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? Understand the problem Identify the Stakeholders Groups with POWER to influence policy Assess the policy’s impact on access to affordable quality care Examine the unintended consequences

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 Populations State 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 Insured Small 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? Stay informed Health Affairs Journal Kaiser Family Foundation: KFF.org Legislation: thomas.loc.gov Ethical Issues: thehastingscenter.org

Getting Involved Contact legislators: , 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 Action Job & 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, Public Participation and Scholarly Pursuit Consumer Educational Empowerment Scientific Scientific Organ function Organ function Disease management Disease management Home health management Home health management Lifespan planning Lifespan planning Health system design Health system design Scholarly Activity Medical/political sociology Medical/political sociology Political psychology Political psychology Health economics Health economics Public health, Medicine Public health, Medicine Nursing Nursing Pastoral care/bereavement Pastoral care/bereavement Interdisciplinary social health leadership curricula Interdisciplinary social health leadership curricula Degrees equipped to manage the evolving health environment Degrees equipped to manage the evolving health environment

The Four Spheres of Political Influence Community Community Workplace Workplace Community Government Organizations (Mason, Leavitt, & Chaffee, 2002) *Community is the sphere that supports and embraces all 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 OPPORTUNITIESSEEKING OPPORTUNITIES

“GET POLITICAL” The future of nursing depends on YOU! Power Voice Vision Action

“GET POLITICAL” The future of nursing depends on YOU! Power Voice Vision Action the development of leadership skills is a major priority for top- level nursing in health systems undergoing major changes.the development of leadership skills is a major priority for top- level nursing in health systems undergoing major changes.