~ Archive for health insurance ~

Development as Freedom

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Amartya Sen’s model

Pg 3

“Growth of GNP or of individual incomes can, of course, be very important as means to expanding the freedoms enjoyed by the members of the society. But freedoms depend also on other determinants, such as social and economic arrangements (for example, facilities for education and health care) as well as political and civil rights (for example, the liberty to participate in public discussion and scrutiny).

Pg 4

“Freedom is central to the process of development for two distinct reasons.

  1. The evaluative reason: assessment of progress has to be done primarily in terms of whether the freedoms that people have are enhanced;
  2. the effectiveness reason: achievement of development is thoroughly dependent on the free agency of people.

Pg 10

“Five distinct types of freedom, seen in an “instrumental” perspective, are particularly investigated in the empirical studies that follow. These include (1) political freedoms, (2) economic facilities, (3) social opportunities, (4) transparency guarantees and (5) protective security.

Pg 10

A CONCLUDING REMARK

“Freedoms are not only the primary ends of development, they are also among its principal means.”

Pg 11

“political freedoms help to promote economic security. Social opportunities facilitate economic participation. Economic facilities can help to generate personal abundance as well as public resources for social facilities.

Pg 14

“The ends and means of development require examination and scrutiny for a fuller understanding of the development process; it is simply not adequate to take as our basic objective just the maximization of income or wealth, ….

Pg 15

“It is sometimes claimed that the denial of these rights helps to stimulate economic growth and is “good” for rapid economic development. … Indeed, the empirical evidence very strongly suggests that economic growth is more a matter of a friendlier economic climate than of a harsher political system.”

Pg 19

“this is not to deny that deprivation of individual capabilities can have close links with the lowness of income, which connects in both directions: (1) low income can be a major reason for illiteracy and ill health as well as hunger and undernourishment, and (2) conversely, better education and health help in the earning of higher incomes.

Pg 25

“The relation of the market mechanism to freedom and thus to economic development raises questions of at least two quite distinct types, which nee to be clearly distinguished. First, a denial of opportunities of transaction, through arbitrary controls, can be a source of unfreedom in itself.

second… markets typically work to expand income and wealth and economic opportunities that people have.

Pg 27

“The shift in the focus of attention of pro-market economics from freedom to utility has been achieved at some cost: the neglect of the central value of freedom itself.

Pg 31

“Individual freedom is quintessentially a social product, and there is a two-way relation between (1) social arrangements to expand individual freedoms and (2) the use of individual freedoms not only to improve the respective lives but also to make the social arrangements more appropriate and effective.

Pg 31-32

“The real conflict is between

1) the basic value that the people must be allowed to decide freely what traditions they wish or not wish to follow; and

2) the insistence that established traditions be followed (no matter what), or, alternatively, people must obey the decisions by religious or secular authorities who enforce traditions – real or imagined.

Pg 33

“The motivation underlying the approach of “development as freedom” is not so much to order all states – or all alternative scenarios – into one “complete ordering,” but to draw attention to important aspects of the process of development, each of which deserves attention.”

Pg 38

“Political freedoms, broadly conceived (including what are called civil rights), refer to the opportunities that people have to determine who should govern and on what principles, and also include the possibility to scrutinize and criticize authorities, to have freedom of political expression and an uncensored press, to enjoy the freedom to choose between different political parties, and so on.

Economic facilities refer to the opportunities that individuals respectively enjoy to utilize economic resources for the purpose of consumption, or production, or exchange.

Social opportunities refer to the arrangements that society makes for education, health care and so on, which influence the individual’s substantive freedom to live better.

Transparency guarantees deal with the need for openness that people can expect: the freedom to deal with one another under guarantees of disclosure and lucidity.

Protective security is needed to provide a social safety net for preventing the affected population from being reduced to abject misery, and in some cases even starvation and death.”

Just or not

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Social Justice Research, Vol. 1, No. 3, 1987

Equity and the allocation of Health Care Resources: proposition or Oxymoron?

Rosemary R. Lichtman

Pg 253

“However, in other circumstances, as individuals possess the ability to make choices about their health , it is necessary to take into account the historical health-related choices made by them in order to make statements relative to any alleged inequities.”

“Any policy decisions concerning changes in the financing of health care should, in their view, be guided by several goals: to induce socially efficient health care utilization, to spread the risk across the population, to spread the risk across a person’s lifetime, and to distribute the resources equitably by need (both in terms of income and health status). Health care revenues generally arise from four different sources: income tax, payroll tax, direct payments (user fees), and insurance premiums.”

Pg 254

“In order to achieve justice with respect to health care, there must be equality of the burdens of health care as well as equal access to care both in terms of the existing supply and the preallocative sphere.”

“…because the social trends of medicalization, social inclusion, biomedical transcendence, and health absolutism have crated a high demand for medical care, it is becoming more and more difficult to provide for all of the increasing health-related needs as perceived by society.

Pg 255

“Our society is in the midst of establishing various innovative programs to bring about the equality to which we have committed ourselves, but with little thought about objectively evaluating the outcome of the programs. If they compromise the quality of care we have been able to achieve to date, that outcome should weigh heavily in the efficiency-efficacy-equity equation.”

Mass. Universal Insurance just or sucks?

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The following points is presented from a talk by Tim Murphy

Local aid, education, criminal spending increases, which brings the deficit, so we need the innovative policy to deal with the issue.

No.1 guiding

Heritage foundation play a vital rule of providing the data with the department.

We need to pay cares for certain people, so we need to start a momentum, do not take money way, we will done something innovatively.

All the healthcare money or universal health insurance money will come from the tax, reimbursement, or federal aid. How does it contribute.

The reason of so many uninsured, which are qualified for some program? Bad intake, follow-up, hospital tracing system.

{{{{All the model the law maker had used was the efficiency model and the cost/benefit analysis. He did not use the rest of the model to test whether there might be a better solution for the universal healthcare or there might be some universal insurance coverage.

35% of people under 30 do not have the insurance, even the employers offer, those people would take risk.

Now we are socializing the healthcare and thus everyone need to contribute at least part of the cost.

Now the incentive for the hospital is that the hospital would not get paid if the hospital did not provide the proof of not enrolling in one of the health program. By using this virtual gateway hospital has the incentive to help enroll the uninsured people.

(((poverty level is fro the federal data

He 100% or 300 is compromise from the data analysis and the common sense. Someone says 400%,but it is insane to set that high. At last it is set 300

(((LPF coverage including kids, which is really cheap and much cheaper than the adult.

(((No solutions to the extent that how the gov is going to fund this universal health insurance, the law makers even did not know.

Why health care reform in Mass?

  1. Double-digit, annual increases in insurance premiums and the highest per capita health care spending in the nation.
  2. 500, 000 uninsured in latest state survey
  3. Small businesses and individuals facing significant barriers to entry for coverage
  4. Limited availability of information to consumers and businesses precludes informed health insurance purchases decisions.
  5. Potential loss of at least $ 385 million in federal government Medicaid funding
  6. $1 billion and growing of “free-care” forcing all stakeholders to deal with costs for uninsured and under-insured.
  7. Two “universal” health care ballot initiatives.

The uninsured in Mass: 2004

Total Commonwealth population: 6,200,000

Currently insured 93%

Employer, Individual, Medicare or Medicaid 5,740,000

Currently uninsured (7%) ~460, 000

100% FPL Medicaid eligible but unenrolled 100,000

100-300% FDL Low Income 150,000

>300% Middle Income 204,000

The law changed eligibility for certain populations and raised enrollment caps:

  1. Children: expanded to 300% FPL
  2. Insurance Partnership: expanded to 300% FPL
  3. MassHealth Essential: raised cap to 60,000 people
  4. HIV Family Assistance: raised to 1300 people

Massachusetts Health Care Reform

medicaid

cost/quality improvements

Insurance Reforms

ßShared Responsibility

contractor authority

commonwealth care

By McKinsey Research

Benefits and challenges of the US health system

Benefits:

  1. Focus on quality of life
  2. convenience
  3. patience choice
  4. innovation
  5. access to new treatments and technologies

Challenges:

  1. Highest per capita expenditure (16% of GDP)
  2. access for uninsured (16% of the population)
  3. compared to OECD, lower life expectancy and higher infant mortality.
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