Dr Andrew Glencross ~ andrew.glencross@eui.eu

1. Government and Politics of the USA Hillary Term, Lecture 28 Health and Social Policy Dr Andrew Glencross ~ andrew.glencross@eui.eu

2. Submit essay online via www.turnitin.comand hard copy to Jane Suiter - Deadline: 5pm, Monday 10th of March (Hillary term wk 10) Choose 1 of 3 titles; strict2,000 word limit (excluding bibliography) “In practice, Congress functions not as a unified institution, but as a collection of semi-autonomous committees that seldom act in unison“. Discuss this view, and explain your response. What are the consequences of pluralism and federalism for the policy-making process in the US? Evaluate these consequences with reference to at least two policy areas. Discuss the role played by money in US Presidential elections. Elaborate your response in the context of attempts at campaign finance reform since the 1970s and the 2008 Presidential election. Details on course website - http://uspoliticstcd.pbwiki.com/Course-assessment Hillary Term Essay

3. Required reading… McKay chap. 16 Singh chap. 17 Additional resources… Uwe Reinhardt, Peter Hussey and Gerard Anderson, ‘U.S. Health Care Spending in Comparative Perspective’, Health Affairs, 23 (3), 2004. Sanford Schram (2000), After Welfare: The Culture of Postindustrial Social Policy (361.973 P6) Readings for today

4. A Case of American Exceptionalism: Health Policy Current Issues in Health Policy Interest Groups and Health Policy Health in the 2008 Election Social Policy in the 2008 Election Agenda

5. American Exceptionalism: Health Policy The World’s Costliest Healthcare System

6. American Exceptionalism: Health Policy

7. American Exceptionalism: Health Policy Why so expensive? • Ability to pay – US very wealthy and so is able to devote more resources to health • Highly fragmented system – huge competition in supply of health services and no single-buyer on the demand side, leads to higher labour and drugs costs • Huge administrative costs – insurers, employers, consumers and providers all burdened with these costs • Very little rationing – little systematic cost control

8. Rising cost of healthcare means employers less likely to provide health insurance deferring cost to individuals who cannot afford premiums Currently 16% of population uninsured, 47 million people of which most are working and more than a third have household income over $50,000 Uninsured contribute to increasing premiums because they use emergency treatment disproportionately and cost passed back to insured Amongst insured, 16 million underinsured Government already provides 27% of population with healthcare through Medicare and Medicaid Private insurance covers only a third of healthcare costs, individuals pay 20%, federal and state govt cover rest Current Issues in Health Policy

9. Medicare – insurance for over 65s, disabled and those with renal disease Paid by payroll taxes and premiums Currently 3.9 workers for every Beneficiary but by 2030 this will fall to 2.4, with 70 million beneficiaries Combined with spiralling healthcare costs, means taxes will have to increase markedly Current Issues in Health Policy

10. Health was centrepiece of 1992 campaign – Bill appointed task force chaired by Hillary that met in private for 8 months resulting in 1000 page report Plan proposed guaranteed basic health care for Americans – coverage mostly through employers through membership of HMOs, government would pay for HMO membership for unemployed Government would establish new health care alliances to organise purchase of health services at a regional level, would also regulate insurance plans available to citizens Financing not through new taxes but efficiency gains Interest Groups and Health Policy The Clinton 1993 Plan

11. Backlash from HMOs – Harry and Louise adverts, focused on attacking proposal rather than endorsing some form of change “Haves” wary of seeing their choices limited for the sake of the have nots Public opinion suspicious of government regulation and ability to prevent waste rather than squander money Promoters of Clinton plan distanced themselves from accusation of government regulation and so did not explain benefits of efficiency gains from health alliances But in 1994 a WSJ-NBC poll asked citizens to review 4 healthcare proposals, 76% preferred Clinton plan Interest Groups and Health Policy The Clinton 1993 Plan

12. Opposes mandated system of federal insurance, wants $2500 tax credits to make purchase of insurance more affordable, expand health insurance to cover all uninsured children. Rated 25% by American Public Health Association for his anti federal health spending record Advocates personal responsibility and change in tort law to prevent frivolous litigation Health in the 2008 Election

13. Things get nasty – “shame on you, Barack Obama” , alleges Obama campaign using tactics from the Karl Rove book by attacking coalition for universal healthcare Clinton proposes federally mandated universal coverage, with subsidies for poor, estimated cost of 110 bill year, to be paid for by rescinding Bush tax cuts for those earning $250,000+, rated 100% by APHA Obama proposes national insurance programme for those without employer insurance or federal schemes, coverage required for all children, cost between $50-65bill funded by rescinding Bush cuts, Health in the 2008 Election Democrats

14. Ohio and Texas primaries 4 March Defence policy and Homeland Security Readings, McKay ch. 12, Singh ch. 25 Immigration Readings, MHW ch. 9, Next Week