Health Policy and Politics

1
Health Policy and Politics

• An Overview and the Issues

2
Best Health Care Infrastructure in the World

• Health care is the largest industry in the US
• Most sophisticated medical equipment in the world
• Adequate supply of highly trained physicians

3
Access to Affordable Care is 1 Concern of Voters
4
(No Transcript)
5
Whats the Problem?

• Only industrialized country in the world without
  national health care
• Per capita spending 348 in 1980 and is over
  5,000 now
• 15 of our population is uninsured
• Double digit increase in cost of care Rx

6
If it is not a crisis, its at least a
substantially bigger problem than it has been
Alliance for Health Reform
7
Goal of Health Policy

• To provide access to quality care at affordable
  cost
• The ability to do this is impacted by
• Multiple Values
• Political System
• Limited resources

8
Your position?

• All senior citizens on Medicare should get free
  prescription drugs.
• Fetuses, rather than pregnant women, should be
  covered by Medicaid.

9
Your Position?

• The federal government should continue to be the
  sole payer for your graduate medical education
  (residency).
• All stem cell research using human embryos should
  be banned.

10
1. Conflicting Values

• A heterogenous group who do not share the same
  values of people formulate and implement policy
• President
• Congress
• Constituency (292 million!)
• Stakeholders

11
2. Political system

• Separation of powers
• Prevent any one entity from assuming complete
  power
• Senate and House Checks and balances
• reactive rather than proactive
• partisan
• focus on short term goals to please the
  electorate
• 1,000s of bills proposed and only a handful pass
• Money talks Drug industry campaign contributions

12
The impact on policy. . .

• Prevents dictatorship or monarchy
• Prevents one party imposing platform
• Makes compromise the key to passing policy
  original policy changes
• Change is slow and incremental

13
Result Few Sweeping Health Care Changes

• 1900s Mothers Pension
• 1930s Aid to Families with Dependent Children
• 1965 Medicare and Medicaid
• 1993 Clinton Plan Failed

14
3. Limited Resources

• Contain spending to under 10 of GNP
• 8 in 1980
• 15 in 2002
• Spending over 1.24 trillion a year

15
(No Transcript)
16
Current Controversial Issues and the Proposed
Solutions

• Access
• Cost
• Quality

17
How Do You Analyze Policy?

• Understand the problem
• Identify the Stakeholders
• Groups with POWER to influence policy
• Assess the policys impact on access to
  affordable quality care
• Examine the unintended consequences

18
(No Transcript)
19
Problem Lack Of Access to Affordable Care

• 43.6 million uninsured
• 15 of the population
• ¾ of the uninsured work
• Loss of employer based insurance
• Employers increase premiums
• Reduce benefits
• Eliminate health care coverage

20
Solution?

• Incremental Changes Expand Current Programs
• Implement sweeping change Universal Health Care

21
Help Vulnerable PopulationsState Budget Relief
Act

• States budgets are in crisis
• Medicaid is their second
• highest expense
• Increase federal funds for
• Medicaid
• Provide care to 1 million

22
Increase Access to Rx Medicare Prescription Drug
and Modernization Act

• 38 have no coverage
• No Rx means more problems later
• 400 billion over 10 years

• 62 have coverage
• No means testing
• Medicare Trust Fund empty in 2006 w/o Rx
• Great politics/ Poor Policy?

23
Pharmaceutical Market Access Act and Greater
Access to Affordable Pharmaceuticals Act

• Lower prices for drugs in Canada and abroad
• Increases access to care

• Against federal law
• Quality and safety issue
• Backfire prices will rise abroad over time

24
Get More People InsuredSmall Business Fairness
Act

• 30 million people working in businesses
• w/ lt 200 employees
• Businesses would be able to join Associated
  Health Plan and bargain for better rates

25
Control Cost of Physician Liability Insurance

• Patients First Act
• Physicians driven out of business
• Advocate Tort Reform
• Place caps on non-economic damages
• Docs vs. insurance companies vs. lawyers
• Passed the House in March

26
Bushs Plan to Increase Access

• Tax credit of 1000-3,000 to allow the poor to
  buy insurance

27
Democratic Candidates Plans

• Dean, Kerry, Edwards, Gephardt and Leiberman
• Beef up Medicaid and increase SCHIP
• Encourage employer-sponsored insurance

28
Kucinich and Mosely-Braun Medicare for All

• Universal Health Care
• Insurance Companies out of health care
• Government would set rates
• 7.7 payroll tax (2.9 now)
• Cost 6 Trillion over 10 years

29
Problem Quality of Care

• Patient Safety 44,00-98,000 deaths a year due
  to medical errors
• Need a better system of reporting errors
• Implement Computerized patient record and CPOE

Duke Medical Center
30
Patient and Physician Safety Act

• Tired Docs compromise patient safety
• ACGME is not enforcing 80 work week
• Federal government should limit, monitor and
  enforce Resident Physician work hours

31
What Can You Do to Get Involved?

• Stay informed
• Health Affairs Journal
• Kaiser Family Foundation KFF.org
• Legislation thomas.loc.gov
• Ethical Issues thehastingscenter.org

32
Getting Involved

• Contact legislators E-mail, letters
• Student Groups
• AOA aoa-net.org
• Every Patient Counts
• Training in Policy Studies (TIPS)
• Health Policy Fellowship

33

• Your legacy should be that you made it better
  than it was when you got it.
• Lee Iacocca