Health Policy Exam 1

Medicare Structure

Part A: covers hospitals and nursing home stays and hospice care. Part B: covers doctor services, outpatient hospital care, durable medical equipment, and other medical services Part C: covers all part A and B benefits, helps fill any gaps. Part D: Drugs

Is the only country in the western world without Universal health care

USA

step 4

a simple majority of both houses of congress vote a second time to pass the revised version of the bill on which they both agree

step 1 for a bill becoming a law

a simple majority- 218 of the 435 members of the house vote to pass their version of the bill

who is covered by medicare

age 65+ with 10 years of social security contributions social security disabled w/ 24 month waiting period end stage renal disease and ALS with no waiting period

The omnibus reconciliation act of 1981

allowed states to makes additonal payments to hospitals with disproprotionate share of medicaid and how low income patients know as DSH hospitals

Death of Ted Kennedy

august 25th 2009: Massachusetts senator Ted dies and puts the senate democrats 60- supermajority required to pass a piece of legislation at risk Sept 24th 2009: Pual Kirk is appointed interim senator to replace him which temporarily restores the democrats fillasbuster.

NURSING

before physicians there were hospitals Florence Nightingale- history of war, crimean war nurses used to be called nitingales nursing shortage-WWI medical assistants helped out Nursing shortage WWII licensed vocational nurse doctors treat diagnosis nurses treat the patient no hospital care without nurses

step 3

both houses of congress have a conference to create one revised version of the bill on which both houses agree.

Shortages lead to higher nurse patient ratios which led to

burnout job dissatisfaction higher mortality rates

who is covered by medicaid

children preg women elderly disabled parents with kids parents with kids who have no other way to pay

AMA (american medical association) and phRMA

code of ethics patent protections for drugs aggressive marketing high profit margins PhRMA- patent last 10 years a way to get back their research and development. Gov. allows so they will stay interested in making more drugs.

Medicare advantage purpose

cost reduction: cheaper for patients, medicare, taxpayers keep medicare sustainable

New Deal Health Plan

created by FDR. wanted universal coverage. dealt with infrastructure..making new jobs. 1945 WWII happened and plans did not go through.

Health Security Act a.k.a Hilary care

during bill clinton's first term task force headed by Hilary Clinton features: individual mandate-have to be insured expand employer sponsored health insurance to all employees.

EPSDT

early and periodic screening diagnosis and treatment.

federal medicaid guidelines

eligibility service benefits payment rates program admin

major ways americans can get health insurance

employers medicare and medicaid individual insurance

What is the problem with Uninsurance for individuals

income insecurity access to care lack of preventive meds medical care is expensive for everyone else: cost increase adverse selection wood work effects

Judicial Branch

interpt and evaluate laws court system supreme court life long position 8 justices usually 9

9/11 rescue worker Reggie Cervantes medicine in the us Cost 12o but in Cuba

it cost 3.20 pesos which is around 5 cents

History of Physicians

lack of consistency in training (informal apprenticeship) no licensure/certification (no assurance of quality-education) large number of doctors

1960s

medicare medicaid

statistics of medicare today

medicare covers around 55 million 505 billion in cost 14% of federal budget

democracy

not a true democracy people choose representatives. reps make decisions on their behalf of their constituents.

In a world health organization ranking of the worlds health system the US slipped to

number 37 just above solvina

part B and D of medicare is covered by

social security tax basically general revenue

Federation

soverign states that adhere to a single federal gov.

July 2009 ACA

speaker of the house nancy Pelosi and a group of democrats from the house reveal their plan for overhauling the health care system. HR 3962

Senator Obama's plan

-private and public group insurance with consumer protections and income-based subsides -similar to Massachusetts Romney care -expand medicaid and CHIP -employer mandates -national health insurance competition -offer citizens the federal employee health plan (public option) -tax credits -income based subsidies (national health insurance competition got dropped health insurers did not want because they would have to lower prices)

Senator John McCain's plan

-tax credits for individual market insurance -tax employer based health insurance premium contribution as income -national health insurance competition -federal assistance to states to cover vulnerable populations -was not well received - no more employer sponsored health insurance

Chronic Illness

1-24% 2-11% 3-7% 4-4% 5-3%

US health spending categorized

1.hospital/nursing homes 2. outpatient facilities 3. drugs 4. public health and admin

When Dr. Linda Peeno started a medical reviewer for Humana, she was told she must keep a

10% denial rate

RN positions unfilled

13%

percentage that doesn't have health insurance in 2009

16.7 or 50.7

Madelyn Durham

1922-2008 Obama's grandmother helped to raise him dies of cancer (no coverage) 3 days prior to his election.

Sen. Ted Kennedy

1932-2009 youngest brother of JFK held office from 1962-2009 called health care reform "the cause of my life" martyr for healthcare

social security amendment in

1967

history facts of medicaid

1982 Arizona was the last state to offer. offered in 56 states.

person to doctor ration

1:416 ratio does not account for specialty. There is not enough primary care doctors because of the huge market difference in payment.

filibuster

2/3 vote can end it (60)

step 2

2/3rds majority 60-100 senators vote to pass their version of the bill

high salaries

280 K- GP 450K- specialists 475K- surgical specilalists

numbers of people uninsured by 1980

30 million

percentage of enrolles in medicare on managed care plans

31%. 69%have not switched

Truman's national health plan

5 Point plan: construction of hospitals and related facilities expansion of public health, maternal, and child health medical education and research prepayment of medical care protection against loss of wages from sickness or disability.

percentage of employer sponsored health insurance

50%

percentage of american over the age of 65 and uncovered

56% reasons: retired forced into individual insurance market no income and very expensive

Every prescription in Great Britain is filled at a cost of

6.65 to the patient except for patients under 16 or over 60 which is free.

public opinion disagreed about how

65% of democrat favored providing health insurance to all uninsured. 42% of republicans favored providing health insurance to only some of the uninsured 27% said to keep things basically the same

how many doctors in the US

741,000

number of americans with some form of health insurance

83.3

percentage of nurses that account for hospital short staffed

84%

federal and state government contribute

9 percent of healthcare expenditures

Public Opinon 2008- Obamacare

90% of Americans felt U.S health care system should not be completely rebuilt or fundamentally changed.

ANA

American Nursing Association: Labor Union: professional credentialing and level pay different than the AMA- every level has a different union

MEDICARE PART C

Balance Budget Act of 1997: medicare choice now medicare advantage Managed Care Plans: HMO's, PPO's, etc. Available to all medicare enrollees except ESRD

Once Billy Tauzin for the drug companies' bill passed that would supposedly help senior citizens, he left congress to become

CEO of Pharma, the industry's drug lobby for a salary of 2 million dollars a year.

Senate Bill "America's Healthy Future Act"

Dec 24th 2009: Mark Baucus (D, Cali) proposed the senates version of the bill passes D-60 republicans against-39 abstinent: Jim Burning Jan 2010: Scott Brown a R,w ins the special election in Mass. to finish out the remaining term of Ted. Brown campaigned heavily against the health care law and won an upset victory in a state that consistently votes in favor of D party.

The US government is

Federalist republic democracy

First president of the American Medical Association

Flexner

tried to establish universal health care

JFK

on july 30th 1965 signed for medicare and medicaid and gave the first medicare card to President Truman

Lyndon B. Johnson

MEDICARE PART D

Prescription drug coverage medicare modernization act not administered through medicare but private companies patients can either enroll through medicare PDP's or apart of medicare advantage plan. a,b,d c with D c and D

Level of Care

Primary- care in office or clinic secondary- inpatient teritary- bigger cities, special care, academic medical centers. care at regional refferal center quaternary- care at national referral center

the only industrialized nation to have a market oriented health economy

The USA #1

The balance budget act of 1997

established the state children's health insurance program SCHIP. give states option to cover insured children with fam income at or below 20 percent

The Federal Government has

expressed Enumerated Powers. Outlined in constitution - in charge of taxes -declaration of war - interstate commerce (Currency) -Internattional commerce

republic

fed gov made up of rep from each state

what is medicaid

federal and state partnership (voluntary state participation) medical assistance program funded by the US federal and state government. designed to provide comprehensive and quality medical care for people who are unable to pay some or all of their own medical expenses.

ACA passing numbers

for democrats 219 R-1 against democrats 39 R-176 in the final bill there were no republican votes

Diversity issues in AMA

gender issues Less than 50 percent of physicians are AMA members it is still politically the voice of the medical profession. Half of all medical students are women

has universal healthcare

germany and UK

Physicians as independent entrepreneurs created fee-for service market

great contributor to cost Issue. Doctor's have an opinion on price and the incentive is to do more so they can get paid more.

old boys club

group controls sector (white and male). They still exclude.

proposed solution for over 65 uncovered

health insurance for all US citizens health service plan for the elderly health insurance for the elderly do nothing

which care providers are covered by medicare?

hospitals skilled nursing facilities physicians and clinics clinical lab tests drugs medical equipment hospice

has socialized medicine

one insurance provider that everyone pays into that is the government- Canada

early statistics of medicare

original budget-10 billion 19 million individuals enrolled in the first year

Flexner Report

part of universities 4 years of training including 2 years of science increased physician quality decreased physician numbers increased physician salaries was a good thing because created quality over quanity

OBAMACARE

patient protection and affordable care act signed into law on March 23rd, 2010

medicaid means tested porgram

payments are based on what you spent last year

part A of medicare is covered by

payroll taxes

TRUMAN CARE

popular with the public during the Great Depression. Wage freezes following WWII. Was opposed by chamber of commerce, american medical association who deemed it as socialism. Labor unions found it desirable (chose employer sponsored coverage due to its practicality) as coverage expanded, national insurance system lost political momentum and failed to pass.

Cost drivers of US health care

population is growing immigration baby boomers lifestyle chronic illness Medical Technology (competition is becoming an issue) Payment structures (fee for service) fraud, waste, and abuse litigation

1970s-1990s

rapid escalation of cost 1297 per capita (1970) to 2937 per capita (1993) reasons fee for service, drug cost, managed care plans.

the omnibus reconciliation act of 1986

requires states to provide medicaid coverage for treatment of emergency medical conditions for immigrants who would otherwise be eligible for medicaid. option of extending medical coverage to pregnant women and infants with family income at or below 100 percent. option to use medicaid funds to pay medicare premiums and cost sharing for qualified low income. medicare beneficiaries at or below 100p FPL.

State Government have

reserved powers -ratify amendments -manage public health and safety -trade and taxes within state

Nursing Shortage

shortage of 285K by 2020, 500K by 2025

Medicaid problem statements

the poor cannot afford medical care sick cannot medical care the children cannot afford medical care

step 5

the president signs the bill into law.

Budget Reconciliation

the senate used this process to get their version of the bill which was created by lawmakers as a way to bring down the deficit by easing the path of budget and tax deals (historically reserved for military) with Budget reconciliation -senate only needs 51 votes to pass legislation -debate on an issue in a bill is limited to 20 hours most importantly- no senate filibusters are allowed.

federal medical assistance

the specified percentage of state medicaid money the federal government pays.

the medicare modernization act of 2003

transfers drug coverage from medicaid to medicare for dual eligible beneficiaries

In france both full time and part time workers get

unlimited sick days a year

Executive branch

veto power can override a bill President (2,4 year terms) vice president- over sees senate departments

1940s

wage freeze employer sponsored insurance expansion

Legislative (Congress)

write laws, declare war house of rep (# based on population, 2 year terms) Senate (2 per state, 6 years terms)