1. Health Care In America From Market Place to Human Right Dr. Peter Mahr PNHP

2. Background Energy as a marketplace Energy as a marketplace The military as a marketplace The military as a marketplace Housing as a marketplace Housing as a marketplace Healthcare as a marketplace Healthcare as a marketplace

3. Energy Energy: ENRON, Rolling Blackouts, Phil Gramm Energy: ENRON, Rolling Blackouts, Phil Gramm Military: military industrial complex, blackwater and arms sales. Military: military industrial complex, blackwater and arms sales. Housing: financial deregulation, 2008 financial crisis, levaraging mortgages, Housing: financial deregulation, 2008 financial crisis, levaraging mortgages,

7. Healthcare Marketplace Doctors Doctors Hospitals Hospitals Pharmaceuticals Pharmaceuticals Insurance Industry Insurance Industry

9. Doctors Specialists in the US outnumber generalist physicians 2/3 to 1/3. the reverse of the ratio in the rest of the world. Specialists in the US outnumber generalist physicians 2/3 to 1/3. the reverse of the ratio in the rest of the world. Fee for service: doctors receive more payments for tests and procedures. Fee for service: doctors receive more payments for tests and procedures. The “specialty hospital.” The “specialty hospital.”

10. Doctors The AMA: specialty physicians The AMA: specialty physicians Concerned about income and protection of profits Concerned about income and protection of profits represents only 20% of physicians, mostly specialists represents only 20% of physicians, mostly specialists Powerful lobbying group Powerful lobbying group

11. Doctors The Specialty Hospital Specialty hospitals allow physicians to refer patients for expensive procedures in hospitals without ER’s. Allows them to avoid uninsured/trauma care.

12. Doctors The Specialty hospital -Results:1996 to 2004. Medicare patients.19 percent increase cardiac sugeries (markets without cardiac specialty hospitals.) Markets with cardiac specialty hospitals: growth rate was 25 percent. -Results:1996 to 2004. Medicare patients.19 percent increase cardiac sugeries (markets without cardiac specialty hospitals.) Markets with cardiac specialty hospitals: growth rate was 25 percent. One recent study of a Tulsa specialty hospital said that, for a patient, "the relative odds of receiving complex spinal surgery was 65 times higher" after doctors acquired ownership, according to a Georgetown University researcher. One recent study of a Tulsa specialty hospital said that, for a patient, "the relative odds of receiving complex spinal surgery was 65 times higher" after doctors acquired ownership, according to a Georgetown University researcher.Georgetown UniversityGeorgetown University

13. Doctors and the Pharmaceuticals Doctors on the take: -Clinical Practice Guidelines: 59% involved with drug company whose drug considered in CPG. -2003: drug industry provides 90% of CME funding (ACCME) -2004: $1.47 billion spent on educational grants: - Shadow writing of medical journal articles - Funding of medical education

15. Hospitals For-profit does not mean for health For-profit does not mean for health

16. For-Profit Hospitals’ Death Rates are 2% Higher Source: CMAJ 2002;166:1399

20. Pharmaceuticals

22. Drug expenditure per capita, public and private expenditure, OECD countries, 2004

23. Sager FDA Testimony 4/04

24. 2004 Revenue Allocation for Top 7 US Pharmaceutical Cos Marketing, Advertising and Administration 32% 14% 18% 36% Research & Development Profits (net income) Other Source: Families USA, The Choice: Health Care for People or Drug Industry Profits, 2005

25. 23 Years Ratings New Drug “Advances” by Prescrire (1981-2003)

26. Other Estimates Me-Too #’s 2002: FDA approved 78 drugs 2002: FDA approved 78 drugs 17 new active ingredient (22%) 17 new active ingredient (22%) 7 improved treatments (9%) 7 improved treatments (9%) Over past 6 years FDA classification of newly approved drugs Over past 6 years FDA classification of newly approved drugs 78% - “unlikely better than existing drugs” 78% - “unlikely better than existing drugs” 60% - didn’t even contain new active ingredients 60% - didn’t even contain new active ingredients Angell, AARP interview 2004

27. Drug Industry Lobbying $108.6m spent industry-wide- 2003: $108.6m spent industry-wide- 2003: Total $750m spent 1997-2003 Total $750m spent 1997-2003 Employed 824 lobbyists (2003) Employed 824 lobbyists (2003) 8 lobbyist per member of senate 8 lobbyist per member of senate 45% lobbying for Industry and HMOs have “revolving door” connections 45% lobbying for Industry and HMOs have “revolving door” connections Both sides of the aisle (2005-06) Both sides of the aisle (2005-06) No. 1 recipient R.Santorum (R-PA) $977,000 No. 1 recipient R.Santorum (R-PA) $977,000 No.2 recipient H.Clinton (D-NY) $854,000 No.2 recipient H.Clinton (D-NY) $854,000

28. Medicare Part D WHY LOBBY? WHY LOBBY? LOBBYING WORKS LOBBYING WORKS

29. But Politicians Ones that Can Really Cheer Paid Well to Protect High Prices

31. Insurance Companies

35. Private Insurance covers two thirds of the population and pays for only one-third of all health care

36. 2004 2004 Personal Health Expenditures Private Funds Private health insurance Private health insurance - Self-funded plans - Self-funded plans - Insurance company plans - Insurance company plans Out-of-pockets payments Out-of-pockets payments Other private funds Other private funds Public Funds* Medicare Medicare Medicaid Medicaid Other public expenditures Other public expenditures $ Billion % $ 1,753 100% $ 965 54% $ 658 37% $340 19% $318 18% $ 236 13% $ 70 4% $ 789 46% $ 309 18% $ 293 17% $ 187 11% * Does not include tax subsidy for private insurance. See Woolhandler & Himmelstein, HealthAffairs 2002 Source: Centers for Medicare and Medicaid Services, 2006

37. RESULTS INURANCE STATUS AND FINANCIAL COSTS TO AMERICANS

42. Source: Kaiser Foundation, 2006

46. Bankruptcy Medical costs in 62% of personal bankruptcies in 2007. Medical costs in 62% of personal bankruptcies in 2007. 77% of those going bankrupt were insured when they first fell ill. 77% of those going bankrupt were insured when they first fell ill. The same year 47% of Americans reported some medical debt or payment problem and 16% of Americans’ had been contacted by medical debt collection agencies. The same year 47% of Americans reported some medical debt or payment problem and 16% of Americans’ had been contacted by medical debt collection agencies.

47. RESULTS BUREAUCRACY

48. Insurance Company Beuracracy $350 billion a year $350 billion a year 1/3 of health care dollar 1/3 of health care dollar

53. Private Insurers’ High Overhead International Journal of Health Services 2005; 35(1): 64-90

54. RESULTS HEALTHCAREOUTCOMES

60. RESULTS FRAUD AND ABUSE

62. RESULTS HEALTHCARE COSTS

70. Closing the Loop How Campaign Finance and Lobbying Tie This All Together

71. Common Dreams- Legislating Under the Influence Health Industry: $373 million campaign contributions since 2000. Health Industry: $373 million campaign contributions since 2000. Healthcare committee members receive most of these contributions (Dem and Rep) Healthcare committee members receive most of these contributions (Dem and Rep) 2009: Healthcare Industry spending $1.4 million per day! 2009: Healthcare Industry spending $1.4 million per day! Revolving door: Baucus aids now lobbying. Revolving door: Baucus aids now lobbying.

72. REVIEW

80. HOW DO WE GET THERE DECLARE ACCESS TO HEALTHCARE A HUMAN RIGHT DECLARE ACCESS TO HEALTHCARE A HUMAN RIGHT DO NOT TREAT HEALTH CARE AS A COMODITY DO NOT TREAT HEALTH CARE AS A COMODITY ENACT SINGLE PAYER NATIONAL HEALTH INSURANCE ENACT SINGLE PAYER NATIONAL HEALTH INSURANCE HR676 HR676

81. Playing Doctor? (cartoon)