Transcript Health Care In America

Health Care In America
From Market Place to
Human Right
Dr. Peter Mahr
PNHP
Background
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Energy as a marketplace
The military as a marketplace
Housing as a marketplace
Healthcare as a marketplace
Energy
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Energy: ENRON, Rolling Blackouts, Phil
Gramm
Military: military industrial complex, blackwater
and arms sales.
Housing: financial deregulation, 2008 financial
crisis, levaraging mortgages,
Healthcare Marketplace
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Doctors
Hospitals
Pharmaceuticals
Insurance Industry
Doctors
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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.”
Doctors
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The AMA: specialty physicians
Concerned about income and protection of
profits
represents only 20% of physicians, mostly
specialists
Powerful lobbying group
Doctors
The Specialty Hospital
Specialty hospitals allow physicians to refer patients for
expensive procedures in hospitals without ER’s.
Allows them to avoid uninsured/trauma care.
Doctors
The Specialty hospital
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-Results:1996 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.
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
Hospitals
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For-profit does not mean for health
For-Profit Hospitals’ Death Rates are 2% Higher
Source: CMAJ 2002;166:1399
Pharmaceuticals
Drug expenditure per capita, public and private
expenditure, OECD countries, 2004
Sager FDA Testimony 4/04
2004 Revenue Allocation for Top 7 US Pharmaceutical Cos
Marketing, Advertising
and Administration
Other
32%
36%
18%
14%
Research & Development
Profits (net income)
Source: Families USA, The Choice: Health Care for People or Drug Industry Profits, 2005
23 Years Ratings New Drug “Advances”
by Prescrire (1981-2003)
Rating
#
%
Bravo
A real advance
Offers an advantage
Possibly helpful
Nothing new
Not acceptable
Judgment reserved
Total
7
77
217
455
1,913
80
122
2,871
0.2%
2.7%
7.6%
15.8%
66.6%
2.8%
4.2%
100
Other Estimates Me-Too #’s
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2002: FDA approved 78 drugs
17 new active ingredient (22%)
 7 improved treatments (9%)
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Over past 6 years FDA classification of
newly approved drugs
78% - “unlikely better than existing drugs”
 60% - didn’t even contain new active ingredients
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Angell, AARP interview 2004
Drug Industry Lobbying
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$108.6m spent industry-wide- 2003:
Total $750m spent 1997-2003
Employed 824 lobbyists (2003)
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8 lobbyist per member of senate
45% lobbying for Industry and HMOs have
“revolving door” connections
Both sides of the aisle (2005-06)
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No. 1 recipient R.Santorum (R-PA) $977,000
No.2 recipient H.Clinton (D-NY) $854,000
Medicare Part D
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WHY LOBBY?
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LOBBYING WORKS
But Politicians Ones that Can Really Cheer
Paid Well to Protect High Prices
Insurance Companies
Private Insurance covers two
thirds of the population and
pays for only one-third of all
health care
2004
Personal Health Expenditures
$ Billion
$ 1,753
Private Funds
$
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Private health insurance
- Self-funded plans
- Insurance company plans
Out-of-pockets payments
Other private funds
Public Funds*
 Medicare
 Medicaid
 Other public expenditures
%
100%
965
54%
$ 658
37%
$340
$318
$ 236
$ 70
19%
18%
13%
4%
$
$
$
$
789
309
293
187
46%
18%
17%
11%
* Does not include tax subsidy for private insurance. See Woolhandler & Himmelstein, HealthAffairs 2002
Source: Centers for Medicare and Medicaid Services, 2006
RESULTS
INURANCE STATUS
AND FINANCIAL
COSTS TO
AMERICANS
Source: Kaiser Foundation, 2006
Bankruptcy
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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.
RESULTS
BUREAUCRACY
Insurance Company Beuracracy
 $350
 1/3
billion a year
of health care dollar
Private Insurers’ High Overhead
International Journal of Health Services 2005; 35(1): 64-90
RESULTS
HEALTHCARE
OUTCOMES
RESULTS
FRAUD AND ABUSE
RESULTS
HEALTHCARE
COSTS
Closing the Loop
How Campaign Finance and Lobbying
Tie This All Together
Common Dreams- Legislating Under
the Influence
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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.
REVIEW
HOW DO WE GET THERE
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DECLARE ACCESS TO HEALTHCARE A
HUMAN RIGHT
DO NOT TREAT HEALTH CARE AS A
COMODITY
ENACT SINGLE PAYER NATIONAL
HEALTH INSURANCE
HR676
Playing Doctor? (cartoon)