Health Care In Health Care In AmericaAmerica

From Market Place to From Market Place to Human RightHuman Right

Dr. Peter MahrDr. Peter Mahr

PNHPPNHP

Background Background

Energy as a marketplaceEnergy as a marketplace The military as a marketplaceThe military as a marketplace Housing as a marketplaceHousing as a marketplace Healthcare as a marketplaceHealthcare as a marketplace

EnergyEnergy

Energy: ENRON, Rolling Blackouts, Energy: ENRON, Rolling Blackouts, Phil GrammPhil Gramm

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

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

Healthcare MarketplaceHealthcare Marketplace

DoctorsDoctors HospitalsHospitals PharmaceuticalsPharmaceuticals Insurance IndustryInsurance Industry

DoctorsDoctors

Specialists in the US outnumber Specialists in the US outnumber generalist physicians 2/3 to 1/3. the generalist physicians 2/3 to 1/3. the reverse of the ratio in the rest of the reverse of the ratio in the rest of the world.world.

Fee for service: doctors receive Fee for service: doctors receive more payments for tests and more payments for tests and procedures.procedures.

The “specialty hospital.”The “specialty hospital.”

DoctorsDoctors

The AMA: specialty physiciansThe AMA: specialty physicians Concerned about income and Concerned about income and

protection of profitsprotection of profits represents only 20% of physicians, represents only 20% of physicians,

mostly specialistsmostly specialists Powerful lobbying groupPowerful lobbying group

DoctorsDoctors The Specialty Hospital The Specialty Hospital

Specialty hospitals allow physicians to Specialty hospitals allow physicians to refer patients for expensive procedures in refer patients for expensive procedures in hospitals without ER’s.hospitals without ER’s.

Allows them to avoid uninsured/trauma Allows them to avoid uninsured/trauma care.care.

DoctorsDoctorsThe Specialty hospitalThe Specialty hospital

-Results:1996 to 2004. Medicare patients.19 -Results:1996 to 2004. Medicare patients.19 percent increase cardiac sugeries (markets percent increase cardiac sugeries (markets without cardiac specialty hospitals.) Markets without cardiac specialty hospitals.) Markets with cardiac specialty hospitals: growth rate with cardiac specialty hospitals: growth rate was 25 percent. was 25 percent.

One recent study of a Tulsa specialty hospital One recent study of a Tulsa specialty hospital said that, for a patient, "the relative odds of said that, for a patient, "the relative odds of receiving complex spinal surgery was 65 receiving complex spinal surgery was 65 times higher" after doctors acquired times higher" after doctors acquired ownership, according to a ownership, according to a Georgetown UniversityGeorgetown University researcher. researcher.

Doctors and the Doctors and the PharmaceuticalsPharmaceuticals

Doctors on the take:Doctors on the take:

-Clinical Practice Guidelines: 59% involved -Clinical Practice Guidelines: 59% involved with drug company whose drug considered with drug company whose drug considered in CPG.in CPG.

-2003: drug industry provides 90% of CME -2003: drug industry provides 90% of CME funding (ACCME)funding (ACCME)

-2004: $1.47 billion spent on educational -2004: $1.47 billion spent on educational grants: grants:

- Shadow writing of medical journal articlesShadow writing of medical journal articles- Funding of medical educationFunding of medical education

HospitalsHospitals

For-profit does not mean for healthFor-profit does not mean for health

For-Profit Hospitals’ Death Rates are 2% HigherSource: CMAJ 2002;166:1399

PharmaceuticalsPharmaceuticals

Drug expenditure per capita, public Drug expenditure per capita, public and private expenditure, OECD and private expenditure, OECD

countries, 2004countries, 2004

Sager FDA Testimony 4/04

2004 Revenue Allocation for Top 7 US Pharmaceutical Cos

Marketing, Advertising and Administration

32%

14%18%

36%

Research & Development

Profits (net income)

Other

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 7 0.2%

A real advance 77 2.7%Offers an advantage 217 7.6%

Possibly helpful 455 15.8%Nothing new 1,913 66.6%

Not acceptable 80 2.8%Judgment reserved 122 4.2%

Total 2,871 100

Other Estimates Me-Too Other Estimates Me-Too #’s#’s 2002: FDA approved 78 drugs2002: FDA approved 78 drugs

17 new active ingredient (22%)17 new active ingredient (22%) 7 improved treatments (9%) 7 improved treatments (9%)

Over past 6 years FDA classification of newly approved drugsOver past 6 years FDA classification of newly approved drugs 78% - “unlikely better than existing drugs”78% - “unlikely better than existing drugs” 60% - didn’t even contain new active ingredients 60% - didn’t even contain new active ingredients

Angell, AARP interview 2004

Drug Industry Lobbying Drug Industry Lobbying $108.6m spent industry-wide- 2003: $108.6m spent industry-wide- 2003: Total $750m spent 1997-2003 Total $750m spent 1997-2003 Employed 824 lobbyists (2003) Employed 824 lobbyists (2003)

8 lobbyist per member of senate8 lobbyist per member of senate 45% lobbying for Industry and HMOs have45% lobbying for Industry and HMOs have

“revolving door” connections “revolving door” connections Both sides of the aisle (2005-06)Both sides of the aisle (2005-06)

No. 1 recipient R.Santorum (R-PA) $977,000No. 1 recipient R.Santorum (R-PA) $977,000 No.2 recipient H.Clinton (D-NY) $854,000No.2 recipient H.Clinton (D-NY) $854,000

Medicare Part DMedicare Part D

WHY LOBBY?WHY LOBBY?

LOBBYING WORKSLOBBYING WORKS

But Politicians Ones that Can Really But Politicians Ones that Can Really CheerCheer

Paid Well to Protect High Prices Paid Well to Protect High Prices

Insurance CompaniesInsurance Companies

Private Insurance Private Insurance covers two thirds of covers two thirds of the population and the population and

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

20042004Personal Health Personal Health

ExpendituresExpenditures

Private FundsPrivate Funds Private health Private health

insuranceinsurance - Self-funded plans- Self-funded plans - Insurance company plans- Insurance company plans Out-of-pockets paymentsOut-of-pockets payments Other private fundsOther private funds

Public Funds*Public Funds* MedicareMedicare MedicaidMedicaid Other public expendituresOther public expenditures

$ Billion$ Billion %%$ 1,753 100%$ 1,753 100%

$ 965 54%$ 965 54%

$ 658 37%$ 658 37%$340 19%$340 19%$318 $318 18% 18%$ 236 13%$ 236 13%$ 70 4%$ 70 4%

$ 789 46%$ 789 46%$ 309 18%$ 309 18%$ 293 17%$ 293 17%$ 187 11%$ 187 11%

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

RESULTSRESULTS

INURANCE STATUS INURANCE STATUS AND FINANCIAL AND FINANCIAL

COSTS TO COSTS TO AMERICANSAMERICANS

Source: Kaiser Foundation, 2006

BankruptcyBankruptcy

Medical costs in 62% of personal Medical costs in 62% of personal bankruptcies in 2007. bankruptcies in 2007.

77% of those going bankrupt were 77% of those going bankrupt were insured when they first fell ill. insured when they first fell ill. 

The same year 47% of Americans The same year 47% of Americans reported some medical debt or reported some medical debt or payment problem and 16% of payment problem and 16% of Americans’ had been contacted by Americans’ had been contacted by medical debt collection agencies. medical debt collection agencies.

RESULTSRESULTS

BUREAUCRACYBUREAUCRACY

Insurance Company Insurance Company BeuracracyBeuracracy

$350 billion a year$350 billion a year

1/3 of health care dollar1/3 of health care dollar

Private Insurers’ High Private Insurers’ High OverheadOverhead

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

RESULTSRESULTS

HEALTHCAREHEALTHCARE

OUTCOMESOUTCOMES

RESULTSRESULTS

FRAUD AND FRAUD AND ABUSEABUSE

RESULTSRESULTS

HEALTHCARE HEALTHCARE COSTSCOSTS

Closing the LoopClosing the Loop

How Campaign Finance and How Campaign Finance and LobbyingLobbying

Tie This All TogetherTie This All Together

Common Dreams- Common Dreams- Legislating Under the Legislating Under the

InfluenceInfluence Health Industry: $373 million Health Industry: $373 million

campaign contributions since 2000.campaign contributions since 2000. Healthcare committee members Healthcare committee members

receive most of these contributions receive most of these contributions (Dem and Rep)(Dem and Rep)

2009: Healthcare Industry spending 2009: Healthcare Industry spending $1.4 million per day!$1.4 million per day!

Revolving door: Baucus aids now Revolving door: Baucus aids now lobbying.lobbying.

REVIEWREVIEW

HOW DO WE GET THEREHOW DO WE GET THERE

DECLARE ACCESS TO DECLARE ACCESS TO HEALTHCARE A HUMAN RIGHTHEALTHCARE A HUMAN RIGHT

DO NOT TREAT HEALTH CARE AS DO NOT TREAT HEALTH CARE AS A COMODITYA COMODITY

ENACT SINGLE PAYER NATIONAL ENACT SINGLE PAYER NATIONAL HEALTH INSURANCEHEALTH INSURANCE

HR676HR676

Playing Doctor? Playing Doctor? (cartoon)(cartoon)