The nation’s economy has produced 9.5 million jobs in the last four years and raised wages for even the lowest-paid workers. As Americans buy more homes, cars and other consumer goods, the number buying health insurance has not budged. Now, the 44 million Americans without insurance are taking a prominent place in the national spotlight, thanks to the Democratic presidential primary. And in Vice President Al Gore and former senator Bill Bradley, the nation has a chance to sort out how far it is willing to go, if at all, toward promising health care for everyone.
In proposals issued recently, both Democratic candidates have promised to cover all 11 million children who have no insurance, with taxpayers paying the entire cost for the poor. Gore and Bradley would also give substantial help to the parents of the nation’s poorest children. But they split over one growing class of people: the millions of adults who are not quite poor, but who find insurance so expensive that they do not buy it.
Almost 17 percent of full-time workers have no insurance, often because employers do not offer it or have shifted costs to employees. Many of the new jobs created in the current boom are at small businesses, which are less likely to offer coverage. Bradley has proposed an expansive plan that helps people further up the economic ladder and which carries an expansive price tag to match. Gore, by contrast, would spend money on the poorest and near-poor while offering only limited help to others.
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The question has barely been raised among the Republican presidential contenders. But it has sparked the sharpest debate yet in the Democratic campaign, and polls show that voters are likely to make it a general election issue. With surveys suggesting that no candidate can win the Democratic nomination without a strong health plan, Bradley boasts that he is proposing a big idea to attack a big problem. He has derided Gore’s plan as ”definitely timid.” The tactic has helped raise Bradley’s profile among Democrats
Gore, by contrast, talks freely of his plan’s limitations, and his staff uses the word ”incremental” to describe it. They say Bradley’s plan is too expensive and would divert dollars from other purposes, such as shoring up Medicare.
The true cost of the two plans is open to debate. Bradley says he would spend up to $650 billion over 10 years to insure as many as 39 million more people. Gore says he would spend $264 billion over 10 years to cover as many as 15 million more people, mostly children and parents of low-income children. The Census Bureau says that 44.2 million people, or 16.3 percent of Americans, are uninsured today.
A health plan’s odds of success are measured in more than just money. Five years ago, after a furious national debate, lawmakers shot down President Clinton’s massive proposal to insure all Americans. Bradley’s plan falls far short of what Clinton would have done, avoiding price controls and other intrusions into the private market. But it is ambitious, and it may antagonize people who fear big changes. In a dramatic move, Bradley would eliminate Medicaid, the federal-state program for 36 million poor and disabled people. In its place, he would give money to low-income people to buy their own insurance. Because individuals often pay high premiums when they buy insurance alone, Bradley would allow the public to buy into the federal government’s insurance system, the Federal Employees Health Benefits Program. The program offers a range of private plans, and it already serves 9 million federal workers, including members of Congress. Bradley would also order parents to buy coverage for their children, but it is unclear how this would be enforced. Aides said that hospitals would make sure that children are enrolled in a plan at birth, and that schools, day-care centers, doctors and others could find children who somehow fall through the cracks. But they assume that the subsidies offered under the plan are high enough so that every parent wants to buy insurance and can afford it, a point that others dispute.
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Gore, by contrast, avoids big changes to the health delivery system and expands programs that already exist. By raising the income cut-offs, Gore would make 1 million more children eligible for Medicaid and a relatively new federal-state program called the Children’s Health Insurance Program, or CHIP. At higher income levels, parents could buy their children into Medicaid or CHIP at what Gore aides say would be modest premiums. The most substantive change in Gore’s plan is to tell parents that if their children are eligible for Medicaid or CHIP, the parents are, as well. Gore aides say this would insure 7 million more adults while giving an extra nudge to parents who have failed to enroll their children in programs for which they already qualify.Gore would offer a modest subsidy to adults with no children and to people age 55-65, who often have trouble buying insurance because of their age. Both plans add optional coverage for prescription drugs to Medicare.
A lot of the debate here is just how expansive you want to be. The Bradley plan moves closer to universal coverage than the Gore plan. It’s also more expensive. Nothing in life is free. But some things in life are more expensive than others. We spend more than anyone in the World on health. Children consume few health services and are relatively inexpensive to insure. So are the poorest adults, because in subsidizing them the government offers aid to relatively few people who already have insurance on their own.
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