Politics and Health Reform:Lessons From a Year in Washington, D.C.


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Politics and Health Reform: Lessons From a Year in Washington, D.C.
James Floyd, M.D.
Global Health Seminar
University of Washington
February 12, 2010

Published in: Business, Economy & Finance
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  • OECD Health Data
  • OECD Health Data 2006
  • History of attempts to enact national health insurance
  • Sickness funds, early attempts at social insurance were for working class only Early health reformers used both economic and moral arguments Argued that money wasted on industrial insurance policies could finance NHI
  • Emphasis shifted from income stabilization to coverage of medical care Extended proposal to middle class as well, because of increased costs of care Depression: revival of social insurance movement and radical political elements
  • 1970s: -medical costs increasing much more sharply because of financing arrangements, because allowed to occur -economic and political leadership seemed ready to change medical care against opposition of providers
  • Politics, not policy
  • Washington Times article
  • Baucus 8
  • Congressional Hearings
  • From NY times online, Prescriptions Blog Nov 6, 2009
  • Politics and Health Reform:Lessons From a Year in Washington, D.C.

    1. 1. Politics and Health Reform: Lessons From a Year in Washington, D.C. James Floyd, M.D. Global Health Seminar University of Washington February 12, 2010
    2. 2. Disclosures/Background <ul><li>Advocate for a government-financed system of national health insurance </li></ul><ul><ul><li>“ single-payer” </li></ul></ul><ul><li>Spent 2008-2009 in Washington D.C. working at Public Citizen, a national consumer-advocacy organization </li></ul>
    3. 3. What I’m Not Going to Talk About <ul><li>Specific details of various reform proposals </li></ul><ul><li>What’s happening in Congress right now </li></ul><ul><li>Problems with our health care system other than insurance </li></ul><ul><ul><li>Fee for service reimbursement of physicians </li></ul></ul><ul><ul><li>Pharmaceutical and medical device development, regulation, and marketing </li></ul></ul><ul><ul><li>Management of chronic diseases, long-term care </li></ul></ul><ul><li>Policy </li></ul>
    4. 4. Life Expectancy: OECD Countries
    5. 5. Spending: OECD Countries
    6. 6. Administrative Spending <ul><li>NEJM 2003;349:768 </li></ul><ul><ul><li>Administrative costs of health care in the U.S. and Canada in 1999 </li></ul></ul><ul><ul><ul><li>insurance overhead </li></ul></ul></ul><ul><ul><ul><li>employers’ costs to manage benefits </li></ul></ul></ul><ul><ul><ul><li>administrative costs to hospitals, practitioners, etc </li></ul></ul></ul><ul><ul><li>Percentage of total health care costs </li></ul></ul><ul><ul><ul><li>US 31%, Canada 17% </li></ul></ul></ul><ul><ul><ul><li>approx. $400 billion in wasteful administrative spending in 2009 </li></ul></ul></ul>
    7. 7. The Problem, in a sentence <ul><li>The U.S. has a fragmented health care system that is inefficient and fails to consistently deliver good care, leaving a large portion of the population without adequate access </li></ul>
    8. 8. A Solution, in a sentence <ul><li>Create a publically-financed system of national health insurance that covers all necessary care for everyone </li></ul><ul><ul><li>Financed through progressive taxation </li></ul></ul><ul><ul><li>Eliminates private health insurance and investor-ownership of facilities </li></ul></ul><ul><ul><li>Would remove barriers to access and incentives that result in unnecessarily costly care </li></ul></ul><ul><ul><li>JAMA 2003;290:798 </li></ul></ul>
    10. 10. A Brief History <ul><li>1883: Germany, 1 st national sickness fund </li></ul><ul><ul><li>Income stabilization rather than medical care </li></ul></ul><ul><ul><li>Rest of Europe soon followed </li></ul></ul><ul><li>Progressive Era: American Association for Labor Legislation </li></ul><ul><ul><li>Opposed by AMA, AFL, and insurance industry </li></ul></ul><ul><ul><li>WWI, Anti-German sentiment, Red Scare </li></ul></ul>
    11. 11. A Brief History <ul><li>1926-32: Committee on Cost of Medical Care </li></ul><ul><ul><li>Increased costs  medical care, middle class </li></ul></ul><ul><ul><li>Economists, MDs, public health, interest groups </li></ul></ul><ul><ul><li>Recommended more national resources go to medical care, but opposed NHI </li></ul></ul><ul><li>1935: Social Security Act, New Deal </li></ul><ul><ul><li>Health insurance left out because of opposition </li></ul></ul>
    12. 12. A Brief History <ul><li>1943: Wagner-Murray-Dingell Bill </li></ul><ul><ul><li>First real bill for national health insurance, funded by payroll taxes </li></ul></ul><ul><li>Truman: Supported a single national health insurance system to include all classes </li></ul><ul><ul><li>Cold War: Red Scare again, “socialized medicine” </li></ul></ul><ul><ul><li>Opposed by AMA, AHA, ABA, mainstream press </li></ul></ul><ul><ul><li>AMA launched most expensive lobbying effort in American history </li></ul></ul>
    13. 13. A Brief History <ul><li>1965: Medicare and Medicaid </li></ul><ul><ul><li>Again, opposition from the AMA </li></ul></ul><ul><ul><li>But strong grassroots support from seniors </li></ul></ul><ul><li>1970s: “Crisis” of cost and access </li></ul><ul><ul><li>Resumed interest in national health insurance </li></ul></ul><ul><ul><li>Nixon: comprehensive coverage through employer mandate and public plan for unemployed </li></ul></ul><ul><ul><li>Watergate, economic recession </li></ul></ul>
    14. 14. A Brief History <ul><li>Clinton: Task Force on National Health Care Reform </li></ul><ul><ul><li>Employer mandated coverage through HMOs, publicly funded coverage for the unemployed </li></ul></ul><ul><ul><li>Opposition from same forces </li></ul></ul><ul><li>2008: Barack Obama elected President, Democratic majorities in House and Senate </li></ul>
    15. 18. Who stood to lose?
    16. 20. Conflicts of Interest
    17. 21. Conflicts of Interest
    18. 22. The Media <ul><li>Coverage of single-payer in mainstream media was minimal </li></ul><ul><ul><li>Editorial policy/bottom line? </li></ul></ul><ul><ul><li>Not considered newsworthy? </li></ul></ul><ul><ul><li>Lack of context? </li></ul></ul><ul><ul><li>Did not fit into political narrative? </li></ul></ul>
    19. 23. A Breakthrough
    20. 24. Then Disappointment
    21. 25. Public Opinion
    22. 26. Success?
    23. 28. <ul><li>Where does social justice </li></ul><ul><li>or human rights fit in? </li></ul>