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Health Policy: Preserving the Best Health Care in America


Preserving the Best Health Care in America. Nancy W. Dickey, M.D. ... 5 years of double-digit percent increase in health care premiums ... – PowerPoint PPT presentation

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Title: Health Policy: Preserving the Best Health Care in America

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

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

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
Who Has Insurance?(Who Doesnt?)
  • 45 million Americans lack health insurance
    (Institute of Medicine Report)
  • 3 million between 18 and 44 lack coverage by
  • 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

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

  • History
  • Today
  • Tomorrow

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

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
  • 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.

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
  • 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

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

  • 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
  • State Issues
  • 25 of the states budget goes to Medicaid or
    nearly 30 billiion dollars

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

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?

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
  • Over the years from FY99 FY2003 Congress
    doubled the National Institutes of Health (NIH)
  • For the FY2006 budget, Congress cut 81 million
    from the NIH budget (0.3)
  • While industry, foundations, philanthropy invest
    in medical

(No Transcript)
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

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!

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
  • Begins to create information for dissemination of
    safety performance

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

Do You Know YourBrazos Valley ..
  • State Representative ????
  • State Senator ????
  • Federal Member of Congress ????
  • 2 Federal Senators ????

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

  • 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