Health Care In America From Market Place to Human Right

1. Health Care In AmericaFrom Market Place to Human Right Dr. Peter Mahr PNHP

2. Background • Energy as a marketplace • The military as a marketplace • Housing as a marketplace • Healthcare as a marketplace

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

7. Healthcare Marketplace • Doctors • Hospitals • Pharmaceuticals • Insurance Industry

9. 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.”

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

11. 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

12. DoctorsThe 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.

13. 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

15. Hospitals • For-profit does not mean for health

16. For-Profit Hospitals’ Death Rates are 2% Higher Source: CMAJ 2002;166:1399

20. Pharmaceuticals

22. Drug expenditure per capita, public and private expenditure, OECD countries, 2004

23. Sager FDA Testimony 4/04

24. 2004 Revenue Allocation for Top 7 US Pharmaceutical Cos 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

25. 23 Years Ratings New Drug “Advances” by Prescrire (1981-2003)

26. 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% - didn’t even contain new active ingredients Angell, AARP interview 2004

27. 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

28. Medicare Part D • WHY LOBBY? • LOBBYING WORKS

29. But Politicians Ones that Can Really CheerPaid Well to Protect High Prices

31. Insurance Companies

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

36. 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

37. RESULTS INURANCE STATUS AND FINANCIAL COSTS TO AMERICANS

42. Source: Kaiser Foundation, 2006

46. 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.

47. RESULTS BUREAUCRACY

48. Insurance Company Beuracracy • $350 billion a year • 1/3 of health care dollar