Health Care In America From Market Place to Human Right

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Health Care In AmericaFrom Market Place to Human
Right

• Dr. Peter Mahr
• PNHP

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Background

• Energy as a marketplace
• The military as a marketplace
• Housing as a marketplace
• Healthcare as a marketplace

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Energy

• Energy ENRON, Rolling Blackouts, Phil Gramm
• Military military industrial complex, blackwater
  and arms sales.
• Housing financial deregulation, 2008 financial
  crisis, levaraging mortgages,

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Healthcare Marketplace

• Doctors
• Hospitals
• Pharmaceuticals
• Insurance Industry

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Doctors

• Specialists in the US outnumber generalist
  physicians 2/3 to 1/3. the reverse of the ratio
  in the rest of the world.
• Fee for service doctors receive more payments
  for tests and procedures.
• The specialty hospital.

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Doctors

• The AMA specialty physicians
• Concerned about income and protection of profits
• represents only 20 of physicians, mostly
  specialists
• Powerful lobbying group

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Doctors The Specialty Hospital

• Specialty hospitals allow physicians to refer
  patients for expensive procedures in hospitals
  without ERs.
• Allows them to avoid uninsured/trauma care.

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DoctorsThe Specialty hospital

• -Results1996 to 2004. Medicare patients.19
  percent increase cardiac sugeries (markets
  without cardiac specialty hospitals.) Markets
  with cardiac specialty hospitals growth rate was
  25 percent.
• One recent study of a Tulsa specialty hospital
  said that, for a patient, "the relative odds of
  receiving complex spinal surgery was 65 times
  higher" after doctors acquired ownership,
  according to a Georgetown University researcher.

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Doctors and the Pharmaceuticals

• Doctors on the take
• -Clinical Practice Guidelines 59 involved with
  drug company whose drug considered in CPG.
• -2003 drug industry provides 90 of CME funding
  (ACCME)
• -2004 1.47 billion spent on educational grants
  
• Shadow writing of medical journal articles
• Funding of medical education

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Hospitals

• For-profit does not mean for health

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For-Profit Hospitals Death Rates are 2 Higher
Source CMAJ 20021661399
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Pharmaceuticals
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Drug expenditure per capita, public and private
expenditure, OECD countries, 2004
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Sager FDA Testimony 4/04
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2004 Revenue Allocation for Top 7 US
Pharmaceutical Cos
Marketing, Advertising and Administration

Other
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Research Development
Profits (net income)
Source Families USA, The Choice Health Care for
People or Drug Industry Profits, 2005
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23 Years Ratings New Drug Advances by
Prescrire (1981-2003)
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Other Estimates Me-Too s

• 2002 FDA approved 78 drugs
• 17 new active ingredient (22)
• 7 improved treatments (9)
• Over past 6 years FDA classification of newly
  approved drugs
• 78 - unlikely better than existing drugs
• 60 - didnt even contain new active ingredients

Angell, AARP interview 2004
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Drug Industry Lobbying

• 108.6m spent industry-wide- 2003
• Total 750m spent 1997-2003
• Employed 824 lobbyists (2003)
• 8 lobbyist per member of senate
• 45 lobbying for Industry and HMOs have
  revolving door connections
• Both sides of the aisle (2005-06)
• No. 1 recipient R.Santorum (R-PA) 977,000
• No.2 recipient H.Clinton (D-NY) 854,000

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Medicare Part D

• WHY LOBBY?
• LOBBYING WORKS

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But Politicians Ones that Can Really CheerPaid
Well to Protect High Prices
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Insurance Companies
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Private Insurance covers two thirds of the
population and pays for only one-third of all
health care
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• 2004
• Personal Health Expenditures
• Private Funds
• Private health insurance
• - Self-funded plans
• - Insurance company plans
• Out-of-pockets payments
• Other private funds
• Public Funds
• Medicare
• Medicaid
• Other public expenditures

• Billion
• 1,753 100
• 965 54
• 658 37
• 340 19
• 318 18
• 236 13
• 70 4
• 789 46
• 309 18
• 293 17
• 187 11

Does not include tax subsidy for private
insurance. See Woolhandler Himmelstein,
HealthAffairs 2002
Source Centers for Medicare and Medicaid
Services, 2006
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RESULTS

• INURANCE STATUS AND FINANCIAL COSTS TO AMERICANS

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Source Kaiser Foundation, 2006
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Bankruptcy

• Medical costs in 62 of personal bankruptcies in
  2007.
• 77 of those going bankrupt were insured when
  they first fell ill. 
• The same year 47 of Americans reported some
  medical debt or payment problem and 16 of
  Americans had been contacted by medical debt
  collection agencies.

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RESULTS

• BUREAUCRACY

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Insurance Company Beuracracy

• 350 billion a year
• 1/3 of health care dollar

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Private Insurers High Overhead
International Journal of Health Services 2005
35(1) 64-90
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RESULTS

• HEALTHCARE
• OUTCOMES

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RESULTS

• FRAUD AND ABUSE

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RESULTS

• HEALTHCARE COSTS

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Closing the Loop

• How Campaign Finance and Lobbying
• Tie This All Together

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Common Dreams- Legislating Under the Influence

• Health Industry 373 million campaign
  contributions since 2000.
• Healthcare committee members receive most of
  these contributions (Dem and Rep)
• 2009 Healthcare Industry spending 1.4 million
  per day!
• Revolving door Baucus aids now lobbying.

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REVIEW
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HOW DO WE GET THERE

• DECLARE ACCESS TO HEALTHCARE A HUMAN RIGHT
• DO NOT TREAT HEALTH CARE AS A COMODITY
• ENACT SINGLE PAYER NATIONAL HEALTH INSURANCE
• HR676

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Playing Doctor? (cartoon)