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Health Care In America From Market Place to Human Right. Dr. Peter Mahr PNHP. Background. Energy as a marketplace The military as a marketplace Housing as a marketplace Healthcare as a marketplace. Energy. Energy: ENRON, Rolling Blackouts, Phil Gramm

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Health care in america from market place to human right

Health Care In AmericaFrom Market Place to Human Right

Dr. Peter Mahr

PNHP


Background
Background

  • Energy as a marketplace

  • The military as a marketplace

  • Housing as a marketplace

  • Healthcare as a marketplace


Energy
Energy

  • Energy: ENRON, Rolling Blackouts, Phil Gramm

  • Military: military industrial complex, blackwater and arms sales.

  • Housing: financial deregulation, 2008 financial crisis, levaraging mortgages,


Healthcare marketplace
Healthcare Marketplace

  • Doctors

  • Hospitals

  • Pharmaceuticals

  • Insurance Industry


Doctors
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.”


Doctors1
Doctors

  • 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


Doctors the specialty hospital1
Doctors expensive procedures in hospitals without ER’s.The Specialty hospital

  • -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 and the Pharmaceuticals expensive procedures in hospitals without ER’s.

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
Hospitals expensive procedures in hospitals without ER’s.

  • For-profit does not mean for health


For-Profit Hospitals’ Death Rates are 2% Higher expensive procedures in hospitals without ER’s.

Source: CMAJ 2002;166:1399


Pharmaceuticals
Pharmaceuticals expensive procedures in hospitals without ER’s.



Sager FDA Testimony 4/04 OECD countries, 2004


2004 Revenue Allocation for Top 7 US Pharmaceutical Cos OECD countries, 2004

Marketing, Advertising

and Administration

Other

32%

36%

14%

18%

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 OECD countries, 2004” by Prescrire (1981-2003)


Other estimates me too s
Other Estimates Me-Too #’s OECD countries, 2004

  • 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% - didn’t even contain new active ingredients

Angell, AARP interview 2004


Drug industry lobbying
Drug Industry Lobbying OECD countries, 2004

  • $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


Medicare part d
Medicare Part D OECD countries, 2004

  • WHY LOBBY?

  • LOBBYING WORKS


But politicians ones that can really cheer paid well to protect high prices
But Politicians Ones that Can Really Cheer OECD countries, 2004Paid Well to Protect High Prices


Insurance companies
Insurance Companies OECD countries, 2004


Private Insurance covers two thirds of the population and pays for only one-third of all health care


2004 pays for only one-third of all health care

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


Results
RESULTS pays for only one-third of all health care

INURANCE STATUS AND FINANCIAL COSTS TO AMERICANS


Source: Kaiser Foundation, 2006 pays for only one-third of all health care


Bankruptcy
Bankruptcy pays for only one-third of all health care

  • 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.


Results1
RESULTS pays for only one-third of all health care

BUREAUCRACY


Insurance company beuracracy
Insurance Company Beuracracy pays for only one-third of all health care

  • $350 billion a year

  • 1/3 of health care dollar


Private insurers high overhead
Private Insurers’ High Overhead pays for only one-third of all health care

International Journal of Health Services 2005; 35(1): 64-90


Results2
RESULTS pays for only one-third of all health care

HEALTHCARE

OUTCOMES


Results3
RESULTS pays for only one-third of all health care

FRAUD AND ABUSE


Results4
RESULTS pays for only one-third of all health care

HEALTHCARE COSTS


Closing the loop

Closing the Loop pays for only one-third of all health care

How Campaign Finance and Lobbying

Tie This All Together


Common dreams legislating under the influence
Common Dreams- Legislating Under the Influence pays for only one-third of all health care

  • 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
REVIEW pays for only one-third of all health care


How do we get there
HOW DO WE GET THERE pays for only one-third of all health care

  • 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
Playing Doctor? (cartoon) pays for only one-third of all health care


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