Author Archives: raaorsini

CDC Report Shows An Increase in Suicide Rates

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There was widespread media coverage of suicide following the deaths of Kate Spade and Anthony Bourdain as well as a research from the Centers for Disease Control and Prevention that concluded suicide rates have increased in the US over the past 20 years. USA Today, Alltucker reported the suicides of Anthony Bourdain and Kate Spade are part of a broader trend of suicides among middle-aged adults. The article pointed out that “middle-aged adults had the highest number of suicides and largest rate increases, according to the” CDC report. The article added, “The CDC said nearly half of people who died by suicide had a known mental health condition. But those without a known mental health condition were more likely to struggle with a significant life event.”

Tanner of the AP reported that Joshua Gordon, MD, the director of the National Institute of Mental Health, said the CDC’s finding that many people who died by suicide had no known mental illness suggests that many people are “undiagnosed and untreated.”

Meanwhile, Carey of the New York Times reported the deaths of Spade and Bourdain “were not simply pop culture tragedies. They were the latest markers of an intractable public health crisis that has been unfolding in slow motion for a generation.” The article pointed out that while “treatment for chronic depression and anxiety – often the precursors to suicide – has never been more available and more widespread,” the recent increase in the national suicide rate poses the question: “if treatment is so helpful, why hasn’t its expansion halted or reversed suicide trends?” Thomas Insel, MD, the former director of the National Institute of Mental Health, said that the expanded access to treatment might be insufficient for the increased demand for such services.

Consider that the U.S. Suicide Rates Are Rising Faster Among Women Than Men

Rhitu Chatterjee noted that the number of people dying by suicide in the United States has risen by about 30 percent in the past two decades. And while the majority of suicide-related deaths today are among boys and men, a study published Thursday by the National Center for Health Statistics finds that the number of girls and women taking their own lives is rising.

“Typically there are between three and four times as many suicides among males as among females,” says Dr. Holly Hedegaard, a medical epidemiologist at the NCHS and the main author of the new study. In 2016, about 21 boys or men out of 100,000 took their own lives. On the other hand, just six girls or women out of 100,000 died by suicide that year.

But when Hedegaard and her colleagues compared the rise in the rates of death by suicide from 2000 to 2016, the increase was significantly larger for females — increasing by 21 percent for boys and men, compared with 50 percent for girls and women.

There’s “sort of a narrowing of the [gender] gap in rates,” Hedegaard notes. The biggest change was seen among women in late middle age. “For females between the ages of 45 and 64, the suicide rate increased by 60 percent,” she says. “That’s a pretty large increase in a relatively short period of time.”

You’re Not Alone

If you or someone you know may be considering suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255 (En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889) or the Crisis Text Line by texting 741741.

That the increase for women was more than double the increase for men “did indeed surprise me,” says Nadine Kaslow, a psychologist at Emory University and the past president of the American Psychological Association, who was not involved in the study. She says she finds the overall trends for both men and women “disturbing.”

Scientists don’t yet know the reasons behind the steeper rise in the number of girls and women taking their own lives, says Kaslow. “We’re really just beginning to see these differences, and so people are just now beginning to look at this.”

Though there are different factors at play in each case, excessive stress is a known risk factor for suicide overall, she says.

“People often die by suicide when they just feel totally overwhelmed,” Kaslow says.

Consider that more than a third of adults take medications that increase the risk of depression, study suggests

Johnson of the Washington Post (6/12, Johnson) “Wonkblog” reports, “More than a third of American adults are taking prescription” medicines, “including hormones for contraception, blood pressure medications and medicines for heartburn, that carry a potential risk of depression,” researchers concluded after analyzing data from “a detailed survey of thousands of American adults taken every two years between 2005 and 2014, in which people opened their medicine cabinets and showed researchers all the prescription” medications “they had taken in the last month.” Those people were also evaluated for depression.

And Lardier of the U.S. News & World Report reported of the study which revealed that “approximately 15 percent of adults who used three or more of these medications simultaneously experienced depression, compared to five percent not taking the” medications, seven “percent taking only one” medicine, and nine “percent taking two” medications simultaneously. The study authors also “observed the symptoms in” medicines “that listed suicide as a side effect but also saw similar results when they excluded participants taking psychotropic medications, which is considered an indicator of underlying depression unrelated to medication use.” The findings were published online June 12 in the Journal of the American Medical Association.

The CDC reported that the U.S. Suicide Rates Have Climbed Dramatically

According to the American Psychological Association, women say their stress levels have risen in recent years. And middle-aged women belonging to the sandwich generation are especially feeling the pressure of their many responsibilities at home and at work.

“So they may be taking care of children, of parents, have work demands and then more responsibilities,” Kaslow says.

There’s also been a rise in the last few decades in the number of single-parent households headed by women. That means more women trying to do everything alone, she says. “And so there’s, sort of, stress everywhere,” she says. “They may not have time to take care of themselves, to be kind to themselves, to get the social support they need.”

The new report also shows that more adolescent girls are choosing to end their lives, notes Kaslow. So the problem is not specific to middle-aged women but across all age groups.

“Suicide is a public health concern,” says Jill Harkavy-Friedman, the vice president of research at the American Foundation for Suicide Prevention. The statistics published Thursday underscore the need for a national prevention effort, she adds.

The report also looked at the means of suicide, as recorded in death certificates, and found that firearms remain an important method, particularly for boys and men.

“For males, pretty much from age 15 and older, the majority of the suicides [involved] firearms,” says Hedegaard.

“We know that limiting access to lethal means of any kind can reduce suicide,” Harkavy-Friedman says, “especially if you limit access during a crisis moment.”

To help prevent suicide, society needs to offer better access to mental health care, she says. And each one of us can do our bit, too, by watching out for the warnings signs among friends and family.

Be aware, she says, if you notice something’s changing in a loved one, friend or colleague. For example, if their mood is changing, she says, “maybe they’re more irritable, or withdrawn. Maybe they’re talking about being a burden.”

At times like these, it is important to let people know they’re not alone. “It sounds simple,” she says. “But it does make a difference.”

There may be one big reason suicide rates keep climbing in the US, according to mental-health experts

Leanna Garfield and Hilary Brueck stated that Anthony Bourdain died on Friday, with early reports indicating that the beloved celebrity chef and TV host killed himself. Earlier in the week, the fashion designer Kate Spade died by suicide as well.

Their deaths are part of a nationwide trend. Since 1999, suicide rates in the US have risen by nearly 30%, and mental illness is believed to be one of the largest contributors.

Mental-health experts say that a decline in funding for mental health care has also contributed to the rise.

Those who can afford out-of-pocket costs for mental-healthcare services are more likely to seek them out and receive treatment.

Anthony Bourdain, the acclaimed chef who explored the globe in search of the world’s best cuisine, died by suicide on Friday in France, CNN said. The fashion mogul Kate Spade also died by suicide earlier this week.

Their deaths are part of larger trend in the US. Since 1999, suicide rates in the US have risen nearly 30%, according to the Centers for Disease Control and Prevention. Nearly every state has seen a rise over that period.

While suicide is a complex response to trauma that often involves many factors, mental illness is one of the leading contributors, according to the CDC. But for those who have a mental illness and can’t afford mental health care, their conditions are more likely to worsen.

According to mental-health experts, that reality makes suicide a far-reaching, systemic public health crisis.

John Mann, a psychiatrist at Columbia University who studies the causes of depression and suicide, said several factors had most likely contributed to America’s rising suicide rates, including stress from the 2008 financial crisis and the current opioid epidemic. But they don’t tell the whole story.

“We have a serious, national problem in terms of adequate recognition of psychiatric illnesses and their treatment. That is the single most effective suicide-prevention method in Western nations,” he told Business Insider. “We’re missing most of these cases. That’s really the bottom line.”

Many people who took their own lives and had a history of psychiatric illness were not receiving treatment at the time of their deaths, according to the CDC.

The US has made substantial cuts to mental-healthcare funding over the past decade

Making mental health care more affordable could help lower suicide rates in the US, Mann said.

In the years after the 2008 recession, states cut more than $4 billion in public mental-health funding.

A budget outline released by President Donald Trump in February proposed slashing a key source of public funds for mental-health treatment: the Medicaid program serving over 70 million Americans with lower incomes or disabilities.

“We have a national strategy for suicide prevention in the United States, but it’s essentially unfunded, and there is no government leadership in systematically implementing this strategy at the federal or state level,” Mann said. “So we have a blueprint, but we do not act on that blueprint.”

Today, many Americans simply cannot afford mental-health services — something that may be because of a flawed healthcare system. A 2014 study published in JAMA Psychiatry found that of all practicing medical providers in the US, therapists were the least likely to take insurance: In 2010, only 55% of psychiatrists accepted insurance plans, compared with 89% of other healthcare professionals, like cardiologists, dermatologists, and podiatrists.

In the US, therapy can cost hundreds of dollars per session when patients pay out of pocket. Prices are usually even higher in cities, which also tend to have higher rates of depression than in rural areas.

‘This is a wake-up call for employers, regulators, and the [insurance] plans themselves’

Mental-health care coverage can vary widely by state as well.

In November, Milliman, a risk-management and healthcare consulting company, published a national study that explored geographic gaps in access to affordable mental health care.

The researchers parsed two large databases containing medical-claim records from major insurers for preferred provider organizations, or PPOs, covering nearly 42 million Americans in all 50 states and Washington, DC, from 2013 to 2015.

The study found that in New Jersey, 45% of office visits for behavioral healthcare were out of network; in DC, it was 63%. In nine states — including New Hampshire, Minnesota, and Massachusetts — payments were 50% higher for primary-care doctors when they provided mental health care.

Of the study, Henry Harbin, the former CEO of the behavioral-healthcare company Magellan Health, told NPR: “This is a wake-up call for employers, regulators, and the [insurance] plans themselves that whatever they’re doing, they’re making it difficult for consumers to get treatment for all these illnesses. They’re failing miserably.”

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Because mental-healthcare providers know that insurance companies aren’t likely to adequately reimburse them, they will often require patients to pay out of pocket. As a result, many states do not have enough in-network therapists and psychiatrists to meet patient demand.

“Too many people have no health insurance; there have been too many budget cuts to treatment dollars, and there are too few providers available to deliver care,” Fred Osher, the director of health systems and services policy at the Council of State Governments Justice Center, wrote in a New York Times op-ed article in 2016. “These obstacles should lead to a call to action, not a call to further confine people with mental illness.”

Correlation does not equal causation. But many other nations with universal or near-universal healthcare, like the Netherlands and Estonia, have seen declines in suicide rates, Mann said.

Following reports of Bourdain’s and Spade’s deaths, many people on Twitter shared stories of their own battles with depression and mental illnesses. Several also expressed worries about those who are unable to pay for therapy visits or psychiatric medications because their insurance plans do not cover them.

If you or someone you know is struggling with depression or has had thoughts of harming themselves or taking their own life, get help. The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations.

How does this information fit into my interest in health care besides the basic problems in our mental health system? One of the suggestions that I have heard from the “talking heads” is that all physicians should be asking all of our patients about their stresses, concerns for depression indicators as the professionals on the media telling us that we should be able to pick up the early signs.

Interesting suggestions but most of us, especially those physicians employed by the corporate health care systems, we barely have time to diagnose and start patients on their treatment in the allotted 11-15 minutes per patient as we are pushed to see more and more patients per day to increase their production models-profits first.

You all also have to understand my feeling regarding suicide, as I have watched friends, physicians and their sons and daughters commit suicide. I consider it the most selfish way to solve their problems. They leave the sorrow, the resolution of problems to their loved ones that they leave behind.

Happy Father’s Day to all the Dads out there! I hope that you all enjoyed your special day.

Trustees Report Warns Medicare Finances Worsening and Bernie Sanders is So Adamant in Medicare for All as the Answer to All Our Problems

 

22141171_1319583611504628_6195948361907076306_nPeter Sullivan reported that House Democratic Leader Nancy Pelosi(Calif.) said Thursday that “Medicare for All” proposals should be “evaluated” if Democrats win back the House this year, adding “it’s all on the table.”

Pelosi has long backed a public option for health insurance, but has not supported going further — as many Democrats want — and setting up government-run, universal health insurance.

The Democratic leader did not explicitly endorse the idea of Medicare for All during a press conference Wednesday, but she also did not rule out the proposal.

“I’ve always been for a public option so I’m always eager to talk about that,” Pelosi said when asked if Democrats would advance a public option or Medicare for All legislation if they win the House.

“Some of the other issues that have been proposed have to be evaluated in terms of the access that they give, the affordability of it and how we would pay for it, but again it’s all on the table,” she added.

Last year, Pelosi pushed back on the idea of Medicare for All, saying, “the comfort level with a broader base of the American people is not there yet.”

Medicare for All has been gaining traction among Democrats in recent years. The idea, championed by Sen. Bernie Sanders (I-Vt.), is now favored by many potential 2020 Democratic presidential contenders.

Many Democratic House candidates in battleground districts support the idea as well, which Republicans think will be a liability for them.

“When they come to Congress, any of those subjects can be on the table,” Pelosi said.

She defended the current Affordable Care Act as well.

“We believe in the Affordable Care Act, that it has the structure to take us forward in many different ways,” she said.

On CNN Thursday night, Chris Cuomo and Sen. Bernie Sanders (I-Vt.) spent a good 15 minutes talking health-care policy, but Cuomo started off with politics, noting that President Trump’s poll numbers are improving. “Don’t you think that President Trump deservedly gets credit for this strong economy, that it’s not just a byproduct of what’s going on globally?” Cuomo asked.

Sanders did not agree, saying Trump has to explain why Germany, Japan, Mexico, and the U.K. also have historically low unemployment. “Our economy is doing well in terms of unemployment,” he said. “But we are not doing well in terms of raising wages for working families,” and policy-wise, Trump “is going to war against working people. He is a tool of the wealthiest people in this country, and I think the American people understand that.”

Cuomo walked over to a whiteboard, saying he had done his homework and Sanders had to explain three things about his Medicare-for-all plan, starting with the idea that “socialized medicine,” and thus socialism, “smacks of the end of capitalism.” Sanders said Cuomo “is going to have to do some more homework,” pointing out that every other capitalist society has single-payer health care, and Americans love Medicare.

Cuomo noted that Americans hate change, and one in nine Americans works in healthcare, so Sanders’ plan endangers their jobs. “We will create more jobs under a rational Medicare-for-all system than currently exists,” Sanders replied. “There will be a transition, just in the same way, Chris, as we have to transform our energy system away from fossil fuel. We create more jobs, but there will be pain and you gotta deal with that pain.” “Right, but dealing with pain is not something that is done well in politics,” Cuomo noted, and they sparred about the political viability of raising taxes versus eliminating private health insurance costs — and also, more personally, family dynasties.

I couldn’t stand listening to Sanders anymore because he is such a Socialist and really doesn’t have a handle on the finances. Basically, he is an idiot and there are people who think that he has a good chance in the 2020 presidential election. Please, don’t let this man get any farther and put him in a retirement facility where he belongs.

Just read the predictions regarding the financial stability of Medicare.                       Ricardo Alonso-Zaldivar wrote that Medicare will run out of money sooner than expected, and Social Security’s financial problems can’t be ignored either, the government said Tuesday in a sobering checkup on programs vital to the middle class.

The report from program trustees says Medicare will become insolvent in 2026 — three years earlier than previously forecast. Its giant trust fund for inpatient care won’t be able to fully cover projected medical bills starting at that point.

The report says Social Security will become insolvent in 2034 — no change from the projection last year.

The warning serves as a reminder of major issues still languishing while Washington plunges deeper into partisan strife. Because of the deterioration in Medicare’s finances, officials said the Trump administration will be required by law to send Congress a plan next year to address the problems after the president’s budget is submitted.

Treasury Secretary Steven Mnuchin said in a statement that there’s time to fix the problems. “The programs remain secure,” Mnuchin said. Medicare “is on track to meet its obligations to beneficiaries well into the next decade.”

“However, certain long-term issues persist,” the statement added. “Lack-luster economic growth in previous years, coupled with an aging population, has contributed to the projected shortages for both Social Security and Medicare.”

Social Security recipients are likely to see a cost of living increase of about 2.4 percent next year, said government number crunchers that produced the report. That works out to about $31 a month.

At the same time, the monthly Medicare “Part B” premium for outpatient care paid by most beneficiaries is projected to rise by about $1.50, to $135.50.

Both the cost-of-living increase and the Medicare outpatient premium are not officially determined until later in the year, and the initial projections can change.

More than 62 million retirees, disabled workers, spouses and surviving children receive Social Security benefits. The average monthly payment is $1,294 for all beneficiaries. Medicare provides health insurance for about 60 million people, most of whom are age 65 or older.

Together the two programs have been credited with dramatically reducing poverty among older people and extending life expectancy for Americans. Financed with payroll taxes collected from workers and employers, Social Security and Medicare account for about 40 percent of government spending, excluding interest on the federal debt.

But demands on both programs are increasing as America ages.

Unless lawmakers act, both programs face the prospect of being unable to cover the full cost of promised benefits. With Social Security that could mean sharply reduced payments for retirees, many of whom are already on tight budgets. The report said the total annual cost of Social Security is projected to exceed total annual income in 2018 for the first time since the Reagan era, meaning the program will have to tap into reserves.

For Medicare, insolvency would mean that hospitals, nursing homes and other providers of medical care would be paid only part of their agreed-upon fees.

Medicare is widely seen as a more difficult problem that goes beyond the growing number of baby boomers retiring. It’s also the unpredictability of health care costs, which can be jolted by high-priced breakthrough cures, and which regularly outpace the overall rate of economic growth.

The Cabinet secretaries for Treasury, Health and Human Services, and Labor usually participate in the annual release of the report, along with the Social Security commissioner, and take questions from reporters. None of those top officials was present Tuesday; an aide cited scheduling conflicts.

The four top officials serve as the Social Security and Medicare trustees, along with two independent trustees who are supposed to represent the public. The public trustees are usually more candid, but those posts remain unfilled.

President Donald Trump campaigned on a promise not to cut Social Security or Medicare, but he hasn’t offered a blueprint for either program.

Democrats, meanwhile, want to extend the social safety net by spending more on health care and education. Advocates for the elderly said Tuesday there should be no cuts to Social Security benefits.

But federal deficits keep rising, and the recent Republican tax-cut bill is expected to add to the debt.

Last year’s tax law, which cut taxes on Social Security benefits, helped exacerbate the shortfall. So too did repeal of the individual mandate in so-called Obamacare, which promises to increase the number of people without health insurance and therefore Medicare payments for uncompensated medical care.

Higher deficits mean less maneuvering room for policymakers when the day of reckoning finally arrives for Social Security and Medicare.

In principle, the U.S. is supposed to be paying forward its Social Security and Medicare obligations by building up trust funds to cover future costs. That money is invested in special government securities, which also collect interest. But when the money is actually needed to pay for benefits, economists say a government deep in debt could be hard-pressed to make good.

Let’s get right to the point: Medicare is not going “broke” and recipients are in no danger of losing their benefits in 2026, but instead 2034. Now a more expanded breakdown of the problems.

Not broke, but not healthy                                                                                               However, that does not mean Medicare is healthy. Largely because of the inexorable aging of the Baby Boomers, program costs continue to grow. And, as the Trustee’s report forthrightly acknowledges, long-term costs could well increase even faster than the official predictions. The main risks: scheduled limits on payments to doctors and other providers may never be implemented and unknown future medical technologies are likely to increase all health costs, including for Medicare.

This will inevitably mean that either premium and/or taxes will rise; payments to doctors, hospitals, and other providers will grow more slowly; some benefits may be trimmed, or a combination of all three.

So what is the Trustee’s report, and what does it really say?

Hospital insurance                                                                                                                        The report is an annual exercise designed to review the health of the nation’s biggest health insurance program.  It looks in detail at each of Medicare’s pieces, including Part A inpatient hospital insurance; Part B coverage for outpatient hospital care, physician services, and the like; Part C Medicare Advantage plans; and Part D drug insurance.

Those “going broke” headlines are all about Part A Hospital Insurance (HI), which accounted for about 40 percent of the program’s $710 billion in spending in 2017. HI mostly is funded by the Medicare tax that is withheld from worker paychecks and paid by the self-employed.  And that tax—as well as other smaller sources of revenue– is not sufficient to pay the bills. It hasn’t been for years.

Because it anticipated the aging Boomers, Medicare built up a trust fund while its costs were relatively low. But that reserve is rapidly being drained, and, in 2026, will be out the money. That is the source of all those “going broke” headlines.

What will Congress do?

It doesn’t mean Medicare will stop paying hospital insurance benefits in eight years. We don’t know what Congress will do—though the answer is probably nothing until the last minute. Lawmakers could raise the payroll tax. But my bet is they’ll use general revenue to support the HI program, which is another way to say they’ll borrow the money and further raise the national debt.

Medicare Parts B and D are funded very differently, and are at no risk of “going broke.”  Unlike Part A, there is no dedicated tax for these programs. Rather, they are funded through a combination of enrollee premiums (which support only about one-quarter of their costs) and general revenues—another way of saying the government borrows most of the money it needs to pay for Medicare.

The coming political debate

As more Boomers age and health care prices increase, Medicare costs will continue to rise. Under the current system, that means premiums will continue to increase and so will government borrowing. The big political debate in coming years will be over how to divvy up those future costs. Will more of the burden fall on beneficiaries or will it fall on taxpayers at large who, eventually, will have to pay off the burgeoning government debt?

Because Medicare costs (like all health care costs) are rising faster than the overall economy is growing, the program will eat up more of the nation’s total economic output. And here is where the news really is scary.

Today, Medicare expenses are approaching about 4 percent of Gross Domestic Product. Under current law, the Trustees project it will increase to about 6 percent in two decades, then level off.

Unlikely assumptions                                                                                                                    But that forecast is built on several key assumptions that are unlikely to occur. In the 2010 Affordable Care Act, Congress adopted a package of cost-cutting measures. In 2015, in a law called the Medicare Access and CHIP Reauthorization Act (MACRA), it began to change the way Medicare pays physicians, shifting from a system that pays by volume to one that is intended to pay for quality. As part of the transition, MACRA increased payments to doctors until 2025.

But what if key ACA cost-cutting measures never take effect, the transition to the new physician payment system is delayed, and the temporary doctor payments continue indefinitely? In that case, the trustees forecast Medicare costs will not flatten out in the mid-2030s, and instead, keep rising—to 8 percent of GDP by 2070 and 9 percent of the entire economy by 2090.

That’s a long way away, you may say, and a lot can happen in the next 75 years. That’s true, but remember that whenever new medical technologies are adopted, overall health care costs tend to rise. So we face what the economists like to call an asymmetric risk: It is possible that future Medicare costs will grow more slowly than predicted, but it is more likely that they’ll be significantly higher than the trustees forecast.

The question is: What are we going to do about it?

Remember, this idea arose with Sen. Bernie Sanders (I-Vt.) during his 2016 campaign for president. Sanders knew that the term “nationalized medicine” would be seen as pejorative by a majority of Americans, so he renamed the concept.

Nationalized healthcare became “Medicare for All.” It was very creative on Sanders’s part. This has become the essence of the left’s proposals for how to pursue medical reform, now that ObamaCare has become too heavy a political burden to bear and is essentially non-functioning.

Even Democrats who presented themselves as being more moderate than the socialist Sanders — such as the two senators representing my home state of New Hampshire, Sens. Jeanne Shaheen and Maggie Hassan — have globed onto Medicare for All as the most convenient way to demonstrate their support for dramatic improvement in our nation’s healthcare system.

It is a spurious claim. It does not pass the smell test of political opportunism.

To assert that Medicare For All — or to use its more honest label, nationalization — would actually produce a better, more effective healthcare system for Americans is a hard sell when one looks at the facts.

The proposal is said to be legitimate because, after all, Medicare works fairly well for the older Americans who are insured by this national plan. So why would it not be just as good for everyone else?

As I have mentioned this seems like a reasonable view until it is submitted to rational analysis. Medicare works because the cost of the healthcare that is delivered to seniors is highly subsidized by those Americans who have private insurance.

It is estimated that the unreimbursed costs of hospital care under Medicare and Medicaid are approximately $58 billion a year. The vast majority of this cost is Medicare-driven. This means that the federal government when it so generously provides hospital coverage to people over 65, is only paying a limited amount of the real cost of the care.

The rest of the burden is borne by everyone else who has private insurance or by the hospitals eating the costs.

Thus if you go to a Medicare for All system, where everyone gets federally-paid health insurance — a nationalized system — the result will be billions and billions of dollars in unreimbursed costs.

Covering those costs becomes extremely problematic. If you look at the two major nationalized systems that presently are wrestling, unsuccessfully, with this problem, Canada, and the United Kingdom, it is evident that the quality and delivery of healthcare services are dramatically and negatively impacted.

Rationing, both overt and indirect, is one consistent outcome of a Medicare for All system as presently used in Canada and Britain. In Canada, the average total wait time to see a general practitioner, then a specialist, and then have a procedure is 20 weeks. This puts people at serious risk. It is one of the reasons that Canadians who can afford it come in droves to the United States for treatment.

In the UK, there is actually a board that determines whether or not a patient qualifies for a procedure. In part, it weighs the patient’s age against the costs and outcomes of the procedure. If you do not meet the criteria, you do not get the procedure.

These are only limited examples of the effects of rationing in these nationalized systems.

A significant reduction in the quality and number of people being attracted into the healthcare system is also a discernible result, as salaries are capped and costs related to quality are foregone.

The incentive to innovate and generate new medicines and procedures is also radically muted under nationalized systems.

The capital needed to pursue these expensive undertakings dries up due to the lack of adequate returns on the investment and the excess regulations of the government bureaucracy.

It takes about 12 years and $1 billion to bring a new, dynamic drug to the market. This type of investment simply cannot realize an adequate return in a nationalized system, and the development of breakthrough drugs and technology is therefore chilled.

Medicare for All, a.k.a. nationalization is one of those ideas that sounds good as a phrase in a stump speech. But if it were actually pursued, Americans would see a deterioration in their healthcare. All Americans would find that at some level their access to better care was rationed.

The track record of socialism in so many arenas is abysmal but it is especially so in healthcare. Yet this is the direction in which the left wants to take this country. The left calls out in full-throated hyperbole for a system they claim will give Americans Medicare for All. It is a failed and cruel policy but it has been sugar-coated in focus-group language.

My concern is and what the left should really be saying is that it wants Rationing for All. That would be a more honest statement of what would happen under the system of healthcare the leftists propose.

And remember, some of the States have taken steps to expand the Medicaid system, which counts on Federal funding as well as State funding. Where do you think that money will come from? Yes, we the tax-payers.

Health Care, Immigration Dominate California Governor Race. But Are We Sure We Want a Single Payer Healthcare System?

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California’s next governor faces a long list of challenges, from housing and health care to immigration. It seems like the upcoming mid-term elections that healthcare will be a dominant item in the debates. As Jonathan Cooper wrote, no topic has dominated California’s governor race like President Donald Trump including what he and the GOP are attempting to do with Obamacare. The Republicans want to be like him; the Democrats want to oppose him. But whoever wins will face a long list of challenges from housing and homelessness to health care. For example, all the Democrats say they support, at least in concept, “single-payer” health care — the idea that the government should pay for health coverage for everyone in the state, instead of the complex mix of employers, unions, individuals, Medicare and Medicaid that reigns today. But that didn’t stop it from being a major sticking point between them. Newsom was an enthusiastic supporter of a bill sponsored by the California Nurses Association that would implement a “single-payer” health care system. But it lacked key details, most notably a plan to cover the $400 billion cost. Chiang and Villaraigosa accuse Newsom of misleading voters with unattainable promises. Villaraigosa called it “snake oil.” For his part, Newsom calls his rivals “can’t-do Democrats” too fixated on the challenges of single-payer health care. Allen and Cox oppose single-payer health care.

Here are more of the specifics of the debates and is it really a single payer system or universal health care?

When Gavin Newsom campaigns on his support for a California single-payer healthcare system, he’s talking about more than the virtues of universal care. He’s trying to sell himself as a bold visionary.

When Antonio Villaraigosa warns of the financial calamity that awaits if the state adopts single payer, he’s trying to send a different message — that he’s a fiscally responsible realist who won’t make promises he can’t keep.

The debate over single payer in California’s race for governor reaches beyond how best to cure the inadequacies of health care in the state. It’s a political marker for the top Democratic candidates trying to woo different factions of their divided party and has emerged as the biggest policy flashpoint in the campaign.

“Single-payer health care has become a clear litmus test. If you support it, you’re a pure progressive. If you’re opposed to it, you’re a pragmatist,” UC San Diego political scientist Thad Kousser said. “It’s more of a declaration than a policy promise because this is never going to happen, certainly during the Trump presidency.”

But Newsom has promised to pursue a state-supported single-payer health care system if he’s elected in November. And fellow Democratic candidate Delaine Eastin, a former state superintendent of public instruction, also declared herself all-in on the concept. Both say California should lead the way but have been criticized by their rivals for failing to provide a concrete plan to fund such a program or overcome the many obstacles it would face.

Depending on who becomes the next governor, every Californian’s well being and bank account could potentially undergo a revolutionary change. With the June 5 primary just two months away, Newsom remains the clear front-runner.

Coverage of California politics:

“My opponents call it ‘snake oil,'” Newsom said at the California Democratic Party convention in February, a reference to Villaraigosa’s oft-used criticism of the lieutenant governor’s support for the plan. “I call it single payer. It’s about access. It’s about affordability. And it’s about time. If these can’t-do Democrats were in charge, we wouldn’t have had Social Security or Medicare.”

Villaraigosa dismisses Newsom’s campaign promise as a hollow attempt to entice the left. He said the system Newsom supports would require all Californians on Medicare to give it up in favor of a new, unproven state healthcare system — a declaration meant to rile up the 5.6 million residents covered by the popular federal program.

“Newsom calls any attempt to demand details of his $200-billion tax increase and plan to force seniors off of Medicare as ‘defeatist,'” Villaraigosa said recently. “I call refusing to say how you will successfully persuade Californians to more than double their taxes while taking away their Medicare simply deceptive.”

State Treasurer John Chiang, the other major Democrat in the running, has also urged caution. Instead of transforming healthcare in California in one fell swoop, the state should implement single payer bit-by-bit to ensure that it’s affordable and effective, he said.

“I support single-payer, but we have to be truthful here,” Chaing said during a fall Democratic debate in San Francisco. “How many of you want to pay an additional 90% in taxes? … Let’s scale up, see what revenues we have because we can’t cover everything.”

In Washington, former presidential candidate Sen. Bernie Sanders (I-Vt.) is leading a push for a plan that would, in essence, expand Medicare to provide healthcare to all Americans., For now, it’s little more than a political mirage — the Trump administration and congressional Republicans have been trying to repeal, not expand, government healthcare coverage provided under the Affordable Care Act.

With federal action unlikely, the California Legislature debated in 2017 whether to implement a state-sponsored single-payer system. The legislation, Senate Bill 562, was shelved in the Assembly over concerns about the cost and the lack of a comprehensive plan of how to pay for and implement such a massive new government program. A legislative analysis estimated the cost to be $400 billion per year. Half of the money for the system would come from existing state funds currently spent on healthcare, with the other half from new revenues such as a payroll tax, according to the analysis.

Newsom’s support of SB 562 has been nuanced. When he spoke at a convention of the California Nurses Assn., which endorsed Newsom and is the most vocal backer of the bill, he told the enthusiastic crowd, “It’s time to move 562.” But later, when talking with reporters, Newsom said he was referring to moving the bill through the legislative process, and acknowledged some “open-ended” issues still needed work.

When a coalition of labor unions, community health organizations and immigrant-rights groups tried to steer the health care debate away from SB 562 in March, proposing a series of measures to make healthcare in California more affordable and accessible, Newsom praised it as a “step in the right direction.” He said it had the potential to move California closer to universal coverage.

Villaraigosa and Chiang have accused Newsom of shifting his message on SB 562 to appease different audiences.

But Newsom has taken shots at them for playing both sides as well. Villaraigosa and Chiang say they support the concept of single payer — ideally at the national level — yet call Newsom fiscally reckless for supporting a California program. Newsom has insinuated that they lack the political courage to make it happen.

He also said the hand-wringing over the cost of single payer is an argument. “Most of the money needed to support a single-payer system already is being spent on the plans that it would replace, he said: government-run exchanges and private healthcare plans.

“I think we can achieve it. Let me tell you why: We’re already spending $367 billion a year on health insurance in the state of California,” Newsom said at a San Diego debate in February. “In every developed nation in the world that has a single-payer financing system, one thing is absolutely true: It costs less money than multi-player.”

U.S. healthcare tab to keep rising, led by higher costs for drugs and services, a government report says. Driven by rising prices for drugs and medical services, the nation’s healthcare tab will continue to outpace economic growth over the next decade, according to a new government report.

And by 2026, healthcare spending will account for almost one-fifth of the U.S. economy, an all-time record. The $367-billion figure Newsom used comes from a 2016 study done in part by Gerald Kominski, a professor of health policy at UCLA. Kominski agrees that, in theory, additional revenue might not be necessary if all of that money spent on healthcare in California can be funneled to a single state healthcare agency. Still, that would require permission from the Trump administration and Republican-led Congress — both hostile to Democratic leaders in California — to take control of Medicare and Medi-Cal funding Washington sends to the state, as well as convincing all Californians to switch to state-run healthcare coverage.

“There are still some significant barriers,” Kominski said. Micah Weinberg, president of the Bay Area Council Economic Institute, said Newsom fails to account for the increased costs of the comprehensive coverage being promised under a state single-payer system. Those costs include covering an estimated 1.8 million immigrant adults in California who are in the U.S. without authorization and covering long-term care not covered by Medicare, as well as eliminating all deductibles and other out-of-pocket expenses for Californians, he said.

“We’re being misled into believing that if you provide free universal care, it’s going to cost less,” Weinberg said.

Eastin, the only candidate of the four to throw her unequivocal support behind SB 562, has said implementing single payer is essential because “people are dying” for lack of proper healthcare. She has also acknowledged that it won’t be simple.

“What we have to do is have a conversation, an adult conversation, with real leaders at the table talking about how we’re going to close the gap and get additional money,” Eastin said at one of the Democratic debates, adding that she’s open to exploring different revenue sources, including a gross receipts tax.

The two top Republicans in the race, Rancho Santa Fe businessman John Cox, and Huntington Beach Assemblyman Travis Allen, have both ripped single payer as a government boondoggle.

Cox mockingly suggested that the state could also provide “single-payer food and single-payer housing” for everyone. Allen said it would be as efficient and customer-friendly as the DMV and bankrupt the state.

A 2017 poll by the nonpartisan Public Policy Institute of California found that 65% of adults in California favored the creation of a state single-payer healthcare program, but that support dropped to 42% when asked about paying higher taxes to fund it.

“You have to wonder, over time, whether this is an issue that candidates want to own,” PPIC President Mark Baldassare said.

Other states are having similar discussions regarding the single-payer system, whether it is Medicare for All or Medicaid for all or some other variety of a government-run system. But is the single-payer system the correct approach as I started reviewing last week?

“Medicare for all” is a popular idea, but for Americans, transitioning to such a system would be difficult, to say the least. Olga Khazan last year wrote that French women supposedly don’t get fat, and in the minds of many Americans, they also don’t get stuck with très gros medical bills. There’s long been a dream among some American progressives to truly live as the “Europeans1” do and have single-payer health care.

Republicans’ failure—so far—to repeal and replace Obamacare has breathed new life into the single-payer dream. In June, the majority of Americans told Pew that the government has the responsibility to ensure health coverage for everyone, and 33 percent say this should take the form of a single government program. The majority of Democrats, in that poll, supported single payer. A June poll from the Kaiser Family Foundation even found that a slim majority of all Americans favor single payer.

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Liberal politicians are hearing them loud and clear. Vermont Senator Bernie Sanders reportedly plans to introduce a single-payer bill once Congress comes back from recess—even though no Senate Democrats voted for a single-payer amendment last month. Massachusetts Senator Elizabeth Warren has also said “the next step is single payer” when it comes to the Democrats’ health-care ambitions.

But should it be? It’s true that the current American health-care system suffers from serious problems. It’s too expensive, millions are still uninsured, and even insured people sometimes can’t afford to go to the doctor.

Single payer might be one way to fix that. But it could also bring with it some downsides—especially in the early years—that Americans who support the idea might not be fully aware of. And they are potentially big downsides.

First, it’s important to define what we mean by “single payer.” It could mean total socialized medicine, in that medical care is financed by—and doctors work for—the federal government. But there are also shades of gray, like a “Medicaid for all” system, where a single, national insurance program is available to all Americans, but care is rationed somewhat—not every drug and device is covered, and you have to jump through hoops to get experimental or pricier treatments. Or it could be “Medicare for all,” in which there’s still a single, national plan, but it’s more like an all-you-can-eat buffet. Like Medicare, this type of single-payer system would strain the federal budget, but it wouldn’t restrict the treatments people can get. Because it’s the term most often used in single-payer discussions, I’ll use that here.

The biggest problem with Medicare for all, according to Bob Laszewski, an insurance-industry analyst, is that Medicare pays doctors and hospitals substantially less than employer-based plans do.

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“Now, call a hospital administrator and tell him that his reimbursement for all the employer-based insurance he gets now is going to be cut by 50 percent, and ask him what’s going to happen,” he said. “I think you can imagine—he’d go broke.” (As it happens, the American Hospital Association did not return a request for comment.)

The reason other countries have functional single-payer systems and we don’t, he says, is that they created them decades ago. Strict government controls have kept their health-care costs low since then, while we’ve allowed generous private insurance plans to drive up our health-care costs. The United Kingdom can insure everyone for relatively cheap because British providers just don’t charge as much for drugs and procedures.

Laszewski compares trying to rein in health-care costs by dramatically cutting payment rates to seeing a truck going 75 miles an hour suddenly slam on the brakes. The first 10 to 20 years after single payer, he predicts, “would be ugly as hell.” Hospitals would shut down, and waits for major procedures would extend from a few weeks to several months.

Craig Garthwaite, a professor at the Kellogg School of Management at Northwestern University, says “we would see a degradation in the customer-service side of health care.” People might have to wait longer to see a specialist, for example. He describes the luxurious-sounding hospital where his kids were born, a beautiful place with art in the lobby and private rooms. “That’s not what a single-payer hospital is going to look like,” he said. “But I think my kid could have been just as healthily born without wood paneling, probably.”

He cautions people to think about both the costs and benefits of single payer; it’s not a panacea. “There aren’t going to be free $100 bills on the sidewalk if we move to single payer,” he said.

He also predicts that, if single payer did bring drug costs down, there might be less venture-capital money chasing drug development, which might mean fewer blockbuster cures down the line. And yes, he added, “you would lose some hospitals for sure.”

Amitabh Chandra, the director of health policy research at Harvard University, doesn’t think it would be so bad if hospitals shut down—as long as they’re little-used, underperforming hospitals. Things like telemedicine or ambulatory surgical centers might replace hospital stays, he suspects. And longer waits might not, from an economist’s perspective, be the worst thing, either. That would be a way of rationing care, and we’re going to desperately need some sort of rationing. Otherwise “Medicare for all” would be very expensive and would probably necessitate a large tax increase. (A few years ago, Vermont’s plan for single payer fell apart because it was too costly.) Also, we have to go back even farther to see the experience in the great State of Massachusetts and their experience.

If the United States decided not to go that route, Chandra says, we would be looking at something more like “Medicaid for all.” Medicaid, the health-insurance program for the poor, is a much leaner program than Medicare. Not all doctors take it, and it limits the drugs and treatments its beneficiaries can get. This could work, in Chandra’s view, but many Americans would find it stingy compared to their employers’ ultra-luxe PPO plans. “Americans would say, ‘I like my super-generous, employer-provided insurance. Why did you take it away from me?’” he said.

Indeed, that’s the real hurdle to setting up single payer, says Tim Jost, emeritus professor at the Washington and Lee University School of Law. Between “80 to 85 percent of Americans are already covered by health insurance, and most of them are happy with what they’ve got.” It’s true that single payer would help extend coverage to those who are currently uninsured. But policymakers could already do that by simply expanding Medicaid or providing larger subsidies to low-income Americans.

Under single payer, employers would stop covering part of their employees’ insurance premiums, as they do now, and people would likely see their taxes rise. “As people started to see it, they would get scared,” Jost said. And that’s before you factor in how negatively Republican groups would likely paint single payer in TV ads and Congressional hearings. (Remember death panels?) It would just be a very hard sell to the American public.

“As someone who is very supportive of the Democratic Party,” Jost said, “I hope the Democrats don’t decide to jump off the cliff of embracing single payer.”

Common misconception: Not all European countries have single payer. But we all know that this is not true!! Those that have money can pay for private healthcare or travel to the U.S.A. for treatment.

More next week.

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Single Payer Here We Come, But What Does It Look Like and What do the Insurers Think?

15439960_1053735618089430_7095899501210775916_nBob Doherty of the American College of Physicians stated that the idea of a single-payer healthcare is enjoying a boom in public opinion and he went on to list the important questions.

A Pew Research Center poll released in June 2017 found that “Overall, 33 percent of the public now favors such a ‘single payer’ approach to health insurance, up 5 percentage points since January and 12 points since 2014.” Fifty-eight percent of those surveyed by Pew said that the government has a responsibility to ensure health for all, with a third saying it should be through a single national government program and 25% through a mix of government and private programs. Another 33% said the government is not responsible to ensure healthcare for all but agreed that Medicare and Medicaid should be continued, while 5% said the government should not be involved at all. The poll also showed that a majority of Democrats now favor single payer; support was also stronger among younger persons than older ones. However, most Republicans and older voters oppose single payer.

The Kaiser Family Foundation’s June 2017 tracking poll found even higher levels of support for single payer, with 53% in favor and 43% opposed. However, it also described support for single payer as being “malleable” and subject to change when presented with arguments for or against: “While a slim majority favors the idea of a national health plan at the outset, a prolonged national debate over making such a dramatic change to the U.S. healthcare system would likely result in the public being exposed to multiple messages for and against such a plan. The poll finds the public’s attitudes on single-payer are quite malleable, and some people could be convinced to change their position after hearing typical pro and con arguments that might come up in a national debate.”

A Harvard-Harris poll conducted in September 2017 found even higher levels of support for single payer, with a narrow majority (52%) supporting it while 48% opposed.

Doctors also appear to be warming to single payer, according to some recent polls. And, as I have traveled around the country in recent months to visit ACP chapter meetings, I’ve found more and more ACP members are advocating that the College come out strongly in favor of single-payer healthcare, and not just in so-called liberal-leaning “blue” states. I’ve explained that a 2008 ACP paper, which I co-authored on behalf of our Health and Public Policy Committee, examined what the United States could learn from other countries’ health systems. We recommended, “that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:

Single-payer financing models, in which one government entity is the sole third-party payer of healthcare costs, can achieve universal access to healthcare without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita healthcare expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain healthcare expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own healthcare choices.

Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector.”

(Note that this paper was written a year before the Affordable Care Act (ACA) became law; the ACA is an example of the second option, although it has fallen short of assuring universal access).

Recognizing the growing interest in single payer, and in other models that may still involve multiple payers but with the government having a much large role in financing and ensuring coverage (most European countries are not truly single payer, because they still allow some role for private insurance), ACP’s Health and Public Policy Committee will over the next several months begin examining different alternatives to advance universal coverage. As it does, I think there are several important questions that will need to be asked, particularly of single payer:

Will all Americans be required to get their coverage through a single, government-financed system (compulsory coverage), meaning that they would have to give up their employer-based or individual coverage? (If not, it really isn’t single payer; if so, will Americans react favorably to being compelled to get their coverage from the new program?)

Related, will Americans conclude that the coverage under the new program is better or worse than what they have now? Will deductibles and co-payments be higher or lower? Many single-payer advocates assume that deductibles will be lower under single payer than most Americans typically now pay, but that is in no way a given; one could imagine a single payer plan based on the ACA’s silver plans, for instance. Will the covered benefits be more or less generous? Will premiums — or if funded solely through taxes, the taxes they pay — cost them more or less compared to what they and their employers now contribute? Will taxes be progressive, meaning the wealthier pay more, or regressive, as is the case with Social Security taxes? Will they have limited networks of physicians and hospitals, like Medicare Advantage plans, or complete choice of physician and hospital, like traditional Medicare? Will they and their physicians be able to have access to any FDA-approved prescription drugs, or will there be a limited formulary to choose from?

Will the government contract with insurance companies to run the new system, like is the case today with Medicaid managed care, Medicare Advantage, and even Medicare Part B (administered by private insurance carriers) and Part D (pharmacy benefit managers)? It would be so typically American to create a single payer system, and then pay insurers to administer it.

How will costs be controlled? With global budgets, price controls, limits on capacity, and/or limiting access to care based on determinations of quality-adjusted life years like in other countries? How will physicians, hospitals, drug companies, and medical device manufacturers be paid?

This may seem like I am arguing against single payer; I’m not. The same questions might be asked of other approaches. And models that continue to rely on multiple payers, as is the case with the ACA, may never be as effective and efficient as a single payer system in ensuring that everyone has affordable coverage. Single payer almost certainly would have lower administrative costs and be more egalitarian.

Rather, what I am suggesting is that as ACP, and the country, considers different approaches to achieve universal coverage and access (not the same things), the questions that will need to be considered are far more complex than the snapshot (do you favor or oppose Medicare for All) questions asked in polls. How those questions are answered will likely determine if the public, and physicians, are truly ready to embrace single-payer healthcare.

Today’s question: What is your view of single payer (Medicare for All) healthcare?

Bob Doherty is senior vice president of Government Affairs and Public Policy at the American College of Physicians and author of the ACP Advocate Blog, where a version of this post originally appeared.

How exactly would a Single Payer System Work?

Whether you call it single payer or Medicare for all, the idea of a government-sponsored universal health care system, no matter how contentiously debated, continues to infiltrate the health care discussion.

The idea of universal health care reemerged during the 2016 presidential primary campaign as one of Bernie Sanders’ main platforms. In September, Sanders, I-Vermont, introduced a “Medicare for All” bill into the Senate with the full knowledge it would likely go nowhere — for now. In August, Rep. John Conyers, D-Michigan, reintroduced an expanded and improved Medicare for All bill in the House.

Both bills would convert the current many-payer system — insurance companies, states, the federal government — into a government-sponsored, tax-supported health care system. As in many other countries, every US citizen would receive health care, and it would essentially be paid for by one source, the government.

In addition to these national legislative moves, which may be more symbolic than realistic, at least three states have been working toward a single-payer system, and those efforts can also help consumers understand how such a plan would work.

The most recent effort toward that goal came from the Massachusetts Senate early in November. Already known for its progressive health care policies, the state approved a broad health care reform bill that seeks to lessen price disparities between hospitals, address rising drug costs and lower the number of patients readmitted for hospital care within 30 days of a discharge.

An important amendment to the bill called for a study of what it would cost Massachusetts to implement a government single-payer health care system. The amendment, introduced by Sen. Julian Cyr, a freshman Democrat, passed by a surprising 33 to 6 vote. “When you consider every other developed nation has single-payer health care, we’ve just got to look at this,” said Cyr.

In addition, he pointed out that Massachusetts is a state that spends one of the highest amounts per capita on health care. Thus, it only makes sense to find out if that money could be spent more equitably and efficiently with a single-payer system.

Other states grappling with this issue haven’t been entirely successful. Back in 2011, Vermont was the first state to implement a universal health care system of its own, in which all citizens were insured under Green Mountain Care. But by 2014, the state abandoned its efforts, citing unmanageable higher taxes.

Now Vermont is moving toward an alternative system that offers healthcare providers lump sum payments that are designed to reward doctors for keeping patients healthy instead of solely treating illness.

California, however, may have had the country’s most ambitious plan for single-payer health care. Such a plan passed the Senate in June but was then stalled in the summer because of the potential increase in taxes and the lack of analysis on how the bill would be funded. The debate continues.

When asked in a recent interview on NPR if state efforts are the shortest way to get to a single-payer system, Linda Blumberg, senior fellow in the Health Policy Center at the Urban Institute, said implementing single-payer health care state-by-state may be far more difficult than a federal system. “High-income states that have a lot of private health care spending … are most likely to be able to do something like this,” she said. But other states without resources can’t just shift costs from one side of the ledger to the other, she added.

In the meantime, pundits such as Drew Altman, president, and CEO of the Kaiser Family Foundation, have other warnings about a national single-payer system. Most people worry about the increase in taxes a single-payer system would cause, Altman has written. But also, most people don’t realize they would need to change providers under a single-payer system, something that has always been complicated and uncomfortable for consumers.

For the moment, how single-payer would work is anyone’s guess. It may take months or years to answer these questions. But the earlier consumers can be aware of the issues involved in a big change like this, the better.

Health insurers are “very mindful” of brewing single-payer battle

Sarah Kliff reviewed this battle and suggested that on June 1, Matt Eyles will take over as the chief executive of America’s Health Insurance Plans (AHIP), the lobbying group that represents insurers. Between a brewing single-payer debate and Obamacare’s unknown future, he has a lot on his plate stepping into this new role.

Eyles currently serves as AHIP’s vice president for public policy. Earlier this week, Dylan Scott and I had the chance to sit down with him to chat about what the health care landscape looks like from his vantage point. Today, I wanted to share some of the parts of our discussion that I found most interesting.

Insurers are “very mindful” of the Democrats’ single-payer discussion.

One question the author had for Eyles was how a group like his will weather the single-payer debate that is brewing within the Democratic Party. There are lots of plans floating around Capitol Hill right now that would have the government play a more significant role in running the health care system — and less of a role for the plans Eyles represents.

”We’re very mindful of that trend within that wing of the party that is focused on moving toward what might be a more single-payer type approach,” Eyles says.

He gave me a bit of what felt like a preview of the arguments you’ll hear from the industry as this debate continues. “We see obviously a lot of risk with that,” he says. “If you think of 180 million people who are covered by the employer market today, that would be enormously disruptive. If you think of all the people that are in Medicare, are they just going to be cut out of that, or what will happen to those in Medicaid?

”There are so many different elements that need to be addressed across so many different problems. We want to focus on making what we have work a lot better rather than fundamentally disrupt what is going on.”

One comment Eyles made that I found especially interesting was how he thought about the origins of this single-payer push — why it’s being discussed at this particular moment.

”We’re very mindful that this has been brewing for quite a while, and a lot of it has to do with costs within the system, and what has happened within the individual market,” he says. “That’s still such a small part of the system, but it feels like, from a bigger-picture debate perspective, we’ve spent so much time on the individual market. … I think it’s the instability that we’ve seen there that has fed into this.”

Obamacare repeal doesn’t seem to be on the table for 2018

There have been rumors here and there about a renewed push toward Obamacare repeal from congressional Republicans.

Eyles, for his part, doesn’t expect to see that happen this year.

”I think it’s very, very small [the odds of a repeal push]. There’s not a lot of hunger, I think, to address that right now,” he says. “Certainly there are, in some corners, people who will say we need to come back and do it. … But I think to come in at this point, as we head into the summer and as we start focusing on the midterms, I think it’s just … really hard to say that we want to come back to that big discussion right now.”

Insurers aren’t that jazzed about auto-enrollment ideas

There’s this one policy idea that has quietly been gaining bipartisan support among health care wonks: automatic enrollment. The idea is to sign up uninsured Americans for a bare-bones health insurance plan to get them into the market.

I thought insurers would be pretty into this idea, as it would mean more consumers enrolled in their products. But Eyles definitely had a measured reaction to the idea.

”It’s an attractive idea but very difficult to actually administer,” he says. “There’s a way it could be workable, but would people feel differently about auto-enrollment and would it create some sort of political challenge? People don’t like a mandate. Would they like auto-enrollment? I don’t know that we’ve actually gone out and asked people that question.”

Next, let’s look at the California plan and Medicare for all.

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Switzerland has a stunningly high rate of gun ownership — here’s why it doesn’t have mass shootings. And Does Gun Control Work?

22281931_1327071464089176_7883183286018314212_nAfter last week’s shootings, I have decided that this topic needs to be covered once again and therefore I put aside the original post that I wrote a few days ago on single-payer health care. Typical NRA response is that the Second Amendment is not the cause of the problem and they go on to cite the Swiss experience with the gun. I thought that it would be a good idea to examine the Swiss gun laws and see their experience. I for one am truly sickened by the continual killing of innocent people, especially children.

Hilary Brueck reviewed this topic nicely and stated that Switzerland hasn’t had a mass shooting since 2001, when a man stormed the local parliament in Zug, killing 14 people and then himself.

The country has about 2 million privately owned guns in a nation of 8.3 million people. In 2016, the country had 47 attempted homicides with firearms. The country’s overall murder rate is near zero.

The National Rifle Association often points to Switzerland to argue that more rules on gun ownership aren’t necessary. In 2016, the NRA said on its blog that the European country had one of the lowest murder rates in the world while still having millions of privately owned guns and a few hunting weapons that don’t even require a permit.

But the Swiss have some specific rules and regulations for gun use.

Business Insider took a look at the country’s past with guns to see why it has lower rates of gun violence than the US.

Switzerland is obsessed with getting shooting right. Every year, it holds a shooting contest for kids aged 13 to 17.

Zurich’s Knabenschiessen is a traditional annual festival that dates back to the 1600s.

Though the word roughly translates to “boys shooting” and the competition used to be only boys, teenage girls have been allowed in since 1991.

Kids in the country flock to the competition every September to compete in target shooting using Swiss army service rifles. They’re proud to show off how well they can shoot.

Having an armed citizenry helped keep the Swiss neutral for more than 200 years.

The Swiss stance is one of “armed neutrality.”

Switzerland hasn’t taken part in any international armed conflict since 1815, but some Swiss soldiers help with peacekeeping missions around the world.

Many Swiss see gun ownership as part of a patriotic duty to protect their homeland.

Most Swiss men are required to learn how to use a gun.

Unlike the US, Switzerland has mandatory military service for men.

All men between the ages of 18 and 34 deemed “fit for service” are given a pistol or a rifle and trained.

After they’ve finished their service, the men can typically buy and keep their service weapons, but they have to get a permit for them.

In recent years, the Swiss government has voted to reduce the size of the country’s armed forces.

Switzerland is a bit like a well-designed fort.

Switzerland’s borders are basically designed to blow up on command, with at least 3,000 demolition points on bridges, roads, rails, and tunnels around the landlocked European country.

John McPhee put it this way in his book”La Place de la Concorde Suisse”:

“Near the German border of Switzerland, every railroad and highway tunnel has been prepared to pinch shut explosively. Nearby mountains have been made so porous that whole divisions can fit inside them.”

Roughly a quarter of the gun-toting Swiss use their weapons for military or police duty.

In 2000, more than 25% of Swiss gun owners said they kept their weapon for military or police duty, while less than 5% of Americans said the same.

In addition to the militia’s arms, the country has about 2 million privately owned guns — a figure that has been plummeting over the past decade.

The Swiss government has estimated that about half of the privately owned guns in the country are former service rifles. But there are signs the Swiss gun-to-human ratio is dwindling.

In 2007, the Small Arms Survey found that Switzerland had the third-highest ratio of civilian firearms per 100 residents (46), outdone by only the US (89) and Yemen (55).

But it seems that figure has dropped over the past decade. It’s now estimated that there’s about one civilian gun for every four Swiss people.

Gun sellers follow strict licensing procedures.

Swiss authorities decide on a local level whether to give people gun permits. They also keep a log of everyone who owns a gun in their region, known as a canton, though hunting rifles and some semiautomatic long arms are exempt from the permit requirement.

But cantonal police don’t take their duty dolling out gun licenses lightly. They might consult a psychiatrist or talk with authorities in other cantons where a prospective gun buyer has lived before to vet the person.

Some lawmakers in US states including New York, New Jersey, Connecticut, and Rhode Island are considering a similar model.

Swiss laws are designed to prevent anyone who’s violent or incompetent from owning a gun.

People who’ve been convicted of a crime or have an alcohol or drug addiction aren’t allowed to buy guns in Switzerland.

The law also states that anyone who “expresses a violent or dangerous attitude” won’t be permitted to own a gun.

Gun owners who want to carry their weapon for “defensive purposes” also have to prove they can properly load, unload, and shoot their weapon and must pass a test to get a license.

Switzerland is also one of the richest, healthiest, and, by some measures, happiest countries in the world.

Switzerland was ranked fourth in the UN’s 2017 World Happiness Report.

The Swiss were applauded for high marks on “all the main factors found to support happiness: caring, freedom, generosity, honesty, health, income and good governance” the report’s authors wrote.

Meanwhile, according to the report, happiness has taken a dive over the past decade in the US.

“The reasons are declining social support and increased corruption,” the authors said.

But the Swiss aren’t perfect when it comes to guns.

Note this well, Switzerland still has one of the highest rates of gun violence in Europe, and most gun deaths in the country are suicides.

Around the world, stronger gun laws have been linked to fewer gun deaths. That has been the case in Switzerland too.

After hundreds of years of letting local cantons determine gun rules, Switzerland passed its first federal regulations on guns in 1999, after the country’s crime rate increased during the 1990s.

Since then, more provisions have been added to keep the country on par with EU gun laws, and gun deaths, including suicides, have continued to drop.

As of 2015, the Swiss estimated that only about 11% of citizens kept their military-issued gun at home.

Most people aren’t allowed to carry their guns around in Switzerland.

Concealed-carry permits are tough to get in Switzerland, and most people who aren’t security workers or police officers don’t have one.

“We have guns at home, but they are kept for peaceful purposes,” Martin Killias, a professor of criminology at Zurich University, told the BBC in 2013. “There is no point taking the gun out of your home in Switzerland because it is illegal to carry a gun in the street.”

That’s mostly true. Hunters and sports shooters are allowed to transport their guns only from their home to the firing range — they can’t just stop off for coffee with their rifle.

And guns cannot be loaded during transport to prevent them from accidentally firing in a place like Starbucks — something that has happened in the US at least twice.

Gun control really works — here’s the science to prove it

After the Shooting in Florida in March, Kevin Loria researched the data behind Gun Control and this discussion belongs front and center.

  • He stated that after last week’s mass shooting at a Florida high school, many in the US are wondering what sort of gun-control measures could prevent more gun violence.
  • Despite some restrictions on gun research, scientists have sought to evaluate whether specific policies effectively reduce gun deaths.
  • Policies that seem to reduce rates of gun violence include stricter background checks, limiting access to dangerous weapons, and prohibiting domestic abusers from owning weapons.

There are close to as many guns in the US as there are people. There may be more, or there may be fewer, depending on which study you look at — there’s no exact count, since there isn’t a national database of gun purchases or firearm owners, and federal law does not require a prospective gun owner to get a license or permit.

That’s one of the many obstacles researchers come up against when trying to evaluate why so many people die from guns in the US.

But as the country tries to figure what — if anything — can be done in the wake of yet last week’s mass shooting at Marjory Stoneman Douglas High School in Florida, it’s worth taking a look at the evidence we have on the effects of gun regulations.

Despite some congressional limitations on gun research, scientists have sought to evaluate the effects of gun-control legislation in the US and in other places around the world.

Here’s what the data shows.

Making it easier to carry concealed guns increases the number of gun homicides.

States that have so-called right-to-carry laws require them to issue concealed-carry permits to anyone who is allowed to own guns and meets the necessary conditions.

Many people have argued that right-to-carry laws deter crime because there would be more armed people around to stop a shooter. Though that idea was supported by a controversial 1997 analysis, recent and more thorough analyses have found the opposite effect.

One recent study found that such laws increased the rate of firearm homicides by 9% when homicide rates were compared state-by-state. That could be because confrontations were more likely to escalate to a shooting, or because there were more guns around that could be stolen, or some other factor.

A spike in gun purchases after the 2012 shooting at Sandy Hook Elementary School led to an increase in accidental gun deaths, especially among kids.

Research has found that when people are around more guns, they’re more likely to end up dying from accidental shootings.

After a 20-year-old man killed 20 children and six adults at Sandy Hook Elementary School in Newtown, Connecticut, in December 2012, calls for legislation aimed at limiting access to firearms resulted in what’s now become a predictable phenomenon after shootings: people bought lots of guns.

With more guns around in the following months, the rate of accidental deaths related to firearms rose sharply, especially among children, a recent study published in the journal Science found.

According to the researchers’ calculations, 40 adults and 20 children died as a result of those gun purchases.

Barring people convicted of domestic abuse from owning guns has a huge effect on the number of gun deaths.

The so-called Lautenberg amendment to the 1968 Gun Control Act disqualifies people with a misdemeanor conviction for domestic violence from buying or owning weapons.

Researchers found that gun murders of female intimate partners decreased by 17% as a result of the amendment.

Laws that call for longer sentences for gun crimes also seem to help a little.

Gun-robbery rates have gone down in states that have approved longer sentences for assault or robbery with a gun.

In the 1970s and 1980s, there were 30 “add-on” sentencing laws calling for additional prison time for people convicted of robbery or assault with a gun.

A 40-year-analysis found that gun-robbery rates dropped by about 5% in the years after the sentencing laws were enacted.

States with stricter gun-control laws that spend more money on education and mental-health care have fewer school shootings.

One recent study found that a smaller number of school shootings was linked with stricter background checks for weapon and ammunition purchases as well as more money spent on education and mental-health care.

Though school shootings are not the most common form of gun violence, a recent spike in these types of events in the US has prompted concern. There was an average of one school shooting a year from 1966 to 2008, but an average of one per week from 2013 to 2015, the study found.

The researchers said that based on available data, it was difficult to say which factor was most important in reducing shootings in schools.

However, mental-health treatment is unlikely to be solely responsible, as people with mental illness are more likely to be a victim of violence than a perpetrator. Though about 20% of Americans have some form of mental illness, people with a serious mental-health problem account for only about 3% of violent crime.

After Congress let a 1994 ban on assault weapons expire in 2004, gun massacre deaths skyrocketed.

Arguments about the exact meaning of “assault weapon” obfuscate an important point: When people in the US were allowed to start buying military-style firearms with high-capacity magazines, the number of people dying in gun massacres, defined as shootings in which at least six people die, shot up.

The number of gun massacres and massacre deaths decreased by 37% and 43% after the 1994 ban on assault weapons went into effect, one researcher found. After it expired in 2004, they shot up by 183% and 239%.

There’s debate over the effectiveness of this legislation in reducing overall gun crime or firearm deaths, as most gun deaths in the US are suicides and most murders involve a handgun.

But most of the deadliest mass shootings in recent US history have one big thing in common: They involved a military-style weapon with a high-capacity magazine.

Reducing access to guns could reduce the number of suicides in the US.

Some gun-rights advocates argue that if you limit access to guns, people will just find other ways to kill themselves or others.

But data indicates that this “substitution hypothesis” is not correct.

More than 60% of gun deaths in the US are suicides, and research has found that people are most likely to try to kill themselves shortly after they decide to do so. People who attempt to do that with a gun as opposed to another method are much more likely to kill themselves.

Data from other countries support restricting gun access, too. When the Israel Defense Forces stopped letting troops bring weapons home on the weekends, suicide rates dropped by 40%, one study found.

Historically, suicides dropped after the UK switched from coal-gas ovens — which used a gas that people inhaled to kill themselves — to another fuel. The country saw an increase in the use of other methods to attempt suicide, but it did not offset the drop in suicides by coal gas.

Weapons buyback programs have been successful in reducing mass shootings.

After at 1996 mass shooting left 35 people dead in Australia, the country said “enough.”

Leaders swiftly enacted gun-control legislation and set up a program for citizens to sell their weapons back to the government so they could be destroyed.

The initiative seems to have been successful; firearm suicides were found to have dropped by 65% and homicides by 59% over the next 10 years.

While Australia had seen 13 mass shootings — defined as five or more deaths — in the 18 years before the 1996 massacre, there have been none there since.

It’s possible that some of those declines were part of other trends. But either way, getting many guns off the streets and out of shops has been connected to big drops in gun deaths in Australia.

The US has a higher rate of gun violence than any other similarly wealthy country. Why not try to change that?

The US has far more mass shootings than just about any country in the world. Of countries with at least 10 million people, there are more mass shootings per capita in only Yemen, which has the second-highest per-capita rate of gun ownership (the US has the highest).

Even other countries with lots of guns, like Switzerland, have far fewer firearm deaths.

In Switzerland, as I pointed out, however, most people gain access to weapons because of military service that provides training; other prospective purchasers have to go through a multi-week background check. Authorities there also prohibit some citizens whom psychologists deem a potential risk from owning weapons.

The US is not inherently a more violent society. What sets the country apart is that it has a lot of guns that are still really easy to get. And the data that we have indicates that some gun-control measures — like banning some types of weapons, improving background checks, and putting more restrictions on weapon access — could help.

Analyzing that data and gathering more information could help leaders determine what sort of changes could help prevent another Parkland, Las Vegas, or Sandy Hook.

Or, as Mr. Loria previously stated, we could do nothing and wait for the same thing to happen again.

I think this has become too big a problem to ignore and blame the Second Amendment and the politicians while they argue and position themselves for the mid-term elections. We need an Executive Order from our leader, the President of the United States.  How many more are going to murder before we find a solution and hold our politicians’ feet to the fire?

I say no more because some of these children in the future may be relatives or children of friends and because these murders are all wrong and avoidable. Wake up America! If nothing is done I think that all candidates for the November election should declare their status on gun laws and those supported by the NRA so that we can vote out those that are not interested in solutions to this horrific “epidemic”!

Remember to visit the Sentia Publishing Company site to view our new book-The Search for Excellence in Clinical Practice-A Handbook on Clinical Process Improvement for Providers.

Repeal Failed but the GOP’s ACA Attack Continues; And Who is to Blame?

16831845_1116900401772951_1540332812797294563_nAs the midterm elections get closer and closer one wonders what the real effect of the GOP’s attack on Obamacare is and will be. Having failed in their effort to repeal the Affordable Care Act outright, the Trump administration and the Republican Congress are now waging a piecemeal assault on Barack Obama’s most significant domestic accomplishment. They have, of course, proclaimed its demise time and time again. But all that 2017 talk about how the law had failed or was starting to fail was just so much blather designed to justify their repeal efforts. However, the GOP’s multi-front assault on the ACA now appears to be having some effect. Last fall, the Trump administration ended the cost-sharing-reduction payments designed to help offset copayments and deductibles for low-to-moderate earners. That roiled the insurance markets. The administration also slashed the advertising and outreach efforts that encourage people to sign up for plans during the ACA enrollment period. The result is obvious and we are seeing presently, the fewer healthy enrollees, the higher the plan premiums.

Then, as part of its tax cut legislation passed on a party-line vote, the Republican Congress nixed the penalty for individuals who fail to buy health coverage, starting in 2019. Without a penalty, the requirement is toothless. (The mandate is hardly the only, or even principal, reason that people bought health care under the ACA; 90 percent of those polled earlier this spring by the Kaiser Family Foundation said they planned to buy insurance next year despite its de facto repeal.)

Meanwhile, the administration is finalizing regulations for short-term health insurance plans; because they needn’t meet ACA coverage requirements, those skimpier plans will be cheaper and thus may lure younger and healthier people from broader but more expensive ACA-compliant plans. And when it comes to having a sufficiently large risk pool to spread costs widely enough to keep premiums affordable, relatively small percentages can matter.

According to the Commonwealth Fund, another nonprofit that specializes in health care policy, the rate of working-age people without insurance has gone from 12.7 percent in 2016 to 15.5 percent today. That means about 4 million fewer people are covered. The Fund also found that 9 percent of those currently covered in the individual insurance markets say they won’t buy coverage next year. Larry Levitt, senior vice president for health reform at the Kaiser Family Foundation, notes that insurers are already citing the pool-depleting effects of impending short-term plans in order to justify price hikes for next year’s ACA-compliant coverage.

Meanwhile, congressional efforts to stabilize the insurance pools, either by re-establishing cost-sharing subsidies or helping states set up reinsurance plans to offset costs of the most expensive patients, have gone nowhere. Given the reflexive hostility Trump and congressional Republicans have for all things Obama, it’s hard to see these issues get worked out while Republicans retain control of both houses of Congress and the presidency.

But rising insurance premiums are likely to be an issue in the fall congressional campaigns. Voters who support the ACA need to hold the proper party responsible for the intentional slow-motion, beneath-the-radar screen effort to gum up the law’s works. And make no mistake, that’s the GOP.

Fact Check: ObamaCare, Not Trump, Is To Blame For the Rise In Uninsured In 2017

As some insurers angle for hefty premium hikes and concerns grow that more Americans will wind up uninsured, the federal health law is likely — once again — to play big in both parties’ strategies for the contentious 2018 election. Candidates are already honing talking points: Is the current dysfunction the result of the law or of GOP attempts to dismantle it?                                                                                                                The impact of changes to the law made by Republicans over the past year — modifications short of the “repeal and replace” they promised — is becoming clear. Initial announcements show health insurers in several states are seeking big increases in premiums for next year for people who buy their own insurance. That is renewing concerns about the potential for “bare” counties that will have no insurer selling coverage and hints that the number of uninsured Americans could again be on the rise.                                                                                                                                      “It’s sort of Insurance 101,” said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. Insurers “are facing a smaller and sicker risk pool as a result of both Trump administration and congressional action, and that means higher premiums,” she said.                                                                                                                           “A number of policy changes definitely impacted rates,” said Jeanette Thornton, a senior vice president for the trade group America’s Health Insurance Plans.

Among those changes is the elimination of the tax penalty for those who forgo insurance, included in December’s tax overhaul, and President Donald Trump’s cancellation of federal payments to insurers who provide discounts to some low-income customers.

Democrats say they will make sure voters know that Republicans deserve the blame. “Senate Democrats will be on the floor of the U.S. Senate every week talking to the American public about these rate increases and make sure they know about this campaign of sabotage,” said Sen. Chris Murphy (D-Conn.).

Republicans, however, say Democrats are at fault for blocking bipartisan legislation, which might not even have had enough GOP votes to pass. The effort sought to stabilize the Affordable Care Act’s marketplace through measures such as setting up reinsurance funding to help keep an individual insurer from facing devastating losses and guarantees for insurers to help pay their share of the out-of-pocket expenses for low-income customers.

“Democrats could have worked with us to lower premiums by as much as 40 percent but instead choose to cling to an unworkable law,” Sen. Lamar Alexander (R-Tenn.), chairman of the Health, Education, Labor, and Pensions Committee, said on the Senate floor Tuesday. “So if you have an insurance premium that is going up 40 percent next year, on top of an over 105 percent increase since 2013, you can thank a Democrat.”

The heightened political rhetoric comes after the first two states unveiled insurance company premium requests for policies on the individual market for 2019. These are not final rates, but they give an idea of what premiums for next year might be for people who don’t get insurance through their job or the government and buy their own coverage on the individual market.

That market included about 15.6 million people, both inside and outside the ACA insurance marketplaces, in the final quarter of 2017, according to the consulting firm Mark Farrah Associates.

State deadlines for filing next year’s rates run from May through July. Once insurers have made their initial premium requests, state regulators negotiate final rates before open enrollment begins in the fall. In Virginia and Maryland, insurers are seeking a wide range of significant increases, from about 15 percent for some plans up to more than 91 percent for one Maryland PPO.

Analysts are not surprised by the requested rate hikes and predict more to come. The first requests in past years have often moderated before being finalized, but this year’s political uncertainties could play a bigger role.

The Congressional Budget Office estimated that the elimination of the tax penalty for people without health insurance, which was included in last December’s tax law, by itself, would result in premium increases of around 10 percent per year. That’s because, without the prospect of a fine, healthier people would be more likely to forgo coverage, making the pool of people who continue to buy insurance sicker and more expensive for insurers.

Separately, Trump roiled the individual insurance market by canceling federal “cost-sharing reduction” payments for moderate-income insurance buyers.

The administration is also trying to extend the availability of short-term insurance plans, which frequently offer only bare-bones coverage, and “association health plans,” which can provide cheaper alternatives for those who are considered healthy. But such plans don’t include all the benefits of ACA plans. Analysts say both types of options would draw even more healthy people out of ACA plans..

The insurance industry acknowledges the actions have boosted next year’s rates. Chet Burrell, the CEO of CareFirst Blue Cross Blue Shield, which serves both Maryland and Virginia markets, told The Washington Post that “continuing actions on the part of the administration to systematically undermine the market … make it almost impossible to carry out the mission.”

AHIP’s Thornton cautioned that it is still early in the process and many things could change. Maryland, for example, has passed legislation to create a “reinsurance” pool that could substantially lower premiums for next year. It still requires formal permission from the Trump administration, however.

And while Congress could still help ameliorate next year’s increases, that appears increasingly unlikely. In a sign that the bipartisanship that characterized the effort last fall has broken down, Alexander said in his Senate speech that he plans to move on to other health issues, including ways to address the opioid crisis.

“Given Democrats’ attitude, I know of nothing the Republicans and Democrats can agree on to stabilize the individual health insurance market,” he said. Sen. Susan Collins (R-Maine), who was promised a vote on her bipartisan bill by Senate Majority Leader Mitch McConnell (R-Ky.) that never materialized, now blames Democrats. In a column she wrote for her home-state Portland Press-Herald late last month, Collins said Democrats refused to accept additional restrictions on abortion funding. “Although federal funding has not been used to pay for elective abortions for decades, some Democrats reopened the long-settled debate on the Hyde Amendment in order to block these much-needed insurance reforms,” she wrote.

Democrats, however, say it was Republicans who reopened the abortion debate by demanding language to create new, permanent restrictions that could eliminate abortion even in private insurance plans. Even so, some say they still hope consensus may be reached.

“Patients and families deserve better than the higher costs and dysfunction they are getting under Trumpcare by sabotage,” Sen. Patty Murray (D-Wash.) told reporters Tuesday. “And as soon as Republicans are ready to work again in a bipartisan way and act actually to lower families’ costs, Democrats will be at the table.”

Health Care: The ranks of the uninsured climbed last year. So, naturally, President Trump is taking the blame because of his attempts to repeal ObamaCare. The fault, however, lies not with Trump, but with ObamaCare itself.

A new Gallup report shows that the ranks of the uninsured climbed from 10.9% in Q4 2016 to 12.2% by Q4 2017. At first blush, it makes sense to point to Trump, given that this increase came during his first year in office.

As Huffington Post put it: “Trump’s sabotage of the Affordable Care Act appears to be working.”

But a closer look at the data and a review of recent history shows that Trump had nothing to do with the increase in the uninsured last year. The factors that did were baked in the cake in the summer of 2016 — when President Obama was sitting in the White House and Hillary Clinton was busy measuring the Oval Office drapes.

Let’s review the facts.

Insurers had to announce their proposed 2017 premiums in mid-2016, which then got reviewed by state regulators. The result was a massive 25% increase in average ObamaCare premiums nationwide. In Pennsylvania, premiums shot up 33%. In Illinois, they climbed 44% and in Oklahoma premiums climbed by 76%!

That was after two previous years of historic rate hikes. And insurance companies fleeing ObamaCare markets marked each year.

At the time, Democrats and the press dismissed skyrocketing ObamaCare premiums, saying that they really didn’t matter since most people enroll in an ObamaCare exchange get generous subsidies, which means their actual premiums would remain unchanged.

But that overlooked the millions who buy coverage in the individual market but who aren’t eligible for any ObamaCare subsidies. Thanks to ObamaCare’s mandates and regulations, basic insurance was fast becoming unaffordable.

Trump and the GOP had nothing to do with these failures. The changes they did enact had only a modest impact on 2018 premiums.

What’s more, open enrollment in the exchange for 2017 closed on January 31, 2017 — one week after Trump took the oath of office. So the fact that enrollment in the exchanges dropped in 2017 also had nothing to do with Trump. Enrollment in the ObamaCare exchanges came in well below forecasts every year since they opened in 2014.

The combination of declining ObamaCare enrollment and skyrocketing premiums ended up pushing more people out of the insurance market in 2017.

What’s more, Gallup’s survey found that the uninsured rate had essentially bottomed out in early 2015, when it hit 11.4%. By the end of that year, it was back up to 11.9%. It dipped down to 10.9% during the last half of 2016, before resuming its upward trend in 2017.

Even if Hillary Clinton had been president, the ranks of the uninsured would have started climbing again last year as ObamaCare’s years of massive rate hikes priced more and more people out of the insurance market.

In fact, Seema Verma, the administrator of the Centers for Medicare & Medicaid Services, lashed out during a recent meeting at critics of the Trump administration’s changes to the Medicaid program and the Affordable Care Act (ACA), also known as Obamacare.

“I take exception to those out there who have made claims that we have tried to sabotage the healthcare of the American people, particularly when it comes to the healthcare exchanges,” she said here at the World Health Care Congress. “Obamacare was failing long before Donald Trump became president and I became CMS administrator.”

The reality, said Verma, is that health insurers have fled the exchange markets “after losing millions of dollars,” adding that with only one insurer offering policies, “half the counties in America, and 10 states in our country, don’t even have a choice of a health insurer.”

Verma went on to detail some of the problems with the ACA’s insurance marketplaces. “We were promised that Obamacare would lower premiums by up to $2,500 for a typical family, but the reality is that premiums more than doubled since its inception,” she said, noting that in states such as Arizona, premiums rose by an average of 190%, and in Oklahoma, they rose 201%.

“These are plain, clear facts,” said Verma. “The stark reality was that when we came into the market, we were faced with health exchanges that were pricing Americans out of the system … and punishing them with penalties for being unable to afford government-mandated coverage.” In December, Congress repealed the individual mandate, which required all Americans to acquire health insurance or pay a penalty.

Supporters of the ACA have blamed Republicans in Congress for the exchanges’ increasing premiums, citing Congress’s failure to continue funding the “risk corridors” that would have helped health insurers pay for higher-cost patients; providing that funding, they say, would have encouraged more insurers to offer policies on the exchanges and made the marketplaces more competitive. They also are critical of the Trump administration’s canceling of the cost-sharing reduction payments the federal government had been making to help lower-income enrollees with their copays and deductibles.

Verma said the administration would “refuse to stand idly by while Americans are suffering,” so officials are “cleaning up regulations to provide states with more flexibility … to create more choice and competition to help drive down costs.”

“We have also proposed to expand the use of short-term insurance to now be used as an affordable option for people caught between individual market premiums they can’t afford and no coverage at all,” she said. These short-term plans are not required to include all of the benefits mandated by the ACA and can, therefore, be sold more cheaply than plans on the exchanges.

In addition, “it’s impossible to address Obamacare without addressing the strain it put on the Medicaid program,” Verma said. For patients who are severely disabled, and for their families, “Medicaid is more than a safety net — it’s a lifeline, one that needs to be preserved and protected for those who truly need it.”

However, the ACA’s Medicaid expansion has resulted in the addition of able-bodied adults to the Medicaid rolls, and with increased reimbursement rates for this population. “That stretches the safety net for fragile populations who are still on the waiting lists for [services like] home care,” argued Verma, and puts millions of people “into a program that wasn’t designed to meet their needs.”

The Obama administration was resistant to efforts aimed at allowing states to tailor their programs to better serve this population, said Verma. The Trump administration is remedying this problem by allowing states to require able-bodied Medicaid recipients to either work, take classes, or volunteer — a mandate known as “community engagement.” Three waivers for community engagement have already been approved, she said, “and we have 11 more we should be making decisions on pretty soon.”

Currently, eight in 10 adults who are receiving Medicaid are in families in which at least one family member is working, according to a report from the Kaiser Family Foundation. In total, 60% of Medicaid recipients are working themselves; of those who aren’t working, most cite impediments such as a disability, illness, or caregiving responsibilities as the reason, the report found.

“I hope it’s clear to everyone in this room that through all our actions we start with the goal of putting patients first,” Verma concluded. “We need to work together to create a healthcare system that pays for value, not merely volume.”

Do I think that the Democrats and the GOP will work together? Not a chance. We are dealing with politicians who are still confused and angered. Bernie and most of the Democrats are looking at some type of single-payer health care system and point to the Europeans and Canada as the models for a health care system. I have already pointed some of the frustrations in the European systems and the way that they pay for their system and some of the limitations. So, what would our model look like and will it work in a free-market society?

I promise that next week I will start putting together the single-payer option; what it is, what it looks like and will it work?

And most important-Happy Mother’s Day to all the Most Important People out there! Thank you for all that you have done for all of us and thank you for your continuous support and love!

Also, remember to check out our new book The Search for Excellence in Clinical Practice: A Handbook on Clinical Process Improvement for Providers, Sentia Publishing Company.

New Disease Treatments! Consideration of Cost and Will We be Able to Afford It?

13077059_884816618314665_778767240526006929_nAs a continuation regarding my experience in a discussion of a single-payer healthcare system in other countries that I visited the CBS 60 minutes story last Sunday discussing the CRISPR discovery struck me. Why do I mention this? Because in speaking with various of my sailing “buddies” from Europe I found out that many don’t have choices of some of the newer more effective treatment therapies including chemotherapy drugs and immunotherapy due to the cost. It is difficult to understand, especially when one listens to the CBS 60 Minute’s episode narrated by commentator Bill Whitaker.

He reviewed a new tool could be the key to treating genetic diseases and may be the most consequential discovery in biomedicine this century

It’s challenging to tell a story about something that’s invisible to the naked eye and tricky to explain. But it’s one we undertook because rarely does a discovery come along that could revolutionize medicine.  It’s called CRISPR and it stands for Clustered Regularly Interspaced Short Palindromic Repeats. CRISPR sounds more like a refrigerator compartment than a gene-editing tool, but it’s giving scientists power they could only imagine before – to easily edit DNA – allowing them to reprogram the genetic code of living things. That’s opening up the possibility of curing genetic diseases. Some researchers are even using it to try to prevent disease entirely by correcting defective genes in human embryos. We wanted to see for ourselves, so we went to meet a scientist at the center of the CRISPR craze.

Bill interviewed Dr. Feng Zhang a young tenured professor at MIT and one of the brains behind CRISPR, he figured out a way to override human genetic instructions using CRISPR.

For the last seven years, Zhang has been working on CRISPR at the Broad Institute in Cambridge, Massachusetts. It’s a research mecca brimming with some of the brightest scientific minds from Harvard and MIT on a mission to fight disease. CRISPR is making medical research faster, cheaper, and easier. Zhang’s colleagues predict it will help them tackle diseases like cancer and Alzheimer’s.  

Bill Whitaker asked how many diseases are we talking about that this could be used to treat?

Feng Zhang stated that there are about 6,000 or more diseases that are caused by faulty genes. The hope is that we will be able to address most if not all of them.

Eric Lander, Director of the Broad Institute, commented that he thought that CRISPR, it’s fair to say, is perhaps the most surprising discovery and maybe most consequential discovery in this century so far.

To understand exactly what CRISPR is, we went to Eric Lander for a quick science lesson. He’s director of the Broad and Zhang’s mentor. He is best known for being a leader of the Human Genome Project that mapped out our entire DNA, which is like a recurring sequence of letters.

Eric Lander stated that during the Human Genome Project, we could read out the entire human DNA, and then, in the years afterward, find the misspellings that caused human diseases. But we had no way to think about how to fix ’em. And then, pretty much on schedule, this mind-blowing discovery that bacteria have a way to fix those misspellings, appears.

Eric Lander went on to clarify that this comes from bacteria.  Bacteria, you know, they have a problem. And they came up with a really clever solution. When they get infected by viruses, they keep a little bit of DNA, and they use it as a reminder. And they have this system called CRISPR that grabs those reminders and searches around and says, “If I ever see that again, I am gonna cut it.”

Zhang used that same bacterial system to edit DNA in human cells. Our DNA is made up of chemical bases abbreviated by the letters A, T, C, and G. As you can see in this animation from Zhang’s lab at MIT, a mutation that causes disease reads like a typo in those genetic instructions. If scientists can identify the typo, they can program CRISPR to find it and try to correct it. Dr. Zhang went on to further describe how the CRISPR will go in, and out of billions and billions of letters on your DNA, find the exact ones that have been programmed and cut it to edit it, snip out the bad part and add something to give the cell a new piece of DNA that carries the sequence you want to be incorporated into the genome.

More was discussed such as the multiple uses and studies and the potential for curing diseases and preventing disease. Mr. Lander states that he didn’t think that we’re close to ready to use it to go edit the human population. He thought that we’ve gotta use it for medicine for a while. I think those are the urgent questions. That’s what people want right now, is they want cures for disease.

Urgent questions are being answered as we speak with small clinical trials, the first in the U.S. using CRISPR to target certain types of cancer, which is now enrolling patients. We all believe that this is gonna have a real effect over the course of the next decade and couple of decades. And for the next generation, others and I believe that it’ll be transformative. Consider these other reports.

Last year, the Food and Drug Administration approved the first cellular immunotherapies to treat cancer and that CRISPR can enhance cancer immunotherapy. These therapies involve collecting a patient’s own immune cells — called T cells — and supercharging them to home in on and attack specific blood cancers, such as hard-to-treat acute lymphoblastic leukemia and non-Hodgkin lymphoma.

But so far, these T cell immunotherapies — called CAR-T cells — can’t be used if the T cells themselves are cancerous. Even though supercharged T cells can kill cancerous T cells, they also can kill each other because they resemble one another so closely.

Scientists at Washington University School of Medicine in St. Louis now have used the gene-editing technology CRISPR to engineer human T cells that can attack human T cell cancers without succumbing to friendly fire.

The study evaluating the approach in mice appears online in the journal Leukemia. The researchers also engineered the T cells so any donor’s T cells could be used. A “matched” donor with similar immunity is not required and neither is the patient’s own T cells, which is important for the obvious reason: Many of the patient’s own T cells are cancerous.

“Cancerous T cells and healthy T cells have exactly the same protein — CD7 — on their surfaces,” said senior author John F. DiPersio, MD, Ph.D., the Virginia E. and Sam J. Golman Professor of Medicine in Oncology.

DiPersio’s team first generated a novel CAR-T strategy targeting CD7, allowing for the targeting and killing of all cells with CD7 on the surface.

“But if we program T cells to target CD7, they would attack the cancerous cells and each other, thus undermining this approach,” DiPersio said. “To prevent this T cell fratricide, we used CRISPR/Cas9 gene editing to remove CD7 from healthy T cells, so they no longer carry the target.”

DiPersio, who treats patients at Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital, and his colleagues also used CRISPR gene editing to simultaneously eliminate the therapeutic T cells’ ability to see healthy tissues as foreign.

To do this, they genetically deleted the T cell receptor alpha (TCRa) subunit. This way, T cells from any normal donor can be used without risk of life-threatening toxicities such as graft-versus-host disease, in which T cells attack the organs of the recipient, sometimes resulting in death. This new approach also may have broad implications for the CAR-T field, allowing for use of therapeutic T cells from any healthy donor. Healthy T cells could be collected in advance and stored for any patient with a relapsed T cell malignancy.

“We have genetically modified these T cells so they are unable to cause graft-versus-host disease but can still kill cancerous cells,” said first author Matthew L. Cooper, Ph.D., an instructor in medicine. “One additional benefit of this approach is that a patient could receive this therapy much more quickly after diagnosis. We wouldn’t need to harvest the patient’s own T cells and then modify them, which takes time. We also wouldn’t have to find a matched donor. We could collect T cells from any healthy donor and have the gene-edited T cells ready in advance, a strategy termed ‘off-the-shelf’ CAR-T cell therapy.”

The researchers demonstrated that this approach is effective in mice with T cell acute lymphoblastic leukemia (T-ALL) taken from patients. Mice treated with the gene-edited T cells targeted to CD7 survived 65 days, compared with 31 days in a comparison group that received engineered T cells targeting a different protein. The researchers also found no evidence of graft-versus-host disease in mice that received T cells lacking the molecular machinery that sees healthy tissues as foreign. They also found that the therapeutic T cells remained in the blood for at least six weeks after the initial injection, suggesting it could ramp up again to kill cancerous T cells if they return.

“T cell malignancies represent a class of devastating blood cancers with high rates of relapse and death in children and adults with the disease,” Cooper said. “In an effort to develop the first clinically viable targeted therapy for this type of cancer, we are scaling up the manufacturing of our gene-edited CAR-T cells for clinical trials, which we hope to complete at Siteman Cancer Center.”

And another announcement about a new application of CRISPR in the report that researchers from the Wellcome Trust Sanger Institute have reported that a new target for the treatment of leukemia has been found. 

A new drug target for acute myeloid leukemia (AML) has been identified that could open new avenues for the development of new treatments against the deadly disease. Researchers from the Wellcome Trust Sanger Institute have published research in Nature that shows the inhibition of the METTL3 gene specifically kills human and mouse leukemia cells. The gene is responsible for the survival of cancer cells but not healthy cells, meaning it could be targeted safely.

AML is an aggressive blood cancer that can affect people of all ages. It develops in the bone marrow, overwhelming the healthy cells that reside there, which impairs the immune system leading to serious infections and bleeding. The disease is rare, with just 3,100 cases per year in the UK, but it develops quickly making it difficult to catch. Current treatments used for AML include chemotherapy and bone marrow transplants, but these save fewer than one in three patients.

The researchers used CRISPR-Cas9 gene-editing technology to screen cancer cells for potential therapeutic targets. They created a leukemia mouse model containing mutations that could be targeted in human AML cells. Each gene was tested to decipher its role in the disease. Forty-six genes were identified that could modify RNA, including METTL3, which had a particularly strong effect.

The group found that the METTL3 protein binds 126 genes, many of which support AML cell survival, and then modifies the RNA that is subsequently produced, increasing their translation. When this modification was blocked, essential proteins for the survival of the leukemia were no longer produced.

George Vassiliou, the joint project leader and consultant hematologist at Cambridge University Hospitals NHS Trust, commented on the implications of the study’s findings: “Our treatments have changed little for decades and outcomes remain poor… We believed that we had to think differently and look in new places for ways to treat the disease… We hope that this discovery will lead to more effective treatments that will improve the survival and the quality of life of patients with AML.”

One way to boost survival could be to improve the treatments that we already have. This is what Italian biotech, MolMed, has done, developing Zalmoxis, which ups the safety of bone marrow transplants. A major area of hype in the blood cancers field is CAR-T, and Novartis’Kymriah was the first to be approved by the FDA after demonstrating efficacy against B cell leukemia, while Celyad has developed a Natural Killer Receptor T cell platform, which cleared a patient of cancer during the early stages of a clinical trial.

Consider the announcement that the F.D.A. Panel Recommended the Approval for a Gene-Altering Leukemia Treatment.

Denise Grady last year reported on a set of cases that started me on my investigation into CRISPR where a Food and Drug Administration panel opened a new era in medicine on Wednesday, unanimously recommending that the agency approve the first-ever treatment that genetically alters a patient’s own cells to fight cancer, transforming them into what scientists call “a living drug” that powerfully bolsters the immune system to shut down the disease.

If the F.D.A. accepts the recommendation, which is likely, the treatment will be the first gene therapy ever to reach the market in the United States. Others are expected: Researchers and drug companies have been engaged in intense competition for decades to reach this milestone. Novartis is now poised to be the first. Its treatment is for a type of leukemia, and it is working on similar types of treatments in hundreds of patients for another form of the disease, as well as multiple myeloma and an aggressive brain tumor.

To use the technique, a separate treatment must be created for each patient — their cells removed at an approved medical center, frozen, shipped to a Novartis plant for thawing and processing, frozen again and shipped back to the treatment center.

A single dose of the resulting product has brought long remissions, and possibly cures, to scores of patients in studies who were facing death because every other treatment had failed. The panel recommended approving the treatment for B-cell acute lymphoblastic leukemia that has resisted treatment or relapsed, in children and young adults aged 3 to 25.

One of those patients, Emily Whitehead, now 12 and the first child is ever given the altered cells, was at the meeting of the panel with her parents to advocate for approval of the drug that saved her life. In 2012, as a 6-year-old, she was treated in a study at the Children’s Hospital of Philadelphia. Severe side effects — raging fever, crashing blood pressure, and lung congestion — nearly killed her. But she emerged cancer free and has remained so.

“We believe that when this treatment is approved it will save thousands of children’s lives around the world,” Emily’s father, Tom Whitehead, told the panel. “I hope that someday all of you on the advisory committee can tell your families for generations that you were part of the process that ended the use of toxic treatments like chemotherapy and radiation as standard treatment, and turned blood cancers into a treatable disease that even after relapse most people survive.”

The main evidence that Novartis presented to the F.D.A. came from a study of 63 patients who received the treatment from April 2015 to August 2016. Fifty-two of them, or 82.5 percent, went into remission — a high rate for such a severe disease. Eleven others died.

“It’s a new world, an exciting therapy,” said Dr. Gwen Nichols, the chief medical officer of the Leukemia and Lymphoma Society, which paid for some of the research that led to the treatment.

The next step, she said, will be to determine “what we can combine it with and is there a way to use it in the future to treat patients with less disease so that the immune system is in better shape and really able to fight.” She added, “This is the beginning of something big.”

At the meeting, the panel of experts did not question the lifesaving potential of the treatment in hopeless cases. But they raised concerns about potentially life-threatening side effects — short-term worries about acute reactions like those Emily experienced, and longer-term worries about whether the infused cells could, years later, cause secondary cancers or other problems.

Oncologists have learned how to treat the acute reactions, and so far, no long-term problems have been detected, but not enough time has passed to rule them out. Patients who receive the treatment will be entered in a registry and tracked for 15 years.

Treatments involving live cells, known as “biologics” are generally far more difficult to manufacture than standard drugs, and the panelists also expressed concerns about whether Novartis would be able to produce consistent treatments and maintain quality control as it scaled up its operation.

Another parent at the meeting, Don McMahon, described his son Connor’s grueling 12 years with severe and relapsing leukemia, which started when he was 3. Mr. McMahon displayed painful photographs of Connor, bald and intubated during treatment. And he added that chemotherapy had left his son infertile.

A year ago, the family was preparing for a bone marrow transplant when they learned about the cell treatment, which Connor then underwent at Duke University. He has since returned to playing hockey. Compared with standard treatment, which required dozens of spinal taps and painful bone marrow tests, the T-cell treatment was far easier to tolerate, Mr. McMahon said, and he urged the panel to vote for approval.

A third parent, Amy Kappen, also recommended approval, even though her daughter, Sophia, 5, had died despite receiving the cell treatment. But it did relieve her symptoms and give her a few extra months. Sophia’s disease was far advanced, and Ms. Kappen thought that if the treatment could have been given sooner, Sophia might have survived.

The treatment was developed by researchers at the University of Pennsylvania Children’s Hospital and licensed to Novartis. The use will not be widespread at first because the disease is not common. It affects only 5,000 people a year, about 60 percent of them children and young adults. Most children are cured with standard treatments, but in 15 percent of cases — like Emily and Connor’s — the disease does not respond, or it relapses.

Although the figure may seem high, people with cancer often endure years of expensive treatment and repeat hospital stays that can ultimately cost even more.

Because the treatment is complex and patients need expert care to manage the side effects, Novartis will initially limit its use to 30 or 35 medical centers where employees will be trained and approved to administer it, the company said.

As to whether the treatment, known as CTL019 or tisagenlecleucel (pronounced tis-a-gen-LEK-loo-sell), will be available in other countries, Ms. Masow said by email: “Should CTL019 receive approval in the U.S., it will be the decision of the centers whether to receive international patients. We are working on bringing CTL019 to other countries around the world.” She added that the company would file for approvals in the European Union later this year.

By late November 2016, 11 of the 52 patients in the study who went into remission relapsed. Twenty-nine were still in remission. Eleven others had further treatments, like bone marrow transplants. One patient was not available for assessment. Three who had relapses died, and one who did not relapse died from a new treatment given during remission. The median duration of remission is not known because it has not been reached: Some patients were still well when last checked.

Researchers are still debating about which patients can safely forgo further treatment, and which might need a bone marrow treatment to give the best chance of a cure.

The treatment requires removing millions of a patient’s T-cells — a type of white blood cell often called soldiers of the immune system — and genetically engineering them to kill cancer cells. The technique employs a disabled form of H.I.V., the virus that causes AIDS, to carry new genetic material into the T-cells to reprogram them. The process turbocharges the T-cells to attack B-cells, a normal part of the immune system that turns malignant in leukemia. The T-cells home in on a protein called CD-19 that is found on the surface of most B-cells.

The altered T-cells are then dripped back into the patient’s veins, where they multiply and start fighting cancer.

Dr. Carl H. June, a leader of the University of Pennsylvania team that developed the treatment, calls the turbocharged cells “serial killers.” A single one can destroy up to 100,000 cancer cells.

Because the treatment destroys not only leukemic B-cells but also healthy ones, which help fight germs, patients need treatment to protect them from infection. So every few months they receive infusions of immune globulins.

In studies, the process of re-engineering T-cells for treatment sometimes took four months, and some patients were so sick that they died before their cells came back. At the meeting, Novartis said the turnaround time was now down to 22 days. The company also described bar-coding and other procedures used to keep from mixing up samples once the treatment is conducted on a bigger scale.

The Food and Drug Administration, ushering in a new era of cancer treatment, has approved the revolutionary cancer therapy that uses genetically engineered immune cells. The FDA calls the treatment, made by Novartis, the “first gene therapy” in the U.S. The therapy is designed to treat an often-lethal type of blood and bone marrow cancer that affects children and young adults. Known as a CAR-T therapy, the approach has shown remarkable results in patients. The one-time treatment will cost $475,000, but Novartis says there will be no charge if a patient doesn’t respond to the therapy within a month.

Michael Werner, a lawyer and expert on gene and cell technologies and regulation, and a partner at Holland and Knight in Washington said that results so far proved that T-cell treatment works. “The fact that it can be done means more people will go into the field and more companies will start developing these products.” He added, “I think we’re in for really exciting times.”

The FDA defines gene therapy as a medicine that “introduces genetic material into a person’s DNA to replace faulty or missing genetic material” to treat a disease or medical condition. This is the first such therapy to be available in the U.S., according to the FDA. Two gene therapies for rare, inherited diseases have already been approved in Europe.

This is the future! But will a new single-payer health care system allow the newer techniques to be used to treat patients? Consider the European experience and wait to see what is on the horizon for the CRISPR technology. I for one am excited!!