Comparative HealthCare Systems Week of 3/8
Comparative HealthCare Systems Week of 3/8 PAM 3780
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This 4 page Class Notes was uploaded by Ashley Notetaker on Thursday March 10, 2016. The Class Notes belongs to PAM 3780 at Cornell University taught by Nicolas Ziebarth in Spring 2016. Since its upload, it has received 20 views. For similar materials see Comparative Health Care Systems in Political Science at Cornell University.
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Date Created: 03/10/16
⅜ Exam 1 3/10 (Lecture 11) Public Health Insurance in the US Health Care Triangle This deals with the lefthand side of the traingle If you’re Republican, the percentage of NHD that goes to Public health insurance scares you/makes you uneasy because there’s more money going to it Overview ● MedicareElderly (50 mil) ● MedicaidPoor (70 mil) ● (S)CHIPKids (basically Medicaid for kids) (8 mil) ● ^For all of these things, you need to be active in order to get it. What is the problem with this? ○ Access/Knowledge of the Program ○ Many uninsured people are eligible for Medicaid, but they just don’t know about it ● Others Just by looking at this you see why the US healthcare system is so disorganized and uncoordinatedthere’s just so much going on (Prof: “I think this is why America has so many issues”) [Slide 5] Medicare Key Facts ● Finances Medical Care for: ○ The elderly above 65 ○ The disabled ○ People with endstage renal disease ● 1967: 20 mil ● 2014: 50 mil ○ ^The increase in enrollment is important to notice ○ The public policy problem with this: Funding  ● Federal Program: eligibility criteria and benefits are consistent(!) throughout the US ● People over 65 get automatically enrolled universal health care ● Single payer system! One federal agency responsible ● Bernie Sanders: ○ Wants to do a whole revamp of the system ○ Is it doable? ■ Probably not in the nearfuture ■ Maybe its best to work with Obamacare and move stepbystep forward towards it ○ [Video] ■ “Medicare for all” ○ Prof: Yea it may not be superpossible, but at least it’s good to know that he has a vision ● Medicare AInpatient Care ● Medicare BOutpaient Care ● Medicare CSupplementary (Substitute for A+B) ○ Difference between A+B: C is privately funded ■ You get a private insurance ■ Managed Care ○ What’s the tradeoff? ■ They brought C in in the 90s because they were hoping more people would switch to use it and then ease the burden off of gov’t money and switch the burden to private sector ■ A+B benefits: you don’t have to worry about provider network, you can go wherever you want BUT you have higher deductible and costsharing ■ C has lower costsharing [Donald Trump Video] Supporting singlepayer system Republicans: many would argue that we should get rid of Medicare [Golden Girls Clip] Medicare Part A (Hospital Insurance): Financing ● Financed through payroll taxes (contribution rate) [Equal rates from all employees, not different percentages depending on different levels of income] ● Employers and employees both pay 1.45% of the employee’s gross wage ● mandatory tax paid by all working individuals (also selfemployed) and covers all earnings [Sidebar: discussed calculating contribution rates, gross wage v net wage]  Medicare Part A: Premiums  Medicare Part B: SMI: Financing & Premiums ● Financed by taxes and incomebased premiums ● Covers outpatient care ● Most people will pay $115 per month ● BUT if you’re pretty rich, you’ll pay $369 ● Deductible: $162 annually ● coinsurance: 80/20 (50/50 for outpatient mental health)  Graph: Medicare has a problem Problem: more beneficiaries and fewer number of working people per beneficiary Possible solutions: Increase eligibility age Increase contribution rate Cut the benefits offered, or make the beneficiaries pay more Medicare Part C: 30% of Medicare beneficiaries offers additional benefits and lower outofpocket expenses Trade off: More benefits and lower costsharing v. provider networks and managed care Medicare Part D: Covers prescription drugs Enacted in 2003 2012: 31 million enrollees Not super easy to sign up for this Google more on this  Medicaid: ● Covers the poor (70 million enrollees) ● A big element of Obamacare=expansion of Medicaid ○ Used to be a staterun program so there were all different regulations on who could get it. Obamacare makes it a little more regulated ● Meanstested statelevel program: e ligibilty criteria and benefits are not consistent across the US ● Technically the states give private insurance some sort of regulations for it ○ As a state you can either directly control payment for it or have insurance companies cover it  The expenditures don’t match the demographic of the enrollees The 5% of the sickest people in the country use 50% of the healthcare  majority of uninsured people=poor The issue: the supreme court said that the federal government can’t set what the threshold is for eligiblity for Medicaid   Now the problem is that the uninsured people in these states are still remaining uninsured Coverage Gap : Now that it is possible for republican states to deny the expansion, there is a whole middle group of people that still remain uninsured (and in the rain) [Colbert Report Video: Health Care Lottery] *He’ll post the “others” part of the outline, but we won’t need to know it for the exam* (S)CHIP: Covers children closely linked to Medicaid more generous than Medicaid financial eligibility more generous Doesn’t cover parents or adults  enrollment has risen over time Means tested  Even if your income may be kinda high, you could still be eligibile  ACA prohibits restricting SCHIP
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