SOCIAL SERVICES

AFFORDING THE AMERICAN WAY OF LIFE

- The majority of Americans can live comfortable lives on the salaries they earn, without the support of a universal
public-welfare system. These so-called middle-class Americans generally own their own homes and cars, spend
some time each year on vacation, and can pay -- at least in part -- for a college education for their children. Most
Americans set aside money in savings accounts to help pay major expenses; many invest in the stock market in
hopes of earning a healthy return on their investments.

- Most buy insurance, especially life and medical insurance, frequently with contributions from the companies for
which they work. Many companies also have retirement plans by which they and their employees put aside money
for their retirement pensions. When added to Social Security payments, pensions enable many retired Americans
to live comfortably. On the other hand, for older Americans who require long-term care outside of a hospital, a
nursing home can be very expensive.

- In 2000, a family of four with a yearly income of $17,603 or less was considered poor by American standards;
11.3 percent of American families fell into this category.

- Many families below the poverty line receive welfare payments, sums of money provided by the government
each month to those whose income is too low to obtain such necessities as food, clothing, and shelter. The most
common form of welfare payment has been through a program called Aid to Families With Dependent Children
(AFDC). Originally designed to help children whose fathers had died, AFDC evolved into the main source of
regular income for millions of poor American families.

The total cost of all federal assistance programs -- including Social Security, Medicare, Medicaid, and various
welfare programs -- accounts for nearly one-half of all money spent by the federal government. That is a doubling
of the percentage that obtained in the 1960s.

HEALTH CARE IN THE US

Health care in the United States is provided by legal entities. Current estimates put US healthcare spending as
GDP, which is the highest in the world. In the United States, around 85% of citizens have health insurance either
through their employer or purchased individually. The federal government does not guarantee universal health care
to all its citizens, but certain publicly-funded health care programs help to provide for some of the elderly, disabled,
and the poor and federal law ensures public access to emergency services regardless of ability to pay.Those
without health insurance coverage are expected to pay privately for medical services. Health insurance is expensive
and medical bills are overwhelmingly the most common reason for personal bankruptcy in the United States.

A 2004 survey released by the National Center for Health Statistics estimated that approximately 70% of
Americans were in "excellent" or "very good" health. The overall performance of the United States health care
system was ranked 37th by the World Health Organization (WHO) in 2000.

Most Americans, 59.5%, receive their health insurance coverage through an employer, and about 9% purchase it
directly from the market. Government sources cover 27.3% of the population. In 2005, there were 46.6 million
people in the U.S. (15.9% of the population) who were without healthcare insurance for at least part of that year.

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AMERICAN MEDICAL PRACTICE

- Self-employed private physicians who charge a fee for each visit by a patient have been the norm for
American medical practice.
- Most physicians have a contractual relationship with one or more hospitals in their community.
- They refer their patients as needed to the hospital, which usually charges according to the number of days a
patient stays and the facilities -- X-rays, operating rooms, tests -- he or she uses.
- Some hospitals are run by a city, a state, or, in the case of hospitals for military veterans, the federal
government. Others are run by religious orders or other nonprofit groups. Still others are run by companies
intending to make a profit.
- In the last 40 years, the cost of medical care in the United States has skyrocketed. Health expenditures rose
from $204 per person in 1965 to $4,481 per person in 2000. One reason for rising health costs is that
physicians are among the highest-paid professionals in the United States. As justification for their high
incomes, they cite the long and expensive preparation they must undergo. Most potential doctors attend four
years of college, which can cost $25,000 a year, before going on to four expensive years of medical school. By
the time they have a medical degree, many young doctors are deeply in debt. They still face three to five years
of residency in a hospital, where the hours are long and the pay relatively low. Setting up a medical practice
can be costly too.
- The new machines and technologies for diagnosing and treating illness also are expensive, and the technicians
who operate them must be well-trained. Physicians and hospitals must buy malpractice insurance to protect
themselves against lawsuits by patients who believe they have received inadequate care. The rates charged for
this insurance rose sharply during the 1970s and 1980s.

SERVICES

"Ambulatory care" refers to health care outside the hospital;

most health care in the United States occurs in the outpatient setting.

"Home health care services" are generally nursing enterprises, but are usually ordered by physicians.

Private sector outpatient medical care is provided by personal primary care physicians (specialists in internal
medicine, family medicine, and pediatric medicine), subspecialty physicians (gastroenterologists, cardiologists, or
pediatric endocrinologists are examples) or non-physicians (including nurse practitioners and physician assistants).

MEDICAID

- Although most Americans have some form of private health insurance, some people cannot afford insurance.
They can get medical coverage through two social programs established in 1965.

- MEDICAID - is a joint federal-state program that funds medical care for the poor. The requirements for
receiving Medicaid and the scope of care available vary widely from state to state. At a cost of about $200
thousand million a year, Medicaid is the nation's largest social-welfare program. Medicaid is a joint federal-state
program that provides health insurance coverage to low-income children, seniors and people with disabilities.

Medicaid was created on July 30, 1965 through Title XIX of the Social Security Act. Each state administers its own
Medicaid program while the federal Centers for Medicare and Medicaid Services (CMS) monitors the state-run
programs and establishes requirements for service delivery, quality, funding, and eligibility standards.

Each state may have their own names for the program. Examples include "Medi-Cal" in California, "MassHealth"
in Massachusetts, and "TennCare" in Tennessee.

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MEDICARE - another form of federal health insurance, pays a large part of the medical bills incurred by
Americans who are 65 and older or who are disabled, regardless of age. Medicare is financed by a portion of the
Social Security tax, by premiums paid by recipients, and by federal funds. Everyone who receives Social Security
payments is covered by Medicare.

- One of the most troubling health care problems facing the United States has been providing care for those who
cannot afford health insurance and who are not eligible for either Medicaid or Medicare. It has been estimated that
one in seven Americans is without health insurance at least part of the year. They may be persons who are
unemployed or have jobs without medical coverage or who live just above the poverty line. They can go to public
hospitals, where they will get treatment in an emergency, but they often fail to obtain routine care that might
prevent illness.

In 1996 Congress passed legislation designed to make health insurance more available to working families and
their children. The law expanded access to health insurance for workers who lose their jobs or who apply for
insurance with a pre-existing medical condition, and it set up a pilot program of tax-deferred savings accounts for
use in paying medical bills. President George W. Bush has proposed several ideas to make health care coverage
more available and affordable, including the expansion of medical savings accounts and legislation that would
make it easier for small employers to pool together to offer their employees better health coverage options.

Although health care costs continue to rise, the rate of increase has leveled off in recent years. In 1990 health
expenses increased 9 percent over the previous year, and by 2000 that rate had fallen to 4.6 percent.

Health care regulation and oversight

There are government institutes such as the Centers for Disease Control and Prevention that identify threats to
public health.

Mental illness and the Emergency Medical Treatment and Active Labor Act (EMTALA)(1986)

Mentally ill patients present a challenge for emergency departments and hospitals. In accordance with the
Emergency Medical Treatment and Active Labor Act, mentally ill patients are evaluated for emergency medical
conditions. Once mentally ill patients are found to be medically stable, regional mental health agencies are
contacted to evaluate patients. Patients are evaluated as to whether they are a danger to themselves or others. If
mentally ill patients are found to be a danger to themselves or others, they are admitted to a mental health facility to
be further evaluated by a psychiatrist.

Different Types of Insurance Coverage

Fee for service plans

This type of insurance will cover most providers and hospitals and pays fees for services that you receive from
them. You will have a deductible, or yearly amount that you must pay before the insurance company starts paying
for services (each year, the deductible renews and you must pay it again). This deductible can vary from a couple
of hundred dollars to several thousand, depending on the policy. Once the deductible is met, the insurance
company pays part of the costs of covered (remember to check what is covered!) medical services, and you pay
the rest. A typical split is 80% paid by the insurance, while you pay 20%.

When you receive medical care, you will be asked to fill out forms and send them to your insurance provider for
reimbursement (your doctor's office may fill them out for you in some cases). Your plan may also have a limit to
how much you are required to pay in a year's time in total medical expenses. This may vary from $1000 to $5000
depending on the policy's maximum for out of pocket expenses.

Health Maintenance Organization (HMO)

This type of health plan is prepaid with a monthly premium. It provides comprehensive coverage, which means that
it covers all medical costs for doctor visits, hospitalizations, lab tests, emergency care, preventive health care such

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as immunizations, and other items provided by medical providers who contract with the HMO. All medical care
must be provided by doctors and hospitals which contract with the HMO (the only exception is medical
emergencies, when you may be taken to the closest medical facility that provides treatment. In this case, the HMO
will pay).

Kaiser Permanente in California is an example of a large HMO: it has its own doctors, medical care providers,
clinics, and hospitals, and anyone with Kaiser coverage must go to a Kaiser (or Kaiser contracted) facility or doctor.
When you sign up for the HMO, they will give you a book with a list of approved providers in your area, and will ask
you to choose a family physician from the list, or they assign one to you. This person becomes your primary care
physician who takes care of your routine health care needs. If you need a specialist, your primary care physician
must first refer you to one.

Sometimes you can self refer yourself to an outside specialist if your HMO has point of service (POS) coverage. If
you see a doctor who is out of network, you will be fully covered if your primary care physician referred you, or you
may receive partial coverage (such as 50%) if you self -referred. But if your HMO does not have this option, then if
you self refer you will have to pay the full cost of the visit.

The copay is usually minimal for routine visits. Once you register with an HMO, you also do not have to fill out
paperwork each time you receive medical care. Instead, they will issue you a card with an identification number on
it, and during each visit you present the card. Normally, clinics are quite busy at HMOs, so it is good to make
appointments quite awhile ahead of time if you need a special hour (early or late), and you can expect a wait once
you arrive.

Preferred Provider Organization (PPO)

A preferred provider organization is a type of compromise between a fee for service plan and an HMO. When you
sign up for this type of insurance, you will be given a list of "preferred providers" or "network providers". When you
visit one of these doctors, most or all of your medical costs will be covered by your health insurance. And like an
HMO, you present a card when seeing a preferred provider (instead of filling out paperwork each time). You will
also be asked to choose a primary physician from the approved list of preferred providers, and to see him or her for
routine visits. If you need a specialist, this primary care physician must be the one to refer you if you want full or
almost full coverage.

But you can also see a doctor who is not part of the preferred list (an "out of network" doctor). Normally you will have to pay a
higher percentage of the cost of the visit (such as 50% or 40%) if you are seeing an out of network provider. When seeing an
out of network provider, you must also fill out paperwork for each visit, similar to that which is filled out with a fee for service
plan.

Social Security number

In the United States, a Social Security number (SSN) is a 9-digit number issued to citizens, permanent residents,
and temporary (working) residents under section 205(c)(2) of the Social Security Act, codified as 42
U.S.C. § 405(c)(2). The number is issued to an individual by the Social Security Administration, an agency of the
federal government. Its primary purpose is to track individuals for taxation purposes. In recent years the SSN has
become a de facto national identification number.

The first SSNs were issued by the Social Security Administration in November 1936 as part of the New Deal
Social Security program. By the end of 1937, over 37 million numbers had been issued.

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Before 1986, people often did not have a Social Security number until the age of about 14, since they were used for
income tracking purposes, and those under that age seldom had substantial income. In 1986, American taxation law
was altered so that individuals over 5 years old without Social Security numbers could not be successfully claimed
as dependents on tax returns. Since then, parents have often applied for Social Security numbers for their children
soon after birth.

The original purpose of this number was to track individuals' accounts within the Social Security program. It has
since come to be used as a unique identifier for individuals within the United States, although duplicates do exist.
Employee records, patient records, student records, and credit records are sometimes indexed by Social Security
number. The U.S. military has used the Social Security number as an identification number for all service members
since 1967.
Contrary to popular belief, there is no law requiring a natural born US Citizen to apply for a Social Security
number to live or work in the United States . Although some people do not have an SSN assigned to them, it is
becoming ever increasingly difficult to engage in legitimate financial activities without one.

There are three different types of Social Security cards issued. The first and most common one contains the
cardholder's name and number. Such cards are issued to U.S. citizens and U.S. permanent residents. There are also
two restricted types of Social Security cards. One of them reads "NOT VALID FOR EMPLOYMENT." Such
cards can't be used as proof of work authorization, and are NOT acceptable as a List C document on the I-9 form.
The second type reads "VALID FOR WORK ONLY WITH DHS AUTHORIZATION." These cards are issued
to people who have temporary work authorization in the U.S. They can satisfy the I-9 requirement, if they are
accompanied by a work authorization card.

Identity Theft

The disclosure and processing of Social Security numbers is of major concern to many citizens and privacy
advocates.

The SSN is frequently used by those involved in identity theft, since it is interconnected with so many other forms
of identification, and because people asking for it treat it as an authenticator — it is generally required by financial
institutions to set up bank accounts, credit cards, and obtain loans, partially because it is assumed that no one
except the person to whom it was issued will know it.

A bill has been proposed that would make use of the social security number as identifiers in schools illegal.[citation
needed]
Exacerbating the problem is the fact that the United States has no national ID document, and that the social
security card contains no biometric identifiers of any sort, making it essentially impossible to tell whether a person
using a certain SSN is truly the person to whom it was issued without relying on some other means of
documentation (which may itself have been falsely procured through use of the fraudulent SSN). Congress has
proposed federal laws that will restrict the use of SSNs for identification and ban their use for a number of
commercial purposes, e.g. rental applications[1].