Public Option

1. Public Option: Optional or Necessary?

3. Industrialized nations around the world have found a way to ensure health care for every citizen.In the United States, millions of uninsured people cannot afford to pay for their health care. Who are these people?

4. The Face of the UninsuredIn 2008 36,560,000 citizens of the U. S. were uninsured8 out of 10of these are members of working families, why aren’t they insured?Many employers cannot continue to offer health insurance, as premium costs are skyrocketingEmployers who continue to offer health insurance have raisedtheemployee contributionfrom $1, 543 to $ 3, 515, an amount that many families find hard to afford About two-thirds of the uninsured are individuals andfamilies who are poor or near poor. These families must often choose between food and shelter needs and insurance, with insurance getting left out.In 2008, there were also 9,140,000 uninsured non-citizens in the United States, which often place a greater burden on the systemby not being able to pay for emergency services. This is often the only contact they have with the health care delivery system, which contributes to higher health care expenditures nationwide.

5. Our civilization and our nation will be judged by how we treat our most vulnerable- Dr. Fizan Abdullah

6. Health Care Systems of the WorldThe Beveridge Model Single Payer SystemGovernment owns and finances health care for all citizens through taxesGovernment owns and operates most hospitals and doctorsUses general practitioners (gatekeepers) which must give a referral for one to see a specialistTakes away choice and has increased waiting timesThe unemployed and poor are provided the same care as everyone that works and pays taxes (universal coverage)Began in Great Britain and is now found in Spain, New Zealand, most of Scandinavia, and Cuba

7. The Bismarck Model Multi-payer System

8. Employers and employees split the cost of insurance through payroll deductions - if you have no employer, the government pays your insurance Hospitals and doctors are private, and there are no restrictions on a choice of doctors and no gatekeepers for specialist referrals Insurance companies, often called “sickness funds”, are mainly non- profit, private, and must provide coverage to everyone, regardless of age, health or income. Insurance companies are strictly regulated, so this model can achieve cost control similar to a single payer system Access to healthcare is universal, so a patient may see any doctor or specialist they choose, and the insurance must cover the bill This system began in Germany, and is now found in France, Belgium, the Netherlands, Japan, and Switzerland

9. The National Health Insurance Model Employs parts of the Beveridge and Bismarck models

10. Single payer system

11. Government owns and finances health care for all citizens through income taxes paid by citizens Doctors and hospitals are private, not government owned

12. Uses general practitioners (gatekeepers) for specialist referrals

13. Takes away choice and has increased waiting times

14. Government is able to control costs by being their own non-profit insurance company Coverage is universal

15. This system is found mainly in CanadaThe Out-of-Pocket Model Single Payer System, the patient pays entire cost

16. No government involvement

17. Most citizens have no access to health care

18. Many citizens never utilize the health care system their entire life, for lack of money to pay medical expenses Found in poor nations such as Africa, India, China, and South AmericaThese four models are found in variations in every country in the world. While none are perfect, they are being transformed by each country to improve the health of its citizens. The United States is unique in that it has a multi-payer system that incorporates parts of each model.

19. How We Mimic That Which WeProfess to HateHow we use parts of the Beveridge ModelThe government exercises control over Medicaid and Medicare funding, the principle insurance used by the elderly, the disabled, and children of recipients of TANF fundingPayments to providers are from a set fee established by the governmentThe government is the single payer for users of these health care servicesThe government decides what treatment is payable and appropriate for these patientsGatekeepers are used for referrals

20. How We Mimic That Which WeProfess to HateHow we use parts of the Bismarck ModelMiddle and upper class Americans who are subject to employer-sponsored health care employ a multi-payer model, each sharing premium costs with an employer, and funds are paid to private insurers. Hospitals and doctors are private, depending on the plan, gatekeepers may or may not be necessary for referralsThe difference between the U.S. and other countries is that the other countries that use the Bismarck model have a plan to cover everyone, and do not make a profit

21. How We Mimic That Which WeProfess to HateHow we use parts of the National Health Insurance ModelThe elderly work their entire lives paying into an insurance fund by income taxes, to use it when they are older (Medicare, a part of Social Security benefits)Single Payer type of insuranceGovernment controls the payments to providersHospitals and doctors are privateUses gatekeepers for specialist referralsThe difference is that in other countries that use The National Insurance Model, the government is its own insurance company

22. How We Mimic That Which WeProfess to HateHow we use parts of the Out-of-Pocket ModelSingle payer system, the patient pays entire costThis is used by the working poor, who cannot afford the high cost of premiumsNo government involvement for these individualsThe difference is that if they cannot afford to pay the costs, they still obtain health care, and expenses may be absorbed or counted as a loss by the hospital, increasing health care expenditures nationwide

23. Was it Always This Way?

24. History of Health Care in the U.S.Early 1900s – 1930Before 1929 most benefits were paid to private hospitals and doctors out-of-pocketCapitation began at Baylor Hospital in 1929, with a private, pre-paid plan using a predetermined fixed fee per month for teachers1930sThe Blue Cross Commission takes over the insurance function and becomes the Blue Cross AssociationBlue Shield was added to provide affordable outpatient careBlue Cross/Blue Shield began as a private, non-profit insurance companyEveryone paid the same regardless of age, sex, or preexisting conditionThe success of Blue Cross/Blue Shield prompted for-profit insurers to enter the market

25. History of Health Care in the U.S.Post 1930s - 1965For-profit insurance companies gain market share by “cream skimming”- mainly covering those who are the healthiest, and ignoring the sickest to increase profitsHigher premiums were charged to those in certain criteria such as age, gender, health status, and pre-existing conditionsThe success of for-profit insurance companies pushed Blue Cross/Blue Shield to become for-profit as wellThis system gained much popularity, with more and more employers offering insurance, and is mainly used todayThis system provided no coverage for the poor or elderly and was not affordable to those with no employer-sponsored insuranceMedicaid and Medicare were established in 1965, to provide a government financed way to obtain insurance for the elderly, the disabled, and the very poor, and these programs helped achieve the highest rate of access to health care the US had ever seen

26. History of Health Care in the U.S.Post 1965 to PresentThere are still 45.7 million uninsured in the U.S. today. What have we done to we reach them?In 1997, the State Children’s Health Insurance Program (SCHIP) was instituted to cover children under 19, whose parents earned too much to qualify for Medicaid for their children.In 2006, Medicare Part D was initiated to assist the elderly with prescription costs.So children from poor families and the elderly are covered-What about the middle and working classes?If we are working, we rely on employer-sponsored plans if available or private insurance plansIf we are not working, we rely on COBRA or out-of-pocket payments for our health care needs

27. The New Middle and Working ClassIncreasingly high numbers of the working and middle class have suddenly found themselves without a job between 2007 and 2009 as the economy crumbled, beginning with the collapse of the credit and auto industries, which spread throughout the manufacturing sectorMany are considered either underqualified for new positions as they have worked the same job with no new skills for decades, or overqualified for the positions that are now availableThose of us who have lost our jobs have also lost our insurance, and those who lost it prior to March 1, 2009, when the new COBRA law went into effect, were unable to afford continuation of our insurance. Many of those who were able to continue coverage were only able to do so for a short time, having to choose between house payments and increasing food costs and their insurance.The new COBRA law was a valiant effort to help those who have lost their jobs continue their insurance, but came too late for many of us. With acute illnesses such as the Swine Flu Pandemic, and chronic illnesses such as Heart Disease on the increase, and which affect many who have been out of work beyond the limit for COBRA, how will they survive to work again, and be a productive member of society?Obama has devised a health care reform plan, but what is it, will it cover all Americans, and will it reach us in time?

28. Current Health Care Proposals Being Considered

29. Obama’s Health Care Plan

30. Current Reform ProposalsObama’s PlanPlan to increase competition in the health care delivery marketPlan to increase quality and access to care while cutting costs in health care deliveryThe creation of a National Insurance ExchangeThe exchange proposed is a warehouse of sorts for the various public and private plans in existence, and is designed to provide consumer choice, and inspire competition in the marketA state-wide exchange would give power to the states to create and run it, and would be valid only in that stateA nation-wide exchange would give power to the federal government, and would be valid in all statesA nationwide exchange is the strongest option for competition while increasing efficiency and lowering costsPlan to include a public option to make health care accessible to all employers and citizensThe public option is the largest issue to date, but what is it?

31. What Is the Public Option?The Public Option is a government-sponsored public plan much like the private plans now used, that employers and citizens alike can use to fund health care expendituresOptions for its fundingSelf-sustaining, meaning it is funded solely by those who buy into the programFederally subsidized by taxesOptions for State ImplementationState run, with each state setting the guidelines for its operationTrigger-effect, which would not be implemented unless private insurers could not keep costs down or find a way to cover those with pre-existing conditions, then it would be implemented

32. Who Would Benefit From a Public Option?In our current system, health insurance is voluntaryThose who purchase health insurance are also the ones who use it most, keeping costs risingMany officials and professionals believe that by having younger, healthier people in the plans, the burden is shared for the costs of those already aged or with chronic conditions requiring costly services.A public option will help younger paying individuals as they age and need more services in the future to keep costs down, and will spread the cost of health care more effectively across the boardWho will benefit most from a public option?Those who cannot already take advantage of an employer-sponsored plan (unemployed or plan not offered)Those with pre-existing conditions who are denied private plansYoung, healthy persons who would find it a cost-effective way to purchase insurance for the long haul

33. Pros of a Public OptionLower PremiumsThere would be more people paying into the program, driving premium prices downNo Profit Margin or Tax LiabilityPlan funds would have federal or state funds to pay for them, so would not require tax hikes to increase profitability, as governments are non-profit entitiesAs they would not make a profit from premiums, they would not be subject to taxationBargaining PowerInsurance companies would have to compete with public-funded programs for customers. Having such a large group to contend with would force private companies to keep the cost of premiums down, and give customers better deals to stay competitivePortability of CoverageWith a public option, an individual could change jobs or move and keep their insurance coverage. Depending on whether it is federally or state funded, one could go anywhere in their state or country and stay covered with this type of plan

34. Cons of a Public OptionPrivate Insurance CompaniesWould Go Out of BusinessWith such a large, profitable group to compete with, insurance companies fear they could not afford the current levels of service to customers and still pay their investorsLower Provider PaymentsSome physicians now refuse to take Medicaid patients because they do not get reimbursed enough for their services from Medicaid payments. With another public program, they worry they will receive even less. Not all doctors enjoy high wages, some rural doctors make just enough to get byA Single-Payer System Might EmergeMany people fear government intervention in individual affairs, and dislike the idea of a single-payer system run by the governmentThe introduction of a public option would cause many to choose that option, and many believe it may well be the first step towards a government-run, single payer system in the U.S., much like that in other countries

35. Pros vs. Cons: Who Wins?The pros clearly outweigh the cons in this case, as the points against the public option are weakOther countries with a national health plan also have some private insurance plans available to supplement the public plans, suggesting that private insurers would not go out of business with a public option planThe point that many physicians fear lack of reimbursement seems ill-founded in that a majority of physicians support the public optionThe point that people fear a single-payer system also seems to be ill-founded in that a majority of the public supports both a public option, and national health care for all citizensLong wait times have been cited as a downfall of the public option, but the uninsured and underinsured wait until it is too late for quick treatment in many cases, then have no choice but to visit the Emergency unit of a hospital- Talk about wait times and choices!The fact is, the majority of the general public, as well as many providers support a single-payer, Universal Health Care Plan

36. The ConclusionAs long as we take care of both patients and providers, it is clear a public option is necessaryA measure of a country is how they take care of their citizenry- it is a moral issueIn most industrialized countries, all citizens are treated equally in the health care arenaThough patients must often wait for treatment of non-emergency conditions, the rich and the poor wait an equal amount of time, suggesting solidarity among people that apparently America does not shareIt takes a true moral commitment to serve the citizens of a nation and succeed in developing a health care system that encompasses all persons, regardless of status in the community

37. Making It HappenHow can each of us assist in accomplishing our task to provide dignified health care for all citizens?GET INVOLVED in the process!Be informedVote (also run for office if you have the desire and abilities)Write and call your representativesWrite a letter to the editor of your local paperE-mail your senatorsAttend ralliesand talk to your friends and familyWe must show them by sheer numbers that we stand together in solidarity to obtain a pubic option in health care – not just today, but ongoingLet us make certain all of us are assured a government-protected right to good health in our quest for life, liberty, and the pursuit of happiness, rights which are already protected by our constitution!

38. CreditsProduced and Directed by: Eric Enright and Dianne DrinkardSources:Barack Obama and Joe Biden’s Plan to Lower Health Care Costs and Ensure Affordable, Accessible Health Coverage for All – http://www.barackobama.com/pdf/issues/HealthCareFullPlan.pdfCarmichael, M: For Kids, Being Uninsured Can Be a Killer – http://blog.newsweek.com/blogs/thehumancondition/archive/2009/10/30/for-kids-being-uninsured-can-be-a-killer.aspxHenry J. Kaiser Foundation: The Uninsured, a Primer – http://www.kff.org/uninsured/upload/7451-05.pdfHenry J. Kaiser Foundation: Poll: Majority of Doctors Support Public Option -http://www.medicalnewstoday.com/articles/1640083.phpJames, R: Which Americans are Uninsured? – http://www.time.com/time/health/article/0,8599,1930096,00.htmlKlein, E: A Market for Health Reform -http://www.washingtonpost.com/wp-dyn/content/article/2009/07/28/AR2009072802114.htmlNational Coalition on Health Care: Health Insurance Costs - http://www.nchc.org/facts/cost.shtmlNeale, T: Nationwide Protests Support a Single Payer Healthcare Plan - http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/9889Shi, L. & Singh, D. A: Delivering Health Care in America: A Systems Approach (2008)Reid, T.R: No Country for Sick Men- http://newsweek.com/id/215290/Torrey, T: Public Option Health Insurance Pros and Cons – http://patients.about.com/od/healthcarereform/a/publicoption.htmImage SourcesSlide 1, 3, & 14 images by Dianne Drinkard & Eric EnrightSlide 2 image obtained from http://www.oldamericancentury.orgBackground flag images obtained from http://www.wpclipart.com/flags/Countries/index.htmlSlide 18 cartoon obtained from http://www.time.com/time/cartoonsoftheweek/0,29489,1930866_1968779,00.html Slide 19 flowchart obtained from http://okpolicy.org/blog/health/health-insurance-reform-explained-in-three-steps/ Slide 26 image obtained from http://commons.wikimedia.org/wiki/File:Goddess_of_justice.jpgSlide 28 image obtained from http://www.archives.gov/education/lessons/constitution-workshop/images/Constitution

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