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?

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 PopulationsState 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 InsuredSmall 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?

Getting Involved

• Contact legislators: E-mail, 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 ActionJob & 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, The Politics of Health Deserves Broad Debate, Public Participation and Scholarly PursuitPublic Participation and Scholarly Pursuit

Consumer Educational EmpowermentConsumer Educational Empowerment Scientific Scientific Organ functionOrgan function Disease managementDisease management

Home health Home health managementmanagement

Lifespan planningLifespan planning Health system designHealth system design

Scholarly ActivityScholarly Activity Medical/political sociologyMedical/political sociology Political psychologyPolitical psychology Health economicsHealth economics Public health, MedicinePublic health, Medicine NursingNursing Pastoral Pastoral

care/bereavementcare/bereavement

Interdisciplinary social Interdisciplinary social health leadership health leadership curriculacurricula

Degrees equipped to Degrees equipped to manage the evolving manage the evolving health environmenthealth environment

The Four Spheres of Political The Four Spheres of Political InfluenceInfluence

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WorkplacWorkplac

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CommunityCommunity

Govern

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(Mason, Leavitt, & Chaffee, 2002)(Mason, Leavitt, & Chaffee, 2002)

**Community Community is the sphere is the sphere that that supports supports and and embraces all embraces all the others.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 OPPORTUNITIES

SEEKING OPPORTUNITIES

““GET POLITICAL”GET POLITICAL”The future of nursing depends onThe future of nursing depends on

YOUYOU!!PowerPower

VoiceVoice

Vision

Vision

Action

Action

““GET POLITICAL”GET POLITICAL”The future of nursing depends onThe future of nursing depends on

YOUYOU!!PowerPower

VoiceVoice

Vision

Vision

Action

Action

• the the development of development of leadership skillsleadership skills is a major is a major priority for top- level priority for top- level nursing in health systems nursing in health systems undergoing major changes .undergoing major changes .