Health Policy: Preserving the Best Health Care in America

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Health Policy Preserving the Best Health Care
in America

• Nancy W. Dickey, M.D.
• President, Health Science Center and
• Vice Chancellor for Health Affairs, AM System

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Health Policy Why Should You Care

• Health Policy Addresses
• Insurance issues including Medicare and Medicaid
• Medical liability issues
• Health care/medical research
• Patient safety
• Information technology
• Reporting

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Insurance Issues

• What is insurance?
• The act, system, or business of insuring
  property, life, ones person, etc., against loss
  or harm arising in specified contingencies.
• Random House Websters Unabridged Dictionary

Auto Vs. Health
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Who Has Insurance?(Who Doesnt?)

• 45 million Americans lack health insurance
  (Institute of Medicine Report)
• 3 million between 18 and 44 lack coverage by
  choice
• 11 million go without insurance because employers
  dont cover or coverage too expensive
• 80 of uninsured people are employed or live in a
  house with someone with a full-time job
• Immigrants comprise a fraction of the uninsured
  population

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What Difference Does it Make to You and Me?

• In 2004, premiums reached an average of 9,950/yr
  for families, 3,695/yr for individuals
• 5 years of double-digit percent increase in
  health care premiums
• 61 of workers are receiving health benefits
  through their employers
• Health insurance is becoming unaffordable,
  especially for small businesses
• Part of the reason for premium rise is that every
  insured person is subsidizing the care of the 45
  million who are not

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Medicare

• History
• Today
• Tomorrow

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History of Medicare

• In 1945, President Harry Truman
• asked Congress for legislation establishing a
  national health insurance plan
• Twenty years later, on July 30, 1965, Medicare
  and its companion program Medicaid, were signed
  into law by President Lyndon Johnson
• Ex-President Truman was the first to enroll in
  Medicare

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History of Medicare (cont)

• The 1950 census showed that the aged population
  had grown from 3 million in 1900 to 12 million in
  1950, or from 4 to 8 percent of the total
  population. Two-thirds of these people had
  incomes of less than 1,000 annually, and only 1
  in 8 had health insurance. Old people were long
  considered "bad risks" by commercial insurers,
  and unions had not made much headway in obtaining
  coverage for retired workers through
  employer-sponsored plans.
• LBJ, 1964told a group of elderly people that the
  Medicare bill "cries out for enactment." Later in
  the spring, he promised "We are going to fight
  for medical care for the aged as long as we have
  breath in our bodies."In 1798 the U.S.
  Government set up a Marine Hospital Service
  (forerunner of the Public Health Service) ,and
  required the owners of merchant ships to
  contribute 20 cents a month into a sickness fund
  for each seaman in their employ.
• It is the Nation's second-largest social
  insurance program, with total expenditures in
  calendar year 2000 estimated to reach 228
  billion.
• From 1967 through (estimated) 2000, Medicare
  expenditures per beneficiary increased at an
  average annual rate of 10.0 percent, while the
  corresponding figure for per capita national
  health expenditures is an estimated 9.3 percent.
  

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Today Medicare 2006

• Effective January 1, 2006, Medicare providing
  prescription drug coverage to help with drug
  costs for the elderly, no matter how they pay for
  drugs today.
• How much money do you pay for prescription drugs
  today?
• 30 every month and 150 occasionally
• 250 every month
• Issues to consider
• Premium amount paid monthly
• Deductible amount paid before any coveage
• Copayment Amount paid out of pocket (may be
  variable for different drugs)
• Gap Coverage lt2250, gt3600, 2252-3599

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Tomorrow Medicare and the Future

• 1999 report by Medicare trustees indicating that
  Medicare will remain solvent until 2015 due to a
  robust economy and reductions included in the
  Balanced Budget Act of 1997
• Throughout its history, Congress has
  underestimated the costs and impacts of Medicare
• 1965 Congress estimated that Medicare would cost
  3.1 billion in 5 yearsthe actual 1970 cost?
  5.8 billion
• 1970 Congress declared Medicare was in trouble
  financially and controls on spending needed to be
  enactedalready eroding the promise that medical
  decisions would be made by patients and
  physicians (PROs, PSROs, utilization review)
• According to one author, no one, least of all
  the sponsors of Medicare and Medicaid could
  predict how large the increase in demand might
  be

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Medicaid

• Medicaid is the insurer for 1 of 6 Americans
• Half of all Medicaid enrollees are children
• 32 of Texas children have Medicaid
• 20 of Texas children are uninsured 74 of
  them qualify for but do not have Medicaid
• Nursing Homes
• In 2001, 3.7 million people received Medicaid
• 20 of the Medicaid budget goes to nursing home
  expenses
• State Issues
• 25 of the states budget goes to Medicaid or
  nearly 30 billiion dollars

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Other Insurance Issues

• Health Savings Account
• Created by the Medicare bill signed by President
  Bush on December 8, 2003
• Designed to help individuals save for future
  qualified medical and retiree health expenses on
  a tax-free basis
• Employers shifting cost to employee
• National health insurance
• A poll conducted for the Canadian Medical
  Association found that 40 of Canadians now grade
  their health care system as a C or worse
• When Canadians need care, they face a series of
  waits one for primary care doctor, another for
  access to scarce diagnostic equipment, and
  another for the necessary procedure

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Medical Liability Issues

• Crisis Nationwide
• Texas solution
• 2003 passed Prop 12
• 5 carriers have reduced rates
• From MDs migrating out to gt3000 new MDs
• Cost impact
• Little hard data BUT estimates that 25 of total
  cost is defensive medicine
• Your role
• Do you ask WHY a test is being done and WHAT
  happens if you dont have it done?

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Medical Research Health Care

• Over the last century, medical research has
  arguably advanced human health more than all the
  previous 5,000 years combined. One statistic puts
  the change into perspective Americans born in
  1900 could expect to live an average of 49 years,
  but those born today will live an average of 77
  years.
• Over the years from FY99 FY2003 Congress
  doubled the National Institutes of Health (NIH)
  budget
• For the FY2006 budget, Congress cut 81 million
  from the NIH budget (0.3)
• While industry, foundations, philanthropy invest
  in medical

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Just a Peak at What Research Advances Mean

• Imaging has reduced heart disease mortality as we
  can detect and treat blockages
• Breast cancer survival improved
• as breast cancer is found earlier
• on mammography
• PET MRI have revolutionized
• diagnosis and treatment of
• disease of the brain

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Drug Safety The FDA

• The FDA was created in 1906 to
• Promote and protect the public health by helping
  safe and effective products to reach the market
  in a timely way
• Monitor products for continued safety after they
  are in use
• Help the public get the accurate, science-based
  information needed to improve health
• The FDA balances effectiveness and safety
• Currently the FDA issues more than one a day
  recalls, warnings, label changes
• There is no such thing as a PERFECTLY safe drug!

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Patient Safety

• 1999 Institute of Medicine Report, To Err Is
  Human Building A Safer Health System
• 44,000 88,000 lives lost annually to
  preventable medical error
• Costs 17 billion and 29 billion annually
• This is NOT a bad apple problem!
• The Patient Safety and Quality Improvement Act,
  passed in 2005
• Creates a confidential reporting system for
  errors and near misses
• Creates patient safety organizations which will
  analyze the above information make
  recommendations
• Begins to create information for dissemination of
  safety performance

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Summation

• 2008 promises health issues will be key
• With 16 of GNP being spent on health care,
  health policy issues are unlikely to fade in
  importance
• With the aging population and their increased
  use of the health system health policy issues
  are unlikely to fade in importance

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Do You Know YourBrazos Valley ..

• State Representative ????
• State Senator ????
• Federal Member of Congress ????
• 2 Federal Senators ????

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• State Representative
• State Senator
• Federal Member of Congress
• 2 Federal Senators

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• As peoples life expectancy increases, their
  satisfaction with their health decreases. This
  is a disconnect that signals we need to engage
  people in their health policy decisions.
• Julie Gerberding, MD, MPH
• Director of the Centers for Disease Control