Healthcare Financing and Sustainability
When looking at Healthcare Financing and Sustainability – I think about the cost of care and being good stewards of resources. “Rising healthcare costs and their consequences for Medicare and Medicaid constitute the nation’s central fiscal challenge. Without changes to federal law, the government’s spending on those two programs is on a path that cannot be sustained” from the Congressional Budget Office in 2009 (Longest, 2010; Appendix 8 p 313).
It is estimated that nearly $3.6 TRILLION was spent in 2018 in the U.S., significantly more than any other nation. The concern is that healthcare costs have been and continue to be unsustainable. There is the added concern regarding disparities in health. Though the U.S. is spending trillions of dollars, there are still many Americans who are un- or under- insured.
Impacting Health Policy
When looking to change healthcare policy, specifically Medicare, one must stop to consider, where does the money come from?
Financing of Medicare Part B is primarily achieved through the general fund of the U.S. Treasury, which is funded by Social Security Administration, which is funded by tax dollars (1.45% of your earnings) (Longest, 2010; CNN, 2018). There is also a monthly premium paid by enrollees that contributes to the funding.
Thus, to request that Medicare cover prophylactic mastectomies – this added benefit may come as an additional cost in tax dollars or and increase in the premium paid by Medicare beneficiaries.
Herein lies the challenge, without a clearly documented benefit of prophylactic mastectomies for Medicare aged women or a defined cost savings for this age group, it is highly unlikely that I will be able to garner enough support from the Health and Human Services committee to move forward with an amendment to Medicare due to the potential increase in spending.
Sustainability
Policy change must be sustainable and cannot only add cost to the current healthcare system, some benefit (decreased cost, improved outcomes) must also be realized. Though I believe that prophylactic mastectomies should be a provided benefit, it will likely come at the cost of the American people.
Perhaps the next best step would be to continue to try to engage with special interest groups, to instill passion and a consensus of the public that breast cancer patients need to have access to prophylactic mastectomies, before attempting to change policy.
References
CNN (2018). Ultimate guide to retirement: Who pays for Medicare? [webpage]. Retrieved from: https://money.cnn.com/retirement/guide/insurance_health.moneymag/index13.htm?iid=EL
Longest, B. B. (2010). Health policymaking in the United States (5th ed.). Chicago, IL: Health administration press.
Sammour, T. (2018, January 25). Healthcare: it is a right or a luxury? A TEDx Adelaide talk . Retrieved from: https://www.youtube.com/watch?v=jCVmY1iOJQs
Schreck, R. (2019, December). Overview of health care financing [webpage]. Retrieved from: https://www.merckmanuals.com/professional/special-subjects/health-care-financing/overview-of-health-care-financing
Preventative Mastectomy 
Thank you for your blog post on healthcare financing and sustainability related to prophylactic mastectomy in Medicare. I listened to the TED talk from Tarik Sammour, I was surprised that he did slightly change my thought process related to access to healthcare.
His 3 point plan: Select a system, Care about Cost, Quality or Quantity.
He mentions a hybrid system and mentions that Australia has one of the most balanced system. He really does bring up some good points about the amount of money the US spends compared to other countries and the overall quality of life. One point that really hit home with me personally is that doctors should be talking to patients about how expensive the treatments they are receiving are going to be. You mention in your blog post that health policy, specifically Medicare should pay for mastectomies but back to the ted talk do you think healthcare is a privilege or a right. Do we think everyone should automatically be privileged to get a mastectomy? Interesting blog and topic.
Thank you, I really enjoyed your post and the TED Talk.
Reference
Sammour, T. (2018, January 25). Healthcare: it is a right or a luxury? A TEDx Adelaide talk. Retrieved from: https://www.youtube.com/watch?v=jCVmY1iOJQs
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I enjoyed reading your informative post on healthcare financing and sustainability for prophylactic mastectomy’s. It is very unfortunate that Medicare does not cover these costs. I can understand how coverage of a prophylactic mastectomy may increase cost for American people, but I think it is important to educate policy makes on the importance of prophylactic mastectomy. Not all women are going to need a prophylactic mastectomy to prevent breast cancer. Women that are at very high risk of developing breast cancer such as those with BRCA1/BRCA2 variants should be the top consideration this risk reducing surgery (National Cancer Institute, 2020).
In my clinical experience not everyone that has the BRCA1/BRCA2 variants even want to have a mastectomy. Also, these gene variants are very rare. These are all important topics that need to be discussed with policy makers. For those that have BRCA1/BRCA2 variants the costs of a prophylactic mastectomy surgery may out way the costs of treating cancer and having a mastectomy later in life after developing cancer. It would also improve health outcomes for these high-risk women.
References
National Cancer Institute. (2020). Genetics of breast and gynecologic cancers (PDQ®)–Health professional version. Retrieved from https://www.cancer.gov/types/breast/hp/breast-ovarian-genetics-pdq#link/_3117
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