Health Care. Health Care: Introduction The Social Problems of Health Care in America The rapidly...

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


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


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.


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.


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 government-sponsored 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 ReconciliationAct of 2010

Summary of the HCER ActCBS 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.


Summary of the HCER ActCBS 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. Closes gaps in Medicare.2. Expands Medicaid.3. Insurers cannot deny coverage to children.4. Does not pay for abortions.5. All citizens, except the very poor, must be purchase health

insurance.


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

http://www.consumer.gov/weightloss/bmi.htm

Risk of

Associated Disea

se According

to BMI and

Waist Size

BMI

Waist less than or equal to

40 in. (men) or35 in. (women)

Waist greater than


18.5 or less

Underweight

--

N/A

18.5 - 24.9

Normal

--

N/A

25.0 - 29.9

Overweight

Increased

High

30.0 - 34.9

Obese

High

Very High

35.0 - 39.9

Obese

Very High

Very High

40 or greater

Extremely Obese

Extremely High

Extremely High

Risk of

Associated Disea

se According

to BMI and

Waist Size

BMI



Waist greater than


18.5 or less

Underweight

--

N/A

18.5 - 24.9

Normal

--

N/A

25.0 - 29.9

Overweight

Increased

High

30.0 - 34.9

Obese

High

Very High

35.0 - 39.9

Obese

Very High

Very High

40 or greater

Extremely Obese

Extremely High

Extremely High

Risk of Associated Disease According to BMI and Waist Size

BMI



Waist greater than

40 in. (men) or

35 in. (women)

18.5 or less Underweight -- N/A

18.5 - 24.9 Normal -- N/A

25.0 - 29.9 Overweight Increased High

30.0 - 34.9 Obese High Very High

35.0 - 39.9 Obese Very High Very High

40 or greater Extremely Obese Extremely High Extremely High


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.


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.


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.


Consequences

Cardiovascular diseasesDiabetesDigestive problemsBone and joint problemsSome 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.


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


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.


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

• 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.


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.


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.


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.

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