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Vw@;~M>\f^Ty+m֮3V(=>h5sCC9ԸjHUEtf~}ntw^f@]s#0\v0a{Al62`]ӡ{D@?9 3z;PH(;yR "5o0s1A,:b$_h9|[;xFeO.A|N(zR圽\?hp>ٛZ~zGm6&pǧ-R76ZfkA4"ЇY C s D pbR~WTEq'Ms#Ѓ'4 Z{yLs yzϝ\mY u=z6]-So׷*aeןWzX07Ewf슲Q.y].~+^Ѿ-KQ[zra }"v_= TK/9s{N/z$? uizZ@hn/308H&$_>#ЇQw]hc_),}:v+ah’z|2d޸Y=QyYh<Swa9b$Ĥ3#0 `ދR58mY0V4z%`4[iyaȑdpG:̀/i)Jݎ^5>b#2i/S#{ĝca&~2ׂC.Qin_]X,ZMuP՗ǡʮW?zwG lE⢨'G1U[\CӍ600nߏ(d{x/EGaF3uh9GML| a0!YxY; ~Џ@fo ew stvo@0[6sFJi&a"}N^k hM_1g7rćVGaNXa[5 Ҷ/rŨOM2\,@o+Nk98c4W+oIU[0ל86Z͐` m2fhr1ws.}r#`/Gݛ±ȺK .V.ۅ]r`n"9P2 oywZD\|^-uPfj`9Te + ~Ⱦdedwx6 qTeێJKhAf wGf}2>B4@|LFF<2 f.NXb>]rh lM,|oi-bH 2@ShBh'56 ñhBI>\]zCW9EaYa^mV;J*y@о- 0mARGlU `]5k0b&ǃt*[$3=ҒDa'pCPuȝC6˿dd r$"pAK]^[V*oO֨Hvs4TPLhމ~gC0̈! 3[ykK"ZF)dZ(4G|ޘlJ 9G^^ ^zjHpH sDq&uսVx q O0xyVQE;H:LfVG?ZB0ZFa(dgwfVK>q-IDATRJ~0Gh xX B*b?3=;W3YHu(V+0GنD0-e.~a|fA|-l |j;`i]`c0{+[)`*!e>3vU3jf.f~4lYhX4ZWf`6Lc":3a&)I޶_c ZGsaql_kYvufKAX~ i\"`LyI& +u =_vCVPD"/$7Y ~FzEo+.`ol!qV› rQ #"@jK{B1+f1[q)1r߲tnPK`*e2׫bO̭S]UL=yXl3@V!R@]`[[-qkS4hX>NP3˛JI/eڀDle ťCW_xV{Ju(WHP2e~ @w-dZ4vaj6&x!6̣Gy6 17l .؊ W^* j^or ]3 *76?5qae zcdDTҀWGYY$eɈ3s0tЩSmҎpae.4%6IENDB`>(  N S <Why Care about the Uninsured? http://www.familiesusa.org/site/PageServer?pagename=Paying_a_Premium_splash<Why Care about the Uninsured? http://www.familiesusa.org/site/PageServer?pagename=Paying_a_Premium_splash<Why Care about the Uninsured? http://www.familiesusa.org/site/PageServer?pagename=Paying_a_Premium_splash(http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1  http://www.washingtonpost.com/wp-dyn/articles/A9447-2005Feb8.htmlhttp://www.washingtonpost.com/wp-dyn/articles/A9447-2005Feb8.html!~http://www.familiesusa.org/assets/pdfs/Paying_a_Premium731e.pdf~http://www.familiesusa.org/assets/pdfs/Paying_a_Premium731e.pdf|A SCHIPVhttp://www.kff.org/medicaid/upload/7642.pdfF(Senator Barack Obamabhttp://www.barackobama.com/pdf/HealthPlanFull.pdfdKIOM 20048http://www.iom.edu/?id=19175LIOM 2002Thttp://www.iom.edu/CMS/3809/4660/4333.aspxMIOM (2002), Thttp://www.iom.edu/CMS/3809/4660/4333.aspxNIOM (2004), Vhttp://www.iom.edu/CMS/3809/4660/17632.aspxO:Haynes Johnson & David Broderhttp://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&EAN=9780316111454&itm=2PJonathan Cohnhttp://search.barnesandnoble.com/booksearch/isbnInquiry.asp?z=y&EAN=9780060580452&itm=1hWeb Exclusivehttp://content.healthaffairs.org/cgi/reprint/hlthaff.w3.391v1.pdfdIOM 20048http://www.iom.edu/?id=19175t$www.johnmccain.com4http://www.johnmccain.com// 0DTimes New Romanllht-a0DTimesNew Romanllht-a0 DTahomaew Romanllht-a0"G .  @n?" dd@  @@`` 0(HSF  ""    #(+.079=> @ACDE/X$b$؛ZjA< x. 0e0e A@A5%8c8c     ?1d0u0@Ty2 NP'p<'p@A)BCD|E?@IH ʚ;js8ʚ;g4EdEd -a0ppp@ <4!d!d8))0lDt<4dddd8))0lDt  0___PPT10 ___PPT9 AFKLMNOPhz? %%1The US Health Care System: Insuring the Uninsured22(Mark G. Kuczewski, PhD Director, Neiswanger Institute for Bioethics & Health Policy Loyola University Chicago Stritch School of Medicine$t63Who are the uninsured?({Current US Census bureau estimates 43- 45 million persons uninsured; 70 million lack insurance for at least one month during the year. Under 65 years of age, normally 25-64 years old. Young adults (20-25 years old) are single largest uninsured group (20%) They work (80% live in a home where the head of household is employed) They work in small firms (fewer than 25 employees) D|P"Why Care about the Uninsured? ( >0PAll measures suggest that the uninsured have less access to needed screening, prevention, and appropriate/ timely interventions. For instance, they often fail to receive care until it is an emergent situation, resulting in worse outcomes, more expensive care (IOM 2002), & premature death (approx. 18,000 deaths per year; IOM 2004, p8) 0QZ* L>0 K>0BJ#Why Care about the Uninsured? (>0Economic consequences of illness, e.g., bankruptcy [middle class] See Himmelstein, et al, Health Affairs, 2005 http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.63/DC1 http://www.washingtonpost.com/wp-dyn/articles/A9447-2005Feb8.html RA$:F CA>0p >0$!Why Care about the Uninsured? (>0REconomic strain on the individual provider (cost shifting;  payer mix ) Economic strain on private insurance system: Over $1000 is added to cost of a family insurance policy each year to cover the uninsured http://www.familiesusa.org/assets/pdfs/Paying_a_Premium731e.pdf Human dignity & solidarity@*z}!>02.*What would insuring the uninsured cost? ++((a) The uninsured currently utilize over $100 billion of health care services; (b) Estimates are that they may use up to $70 billion more of services, if insured. (IOM 2004, p. 120) Comparison  Iraq war $125 billion/year 8?"J>0&#&What kind of Insurance do People Have?''$C Employer-based Insurance = 175 million (56% - down from a high of about 70%) Individual Insurance policies (for those under 65) = 18 million (5%) Medicaid = 38 Million (12%) [includes about 5 million SCHIP] Medicare = 40 Million (13%) Uninsured = 46 million uninsured (15%) P3PLP5 :] %A>074Small employers & individuals`Individual rating v. community rating  small businesses & individuals cannot get community-rated policies Individuals cannot get the employer tax deduction for health benefits30'Current Health Insurance Tax Deduction(((Employer contributions to health insurance are not taxed as employee income. ($100 billion a year in regressive tax credits) Example: Employer provides health insurance worth $10,000.00 to employees. No one is taxed on this income. If they were taxed on this, those in 33% bracket (married couple with $200,300+ income) receive $3000 tax break, those in 15% bracket receive $1500 break (married couple with $16,050 - $65,100 income) .Z41#Sen. John McCain www.johnmccain.com$(>0#<Persons without employer-based insurance eligible to receive a direct refundable tax credit of $2,500/individuals and $5,000/families to offset the cost of insurance. Families choose the insurer & money sent directly to insurance provider. Problem of individual policies & community rating, pre-existing conditions -*_Candidate Barack Obama Strengthen employer-based system, increase individual purchaser options(`(H4 IF>06Employer  pay or play provision; subsidy for small businesses Insurance Pool  guarantee access to purchase a comprehensive plan; guarantee affordability through regulation & subsidy for catastrophic costs Expand Medicaid & SCHIP No individual mandate  No  Universal Participation P854H.R. 3200  the House bill (Guarantees issue of a community-rated policy from any insurer Employer mandate- pay or play ($12,000 for a firm that has $300,000 payroll) Individual mandate ($600-1000 for individual making $20,000) Public option to buy plan; based on Medicare reimbursement rates   Defeating Reform: The Rhetoric(Conservative nation in sense of fear of losing what you have  Rationing (Fear of the poor? I.e., playing on the fear that the needs of the poor constitute a  bottomless pit )  Socialized medicine  Government run healthcare Loss of choice of doctorP/,Suggested further reading(|IOM (2002), Care Without Coverage: Too Little, Too Late IOM (2004), Insuring America s Health: Principles and Recommendations Haynes Johnson & David Broder, The System: The American Way of Politics at the Breaking Point Jonathan Cohn, Sick: The Untold Story of America s Health Care Crisis and the People Who Pay the Price Jonathan Oberlander,  The Politics of Health Reform: Why Do Bad Things Happen to Good Plans? Health Affairs Web Exclusive Z , ;@ Z^l , :A c Z M>0 N>08DO>0~P>0h>0  0` 33` Sf3f` 33g` f` www3PP` ZXdbmo` \ғq>9y`Ӣ` 3f3ff` 3f3FKf` hk]wwwfܹ` ff>>\`Y{ff` R>&- {p_/̴>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> 0p(    6 "P  `,Click to edit MThe Decisionaster title style- -$  0 "  RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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