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Health Policy and Politics. An Overview and the Issues. 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.
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Health Policy and Politics An Overview and the Issues
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
What’s 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
“If it is not a crisis, it’s at least a substantially bigger problem than it has been” Alliance for Health Reform
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
Your position? • All senior citizens on Medicare should get free prescription drugs. • Fetuses, rather than pregnant women, should be covered by Medicaid.
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.
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
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 • 1,000’s of bills proposed and only a handful pass • Money talks: Drug industry campaign contributions
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
Result: Few “Sweeping” Health Care Changes • 1900’s: “Mother’s Pension” • 1930’s: Aid to Families with Dependent Children • 1965: Medicare and Medicaid • 1993: Clinton Plan Failed
3. Limited Resources • Contain spending to under 10% of GNP • 8% in 1980 • 15% in 2002 • Spending over $1.24 trillion a year
Current Controversial Issues and the Proposed Solutions Access Cost Quality
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
Solution? • Incremental Changes: Expand Current Programs • Implement sweeping change: Universal Health Care
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
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? Increase Access to Rx Medicare Prescription Drug and Modernization 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 Pharmaceutical Market Access Act and Greater Access to Affordable Pharmaceuticals Act
Get More People InsuredSmall Business Fairness Act • 30 million people working in businesses w/ < 200 employees • Businesses would be able to join Associated Health Plan and bargain for better rates
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
Bush’s Plan to Increase Access • Tax credit of $1000-$3,000 to allow the poor to buy insurance
Democratic Candidates’ Plans • Dean, Kerry, Edwards, Gephardt and Leiberman • Beef up Medicaid and increase SCHIP • Encourage employer-sponsored insurance
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 Kucinich and Mosely-Braun “Medicare for All”
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
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
Getting Involved • Contact legislators: E-mail, letters • Student Groups • AOA: aoa-net.org • Every Patient Counts • Training in Policy Studies (TIPS) • Health Policy Fellowship
“Your legacy should be that you made it better than it was when you got it.” Lee Iacocca
Four Spheres of Political Action Job & Patient Care Issues Laws, Rules & Regulations Government Workplace Professional Organizations Community Shaping Nursing Practice Healthy Communities Four Spheres of Political Action
The Politics of Health Deserves Broad Debate, Public Participation and Scholarly Pursuit Consumer Educational Empowerment • Scientific • Organ function • Disease management • Home health management • Lifespan planning • Health system design Scholarly Activity • Medical/political sociology • Political psychology • Health economics • Public health, Medicine • Nursing • Pastoral care/bereavement • Interdisciplinary social health leadership curricula • Degrees equipped to manage the evolving health environment
The Four Spheres of Political Influence Community Workplace Community *Community is the sphere that supports and embraces all the others. Government Organizations Community (Mason, Leavitt, & Chaffee, 2002)
SEIZING OPPORTUNITIES SEEKING OPPORTUNITIES OPPORTUNITY Mining the Possibilities • Nursing professionals need to understand the sources of power and patterns in politics to effectively promote health and prevent disease in a culturally effective way . SEEINGOPPORTUNITIES
“GET POLITICAL” The future of nursing depends on YOU! Power Vision Action Voice
“GET POLITICAL” The future of nursing depends on YOU! Power Vision Action Voice the development of leadership skills is a major priority for top- level nursing in health systems undergoing major changes .
