I a b c d II a b Healthy Insurance in the U S Insurance is pooling of risk Types of health care i Beveridge Model health insurance is public financed by taxes like libraries police many most hospitals are public and users don t get doctor bills Government limits treatments and charges to keep costs down UK most of Scandinavia HK Spain Cuba ii The Bismarck Model insurance paid for by employers and employees but plans are non profit tightly regulated and must cover everyone Despite private doctors hospitals costs are kept low down Germany France Belgium Switzerland Japan iii The National Health Insurance Model private providers however payment comes from universal public insurance program government run Costs low because of non profit and single payer can negotiate low drug prices but also b c treatments may be limited and waits may be long iv The Out of Pocket Model much of the world including developing countries 1 Public insurance single payers Beveridge model public providers national health insurance model private providers 2 Private insurance not single payers Bismarck model but w major government regulation private providers and no insurance out of pocket model The US is a mix of all the above i Veterans getting healthcare through the veterans health administration 1 Beveridge Model public public ii For employed adults getting healthcare through employers 1 Bismarck Model private private iii For the uninsured tough luck 1 Out of pocket Model US Healthcare most expensive and worst performing Khazan 2014 i Commonwealth fund report compared 11 countries healthcare systems US UK NZ Australia Canada and 6 European countries ii Most expensive US spends 17 7 of GDP on healthcare other countries 7 11 US has highest per capita health expenditures 8 508 iii Worst performing US scores high on effective care but ranked worst in efficiency equity healthy lives and cost related barriers Obamacare Single payer healthcare i Refers to universal health care systems where costs are paid by a single public government system ii Some countries Canada Taiwan are considered pure single payer systems iii Other countries have a combination of public and private payers or regional rather than national public payers Health insurance b t jobs i How do Americans b t jobs get health insurance c d e f g h i 1 OPT1 Pay for COBRA insurance up to 18 months post job loss but very expensive must pay full cost of former employer s insurance and admin fee 2017 avg 569 month singles and 1595 month families 2 OPT2 Pay out of pocket even more expensive 3 OPT3 sign up for short term 1 year plans w limited benefits 4 OPT4 sign up for Medicaid if eligible 5 OPT5 none uninsured Germany s healthcare i All residents of Germany are required by law to have health insurance ii 87 have statutory HI 1 Nonprofit firms offer same mandated coverage but compete with eo by offering optional perks covering costs of exercise classes travel vaccines 2 Costs 14 6 of gross income split evenly b t employee and employers 3 Unemployed students retirees also iii Others have highly regulated private insurance Obamacare Goals Timeline Kliff i Obamacare Patient Protect and Affordable Care Act ACA PPACA ii Main goal increase of Americans covered by health insurance and decrease of HC iii 03 2010 signed into law indiv Mandate upheld by supreme court in 06 2012 Medicaid expansion optional exchanges opened 10 2013 indiv Mandate went in effect 01 2014 indiv Mandate repealed 12 2017 effective 2019 Main features of Obamacare i Individual mandate individuals must get minimum essential coverage pay a fee at tax time ii All plans must cover minimum benefits w no limits on 10 essential health benefits ER care hospital stays lab services maternity care mental health substance abuse treatment preventive care pediatric care iii Guaranteed issue insurance companies cannot deny coverage charge more based on pre existing conditions iv Employer mandate business w 50 full time employees must provide insurance effective 2015 2016 v 26 is when young adults can t stay on parent s plan vi Expansion of Medicaid in states choosing to accept vii Marketplace exchanges through HC gov state run w some people eligible for subsidies Tax penalties increased from 2015 2016 not qualified for insurance for year and don t qualify for exemption Bronze covers 60 silver 70 gold 80 platinum 90 of medical costs Tax penalties smaller than actual cost of insurance for those not eligible for waivers reason why many choose to pay penalties and not insurance Democratic states expanded Medicaid alternative plan republican states did not j Evaluating Obamacare successes Cliff 2017 Sanger Katz 2017 i 17 20 million more people have HI 1 of uninsured in US dropped 48 6 31 million 2 uninsured dropped by 40 in Medicaid expansion states but only 10 in non expansion states ii Made American more financially secure medical debt is 1 cause of bankruptcy iii Reduced inequality a redistributive law iv HI more comprehensive v Reduced federal deficit vi Some insurance companies pharmaceutical companies and hospitals flourishing because ACA provides them with new costumers k Evaluating Obamacare Failures i Health insurance is still very expensive ii HC system remains complex and confusing iii Can t always keep your plan doctor 1 Overregulation insurance companies employers and individuals 2 Too much govmt spending 3 Employer mandate can discourage job growth employers don t want to hit 30h week cut off for getting insurance l Too soon to tell if people healthier if law contributed to slowdown in HC spending if hospital care quality improved III Immigrant Health a Immigrant health paradox immigrants face challenges such as language barriers financial difficulties and discrimination i Despite difficulties immigrants tend to have better health and mortality profiles than native born health paradox markides ii Immigrant health advantages reduced w time in host country and disappear by next gen due to part to changes in health behaviors and acculturation processes process which individual adopts acquires and adjust to a new cultural environment b Immigrant ethnic enclaves i Some scholars propose immigrant ethnic enclaves are protective of health because they contain sets of relationships institutions and social resources that facilitate day to day survival and functioning of immigrants and buffer effects of social disad ii Other academics observe 1 Limited opportunities for social economic residential