hello, i'm drew halfmannfrom uc davis sociology. this video provides an overview ofthe affordable care act, or the aca. critics call it obamacare, and obama eventually embraced this labelhimself, but this is probably not the best political decision since obama has verylow approval ratings at this moment. and these approval ratings mayend up tarnishing the program. the american healthcare system, somepeople call it a non-system, had several main shortcomings before the passageof the aca, and some of these continue. first, the american healthcare system hasthe highest expenditures in the world, but
does not have better quality, and in fact, often has poorer qualitythan countries that spend much less. in 2010, the united states spent17.6% of gdp on healthcare, while canada spent 11.4%, andthe united kingdom spent just 9.6%. just a reminder,gdp equals the sum of all the goods and services produced byan economy in a given year. second, even with all this spending, the united states did notprovide universal coverage. before the aca,14% of the population was uninsured, and
the aca is projected to reduce the numberof uninsured only by about half. third, most insuredpeople were underinsured. many policies contain lifetime orannual expenditure limits and high levels of cost sharing. many excluded certain conditions andrefuse to pay for pre-existing conditions. as a result, many people whobelieved they were covered for a particular illness episodefound their claims denied. a fourth problem was insecure coverage. because most insurance is employersponsored, people often lose their
insurance at the worst possible time,when they've lost their job. others lose coveragewhen they get divorced or when their employer decides that he or shecan no longer afford to provide coverage. finally, some people are excludedfrom coverage because they have particular conditions forwhich insurers do not offer coverage or because insurers deny coverage onthe basis of their health histories. this is called medical underwriting. the aca sought to addressthese four problems of cost, uninsurance, underinsurance,and insecurity of coverage.
it increased the number of insuredpeople by requiring everyone to sign up for insurance. this is called the individual mandate. it expanded eligibility for medicaid,the health insurance program for some of the poor, andit provided subsidies to low and middle income people who do nothave employer-provided insurance. these people, and some small businesses, can now buy private coverage in aregulated state-level insurance exchange. the reform also provided tax credits forsmall employers to purchase coverage for
their employees and penalties for large employers who fail to provideinsurance for their employees. finally, the reform required insurers toprovide insurance to everyone who applies without medical underwriting and withoutannual lifetime limits on spending. the aca seeks to controlcosts in four main ways. first, it established pilot projects inwhich the medicare program attempts to pay for the quality of servicesrather than the number of services. second, it established an independentpayment advisory board appointed by the president that will propose thatsuccessful pilot programs be applied to
the entire medicare population. these recommendations will takeeffect unless congress vetoes them. third, it funded comparativeeffectiveness research to determine which medical proceduresare most efficient and effective. and finally, it taxed expensive,employer-provided plans, so-called luxury or cadillac plans. the reform has its critics. critics on the left complained thatthe reform simply pumps more money into a dysfunctional system and forcesamericans to buy a defective product.
they predict that insurerswill game the system so that they can continue to avoidthe sick and reject claims. they note that 22 million americans, about 7% of the population,will remain uninsured under the reform. they are also skeptical aboutthe effectiveness of the cost control measures in the reform, and argue that reform should have gonemuch further on cost control. many argue that a public single-payersystem could cover more people at a lower cost than the aca, which is built on anexisting foundation of private insurance.
on the right, republicans have complainedof a government takeover of healthcare and socialized medicine. these claims are clearly exaggerations. the reform leaves the vast majority ofthe healthcare system in private hands. most republican critiques of the billfollow standard tenets of market fundamentalism, the idea that markets cando everything better than the government. this is quite odd because manyof the ideas in the reform, including the individual mandate,first appeared in free market republican alternatives tothe clinton reform attempt of 1994.
most republican opposition to the billcan be understood as an attempt to deny obama a victory in order toenhance their electoral prospects. in 1994, republicans made major gainsafter the defeat of the clinton reform and they learned an important lesson. obstructionism can pay off in elections. at the same time, the debate over theobama reform witnessed the emergence of an extreme right-wing faction withinthe republican party, the tea party. tea party activists erroneouslyclaimed that a measure to fund end-of-life counseling was meant to createdeath panels, who would kill our grandmas.
tea party activists also claimedthat the independent, the ipab, would be an instrument for rationing, which is denying needed care tosome people while providing it to others. and they have argued that the individualmandate is an unconstitutional violation of personal liberty. this claim was mainly rejectedby the supreme court. we'll talk more about the specifics of theaca later in the course, but hopefully, this video has given youa brief introduction.
0 comments:
Post a Comment