Honors Gov: Social Science Analysis Research

Social Science Analysis Research: Heath Care

Sick Around America

At its best, American health care can be very good. For Microsoft employee Mark and his wife Melinda, their employee health plan paid for medical bills that totaled between $500,000 and $1 million. But beyond large, high-wage employers like Microsoft, Frontline learns that available, affordable, adequate insurance is becoming hard to find. Small businesses face a very bleak outlook for finding and keeping coverage. Coverage is becoming more expensive and less comprehensive, with high deductibles, co-pays and coverage limits. Outside of employer-based health care plans, matters are even worse. Americans seeking insurance in the individual market must submit to medical underwriting, and if they have a pre-existing condition, they will likely be denied. For those Americans who find health coverage in the private market, there’s no guarantee it will protect them. In the past, some states required insurance companies to cover everyone but found that many people waited to buy insurance until they fell ill, causing higher ratio of unhealthy to healthy people in the insurance pool. As a result, insurance companies stopped doing business in those states. Today, only five states, New   York, New Jersey, Massachusetts, Maine and Vermont, guarantee everyone insurance, a privilege reflected in premiums that is three times higher on average. Around the world, other developed democracies offer universal health care, requiring insurance companies to cover everyone. People are mandated to buy it; insurance for the poor is subsidized; and governments control prices by setting the cost of everything. But efforts to implement similar policies in the U.S. have proven unsuccessful.

Misc-05-june

Sick In America: Whose Body Is It, Anyway?

Who is to blame for America’s healthcare mess, and how can we fix it? John Stossel reports on socialized health care from an explicit pro-freedom point of view. Stossel examines the insurance industry, the need for competition to create better care and innovative experiments aimed at combining lower costs with better medicine. He also argues with Michael Moore whose documentary Sicko is a scathing criticism of America’s healthcare system. To Michael Moore the insurance companies are crooks and we’d be better off in places like Cuba, Canada, France, or England – any country that offers socialized medicine. But in countries where healthcare’s free governments deal with that increased demand for it by limiting what’s available. Government rationing healthcare in Canada is why when Karen Jepp went into labor with her identical quadruplets last month — no neonatal unit in Canada had room for her. She flew to Montana to have the babies. Stossel and Moore agree that healthcare in America is sick but they have opposite prescriptions for the cure. Health costs are rising faster than inflation but a few experiments show that there is a different way that reduces costs but still makes medicine good for patients. Stossel interviews Harvard Business School professor Regina Herzlinger, who takes aim at the legislative process as well as insurers and hospitals. Herzlinger tells Stossel, “Healthcare is vibrant and living. It’s full of great doctors and great hospitals and great scientists and great medicines and great technologies and it’s been killed…It’s the insurers. They have our money…It’s the hospitals. You go to a hospital you have no idea what it costs…and it’s the U.S. Congress.” Then the good news…Yes health costs are rising faster than inflation but a few experiments show that there is a different way one that reduces costs but still makes medicine good for patients. Stossel talks to doctors who deal directly with patients without insurance and therefore have a different relationship with their patients by eliminating insurance middlemen. These doctors answer patients’ emails give out their own cell phone numbers and work hard to cater to their patients. He also looks at new kind of medical clinic walk-in clinics in places like drugstores and grocery stores. Stossel also talks to John Mackey CEO of Whole Foods about his company’s innovative health savings account plans, which puts employees more in control of their healthcare dollars. Harvard’s Regina Hertzlinger sums it up: Who should decide whether you live or die* Is it gonna be a government* Is it gonna be an insurer* is it gonna be you and me?

Misc-05-june

Sick Around the World

Washington Post foreign correspondent T.R. Reid finds out how five other capitalist democracies — the United Kingdom, Japan, Germany, Taiwan and Switzerland — deliver health care, and what the United States might learn from their successes and their failures.

SSA_United Kingdom     The British system is socialized medicine because the government both provides and pays for health care. The British pay taxes for health care, and the government run National Health Service or NHS distributes those funds to health care providers. Hospital doctors are paid salaries while General Practitioners are paid based on the number of patients they see. A small number of specialists work outside the NHS and see private pay patients. Because the system is funded through taxes, administrative costs are low. There are no bills to collect or claims to review. Patients have a medical home with their General Practitioners, who also serves as a gatekeeper to the rest of the system. Patients must see their General Practitioners before going to a specialist. General Practitioners are paid a bonus for keeping their patients healthy and are instrumental in preventive care. Preventive care is an area in which Britain is a world leader.

SSA_Japan     The Japanese go to the doctor three times as often as Americans, have more than twice as many MRI scans, use more drugs, and spend more days in the hospital. Japan spends about half as much on health care per capita as the United States. Japan uses a social insurance system in which all citizens are required to have health insurance. The Japanese receive insurance either through their work or purchased from a community based plan. Those individuals who cannot afford the premiums receive public assistance. Most health insurance is private and cannot turn down a patient for a pre-existing illness, nor are they allowed to make a profit. Doctors and almost all hospitals are in the private sector. In Japan there are no gatekeepers. Having no gatekeepers means there’s no check on how often the Japanese use health care. The Japanese can go to any specialist when and as often as they like. Every two years the Ministry of Health negotiates with physicians to set the price for every procedure. This helps keeps costs down.  Japan has been so successful at keeping costs down that Japan now spends too little on health care. The result is half of the hospitals in Japan are operating in the red.

SSA_Germany     Germany, like Japan,  uses a social insurance model. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 240 private, nonprofit sickness funds. For its 80 million people, Germany offers universal health care, including medical, dental, mental health,  homeopathy and spa treatment. As in Japan, the poor receive public assistance to pay their premiums. Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they pay higher co-pay if they do. Like Japan, Germany is a single-payment system and medical providers must charge standard prices, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. This keeps costs down, but it also means physicians in Germany earn between half and two-thirds as much as their U.S. counterparts. This system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. However, German doctors pay much less for malpractice insurance, and many attend medical school for free. Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.

SSA_Taiwan     In the 1990s, Taiwan researched many health care systems before settling on one where the government collects the money and pays providers. But the delivery of health care is left to the market. Taiwan adopted a National Health Insurance model in 1995 after studying other countries’ systems. Like Japan and Germany, all citizens must have insurance, but there is only one government-run insurer. Working people pay premiums split with their employers; others pay flat rates with government help; and some groups, like the poor and veterans, are fully subsidized. The resulting system is similar to Canada’s and the U.S. Medicare program. Taiwan’s new health system extended insurance to the 40 percent of the population that lacked it while actually decreasing the growth of health care spending. The Taiwanese can see any doctor without a referral. Every citizen in Taiwan has a smart card, which is used to store his or her relevant health information, medical history and bills the national insurer automatically. The system also helps public health officials monitor standards and effect policy changes nationwide. Thanks to this use of technology and the country’s single insurer, Taiwan’s health care system has the lowest administrative costs in the world. But the Taiwanese are spending too little to sustain their health care system and the government is borrowing from banks to pay what there isn’t enough to pay the providers. The problem is compounded by politics, because it is up to Taiwan’s parliament to approve an increase in insurance premiums, which it has only done once since the program was enacted.

SSA_Switzerland      Switzerland, a country which, like Taiwan, set out to reform a system that did not cover all its citizens. In 1994, a national referendum approved a law called LAMal or the sickness, which set up a universal health care system. Switzerland didn’t have far to go to achieve universal coverage as 95 percent of the population already had voluntary insurance when the law was passed. Today, Swiss politicians from the right and left enthusiastically support universal health care. The Swiss system is social insurance like in Japan and Germany. All citizens are required to have coverage and those not covered are automatically assigned to a company. The government provides assistance to those who cannot afford the premiums. The Swiss shows health care reform is possible, even in a highly capitalist country with powerful insurance and pharmaceutical companies. Insurance companies are not allowed to make a profit on basic care and are prohibited from cherry-picking only young and healthy applicants. However, they can make money on supplemental insurance. Like Germany, the insurers negotiate with providers to set standard prices for services, but drug prices are set by the government. The Swiss system is the second most expensive in the world, but it is still cheaper than U.S. health care. Drug prices are higher than in other European nations and are subsidized by the more expensive U.S. market, where some Swiss drug companies make one-third of their profits. The Swiss do not have gatekeeper doctors, although some insurance plans require them or give a discount to consumers who use them.

SSA_United States     American health insurance companies routinely reject applicants with a preexisting condition, precisely the people most likely to need the insurers’ service. Insurance companies employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer’s rescission department digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this to survive in a tough business. Foreign health insurance companies, in contrast, must accept all applicants, and they can’t cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital, usually within tight time limits. The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage. Foreign health care models are not really foreign to America, because our health care system uses elements of all of them. For Native Americans or veterans, we are like Britain or Cuba. The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we are like Japan or Germany. Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we are like Taiwan or Canada. Everyone pays premiums for an insurance plan run by the government and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we are like Cambodia, Burkina Faso, Burundi, Burma, or rural India. In the world’s poor nations, sick people pay out of pocket for medical care and those who cannot pay stay sick or die. This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance. The United States is unlike every other country because it maintains so many separate systems for separate classes of people. We have blended them all into a costly, confusing bureaucratic mess. Which, in turn, punctures the most persistent myth of all: that America has “the finest health care” in the world. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero. Given our remarkable medical assets, the best-educated doctors and nurses, the most advanced hospitals, and world-class research; the United States could be and should be the best in the world.

Misc-05-june

Honors Gov Homework:
1. Judicial Quiz II – close Thurs 10/24
2. Health Care Quiz I – Mon 10/28

47l

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Gov: Social Science Analysis

Frame

  • Identifies and provides a reasonable explanation of the significance of an event, issue, or problem.
  • Introduces and defines most of the critical components of the event, issue, or problem (who, what, when, where, why).
  • Communicates the purpose of the study throughout the analysis by establishing or reframing a question or thesis.

Examine

  • Identifies and objectively explains with some detail multiple points of view related to the topic.
  • Explains several factors which influenced or caused the event, issue, or problem.
  • Explains some probable implications, effects, and/or results and their relationship to the event, issue, or problem

Research

  • Presents appropriate information from various primary and secondary sources.
  • Uses and connects information from various sources throughout the analysis with appropriate acknowledgment (e.g. attributes, quotes, citations, references, etc.)
  • Notes source credibility, biases, stereotyping, and/or misrepresentations.

Misc-05-june

Government Homework:
1. Constitution Quiz III close Thurs 10/24
2. Amendments Quiz I – Fri 10/25

47l