Sunday, September 16, 2012

US Health Care Some Little Known Facts & Secrets!


US Government directly finances 44% of total health care costs to cover Medicare, Medicaid and other government health care programs ...


Little Known Health Care Fact ...
Until early 20th century 1900's hospitals were places where poor
people were sent to die!
Another Health Care Fact ...
Obama is cutting $600 Billion from Medicare like Romney says, but it is from Insurance Company cost over runs and high-end exec salaries NOT the insured ...
Private insurance accounts for 36% of health care cost ...
Government subsidizes $100 billion of employers health insurance ...
Individuals are responsible for 16% of total health care costs
This amount can be very large in the event of a catastrophic illness
Many families have gone bankrupt because of excessive medical expenses
Health care politics are dominated by two concepts:
- Fairness
- Efficiency
But the two terms conflict with each other
Each term carries multiple meanings & interpretations
The 3 Most Important Politics Health Care Themes ...
Health Care Cost
Health Care Access
Health Care Quality
Excessive waste in the US health care system accounts for 22%-27% of the total cost of Health Care!
Interesting Fact Quality vs Cost
Rand study U.S. is Money Driven Medicine!
Dallas v Miami (25% higher cost in Dallas, yet same health outcomes
Dr. Wennberg study
Boston v New Haven ($300 m higher cost in Boston, yet same health outcomes ...

Brief History of US Health Care System
1912-1919: National Health Insurance IAALL introduced a model national health care Bill in 14 states. The Bill was strongly opposed as Un-American
The battle left a legacy of powerful coalition, lead by the AMA against government involvement in health care 
1921-1929: Life insurance companies began offering health insurance
1935: President Roosevelt passed The Social Security Act:
Old Age Insurance (OAA) Aid to Families of Independent Children (AFDC)
1945-1948: National Health Insurance (II). President Truman introduced a national health care bill in 1945.The bill was killed due to Republican opposition. In a backlash, Democrats lost both houses President Truman re-introduced the bill again in 1948. The bill died in congressional committees. The Hill-Burton Act was introduced as a compromise.
1946-1957: Employers began offering employees health insurance to lower their taxes, and to fend off government attempt for national health care.
1965: After many attempts, and despite opposition of Republicans and AMA, Democrats introduced the Medicare to provide health insurance for the elderly. With control over the two houses, they enough support to pass it.
To avoid being seen as an obstacle to the Bill, Republicans and the AMA introduced an alternative Medicare and the Medicaid Bill. Both Bills passed.
Medicare paid physicians’ fees. Congress pledged no intervention in medical practice. Resulted in exponential increase in health care prices.
1970s: Cost control Cost control through price regulation in the 1970s failed
Cost control through market competition: Start of HMOs and The Rand Experiment
1980s: Prospective Payment System. Diagnostic Related Groups (DRGs) for hospitals. Resource Based Relative Value Scale (RBRVS) for physicians
1980s: Cost Control. Payer competition. Start of Managed Care. Drawing on statistics to find best practices and practitioners. 
1993-94 The Clinton Health Care Reform Plan. Federally designed, regionally implemented coverage for the uninsured The plan was to be implemented through managed care companies (HMOs). Killed by Republicans Caused a  backlash that cost Democrats majorities in the House and the Senate
2000: Managed Care: Revolution and Backlash. Managed Care companies curtailed authorizing expensive medical treatments. Doctors complained to their patients, who, in turn, complained to their representatives, and dropped their plans. Managed Care plans loosened and promised not to deny payments
2009 Affordable Health Care Act - Obama Care!
Eliminating racism, waste, fraud, crime ...

Waste By Country

Romney Health Care ...
Health Care by the Numbers ...  NOT For the People .. Actuarial Health Care ...
Romney Care - By the Numbers Only
Romney Care Looks at Your ...
- Family's Medical History
- Personal Medical History
- Occupation
- Hobbies
- Genetics
- Race
Advantages of Demand Side OBAMA Over Supply Side ROMNEY ...
We the People Health Care - Demand Side is
- More efficient
- More equitable
Models of American Politics:
Individualism Self NOT - About We ... About Me ... Republican
Community We People Democratic 
American Health Politics are shaped by ...
- Interest Groups politics
- Legacy of collective cooperation
- Moral Values
- Puritan Religious Legacy
Lobbyists & Interest Groups 
Lobbyists: Myths About Power & Influence ...
Myth: It is a man’s world
Women are underrepresented in the lobbying industry
However, they have achieved numerical parity in the health care lobbying business: 42%
Myth: K is for Republican
“K street” denotes lobbying industry
Studies show equal lobbying effort and money spent on both party over the same period of time
Myth: Lobbying targets are rational choices
Lobbying target choice is often chaotic due to:
Uncertain legislative process
Coalition assignment
Myth: Clients are King
The usual relation is:
Client (interest) - Public official (target) - Policy outcome
However, lobbyists are not necessarily committed to clients’ interests
Lobbyists have their own agenda
They work on two directions:
Influencing clients
Influencing targets
Myth: The revolving door corrupts, absolutely
The number of public officials departing office to work for lobbying firms increased dramatically since the 1970s
Some public officials act as opportunists looking to “cash in”
Others are professional politicians who commit to their beliefs
Myth: Donations buy access, even votes.
Special interests give campaign contributions in exchange for a special treatment in the legislation process!!….or not
Reasons for contributions:
Access & policy influence
Insurance, covering all bases
MC (member of Congress) status
Myth: Everybody does it, Abramoff-style
Abramoff scandal was exceptional
However, in the last 15 years there has been a decline in civility, propriety & balance among MCs
Ties between lobbyists and MC have strengthened due to professionalization of lobbying
Myth: It’s all about the spin.
Information is tailored narrowly to spin the target!!!!
Lobbyists never altered information
Good lobbyists provide good information to keep their good reputation

How U,S, Health Politics are shaped by Puritan Religious Legacy
Americans take religion and morality more seriously than citizens of other countries!  In the U.S. in particular Politics in order to have Value You MUST have Religion!

"U.S. Medical Care is Based on Need" says AMA "Civil Rights Don't Count"
Misc Medical Profession Facts
- MDs control 70-80% of total health care expenditures.
- 15-20% of total health care cost is MD expenditures.
Main Levels of Health Care in U.S. 
- Primary: MD offices
- Secondary: Specialists & Hospitals
- Tertiary: Regional Centers
- Quaternary: National Centers
The Number Physicians are Declining ...
Because of ...
- Money
- Prestige
- Frustration with the field
- Lack of primary care models
Secondary Care is ....
- Provided by specialists
- Drives up the cost of health care, because procedure driven
- HMOs have attempted to control its cost through gatekeepers