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Bioethics Midterm 1 with verified Solutions | Latest updated | Rated A+
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Bioethics Midterm 1 with verified Solutions | Latest updated | Rated A+
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Bioethics Midterm 1 with verified Solutions | Latestupdated | Rated A+
U.S. versions of the 5 forms of insurance - ✔✔We do all 5 in a weird and haphazard way
1: national health service: VA (veterans hospitals)
-Tax-supported care from doctors salaried by government
-Third largest national health service in world
-Pretty high quality and pretty efficient, used to not be great but now is really good, technological
development in these hospitals, good mental health care
-Also: programs providing care to members of congress, etc
-Also: care for native Americans living on reservations
2: national health insurance: Medicare
3: corporatist: how most Americans are insured
-Most americans get it through jobs as employee benefit
-Other corporate bodies that can provide health insurance like labor unions just like in
germany -Self employed people often get insurance through organizations -Corporate benefit
for health care is tax deductible
-It's way cheaper for them to provide benefits than to provide the amount of salary that people would
need to buy insurance (big pool, don't have to pay income tax on money to buy their own insurance,
the employer deducts tax)
4- poverty/means tested: Medicaid
Medicare v. Medicaid - ✔✔Medicare:
-For people who are 65 and over and for some others with certain conditions
,-Nationally administered, national standards of coverage
-Government contracts with private entities
-Pays for almost every kind of healthcare
-Comes with some burdens/copayments
-Couple of things it doesn't fund- nursing care
-Pays for you to get over an injury but not long-term care (A lot of older people need to live in
nursing facilities for years, hopefully they have purchased medigap to cover)
Medicaid:
-Means-tested eligibility- must earn under a certain amount as a household
-federally set minimum standard but administered by state
-slightly more expansive coverage than medicare
Obamacare Impact on Medicaid - ✔✔-Before Obama, wide variation of how poor you had to be to
apply for Medicaid, differed by state
-Obamacare made it more generous all around the country, said the federal gov would pitch in
money to cover people up to 144% (the federal government would pay for the difference of what is
covered now and what would be covering
-Statute pushed this onto states with threat- said states must take federal expansion or would
completely lose medicaid
-Supreme Court said its unconstitutional for fed gov to threaten to get rid of a program- so made the
medicaid expansion part voluntary
-Once the statute got rid of the threat, all red states didn't take the expansion and blue states did
-States with the most generous programs took the expansion
-2 reasons why states didn't take: (1) A lot of states dont like the idea of gov funded health insurance,
think private markets are more efficient, when you're funding something a lot end up regulating it a lot-
states didn't want to give up control over how healthcare runs in their states (a lot of healthcare
happens on state level, doctors licensed at state level, what counts as medical practice like weed
abortion is determined on state level), (2) States worried that a few years from then the federal gov
would say that states need to cover costs of medicaid, worried about longevity of deal
-Over time/during covid- other states took expansion, lots of people lost health insurance bc lost
jobs, states said need to figure out a way to care for the poorest- 10 states still haven't taken it
(mostly in southeastern U.S.)
,Obamacare Mandates - ✔✔Employer Mandate:
-Obamacare put in place an employer mandate saying if above a certain number of employees need to
provide insurance- More people got covered bc of this
Individual Mandate:
-If you don't buy you have to pay a fee/tax
-Idea is that you want young people to buy into insurance, would make price of insurance go down
because young people are cheap to insure- don't get as many diseases
-Insurance death spiral: a population of people wanting to buy insurance would have a pretty
predictable cost, everyone's premiums are enough that everyone who gets sick is cared for, handful
of people have problems and need treated, others money pays for their care... Problem is that some
people might think they won't need healthcare that year, don't want to participate in pool....
Takes the healthiest people out of the pool, the people who remain are sicker, the average cost per
person goes up, the premium you have to charge them goes up... healthy people continue to drop
out as price goes up
-To prevent death spiral: try to keep young people in pool, so you cover things that young healthy
people want: things having to do with babys, physical therapy, gym membership, alternative healthcare
-Obamacare did something more direct: everyone has to get health insurance or get fined
-Also said that everyone is covered under their parent's plan until 26
-Was a political hot potato
-Some SCOTUS justices saying it was interference with individual health
-Fine was around 700 dollars, so even if it was enforced people could pay tax which was way lower
-Has been effectively repealed
-Individual mandate didn't do much but employer mandate did a little
Current state of insurance/gap in insured under Obamacare - ✔✔-Above 144 and up to 400 percent of
the poverty level, Obamacare decided to give people graduated levels of subsidies to buy insurance
on private market, tinker with private market a bit and set up state exchanges, make sure exchanges
sell inexpensive products that covered conditions
-A bunch of people went to exchanges and bought relatively less expensive insurance
-At the end of the initial expansion of Obamacare- who is uninsured? It is people who are not
wealthy enough for subsidies to kick in who make more than the medicaid line in their state
, -Gap wouldn't occur without the SCOTUS interference which made Medicaid expansion optional
-State of health insurance in U.S today: More people getting employer-sponsored health insurance,
all nut 10 states took the expansion
-People denounce Obamacare as socialized medicine but a big part of what it did was incentivize people
to get private insurance
-Now there's way less people without insurance- about 9 million not 45 million (These people are mostly
in states w/o expansion who dont make enough for subsidy and dont have enough money to buy
insurance)
-Also undocumented immigrants: lots of people in Texas etc show up at hospitals without insurance,
border states argue with nonborder states about who should be paying for these people's care
-There are nonprofits that run clinics that provide free health care, but there are still people who can't
get care
-This is a huge problem with undocumented immigrants in many other countries too
Administrative costs of U.S. healthcare system - ✔✔-US system has very high administrative costs,
many players and moving pieces
-many corporatist players
-different state administers for medicaid in each state bc varies by state
-many private insurance companies (who often cut deals with local hospitals to save costs, insurance
companies negotiate usually locally, charges for various services vary)
-hospital administrators have to figure out who your provider is what the deal is with the insurance
provider etc- bc you're paying something different depending on where you work and the deals
your insurance company
Lack of preventative care in the U.S. - ✔✔-national health insurance owns you your whole life: when you
turn 21, they tell you long-term effects of alcohol- gonna have to pay for impacts when you turn 65
- BUT private insurance entities hand you over to Medicaid at 65- hand you over before things
become worse, before health care becomes an incentive
-private companies don't have an incentive to interfere with lifestyle or do optional preventative care
-Punchline: we pay double the amount of money per person than most other richest countries and our
outcomes for health are terrible
-National health services/insurance are concerned about getting messages out to young people about
not smoking/living a healthy lifestyle but profit motivated private market does not have this motivation
to keep you well in your old age
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