1. Stephen Hansell, Ph.D.
Department of Sociology
Institute for Health Research
http://sakai.rutgers.edu
shansell@rci.rutgers.edu
609-203-2830

3. EXAM 3

4. EXAM 3
Thursday 12/23

5. EXAM 3
Thursday 12/23
8-9:20am

6. EXAM 3
Thursday 12/23
8-9:20am
Scott 135

7. EXAM 3
Thursday 12/23
8-9:20am
Scott 135
Bring Pencils

8. EXAM 3
Thursday 12/23
8-9:20am
Scott 135
Bring Pencils
Know your RUID

9. EXAM 3
Thursday 12/23
8-9:20am
Scott 135
Bring Pencils
Know your RUID
no names dates and numbers

10. Class 25 – More Problems, Some

11. I. Problem: uninsured people
A. Medicare and Medicaid increased access to care
tremendously
B. But many people still cannot get needed care
• because of recent budget cuts and debts, so now
there are less and less people who have the
privileges

12. C. Uninsured are diverse group
• 60% of uninsured are employed but their employers do not provide
health insurance
• 16% work part time
• 24% dont work
• most recent college graduates, migrate workers, temporarily
unemployed, near poor, minorities and people with low education
have no health insurance
• medicade is for single mothers under AFDC! hence most adult males
do not have medicade!
D. Problems of the uninsured
• the uninsured die at twice the rate as the insured people
• no regular medical care
• so delay until something is serious and so their problems are
intensified
• hospitals do pay for some charity care but they are very few
• private insured people pay for more than they owe but they get
better service
• so the poor people get care from the ER, the most expensive and the
worst care place

13. II. Problem: homeless people
A. More homeless now than at any time since
Depression of 1930's
• very difficult to track them.
• due to the shortage of the supply of low rent
occupancy
B. Determinants of homeless not well understood

14. C. Rossi's Chicago study
1. Old “windshield studies”
– researcher drives down the city and look out the
windshield and count the homeless
– they crazily underestimated the numbers
2. Rossi's survey of homeless
– a 25% did not have money
– 25% mental illness
– half of the homeless had depression studies
– many had lots of criminal records
– 1/3 of them were women and they had children living on
the streets
– alcohol abuse was common
– they were all applicable for medicaid but no permanent
address so no medicaid
– patients who had been expelled from mental hospitals
after a week or so without treatment
– so when they get sick, they end up in the er

15. III. Problem: seriously mentally ill
A. Many mentally ill do not get needed treatment
B. Barriers to treatment of mentally ill
• lack of parity for coverage
• insurance companies pay for the same for medical illness
as for mental illness
• but they do not pay as much for mentally ill patients
• they have co morbidity
– they have substance abuse problems
– they are super hard to treat as they use group attack
therapies, but you cant go to these meetings
• paranoid schizophrenia = you think people are out
to get you
– groups DO attack you and you are afraid to death
C. Mentally ill often have co-morbidity

16. IV. Problem: costs are still rising
A. Medical care costs still rising
• we spend more than most countries in the world
B. Hospitalization and drugs most expensive
• Private insurance companies cut care to make
more money
• they raise premiums
C. DRG's and managed care have slowed rising costs,
but not stopped them
D. Are we getting our money's worth?
• it is getting better with everyday

17. V. The Clinton Plan for national health insurance
VI. hybrid public and private health plan, it was awesome and created by
hillary
– universal coverage of all citizens and legal alliens
– insurance cannot be taken away if you got sick
– really remarkable - break the link between employment and health
insurance
• Proposed in 1993
• Universal coverage
• Four major players
– Patients - had a choice of 3 different versions, more expensive =
more choice of physicians
– covered almost everything
– prescription drugs
– home health care
– mental health care
– medical appliances for old people

18. 2. Alliances = large group of patients who worked together to buy health
insurance; not profit purchasing co operative
– people who do not work are automatically in the state alliance
– insurance companies throw in extras like dental insurance and well ness
programs to attract people
3. Private insurance companies
– compete with each other for the alliances
– then they negotiate with health care providers and get most care for the least
cost
4. Health care providers
– doctors were free to participate or not in the system
– but since all the hospitals are in the plan, they might all end up joining and
they are still free to have private practice
– but doctors might loose some pay
– main advantage for docs - there is no paperwork! there is just one simple
form for each patient
D. Plan died in 1994
D. it never actually came to a vote on the house of congress cz it was very
complicated
E. they didnt work with congressmen! didnt suck up to them
F. this was totally new and nobody knew if it would work.
G. they provided healthcare to people 40 million more people
H. they thought that the efficient paper work and stuff like that might pay for
those people

19. • III. Health Care Legislation 2010 - aka Obamacare
– promised decrease control costs and increased availability
– not a single republican voted for it
– it is a bandaid - it dosent fix the problem of rising cost
– does not turn doctors into government employees
– does provide a better safety net for more people
– particularly helps people who dont get insurance
– ensure greater profits for private insurance companies
A. What will happen this year?
A. adults with a pre existing health condition will be able to get health insurance through a high risk pool with
subsidized premiums 6k for individuals and 12 k for families
B. insurers will not be able to deny kids with pre existing conditions
C. children get 3 more year of coverage until age 26
D. expanded coverage - insurers will not be able to place limits on time of care like stay in hospitals for more
than 3 days etc
E. it will diminish the donut holes for medications = medical beneficiaries will get 250$ rebate when they
reach the donut hole
B. What will happen in 2014?
B. state based insurance for people w/o insurance from employers
C. but you gotta pay for it, so there will be some subsidies available in the form of tax credits. credits will cost
450 billion dollars every year
C. What’s the new law going to cost me?
C. tax the rich, but obama is gonna cut taxes from all people
D. healthy people will be paying more
E. make sure healthy people join the program even if they dont want to
F. this will make insurance companies richer so a lot of more money for the insurance companies
D. What does this reform fail to fix?

20. Stephen Hansell, Ph.D.
Department of Sociology
Institute for Health Research
http://sakai.rutgers.edu
shansell@rci.rutgers.edu
609-203-2830