Lecture 6 (3 pages)

• 1883 - Otto von Bismarck introduces universal health insurance in Germany
• Early 20th Century - European democracies adopt "sickness insurance" to protect against wage loss, evolving towards universal coverage.
• 1901 to 1909 - Theodore Roosevelt becomes the first U.S. president to support universal health insurance, but no legislation is passed.
• 1912 - American Association of Labor Legislation (AALL) creates a committee on health insurance.
• 1917 - AALL's model legislation is endorsed by the American Medical Association (AMA) House of Delegates.
• 1920s to 1930s - Efforts for universal coverage stall; excluded from the Social Security Act of 1935.
• 1939 - Senator Robert Wagner introduces the National Health Act, which dies in committee.
• 1943 - The Wagner–Murray–Dingell Bill is introduced but never passes.
• 1945 to 1948 - President Truman proposes national health insurance, facing opposition from various sectors.
• 1960s - Incremental increases in coverage begin; Medicare and Medicaid are enacted in 1965.
• 1971 - President Nixon proposes compulsory employment-based health insurance, which fails.
• 1990s - Congress introduces bills for single-payer universal health insurance, but none gain traction.
• 1993 to 1994 - The Clinton administration proposes the Clinton National Health Security Plan, which fails to pass.
• 2009 to 2010 - The 111th Congress passes H.R. 3590 (ACA 2010) and H.R. 4872 (Health Care and Education Reconciliation Act).
• By 2010 - the fraction of the population lacking health insurance had reached more than 16%
• By the early 20th century, essentially all European democracies had “sickness insurance”.
• In 2010 - Congress passed and President Obama signed H.R. 3590, the ACA 2010, and H.R. 4872, the Health Care and Education Reconciliation Act.
• Private insurance coverage is required for all by individual or employer mandate (Bismarck model).
• The government owns and provides all required medical services (Beveridge or National Health Service model).
• The government provides health insurance (National Health Insurance model).
• Acquiring health insurance coverage was mandated to all Americans, including legal immigrants. If they do not have health insurance, they will be paying a penalty.
• Adults with incomes up to 400% of poverty level receive subsidies or monetary support to help with premium support and out of pocket expenses made for needs involving health.
• Small businesses receive tax credits to reduce the cost of acquiring health insurance coverage to their employees.
• Key Provisions of the Health Care reform legislation of 2010 (ACA)

  1. Mandated health Insurance
  2. Medicaid Eligibility expansion
  3. Improved medicare benefits
  4. Substantial insurance reform
  5. Substantial support in improving quality
• Medicaid - government program that provides health insurance limited to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities of the United States, funded jointly by the states and the federal government
• Medicare - a federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease or permanent kidney failure that requires dialysis or a transplant).
• Medicare has 3 parts.

  1. Part A - covers hospital insurance such as inpatient hospital stays.
  2. Part B - covers medical insurance such as doctor's services, outpatient care, medical supplies, and preventive services.
  3. Part D - covers the cost of prescription of drugs.
• support of comparative effectiveness research - involves the studying of different medical treatments and interventions to determine which ones are most effective for specific conditions or patient populations.
• support for the integration and coordination of healthcare services - the support to ensure that healthcare services are well-coordinated and integrated across different providers and settings
• Incentive payments to providers on the basis of quality measures - involves rewarding healthcare providers financially for delivering high-quality care, often measured by specific quality metrics or performance indicators.
• Article 25 of the Universal Declaration of Human Rights (UDHR) - the rights to food, clothing, housing and healthcare.
• Article 25 of UDHR also states that - “Motherhood and childhood are entitled to special care and assistance”
• Constitution of the World Health Organization (p. 1) - Health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.
• International Covenant on Economic, Social and Cultural Rights (Article 12) - This article also includes the improvement of all aspects of environmental and industrial hygiene such as the reduction of community exposure to harmful substances like radiation and harmful chemicals that directly or indirectly impact human health, like tobacco and drugs
• UNESCO Declaration on Bioethics and Human Rights (Article 14) - highlights the importance of access to quality healthcare, essential medicines, adequate nutrition, and water for all individuals, particularly women and children without discrimination, and reducing poverty and illiteracy.
• Convention on the Rights of the Child (Article 24) - states that no child should be deprived of his or her right of access to such health care services.
• Convention on the Rights of Persons with Disabilities (Article 25) - persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability.
• A social good, also known as a common good - is something that benefits the largest number of people in the largest possible way; it has a similar concept sa utilitarianism.
• Contractarianism - it views the patient-physician relationship as one of respectful communication and negotiation.
• Communitarianism - focuses on the importance of the community and emphasizes the influence the community has on human beings.