faster
than the level of general inflation and the growth in the
economy,
• the role of the federal government in bringing about such
change,
• concerns over unfunded liabilities.
Health Care and Education Reconciliation
Act of 2010
Summary of the HCER Act
CBS News: Jill Jackson and John Nolan
Cost: $940 billion over 10 years.
Deficit: Would reduce the deficit by $143 billion over the first ten
years. Would reduce the deficit by $1.2 trillion dollars in the second
ten years.
Coverage: Would expand coverage to 32 million Americans who
currently are uninsured.
Health Care and Education Reconciliation
Act of 2010
Summary of the HCER Act
CBS News: Jill Jackson and John Nolan
Paying for the Plan:
1. Medicare Payroll Tax.
2. Excise Tax on High End Health Insurance.
3. Tanning Tax.
Changes:
1.
2.
3.
4.
5.
Closes gaps in Medicare.
Expands Medicaid.
Insurers cannot deny coverage to children.
Does not pay for abortions.
All citizens, except the very poor, must be purchase health
insurance.
Health Care and Education Reconciliation
Act of 2010
If…
Health Care
• Obesity
Health Care: Obesity
Definitions and Measurement
Obesity: A condition in which the natural energy reserve, stored as
fatty tissue, is increased to a point where it is associated with
certain health conditions or increased mortality.
Obesity typically is measured in relation to the Body Mass Index
(BMI).
BMI = kilograms / meters2
The www provides BMI calculators that accept inches and pounds.
See, for example: http://www.consumer.gov/weightloss/bmi.htm
Risk of Associated Disease According to BMI and Waist Size
Waist less than or Waist greater
equal to
than
40 in. (men) or 40 in. (men) or
1U - N
35 in.
8 n - / 35 in. (women)
(women)
. d A
BMI
18.5 or less
18.5 - 24.9
25.0 - 29.9
30.0 - 34.9
35.0 - 39.9
40 or greater
5e
Underweighto r
r w
Normal l e
ei
Overweights g
sh
Obese
t
Obese
--
N/A
--
N/A
Increased
High
High
Very High
Very High
Very High
1N - N
8 o - / Extremely High
Extremely Obese
. r
A
5m
- a
2l
Extremely
High
Health Care: Obesity
Cultural Significance of Body Weight
The perceived attractiveness of body weight varies across time and
societies.
• In some settings, a large, well-fed body has been associated
with physical attractiveness.
• Size has been associated with health, strength, and fertility.
• The culture in modern, western societies favors the normal
body type (as would be indicated by the BMI).
• In fact, in America it is popular to refer to “normal,” as indicated
by the BMI, as “skinny” Thus, “skinny” is “good.”
• Contemporary culture sometimes associates obesity with
character traits, some good and some bad:
• Lazy, undisciplined, stupid, gluttonous.
• Warm, jolly, easy-going, happy.
Health Care: Obesity
Cultural Significance of Body Weight
The cultural significance of body weight is not a social problem,
unless perceptions lead to negative health or social outcomes.
Thus, what is thought of as “attractive” is not a social problem.
If, however, people hurt themselves physically (e.g., anorexia) to
obtain a certain body image or are discriminated against because
of their body type, then body weight becomes a social problem.
Contemporary social science research examines how body image,
as perceived by self and others, affects how people treat
themselves and are treated by others.
Most current attention, however, focuses upon the social causes
and consequences of rapid increases in the rates of obesity.
Health Care: Obesity
Prevalence
The United States has the highest rates of obesity in the developed
world.
• From 1980 to 2006, obesity has doubled in adults and
overweight prevalence has tripled in children and adolescents.
• Approximately 18% of children are overweight.
• Approximately 35% of adults are obese.
These rapid increases in rates of obesity cannot be attributed to
biology because biological processes (i.e., evolution) do not occur
that quickly.
Health Care: Obesity
Consequences
Cardiovascular diseases
Diabetes
Digestive problems
Bone and joint problems
Some types of cancer
The U.S. Surgeon General estimates that, because of rising rates
of obesity, the current generation of Americans will be the first to
have a lower life expectancy than their parents.
Health Care: Obesity
Causes
In its simplest conception, weight gain is the intake of more food
energy than is expended.
Additional Factors That Affect Weight Gain
•
•
•
•
•
•
•
•
•
•
Genetics
Chronic illnesses
Eating disorders
Certain medications
Weight cycling
Stress
Insufficient sleep
Smoking cessation
Race and ethicity
ISU Tailgating
Health Care: Obesity
Environmental Factors
Lack of activity
• Since 1986, physical activity of children has declined by 13%.
Increased marketing
• Supersized!
• Fries with that?
• “Small” = 16 oz.
Changing labor force
• Women in careers rather than at home.
• Children tending for themselves after school.
• Eating out during the day (working) and evening (too busy).
• Cheap food.
Health Care: Obesity
Suggested Policies
School Environment
• Healthier luncheons
• Fewer pop machines
• More choices
Marketing
• Recognition of the “fast food nation”
Emphasis on Exercise
• Awareness of the problem
• Suggestions for walking, quick exercise routines
Emphasis on Food Intake
• “Diets” can be hazardous to your health!
• How to eat right, not how to lose weight.
Health Care: Obesity
Health Care
• Euthanasia
Health Care: Euthanasia
Adapted from: Wikipedia, The Free Encyclopedia
Euthanasia: The practice of terminating the life of a person,
because they are perceived as living an intolerable life, in a
painless or minimally painful way, either by lethal injection, drug
overdose, or by the withdrawal of life support.
Euthanasia is a social problem because it challenges the moral
principles that maintain social cohesion and social solidarity. That
is, because it challenges our sense of ethics and morality, it
threatens to hinder our sense of belonging to one another or our
willingness to work effectively with one another.
Health Care: Euthanasia
Physician Assisted Dying
The process whereby board-approved physicians provide a
prescription for a terminally-ill patient to hasten their death.
• Some physicians will assist the patient in administering the
medicine.
• Others rely upon the patient or other approved caregivers to
administer the medicine.
Government-Sponsored Execution by Lethal Injection
The process whereby board-approved technicians provide an
injection of lethal medicine to cause the death of a felon who has
been sentenced to death.
Health Care: Euthanasia
Arguments of Proponents
Physician Assisted Dying
• Ends the needless suffering of a terminally-ill patient.
• Ends the added expense of caring for the patient.
• “Living wills” can specify end-of-care guidelines.
• Ends the stress on family and friends of the patient.
Government-Sponsored Execution by Lethal Injection
• Religion-based retribution.
• Closure to a heinous crime.
• Revenge.
• Deterrent to crime.
Health Care: Euthanasia
Arguments of Opponents
Physician Assisted Dying
• Morally wrong.
• The patient might make valuable contributions to family
members, friends, or society in their final days.
• The decision is irreversible.
Government-Sponsored Execution by Lethal Injection
• Discrimination, bias, and mistakes made in the criminal justice
system (ethically wrong).
• Expensive system of appeals and procedures.
• The felon might make valuable contributions to family
members, friends, or society in the remaining life.
• Research shows that the possibility of capital punishment is not
a detriment to capital crimes.