This lecture proposes an overview of the American welfare policy. It covers the different insurance schemes and the latest developments including Obamacare and Trump's proposed reforms.

1. Welfare Policy
“Welfare is hated by those who
administer it, mistrusted by those who
pay for it and held in contempt by those
who receive it.”
—Peter C. Goldmark, Jr.

2. Eight Categories of Welfare
Programs and Total Costs,
2002
Medical Aid: $282 billion, 54%
Cash Aid: $102 billion, 20%
Food Aid: $39 billion, 7%
Housing Aid: $36 billion, 7%
Education Aid: $30 billion, 6%
Other Services: $22 billion, 5%
Jobs and Training Aid: $8 billion,
2%

3. Social Security
 Old-Age and Survivors
Insurance: retirement pensions to which
all Americans over 65 are entitled
 Disability Insurance / Unemployment
Insurance / Health insurance
 Medicare: Medical care for the over 65

4. Welfare: social protection for the
poor
 Medicaid: medical coverage for the poor.
 Food Stamps (Vouchers that can be
exchanged for food)
 Housing Assistance
 Temporary Assistance for
Needy Families
(most often single mothers with children)

5. Food Stamps
 Paid by the U.S. Department of Agriculture
 Provides food for low-income people, and
subsidies to farmers.
 49 million
Americans on
food stamps

6. Health Programs
 Unlike Britain or France the US has no
national free healthcare system
 Americans required to purchase insurance
privately or through employer, or else pay
for treatment upfront.
 2 programs:
Medicare
Medicaid

7. Medicare
 Helps pay hospital and medical costs
 Anything not paid by Medicare is often
paid through supplemental insurance
as medical costs rise the elderly are paying
more for their health care
 There is no long-term care provision for
in-home assistance

8. Medicaid
 Pays for health care for:
low income families with children
low income elderly
people with disabilities
 65 million Americans received Medicaid in
2014

9. An Imperfect safety net
 People can buy individual
insurances but these are
very expensive. (15% of
the population without
coverage).
 However when illness
strikes, people postpone
treatment.

10. Unequal health
 American medicine the most
sophisticated and innovative in the
world.
 But reflects growing inequalities
 Disparities resulting from
Income &
race

11. Physical Health by Income group
Gallup 2010

12. Access to health care by income
group

13. African Americans
 infant mortality rate is
2.4 times higher than
that of white infants
 30% higher death rate
for all cancers
 Seven times more likely
to die from HIV / AIDS
 Five times more likely
to develop glaucoma

14. Hispanics and Latinos
 twice more likely to die from diabetes
 20% of new cases of TB
 Higher rates of high blood pressure and
obesity

15. American Indians & Alaskan
Natives
 Diabetes rates that are
twice the national
average
 Disproportionately high
death rates from
unintentional injuries
and suicide

16. Soaring Costs
 Prices regularly increasing (15% a year)
 Malpractice suits
 Insurance policies
more expensive.

17. Reasons Why People Sue TheirReasons Why People Sue Their
DoctorsDoctors
 Advised to sue by influential otherAdvised to sue by influential other 3232
 Needed moneyNeeded money 2424
 Believed there was a cover-upBelieved there was a cover-up 2424
 Child would have no futureChild would have no future 2323
 Needed informationNeeded information 2020
 Wanted revenge, licenseWanted revenge, license 1919
Percent ExpressingPercent Expressing
ConcernConcern
Source - Hickson, 1992

18. Soaring Costs (drugs)
 Drugs are 3 times higher than in Britain
and 6 times higher than in Brazil
 The United States leaves pricing to
market competition

19. Soaring Demand
 Population aging &
higher life expectancy.
 By 2030 the baby boomers will be retiree
 Medicare and social security place an
increasing burden on workers.
 Possible solutions are to increase the
retirement age...

20. 2010 Obamacare
 First major US healthcare.
 Aims to extends health insurance to the
15% of US population without coverage.
 Subsidies to make coverage affordable.
 Requirement on businesses to offer
employees healthcare plans
 More control on insurance companies
 Young people are allowed to remain on
their parents’ plans until the age of 26.

21. Why does Trump want to repeal
Obamacare?
 President Trump has called Obamacare
an “incredible economic burden”
 He proposes a return to free market
principles for the health care sector.

22. Welfare and Public Opinion
Why do Americans hate welfare?
Welfare associated with racial prejudice.
Americans value autonomy self-reliance and self-
help
The poor are regarded as responsible for their fate.
Welfare is thought to be a wasteful program
encouraging laziness and fraud.
An insult to the American work ethic