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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 ...
Disclosures/Background <ul><li>Advocate for a government-financed system of national health insurance </li></ul><ul><ul><l...
What I’m Not Going to Talk About <ul><li>Specific details of various reform proposals </li></ul><ul><li>What’s happening i...
Life Expectancy: OECD Countries
Spending: OECD Countries
Administrative Spending <ul><li>NEJM 2003;349:768 </li></ul><ul><ul><li>Administrative costs of health care in the U.S. an...
The Problem, in a sentence <ul><li>The U.S. has a fragmented health care system that is inefficient and fails to consisten...
A Solution, in a sentence <ul><li>Create a publically-financed system of national health insurance that covers all necessa...
HEALTH REFORM
A Brief History <ul><li>1883: Germany, 1 st  national sickness fund </li></ul><ul><ul><li>Income stabilization rather than...
A Brief History <ul><li>1926-32: Committee on Cost of Medical Care </li></ul><ul><ul><li>Increased costs    medical care,...
A Brief History <ul><li>1943: Wagner-Murray-Dingell Bill </li></ul><ul><ul><li>First real bill for national health insuran...
A Brief History <ul><li>1965: Medicare and Medicaid </li></ul><ul><ul><li>Again, opposition from the AMA </li></ul></ul><u...
A Brief History <ul><li>Clinton: Task Force on National Health Care Reform </li></ul><ul><ul><li>Employer mandated coverag...
 
 
 
Who stood to lose?
 
Conflicts of Interest
Conflicts of Interest
The Media <ul><li>Coverage of single-payer in mainstream media was minimal </li></ul><ul><ul><li>Editorial policy/bottom l...
A Breakthrough
Then Disappointment
Public Opinion
Success?
 
<ul><li>Where does social justice </li></ul><ul><li>or human rights fit in? </li></ul>
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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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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>
  9. 9. HEALTH REFORM
  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>

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