Health Policy and Politics
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Transcript of Health Policy and Politics
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
Access to Affordable Care is #1 Concern of Voters
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
How Do You Analyze Policy?
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
Increase Access to Rx Medicare Prescription Drug and
Modernization Act
• 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?
Pharmaceutical Market Access Act and Greater Access to Affordable Pharmaceuticals
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
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
Kucinich and Mosely-Braun “Medicare for All”
• 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
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
What Can You Do to Get Involved?
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 ActionJob & Patient Care Issues
Workplace
Laws, Rules & Regulations
Shaping Nursing Practice
Healthy Communities
Professional Organizations
Government
Community
Four Spheres of Political Action
The Politics of Health Deserves Broad Debate, The Politics of Health Deserves Broad Debate, Public Participation and Scholarly PursuitPublic Participation and Scholarly Pursuit
Consumer Educational EmpowermentConsumer Educational Empowerment Scientific Scientific Organ functionOrgan function Disease managementDisease management
Home health Home health managementmanagement
Lifespan planningLifespan planning Health system designHealth system design
Scholarly ActivityScholarly Activity Medical/political sociologyMedical/political sociology Political psychologyPolitical psychology Health economicsHealth economics Public health, MedicinePublic health, Medicine NursingNursing Pastoral Pastoral
care/bereavementcare/bereavement
Interdisciplinary social Interdisciplinary social health leadership health leadership curriculacurricula
Degrees equipped to Degrees equipped to manage the evolving manage the evolving health environmenthealth environment
The Four Spheres of Political The Four Spheres of Political InfluenceInfluence
Com
munit
y
Com
munit
y
Com
muni
Com
muni
tyty
WorkplacWorkplac
ee
CommunityCommunity
Govern
ment
Govern
ment O
rgan
izations
Org
anization
s
(Mason, Leavitt, & Chaffee, 2002)(Mason, Leavitt, & Chaffee, 2002)
**Community Community is the sphere is the sphere that that supports supports and and embraces all embraces all the others.the others.
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 .
SEEING OPPORTUNITIES
SEIZING OPPORTUNITIES
SEEKING OPPORTUNITIES
““GET POLITICAL”GET POLITICAL”The future of nursing depends onThe future of nursing depends on
YOUYOU!!PowerPower
VoiceVoice
Vision
Vision
Action
Action
““GET POLITICAL”GET POLITICAL”The future of nursing depends onThe future of nursing depends on
YOUYOU!!PowerPower
VoiceVoice
Vision
Vision
Action
Action
• the the development of development of leadership skillsleadership skills is a major is a major priority for top- level priority for top- level nursing in health systems nursing in health systems undergoing major changes .undergoing major changes .