Category Archives: Bernie Sanders

Amid a public health crisis, Americans’ views on health care policy haven’t changed, survey says; And What will Biden do to Healthcare?

Rebecca Morin reported that over the past several weeks, the majority of Americans have had to alter their lives due to the coronavirus pandemic.

Face masks have become part of most people’s daily wardrobe. Social distancing restrictions are still being ordered in many of the states. And millions have lost their jobs, as well as their health insurance.

Now that Joe Biden has been declared the next president, we need to consider what I have been saying, that if we have learned nothing else, a form of universal affordable health care is a necessity.

Despite the changes, the majority of Americans’ long-held beliefs surrounding health care haven’t changed, according to a new survey.

About half of Americans – 51% – said they agree that government-run health insurance should be provided to all Americans, according to a survey from the Democracy Fund + UCLA Nationscape Project. That’s just a 1 percentage point less than in February.

“The events themselves have not driven people to some radical new conclusions about whether the government should be providing certain types of services,” said Robert Griffin, research director for the Democracy Fund Voter Study Group. “These are not attitudes that have suddenly changed overnight in response to political events that have occurred.”

The new survey comes amid a public health crisis, where most of the United States was closed down for more than a month to help limit the spread of the coronavirus. Over the past couple of months, more than 36 million people have sought jobless benefits. The Labor Department said Thursday that about 3 million Americans filed initial unemployment benefit claims last week.

Are lockdowns being relaxed in my state? Here’s how America is reopening amid the coronavirus pandemic.

Half the states across the nation have also begun loosening social distancing restrictions over the past several weeks. Experts show that the curve showing the rate of new cases may be flattening, but they are estimating at least 60,000 more people will die from coronavirus by August.

The Democracy Fund + UCLA Nationscape Project is a large-scale study of the American electorate. Throughout the 2020 election cycle, the researchers aim to conduct 500,000 interviews about policies and the presidential candidates. This survey was conducted between April 29 and May 6, with 6,366 Americans surveyed. There is a margin of error of plus or minus 2.1 percentage points.

Another policy view that hasn’t seen a lot of change? Subsidizing health insurance for lower-income people who are not receiving Medicare or Medicaid.

Sixty-three percent of Americans said that they agree with that – a 2 percentage-point drop from February.

However, a majority of Americans believe there should be more short-term aid for those in need during the coronavirus pandemic, according to an analysis on Nationscape Insights, a project of Democracy Fund, UCLA, and USA TODAY.

Pandemic protocols: Safety measures vary from the White House to the Supreme Court

Griffin noted that during the pandemic, Americans are “much more flexible in terms of thinking about what types of policies they might consider,” even if their attitudes about basic policies haven’t shifted much.

Seventy-nine percent of Americans strongly or somewhat support increasing spending on health insurance and food aid for the poor during the coronavirus pandemic. When broken down between Democrats and Republicans, the majority of both also support to increase spending.

The coronavirus pandemic also hasn’t affected long-standing political norms for Republicans and Democrats, according to the survey.

Sixty-nine percent of Democrats said they agree with providing government-run health insurance to all Americans. In February, that number was at 68%. In terms of agreeing on subsidizing health insurance for lower income people who are not receiving Medicare or Medicaid, Democrats are at 78%, a 2-percentage point drop from February.

For Republicans, the numbers don’t change drastically either. Thirty percent of Republicans agree to providing government-run health insurance to all Americans, compared with 33% in February. There was also a three-point drop from February to May among Republicans when asked if they agree on subsidizing health insurance for lower income people who are not receiving Medicare or Medicaid, from 53% to 50%.

Biden Wants to Lower Medicare Eligibility Age To 60, But Hospitals Push Back

Phil Galewitz reported that President-elect Joe Biden’s plan to lower the eligibility age for Medicare is popular among voters but is expected to face strong opposition on Capitol Hill.

Of his many plans to expand insurance coverage, President-elect Joe Biden’s simplest strategy is lowering the eligibility age for Medicare from 65 to 60. Is this the first step to Medicare-for-All?

But the plan is sure to face long odds, even if the Democrats can snag control of the Senate in January by winning two runoff elections in Georgia.

Republicans, who fought the creation of Medicare in the 1960s and typically oppose expanding government entitlement programs, are not the biggest obstacle. Instead, the nation’s hospitals — a powerful political force — are poised to derail any effort. Hospitals fear adding millions of people to Medicare will cost them billions of dollars in revenue.

“Hospitals certainly are not going to be happy with it,” said Jonathan Oberlander, professor of health policy and management at the University of North Carolina at Chapel Hill.

Medicare reimbursement rates for patients admitted to hospitals are on average half what commercial or employer-sponsored insurance plans pay.

“It will be a huge lift [in Congress] as the realities of lower Medicare reimbursement rates will activate some powerful interests against this,” said Josh Archambault, a senior fellow with the conservative Foundation for Government Accountability.

Biden, who turns 78 this month, said his plan will help Americans who retire early and those who are unemployed or can’t find jobs with health benefits.

“It reflects the reality that, even after the current crisis ends, older Americans are likely to find it difficult to secure jobs,” Biden wrote in April.

Lowering the Medicare eligibility age is popular. About 85% of Democrats and 69% of Republicans favor allowing those as young as 50 to buy into Medicare, according to a Kaiser Family Foundation tracking poll from January 2019. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

Although opposition from the hospital industry is expected to be fierce, it is not the only obstacle to Biden’s plan.

Critics, especially Republicans on Capitol Hill, will point to the nation’s $3 trillion budget deficit as well as the dim outlook for the Medicare Hospital Insurance Trust Fund. That fund is on track to reach insolvency in 2024. That means there won’t be enough money to pay hospitals and nursing homes fully for inpatient care for Medicare beneficiaries.

It’s also unclear whether expanding Medicare will fit on the Democrats’ crowded health agenda, which includes dealing with the COVID-19 pandemic, possibly rescuing the Affordable Care Act (if the Supreme Court strikes down part or all of the law in a current case), expanding Obamacare subsidies and lowering drug costs.

Biden’s proposal is a nod to the liberal wing of the Democratic Party, which has advocated for Sen. Bernie Sanders’ government-run “Medicare for All” health system that would provide universal coverage. Biden opposed that effort, saying the nation could not afford it. He wanted to retain the private health insurance system, which covers 180 million people.

To expand coverage, Biden has proposed two major initiatives. In addition to the Medicare eligibility change, he wants Congress to approve a government-run health plan that people could buy into instead of purchasing coverage from insurance companies on their own or through the Obamacare marketplaces. Insurers helped beat back this “public option” initiative in 2009 during the congressional debate over the ACA.

The appeal of lowering Medicare eligibility to help those without insurance lies with leveraging a popular government program that has low administrative costs.

“It is hard to find a reform idea that is more popular than opening up Medicare” to people as young as 60, Oberlander said. He said early retirees would like the concept, as would employers, who could save on their health costs as workers gravitate to Medicare.

The eligibility age has been set at 65 since Medicare was created in 1965 as part of President Lyndon Johnson’s Great Society reform package. It was designed to coincide with the age when people at that time qualified for Social Security. Today, people generally qualify for early, reduced Social Security benefits at age 62, but full benefits depend on the year you were born, ranging from age 66 to 67.

While people can qualify on the basis of other criteria, such as having a disability or end-stage renal disease, 85% of the 57 million Medicare enrollees are in the program simply because they’re old enough.

Lowering the age to 60 could add as many as 23 million people to Medicare, according to an analysis by the consulting firm Avalere Health. It’s unclear, however, if everyone who would be eligible would sign up or if Biden would limit the expansion to the 1.7 million people in that age range who are uninsured and the 3.2 million who buy coverage on their own.

Avalere says 3.2 million people in that age group buy coverage on the individual market.

While the 60-to-65 group has the lowest uninsured rate (8%) among adults, it has the highest health costs and pays the highest rates for individual coverage, said Cristina Boccuti, director of health policy at West Health, a nonpartisan research group.

About 13 million of those between 60 and 65 have coverage through their employer, according to Avalere. While they would not have to drop coverage to join Medicare, they could possibly opt to pay to join the federal program and use it as a wraparound for their existing coverage. Medicare might then pick up costs for some services that the consumers would have to shoulder out of pocket.

Some 4 million people between 60 and 65 are enrolled in Medicaid, the state-federal health insurance program for low-income people. Shifting them to Medicare would make that their primary health insurer, a move that would save states money since they split Medicaid costs with the federal government.

Chris Pope, a senior fellow with the conservative Manhattan Institute, said getting health industry support, particularly from hospitals, will be vital for any health coverage expansion. “Hospitals are very aware about generous commercial rates being replaced by lower Medicare rates,” he said.

“Members of Congress, a lot of them are close to their hospitals and do not want to see them with a revenue hole,” he said.

President Barack Obama made a deal with the industry on the way to passing the ACA. In exchange for gaining millions of paying customers and lowering their uncompensated care by billions of dollars, the hospital industry agreed to give up future Medicare funds designed to help them cope with the uninsured. Showing the industry’s prowess on Capitol Hill, Congress has delayed those funding cuts for more than six years.

Jacob Hacker, a Yale University political scientist, noted that expanding Medicare would reduce the number of Americans who rely on employer-sponsored coverage. The pitfalls of the employer system were highlighted in 2020 as millions lost their jobs and their workplace health coverage.

Even if they can win the two Georgia seats and take control of the Senate with the vice president breaking any ties, Democrats would be unlikely to pass major legislation without GOP support — unless they are willing to jettison the long-standing filibuster rule so they can pass most legislation with a simple 51-vote majority instead of 60 votes.

Hacker said that slim margin would make it difficult for Democrats to deal with many health issues all at once.

“Congress is not good at parallel processing,” Hacker said, referring to handling multiple priorities at the same time. “And the window is relatively short.”

Biden has room on health care, though limited by Congress

Biden’s proposals for a public health insurance option and empowering Medicare to negotiate prescription drug prices seem out of reach

President-elect Joe Biden is unlikely to get sweeping health care changes through a closely divided Congress, but there’s a menu of narrower actions he can choose from to make a tangible difference on affordability and coverage for millions of people.

With the balance of power in the Senate hinging on a couple of Georgia races headed to a runoff, and Democrats losing seats in the House, Biden’s proposals for a public health insurance option and empowering Medicare to negotiate prescription drug prices seem out of reach. Those would be tough fights even if Democrats controlled Congress with votes to spare.

But there’s bipartisan interest in prescription drug legislation to limit what Medicare recipients with high costs are asked to pay, and to restrain price increases generally. Biden also could nudge legislation to curb surprise medical bills over the finish line.

Moreover, millions of people already eligible for subsidized coverage through “Obamacare” remain uninsured. A determined effort to sign them up might make a difference, particularly in a pandemic. And just like the Trump administration, Biden is expected to aggressively wield the rule-making powers of the executive branch to address health insurance coverage and prescription drug costs.

With COVID-19 surging across the country, Biden’s top health care priority is whipping the federal government’s response into shape. In his victory speech Saturday, he pledged to “spare no effort, or commitment, to turn this pandemic around.” He appointed a pandemic task force to develop “an action blueprint” that could be put into place on Inauguration Day.

On broader health policy issues, Biden has signaled he will stick with his robust campaign platform, which called for covering all Americans by building on the Affordable Care Act, adding a new public insurance option modeled on Medicare and lowering the eligibility age for Medicare.

“We’re going to work quickly with the Congress to dramatically ramp up health care protections, get Americans universal coverage, lower health care costs, as soon as humanly possible,” the president-elect said earlier this week.

Progressives who drive the Democratic Party’s health care agenda say Biden must try as hard as he can to deliver, no matter if Sen. Mitch McConnell, R-Ky., remains majority leader of the Senate.

“I would vote for anything that improves health care for the American public, but what we need to do is push boldly and clearly for progressive policies,” said Rep. Ro Khanna, D-Calif., first vice chair of the Congressional Progressive Caucus.

Khanna says he’d like to see a President Biden calling out McConnell in public. “Right at the State of the Union, he should say, ‘One person potentially stands in the way of this, and that is Mitch McConnell,’” said Khanna.

Not in the real world, Republicans say.

They say the only way Democrats could get a big health care bill through is to first win the two Senate seats in Georgia and then rely on a special budget procedure that would allow them to pass legislation in the Senate on a simple majority vote. Either that or change Senate rules to abolish the filibuster. None of that can be done with a snap of one’s fingers.

“I put the odds of large-scale comprehensive health care reform at almost zero,” said Brendan Buck, who served as a top adviser to former House Speaker Paul Ryan, R-Wis.

Biden’s to-do list on health care begins with new hires and a rewrite of Trump administration policies.

Democrats have a deep talent pool he can tap for top jobs. Among the leading contenders for health secretary is former Surgeon General Vivek Murthy, who is a co-chair of Biden’s coronavirus task force. North Carolina state health secretary Dr. Mandy Cohen, another Obama administration alum, is also being promoted.

The rewrite project involves rescinding regulations and policies put in place by the Trump administration that allowed states to impose work requirements on Medicaid recipients, barred family planning clinics from referring women for abortions, made it easier to market bare-bones health insurance and made other changes.

But Biden can also use the government’s rule-making powers proactively. Prescription drugs is one area. The Trump administration was unable to finalize a plan to rely on lower overseas prices to limit what Medicare pays for some drugs. It’s a concept that Democrats support and that Biden may be able to put into practice.

On Capitol Hill, there doesn’t seem to be a clear path.

A Republican advocate for action to curb prescription drug costs, Sen. Chuck Grassley of Iowa, is expected to take on a new role in the next Congress, with less direct influence over health care issues.

A factor that may work in Biden’s favor is that many Republicans want to change the subject on health care. Exhaustion has set in over the party’s decade long campaign to overturn the Affordable Care Act, which has left the main pillars of former President Barack Obama’s health law standing, while knocking off some parts.

Though not ready to embrace the ACA, “Republicans have tired of banging their heads against the wall in an effort to get rid of it,” said Buck.

Brian Blase, a former Trump White House health care adviser, says he thinks there is potential on prescription drugs.

“Biden, I think, will be pragmatic in this area,” Blase said.

He expects a Biden administration to wield its rule-making powers aggressively, looking at international prices to try to limit U.S. prescription drug costs.

Coronavirus relief legislation could provide an early vehicle for some broader health care changes.

Former Health and Human Services Secretary Kathleen Sebelius, who oversaw the rollout of the ACA under Obama, says it’s not a question of all or nothing.

“Will it be as much progress as if we had had a big Senate win?” she asked.

It may not look that way.

“But can he make progress? I think he can.”

What You Need to Know About the ‘90% Effective’ COVID-19 Vaccine

There is promise—but there are also questions.

Marty Munson noted that on Monday, a COVID-19 vaccine made by the drug company Pfizer in conjunction with BioNTech made headlines. An early analysis released by the drug maker suggested that the vaccine could be more than 90 percent effective in preventing COVID-19.

No doubt it’s promising news—in fact, a CNN report says that Anthony Fauci, M.D., the nation’s top infectious diseases expert, texted CNN and called it “extraordinarily good news.”

The early analysis is of a trial that involved nearly 44,000 subjects; half receiving a placebo and the other half receiving a two-dose regimen of the new vaccine. The report says that 94 people got COVID-19. It’s not clear how many of those received a placebo and not the vaccine, but it would have to be most of them for the reports to claim more than 90 percent efficacy.

The excitement among scientists and the financial sector isn’t just about the robustness of the results. This vaccine uses a new technology, known as mRNA, a gene-based drug technology that has never been used in a vaccine before. So, the potential success of this drug is also a huge success for science. The Wall Street Journal quotes Professor John Bell, a UK health-policy advisor involved in the Oxford-AstraZeneca vaccine as saying, “the most important message is that you can make a vaccine against this critter.”

What it means so far

The news is encouraging, but the vaccine is not a panacea yet. The New York Times pointed out on Tuesday that “independent scientists have cautioned against hyping early results before long-term safety and efficacy data has been collected. And no one knows how long the vaccine’s protection might last.”

Data hasn’t been released on whether any people in the trial developed milder forms of COVID-19, what kind of side effects are associated with it, and how long protection might last. A few more considerations that moderate enthusiasm for the results: The results were released by the company, not in a medical journal, and the trial hasn’t concluded, so the numbers may change, The New York Times report points out.

If the company does receive emergency authorization of the vaccine after it collects the required amount of safety data, there are still questions and concerns about whether it is effective in all populations, how much vaccine the company can produce and how quickly, who would get it first, how it will be transported and delivered and whether people will accept the vaccine and get it when it’s offered.

What else to know

The news is promising and especially with the latest information regarding the Moderna vaccine, but there’s more data to come out, and many more problems need to be solved before a vaccine is a reality for most Americans. The pandemic is far from over, and this news doesn’t change that yet. So for now, at a time when there have been about 110,000 COVID-19 cases a day surging in the U.S., it’s still important to wear masks and continue to use social distancing measures and common sense. It seems that we are all forgetting common sense.

So, as my favorite candidate for the presidency. Governor Larry Hogan, says-Wear the damn masks and…get your flu shots!!!!

Also, I have included a cartoon from Rick Kollinger who has suffered a setback in his fight with his cancer. But after my visit with him, and my harassment he has attempted to draw a few more cartoons for me and his fans. Thank you Rick and please get better!

[r1]

Election 2020: What Exactly Is Joe Biden’s Healthcare Plan? And Really, Telehealth to Care for Our Patients?

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So, first I wanted to relate an experience, which exemplifies the failure of telehealth, or maybe the failure of healthcare workers who are taking advantage of the “new” health care system of patient care.

Consider the case a two weeks ago. As I was about to operate on a cancer surgery patient, I was asked to evaluate a patient healthcare conundrum. One of our nurse teammate’s husband was sick and no one knew what was the problem. He had lost 23 pounds over 3 ½ weeks, was dehydrated, appetite, sore throat, weak and needed to go to the emergency room multiple times for intravenous fluids. Each time he was told that they were very sorry but they had no idea what the problem was.

His Primary care physician would not see him in person, and he had another telehealth visit, which he was charged for and was prescribed an antibiotic with no improvement.

I asked if he had a COVID test which he did and it was negative.

I then asked if I could examine him or if she had any pictures. She had pictures, with no skin rashes except I noticed something interesting on the intraoral pictures, which showed left sided ulcers on his cheeks, left lateral posterior tongue and palate, again-only on the left side.

I asked if this was true in that the ulcers were only on one side of his mouth? When his wife responded with a yes to the question I then responded that he had intraoral shingles involving the nerve to the tongue, cheek, palate ( glossophyngeal nerve ) and sometimes also affected additional nearby cranial nerve, which is probably why he was having some of his stomach problem. She thought that was interesting and wanted to know what to do since he was about to have some gallbladder studies.

I outlined a treatment plan and low and behold he is getting better. My question is why didn’t anyone in the doc’s office or ER never complete a thorough physical exam? Oh, wait- how does one do a complete physical exam through the telehealth system? What about heart or lung disease patients, how does a nurse or physician listen to their heart or lungs, etc?? Are we physicians forgetting our teachings and training regarding the proper approach to physical diagnosis?

And now what about Biden’s proposal for health care?

Leigh Page pointed out that physicians — like all Americans — are trying to size up Joe Biden’s healthcare agenda, which the Democratic presidential nominee has outlined in speeches and on his official website.

Many healthcare professionals, patients, and voters of all political stripes think our current healthcare system is broken and in need of change, but they don’t agree on how it should change. In Part I of this article, we take a look at Biden’s proposals for changing the US healthcare system. Then, we include comments and analysis from physicians on both sides of the fence regarding the pros and cons of these proposed healthcare measures.

Part 1: An Overview of Biden’s Proposed Healthcare Plan

Biden’s proposed healthcare plan has many features. The main thrust is to expand access to healthcare and increase federal subsidies for health coverage.

If elected, “I’ll put your family first,” he said in a speech in June. “That will begin the dramatic expansion of health coverage and bold steps to lower healthcare costs.” He said he favored a plan that “lowers healthcare costs, gets us universal coverage quickly, when Americans desperately need it now.”

Below are Biden’s major proposals. They are followed by Part 2, which assesses the proposals on the basis of comments by doctors from across the political spectrum.

Biden Says We Should Restore the ACA

At a debate of the Democrat presidential candidates in June 2019, Biden argued that the best way to expand coverage is “to build on what we did during the Obama administration,” rather than create a whole new healthcare system, as many other Democratic candidates for president were proposing.

“I’m proud of the Affordable Care Act,” he said a year later in his June 2020 speech. “In addition to helping people with preexisting conditions, this is the law that delivered vital coverage for 20 million Americans who did not have health insurance.”

At the heart of the ACA are the health insurance marketplaces, where people can buy individual insurance that is often federally subsidized. Buyers select coverage at different levels ― Gold, Silver, and Bronze. Those willing to pay higher premiums for a Gold plan don’t have high deductibles, as they would with the Silver and Bronze plans.

Currently, federal subsidies are based on premiums on the Silver level, where premiums are lower but deductibles are higher than with the Gold plan. Biden would shift the subsidies to the Gold plan, where they would be more generous, because subsidies are pegged to the premiums.

In addition, Biden would remove the current limit on subsidies, under which only people with incomes less than 400% of the federal poverty level qualify for them. “Many families making more than 400% of the federal poverty level (about $50,000 for a single person and $100,000 for a family of four), and thus not qualifying for financial assistance, still struggle to afford health insurance,” the Biden for President website states.

Under the Biden plan, there would still be a limit on insurance payments as a percentage of income, but that percentage would drop, meaning that more people would qualify. Currently, the level is 9.86% or more of a person’s income; Biden would lower that level to 8.5%.

“We’re going to lower premiums for people buying coverage on their own by guaranteeing that no American ever has to spend more than 8.5% of their income on health insurance, and that number would be lower for lower-income people,” Biden said in the June speech.

Add a Public Option, but Not Medicare for All

In the primary, Biden parted company from rivals who backed Medicare for All, a single-payer health system that would make the government pay for everyone’s healthcare. “I understand the appeal of Medicare for All,” he said in a video released by his campaign. “But folks supporting it should be clear that it means getting rid of Obamacare, and I’m not for that.” But he nor anyone else who supported Obamacare has come up with a way to finance this type of healthcare system.

However, Biden embraced a “public option” that would allow people to buy into or be subsidized into “a Medicare-like” plan. It is unclear how similar the public option would be to regular Medicare coverage, but the Biden campaign has made it clear that it would not take funds from the Medicare trust fund, which is expected to start losing funds by 2026.

The more than 150 million Americans who have employer-sponsored insurance could keep it, but they could still buy into the public option if they wanted to. In addition, the public option would automatically enroll ― at no cost to them ― some 4.8 million low-income Americans who were excluded from the ACA’s Medicaid expansion when many states chose to opt out of the Medicaid expansion.

In addition, the 37 states that participate in expanded Medicaid could switch coverage to the new public option, provided that they continue to pay their current share of the costs. (In June, Oklahoma became the 37th state to allow the expansion, following the results of a ballot measure.)

“We need a public option now more than ever, especially when more than 20 million people are unemployed,” Biden said in the June speech. “That public option will allow every American, regardless of their employment status, the choice to get a Medicare-like plan.”

Lower the Medicare Age

In spring 2020, Biden proposed lowering the age to qualify for Medicare from 65 to 60. This provision is not included among the official policies listed on the Biden for President website, but it has been cited by many, including the Biden-Sanders Unity Task Force.

This provision would bring almost 23 million people into Medicare, including 13.4 million from employer-sponsored coverage, according to one analysis. It’s not clear whether these people would buy into Medicare or simply be covered. Their care would not be paid for by the Medicare Trust Fund but would use tax dollars instead. Oh, finally, we find out that our taxes would go up. How much is the problem as we consider all the other programs that Biden and Harris have promoted.

Provide Relief in the Covid-19 Pandemic

Biden would cover the cost of COVID-19 testing and the cost of health coverage for people laid off during the pandemic.

“Testing unequivocally saves lives, and widespread testing is the key to opening our economy again,” Biden said in his June speech. “To fix the economy, we have to get control over the virus.”

Prescription Drug Reform

Biden would repeal a Bush-era exception that bars the Medicare program from negotiating prescription drug prices for the Part D prescription drug benefit. “There’s no justification for this except the power of prescription drug lobbying,” the Biden for President website states.

In addition, Biden’s prescription drug reform plan would do the following:

• Limit launch prices for drugs. The administration would establish an independent review board that would assess the value of new drugs and would have the power to set limits on their prices. Such drugs are “being abusively priced by manufacturers,” the Biden for President site says.

• Limit price increases to inflation. As a condition of participation in government programs, drug prices could not rise more than the general inflation rate. Biden would impose a tax penalty on drug makers whose prices surpassed inflation.

• Allow consumers to buy prescription drugs from other countries. Biden would allow consumers to import prescription drugs from other countries, provided the US Department of Health and Human Services certifies that those drugs are safe.

• Stop tax breaks for pharma ads: Biden would drop drug makers’ tax breaks for advertising, which amounted to $6 billion in 2016.

Stop Surprise Billing

Biden proposes to stop surprise billing, which occurs when patients receive care from a doctor or hospital that is not in their insurer’s network. In these situations, patients can be surprised with very high bills because no payment limit has been negotiated by the insurer.

Twenty-eight states have enacted consumer protections to address surprise medical billing, but Congress has not passed such a measure. One proposed solution is to require payers to pay for out-of-network services on the basis of a benchmark, such as the average Medicare rate for that service in a specific geographic area.

Closely Monitor Healthcare Mergers

Biden would take a more active stance in enforcing antitrust laws against mergers in the healthcare industry.

“The concentration of market power in the hands of a few corporations is occurring throughout our health care system, and this lack of competition is driving up prices for consumers,” the Biden for President website states.

Overhaul Long-term Care

Biden’s latest plan calls for a $775 billion overhaul of the nation’s caregiving infrastructure. Biden says he would help create new jobs, improve working conditions, and invest in new models of long-term care outside of traditional nursing homes.

Restore Funding for Planned Parenthood

Biden would reissue guidance barring states from refusing Medicaid funding for Planned Parenthood and other providers that refer for abortions or that provide related information, according to the Biden for President website. This action would reverse a Trump administration rule.

Boost Community Health Centers

Biden promises to double federal funding for community health centers, such as federally qualified health centers, that provide care to underserved populations.

Support Mental Health Parity

Biden says he supports mental health parity and would enforce the federal mental health parity law and expand funding for mental health services.

Part 2: Physicians’ Opinions on Biden’s Healthcare Plans: Pro and Con

Biden’s plans to expand coverage are at the heart of his healthcare platform, and many see these as the most controversial part of his legislative agenda.

Biden’s Medicare expansion is not Medicare for All, but it can be seen as “Medicare for all who want it.” Potentially, millions of people could enter Medicare or something like Medicare. If the Medicare eligibility age is dropped to 60, people could switch from their employer-sponsored plans, many of which have high deductibles. In addition, poor people who have no coverage because their states opted out of the Medicaid expansion would be included.

The possibility of such a mass movement to government-run healthcare alarms many people. “Biden’s proposals look moderate, but it is basically Medicare for All in sheep’s clothing,” said Cesar De Leon, DO, a family physician in Naples, Florida, and past president of the county’s medical society.

Reimbursements for Doctors Could Fall- No, Will Fall!

A shift of millions of people into Medicare would likely mean lower reimbursements for doctors. For example, the 13.4 million people aged 60 to 65 who would switch from employer-sponsored coverage to Medicare would be leaving some of the best-paying insurance plans, and their physicians would then be reimbursed at Medicare rates.

“Biden’s plan would lower payments to already cash-strapped doctors and hospitals, who have already seen a significant decrease in reimbursement over the past decade,” De Leon said. “He is trying to win the support of low-income voters by giving them lower healthcare prices, which doctors and hospitals would have to absorb.

“Yes, the US healthcare system is dysfunctional,” De Leon added, “but the basic system needs to be fixed before it is expanded to new groups of people.”

The American Association of Neurological Surgeons/Congress of Neurological Surgeons warns against Biden’s proposed government-run system. “We support expanding health insurance coverage, but the expansion should build on the existing employer-based system,” said Katie O. Orrico, director of the group’s Washington office. “We have consistently opposed a public option or Medicare for All.

“Shifting more Americans into government-sponsored healthcare will inevitably result in lower payments for physicians’ services,” Orrico added. “Reimbursement rates from Medicare, Medicaid, and many ACA exchange plans already do not adequately cover the costs of running a medical practice.”

Prospect of Higher Taxes- Absolutely, grab your wallets and your retirement funds!!

Paying for ambitious reforms means raising taxes. Biden’s plan would not make the Medicare trust fund pay for the expansions and would to some extent rely on payments from new beneficiaries. However, many new beneficiaries, such as people older than 60 and the poor, would be covered by tax dollars.

Altogether, Biden’s plan is expected to cost the federal government $800 billion over the next 10 years. To pay for it, Biden proposes reversing President Trump’s tax cuts, which disproportionately helped high earners, and eliminating capital gains tax loopholes for the wealthy.

“Rather than tax the average American, the Democrats will try to redistribute wealth,” De Leon said.

“The elephant in the room is that taxes would have to be raised to pay for all these programs,” said Gary Price, MD, president of the Physicians Foundation. Because no one likes higher taxes, he says, architects of the Biden plan would try to find ways to save money, such as tamping down reimbursements for physicians, to try to avoid a public backlash against the reforms.

“Physicians’ great fear is that efforts to keep taxes from getting too high will result in cutting physician reimbursement,” he said.

Impact of COVID-19

Perhaps an even larger barrier to Biden’s health reforms comes from the COVID-19 crisis, which didn’t exist last year, when health reform was the central issue in the presidential primary that pitted Biden against Vermont Senator Bernie Sanders, the chief proponent of Medicare for All.

“The top two issues on voters’ minds right now are the pandemic and the economy,” said Daniel Derksen, MD, a family physician who is professor of public health policy at the University of Arizona in Tucson. “Any other concerns are pushed down the list.”

The COVID-19 crisis is forcing the federal government to spend trillions of dollars to help businesses and individuals who have lost income because of the crisis. Will there be enough money left over to fund an ambitious set of health reforms?

“It’s not a good time to start reforms,” warned Kevin Campbell, MD, a cardiologist in Raleigh, North Carolina. “Given the current pressures that COVID-19 has placed on physicians, healthcare systems, and hospitals, I don’t believe that we can achieve meaningful change in the near term.”

However, supporters of Biden’s reforms think that now, during the COVID-19 crisis, is precisely the right time to enact healthcare reform. When millions of Americans lost their jobs because of the pandemic, they also lost their insurance coverage.

“COVID-19 has made Biden’s healthcare agenda all the more relevant and necessary,” said Don Berwick, MD, who led the Center for Medicare & Medicaid Services (CMS) under President Obama. “The COVID-19 recession has made people more aware of how vulnerable their coverage is.”

Orrico at the neurosurgeons group acknowledges this point. “The COVID-19 pandemic has exposed some cracks in the US healthcare system,” she said. “Whether this will lead to new reforms is hard to say, but policymakers will likely take a closer look at issues related to unemployment, health insurance coverage, and healthcare costs due to the COVID-19 emergency.”

Many Physicians Want Major Reform

Although many doctors are skeptical of reform, others are impatient for reform to come and support Biden’s agenda ― especially its goal to expand coverage.

“Joe Biden’s goal is to get everyone covered,” said Alice Chen, MD, an internist who is a leader of Doctors for Biden, an independent group that is not part of the Biden campaign. “What brings Democrats together is that they are united in the belief that healthcare is a right.”

In January, the American College of Physicians (ACP) endorsed both Medicare for All and the public option. The US healthcare system “is ill and needs a bold new prescription,” the ACP stated.

The medical profession, once mostly Republican, now has more Democrats. In 2016, 35% of physicians identified themselves as Democrats, 27% as Republicans, and 36% as independents.

Many of the doctors behind reform appear to be younger physicians who are employed by large organizations. They are passionate about reforming the healthcare system, and as employees of large organizations, they would not be directly affected if reimbursements fell to Medicare levels ― although their institutions might subsequently have to adjust their salaries downward.

Chen, for example, is a young physician who says she has taken leave from her work as adjunct assistant clinical professor of medicine at the University of California, Los Angeles, to raise her young children.

She is the former executive director of Doctors for America, a movement of thousands of physicians and medical students “to bring their patients’ experiences to policymakers.”

“Doctors feel that they are unseen and unheard, that they often feel frankly used by large health systems and by insurance companies,” Chen said. “Biden wants to hear from them.”

Many idealistic young physicians look to health system leaders like Berwick. “I believe this nation needs to get universal coverage as fast as we can, and Biden’s policies present a path to get there,” the former CMS director said. “This would be done chiefly through Biden’s public option and his plans to expand coverage in states that have not adopted the ACA Medicaid expansion.”

But what about the potential effect of lowering reimbursement rates for doctors? “The exact rates will have to be worked out,” Berwick said, “but it’s not just about who pays physicians, it’s about how physicians get paid.” He thinks the current fee-for-service system needs to be replaced by a value-based payment system such as capitation, shared savings, and bundled payments.

The Biden-Sanders Task Force

Berwick was a member of the Biden-Sanders Unity Task Force, which brings together supporters of Biden and Sanders to create a shared platform for the Biden campaign.

The task force issued a report in early July that recommended a variety of healthcare reforms in addition to expanding access to care. One of them was to find ways to address the social determinants of health, such as housing, hunger, transportation, and pollution, which can harm health outcomes.

Chen specifically cites this provision. “We need to focus on the social determinants of heath and try to encourage better health,” she said. “I remember as a doctor advising a patient who was a young mother with several small children that she needed to exercise more. She asked me, ‘When am I supposed to exercise, and who will watch my kids?’ I realized the predicament that she was in.”

Price is also glad to see the provision in Biden’s plan. “Social determinants of health has been a key focus of the Physicians Foundation,” he said. “To my knowledge, this is the first time that a political candidate’s healthcare policy has included this point.

“Physicians are not in control of the social determinants of health, even though they affect their reimbursements,” he said. Under Medicare’s Merit-based Incentive Payment System, for example, doctors are penalized when their patients don’t meet certain health standards, such as when diabetes patients can’t get their A1C levels under control, he says.

However, Price fears that Biden, in his efforts to make peace with Sanders supporters, may have to some degree abandoned his moderate stance on health reform.

Is the Nation Ready for Another Health Reform Battle?

Clearly, many Democrats are ready to reform the system, but is the nation ready? “Are American voters ready for another major, Democratic-led health reform initiative?” asked Patricia Salber, MD, an internist and healthcare consultant who runs a blog called The Doctor Weighs In.

“I’ve been around long enough to remember the fight over President Clinton’s health plan and then President Obama’s plan,” she said. Each time, she says, there seemed to be a great deal of momentum, and then there was a backlash. “If Biden is elected, I hope we don’t have to go through the same thing all over again,” Salber said.

Derksen believes Biden’s proposed healthcare reforms could come close to rivaling President Obama’s Affordable Care Act in ambition, cost, and controversy.

He shares Biden’s goal of extending coverage to all ― including paying the cost of covering low-income people. But the result is that “Biden’s agenda is going to be a ‘heavy lift,’ as they say in Washington,” he said. “He has some very ambitious plans to expand access to care.”

Derksen speaks from experience. He helped draft part of the ACA as a health policy fellow in Capitol Hill in 2009. Then in 2011, he was in charge of setting up the ACA’s insurance marketplace for the state of New Mexico.

Now Biden wants to begin a second wave of health reform. But Derksen thinks this second wave of reform could encounter opposition as formidable as those Obama faced.

“Assuming that Biden is elected, it would be tough to get this agenda passed ― even if he had solid Democratic majorities in both the House and Senate,” said Derksen,

According to polls by the Kaiser Family Foundation (KFF), 53% of Americans like the ACA, while 37% dislike it ― a split that has been relatively stable for the past 2 years, since the failed GOP effort to repeal the law.

In that KFF poll, the public option fared better ― 68% of Americans support the public option, including 42% of Republicans. These numbers help explain why the Biden campaign moved beyond its support of the ACA to embrace the public option as well.

Even when Democrats gain control of all the levers of power, as they did in 2009, they still have a very difficult time passing an ambitious healthcare reform bill. Derksen remembers how tough it was to get that massive bill through Congress.

The House bill’s public option might have prevailed in a reconciliation process between the two bills, but that process was cut short when Sen. Ted Kennedy died and Senate Democrats lost their filibuster-proof majority. The bill squeaked through as the Senate version, without the public option.

The ACA Has Survived-But at What Cost?

The ACA is much more complex piece of legislation than the public option.

“The ACA has survived for a decade, despite all efforts to dismantle it,” Salber said. “Biden wants to restore a law that the Republicans have been chipping away at. The Republicans eliminated the penalty for not having coverage. Think about it, a penalty of zero is not much of a deterrent.”

It was the loss of the ACA penalty in tax year 2019 that, paradoxically, formed the legal basis for the latest challenge of the ACA before the Supreme Court, in a suit brought by the Trump administration and 18 Republican state attorneys general.

The Supreme Court will make its ruling after the election, but Salber thinks the suit itself will boost both Biden and the ACA in the campaign. “I think most people are tired of all the attempts to repeal the ACA,” she said.

“The public now thinks of the US healthcare system as pathetically broken,” she added. “It used to be that Americans would say we have the best healthcare system in the world. I don’t hear that much anymore.”

Physicians who oppose the ACA hold exactly the opposite view. “Our healthcare system is in shambles after the Obamacare fiasco,” Campbell said. “Even if Biden has a Democrat-controlled House and Senate, I still don’t think that there would be enough votes to pass sweeping changes to healthcare.”

Biden Could Choose Issues Other Than Expanding Access

There are plenty of proposals in the Biden healthcare plan that don’t involve remaking the healthcare system.

These include making COVID-19 testing free, providing extra funding for community health centers, and stopping surprise billing. Proposals such as stepping up antitrust enforcement against mergers would involve administrative rather than Congressional action.

Some of these other proposals could be quite expensive, such as overhauling long-term care and paying for health insurance for laid-off workers. And another proposal ― limiting the prices of pharmaceuticals ― could be almost as contentious as expanding coverage.

“This proposal has been talked about for many years, but it has always met with strong resistance from drug makers,” said Robert Pearl, MD, former CEO of the Permanente Medical Group and now a faculty member at Stanford School of Medicine and Graduate School of Business.

Pearl thinks the first item in Biden’s drug plan ― to repeal a ban against Medicare negotiating drug prices with drug makers ― would meet with Congressional resistance, owing to heavy lobbying and campaign contributions by the drug companies.

In addition, Pearl thinks Biden’s plans to limit drug prices ― barring drug makers from raising their prices above the general inflation rate and limiting the launch prices for many drugs ― enter uncharted legal waters and could end up in the courts.

Even Without Reform, Expect Lower Reimbursements

Although many doctors are concerned that Biden’s healthcare reforms would reduce reimbursements, Pearl thinks reimbursements will decline even without reforms, owing in part to the COVID-19 pandemic.

Employer-based health insurance has been the bedrock of the US healthcare system, but Pearl says many employers have long wanted to get rid of this obligation. Increasingly, they are pushing costs onto the employee by raising deductibles and through premium sharing.

Now, with the pandemic, employers are struggling just to stay in business, and health insurance has truly become a financial burden, he says. In addition, states will be unable to balance their budgets and will try to reduce their Medicaid obligations.

“Before COVID-19 hit, healthcare spending was supposed to grow by 5% a year, but that won’t happen for some time into the future,” Pearl said. “The COVID economic crisis is likely to continue for quite some time, forcing physicians to either accept much lower payments or find better ways to provide care.”

Like Berwick, Pearl believes healthcare will have to move to value-based payments. “Instead of producing more services, doctors will have to preserve resources, which is value-based healthcare,” he said. The primary form of value-based reimbursement, Pearl thinks, will be capitation, in which physicians agree to quality and service guarantees.

Even steadfast opponents of many of Biden’s reforms foresee value-based payments taking off. “Certainly, there are ways to improve the current healthcare system, such as moving to value-based care,” said Orrico at the neurosurgeons’ group.

In short, a wide swath of observers agree that doctors are facing major changes in the payment and delivery of healthcare, regardless of whether Biden is elected and succeeds with his health agenda.

Notice that no one has mentioned tort reform in healthcare. Why Not???????

Can You Afford To Get Coronavirus? How to Prepare for the Virus andHow The U.S. Healthcare System Is Failing Us

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This is a lengthy post but with all the fear regarding COVID-19 I thought that it would be worth the time. I became more aware as we traveled to the West Coast for a half marathon at Napa Valley. There were many people on our planes wearing masks and my wife was so worried about our planned trip to Europe in April. The cruise companies now our offering to either give one hundred percent refund or hold the paid fees for 2 years to allow rescheduling of the cruises. Can you imagine what the Corona Virus scare is doing to economies around the world>

Sarah Midkiff reported that as the deadly coronavirus outbreak approaches pandemic status, the U.S. government remains in the midst of approving legislation for a $7.5 billion emergency spending bill. Meanwhile, coronavirus continues its spread in the U.S. — with 100 confirmed cases and six deaths across 15 states — so the need for these funds is more imperative than ever. The emergency bill will allocate money to the Department of Health and Human Services for vaccine development, protective and medical equipment, and aid for state and local governments affected by an outbreak, according to the Washington Post.

But, what legislators have yet to mention is whether subsidizing treatment or funding low-cost and free clinics will be part of the plan. The bill may address availability of vaccine development, but it does not directly address affordability of testing or treatment, which is of the utmost importance during a pandemic.

A report published by America’s Health Insurance Plans (AHIP) on Thursday stated that the Centers for Disease Control and Prevention (CDC) is currently the only facility equipped to test for COVID-19. The CDC is not billing for testing, but the test itself isn’t the only line item on a possible medical bill. There is the cost of the doctor’s visit; other tests they might run in conjunction with COVID-19, such as standard flu tests; treatment and medication, as well as getting the vaccine when it becomes available. And, medical bills can grow astronomically high if someone requires in-patient care, like an overnight stay in the hospital.

Stories have already begun to emerge of Americans seeking testing only to find that their insurance was insufficient to the tune of thousands of dollars in medical bills. One such example is a man in Florida who faces a $3,270 medical bill after he went through his insurance when he was concerned he might have been exposed to coronavirus. He was confirmed negative for COVID-19 after testing positive for the flu via a standard flu test rather than the more expensive CT scan which has been proven to be the most consistent test in diagnosing coronavirus.

Others have undergone government-mandated treatment and found that, despite the procedure being required, they were the ones left to foot bills that totaled thousands of dollars. Experiences like this make it easy to see why a 2018 national poll conducted by West Institute and NORC at the University of Chicago found that 44% of Americans declined to see a doctor due to cost.

Notably, the U.S. is alone among other developed countries as the only one that doesn’t offer federally mandated paid sick leave. This makes it particularly difficult to follow the CDC’s current advice that people experiencing even mild respiratory symptoms should stay home, other than when getting medical care. Between a lack of mandated paid sick leave and approximately 27 million Americans currently without health insurance, the coronavirus outbreak is at risk of exhausting our already failing public health system.

Even among people with health insurance, 29% are underinsured, according to results from a 2018 Commonwealth’s Fund survey, meaning that even though they technically have an insurance plan, the copays and deductibles make seeking care unaffordable in relation to their income. Cases of the virus could go undetected and untreated simply because Americans cannot afford to be saddled with medical debt or go without pay to take sick leave (or both), thus encouraging a rapid spread of the virus as people attempt to “power through” in spite of symptoms.

And then there are the approximately 11 million undocumented U.S. residents: Many of these people are un- or under-insured, and also have to grapple with the justified fear of coming into contact with federal authorities, therefore preventing them from seeking medical care.

If further evidence is needed that our health care system has been crippled by privatization, government officials are not debating whether or not pharmaceutical companies should be allowed to profit from a vaccine, but are just figuring out by how much. Last week, the Department of Health and Human Service secretary, Alex Azar, would not commit to price controls on a coronavirus vaccine. “We need the private sector to invest… price controls won’t get us there,” said Azar.

House Speaker Nancy Pelosi responded directly to Azar’s comments. “This would be a vaccine that is developed with taxpayer dollars…We think that should be available to everyone—not dependent on ‘Big Pharma,’” she said in a press release on February 27. She described the vaccine as needing to be “affordable,” but what does that even mean? What is affordable to some is not affordable to all.

Still, a vaccine – affordable or not – is a ways off. In a coronavirus task force briefing with Donald Trump on Monday, experts estimated that it would take a year to a year-and-a-half before a vaccine would be effective and safe for the public, reports CNN. Until then, the economic inequality that runs rampant in America is bound to be reflected in who can afford to survive this epidemic, and who can’t.

US may pay for uninsured coronavirus patients

Washington (AFP) – The US may invoke an emergency law to pay for uninsured patients who get infected with the new coronavirus, a senior health official said Tuesday.

Public health experts have warned that the country’s 27.5 million people who lack health coverage may be reluctant to seek treatment, placing themselves at greater risk and fueling the spread of the disease.

Robert Kadlec, a senior official with the Health and Human Services department told the Senate on Tuesday that talks were underway to declare a disaster under the Stafford Act, which would allow the patients’ costs to be met by the federal government.

Under this law, their health care providers would be reimbursed at 110 percent of the rate for Medicaid, a government insurance program for people with low income, he added.

“We’re in conversations, initial conversations with CMS (Centers for Medicare & Medicaid Services) to understand if that could be utilized in that way and be really impactful,” Kadlec told a Senate committee.

President Donald Trump also touched on the issue as he headed to a briefing on the coronavirus outbreak at the National Institutes of Health in Washington on Tuesday.

“We’re looking at that whole situation. There are many people without insurance,” Trump told reporters.

The number of Americans without health insurance began falling from a high of 46.5 million in 2010 following the passage of Obamacare (the Affordable Care Act).

It climbed again to 27.5 million in 2018, or 8.5 percent of the population, from 25.6 million the year before.

The reasons include policies by Trump’s administration that made it harder to enroll in Medicaid — such as adding requirements to work — or to sign up for insurance under the marketplaces created by Obamacare.

The Republican-held Congress also repealed a penalty on people who lack insurance, which may have led people to voluntarily drop out.

The Centers for Disease Control and Prevention (CDC) has said patients who are advised by their health care providers to stay at home should do so for at least two weeks, but a work culture that emphasizes powering through while sick could compound the problem further.

The US is alone among advanced countries in not offering any federally mandated paid sick leave. While some states have passed their own laws, 25 percent of American workers lacking any whatsoever, according to official data.

Maia Majumder, an epidemiologist at Harvard, told AFP she was particularly concerned by low-wage workers in the service and hospitality sector, who cannot afford to take time off but could act as vectors to transmit the spread of the disease.

The latest coronavirus death rate is 3.4% — higher than earlier figures. Older patients face the highest risk.

The global death rate for the novel coronavirus based on the latest figures is 3.4% — higher than earlier figures of about 2%.

In contrast, the seasonal flu kills 0.1% of those infected.
A patient’s risk of death from COVID-19 varies depending on age and preexisting health conditions.
Though the latest numbers mark an increase in mortality, experts have predicted that the fatality rate of COVID-19 could decrease as the number of confirmed cases rises.

The latest global death rate for the novel coronavirus is 3.4% — higher than earlier figures of about 2%.

The coronavirus outbreak that originated in Wuhan, China, has killed more than 3,100 people and infected nearly 93,000 as of Tuesday. The virus causes a disease known as COVID-19.

Speaking at a media briefing, the World Health Organization’s director-general, Tedros Adhanom Ghebreyesus, noted that the death rate was far higher than that of the seasonal flu, which kills about 0.1% of those infected.

The death rate is likely to change further as more cases are confirmed, though experts predict that the percentage of deaths will decrease in the longer term since milder cases of COVID-19 are probably going undiagnosed.

“There’s another whole cohort that is either asymptomatic or minimally symptomatic,” Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases, said at a briefing last month. “We’re going to see a diminution in the overall death rate.”

‘It is a unique virus with unique characteristics’

Tedros noted differences between the novel coronavirus and other infectious diseases like MERS, SARS, and influenza. He said the data suggested that COVID-19 did not transmit as efficiently as the flu, which can be transmitted widely by people who are infected but not yet showing symptoms.

He added, however, that COVID-19 caused a “more severe disease” than the seasonal flu and explained that while people around the world may have built up an immunity to the flu over time, the newness of the COVID-19 meant no one yet had immunity and more people were susceptible to infection.

“It is a unique virus with unique characteristics,” he said.

Tedros said last week that the mortality rate of the disease could differ too based on the place where a patient receives a diagnosis and is treated. He added that people with mild cases of the disease recovered in about two weeks but severe cases may take three to six weeks to recover.

Older patients face the highest risk

A patient’s risk of dying from COVID-19 varies based on several factors, including where they are treated, their age, and any preexisting health conditions.

COVID-19 cases have been reported in at least 76 countries, with a vast majority in China.

A study conducted last month from the Chinese Center for Disease Control and Prevention showed that the virus most seriously affected older people with preexisting health problems. The data suggests a person’s chances of dying from the disease increase with age.

Notably, the research showed that patients ages 10 to 19 had the same chance of dying from COVID-19 as patients in their 20s and 30s, but the disease appeared to be much more fatal in people ages 50 and over.

About 80% of COVID-19 cases are mild, the research showed, and experts think many mild cases haven’t been reported because some people aren’t going to the doctor or hospitals for treatment.

CDC reports 108 cases of coronavirus, including presumed infections; 4 more deaths

The Centers for Disease Control and Prevention (CDC) on Tuesday confirmed 17 new cases of the coronavirus and four more deaths due to the outbreak, bringing the total number of U.S. cases to 108, including among repatriated citizens.

Coronavirus is making some Republicans reconsider the merits of free health care

Tim O’Donnell reported that the Coronavirus has a lot of people re-thinking things. That apparently includes Republicans and government-funded health care.

With the possibility of an outbreak of the respiratory virus in the United States looming, the government is still trying to piece together its response. And it sounds like free testing could be on the table. Rep. Ted Yoho (R-Fla.), at least, thinks it’s really the only option. Yoho is normally known for opposing the Affordable Care Act, and certainly doesn’t seem likely to advocate for Medicare-for-All anytime soon. But he’s willing to blur the lines when an unforeseen circumstance like coronavirus comes to town and is even ok if you want call it “socialized medicine.”

Truly stunning to hear some Republicans advocate for free Coronavirus testing and treatment for the uninsured.

Rep. Ted Yoho (R-Fla.), one of the most anti-ACA members:

“You can look at it as socialized medicine, but in the face of an outbreak, a pandemic, what’s your options?”

The Trump administration, meanwhile, is contemplating funding doctors and hospitals so they can care for people who don’t have insurance should they become infected with the virus, a person familiar with the conversation told The Wall Street Journal. Read more at The Wall Street Journal.

The Coronavirus Outbreak Could Finally Make Telemedicine Mainstream in the U.S.

Time’s reporter, Jamie Ducharme noted that for years, telemedicine has been pitched as a way to democratize medicine by driving down costs, increasing access to care and making appointments more efficient. It sounds great—until you look at the data, and find that only about 10% of Americans have actually used telemedicine to make a virtual visit, according to one 2019 survey.

An outbreak of the novel coronavirus COVID-19 could change that. If extreme measures like mass quarantines come to pass, telehealth could finally have its bittersweet moment in the spotlight, potentially generating momentum that proponents hope will continue once life returns to normal.

“Something like having to stay home could springboard telehealth tremendously, because when we get over this—and we will—people will have had that experience, and they’ll be saying, ‘Well, why can’t I do other aspects of my health care that way?’” says Dr. Joe Kvedar, president-elect of the American Telemedicine Association (ATA).

As of March 3, more than 92,000 people worldwide have been sickened by the virus that causes COVID-19, including more than 100 in the U.S. As both numbers trend upward, the U.S. Centers for Disease Control and Prevention (CDC) has warned that increased person-to-person spread in U.S. communities is likely, and that containment measures may become increasingly disruptive to daily life. If the situation reaches the point where public health officials are encouraging or requiring people to stay home, the health care system may have to offer many medical appointments via telehealth services, the CDC’s Dr. Nancy Messonnier said during a Feb. 26 press briefing.

Kvedar says telehealth tools offered by health plans, private companies and pharmacies are ready and waiting for that possibility. There are some limitations to telehealth’s utility for COVID-19 testing—you can’t take a chest x-ray or collect a sample for lab testing remotely, after all—but Kvedar says it could be used for initial symptom assessment and questioning, as well as non-virus-related appointments that couldn’t happen in person due to precautions. If a patient turned up at an emergency room with possible COVID-19 symptoms, doctors could also do initial intake via virtual platforms, while keeping the patient in isolation to minimize spread within the vulnerable health care environment, he says.

Telehealth giants like Amwell and Teladoc are now advertising their availability for coronavirus-related appointments, and Teladoc’s stock prices spiked in late February. XRHealth, a company that makes health-focused virtual reality applications, is this week providing Israel’s Sheba Medical Center with VR headsets that will both allow doctors to monitor COVID-19 patients remotely, and enable quarantined patients to “travel” beyond their rooms using VR, says XRHealth CEO Eran Orr. The company will next week begin working with hospitals to deploy the technology in the U.S., Orr says.

All of these solutions seem logical. But in practice, there’s a “thicket of state laws and regulations that make telemedicine very complex…to implement broadly,” says Dr. Michael Barnett, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health. Insurers—especially Medicare—don’t always cover telehealth visits, and, since medical licenses are state-specific, there could be legal issues if a doctor is located in a different state than the patient they’re treating, Barnett says. Drug prescription and privacy laws can also complicate regulation, according to the American Hospital Association.

These regulatory issues, as well as a lack of patient awareness, have kept telehealth from being as widely adopted as it could be, Barnett says. COVID-19 could be “a good use case” for telemedicine, he says, but it will partially depend on lawmakers’ willingness to relax, or at least streamline, regulation.

The wheels are already in motion. On Feb. 28, telehealth groups including the ATA, the Personal Connected Health Alliance and the eHealth Initiative sent a letter to Congressional leaders, urging them to expand access to telehealth and to grant the Department of Health and Human Services the power to let Medicare cover telemedicine appointments during emergency situations. On March 3, Arizona Rep. Ruben Gallego announced he was introducing a bill that would allow Medicaid to cover all COVID-19-related charges, including virtual appointments.

That’s a good step, but Julia Adler-Milstein, director of the University of California, San Francisco’s Center for Clinical Informatics and Improvement Research, says there are still logistical challenges.

She says larger health systems that have invested heavily in telehealth, like Kaiser Permanente, have seen benefits from it, but providers with a less built-out infrastructure will have to grapple in real-time with questions like, “How do we know which patients are well-suited to telehealth?” and “How do we get their information into the doctor’s hands?” These issues are especially salient for patients with complex medical histories, who may have choose between seeing their regular doctor in person, potentially risking infection, or seeing a doctor virtually who does not have access to their medical records, she says.

Kvedar acknowledges that widespread adoption of telehealth during the COVID-19 outbreak may require some goodwill on the part of companies and doctors. Companies like CVS and Walgreens could waive fees for the use of their telemedicine services during the crisis, Kvedar suggests, or doctors could offer to see patients virtually for free for a few hours a week. “People pull together for all sorts of things,” he says.

Barnett is less optimistic that providers can seamlessly overcome regulations, but says patients and doctors will find a way through the outbreak with or without telemedicine, even if it means conducting many appointments over the old-fashioned telephone. “We have more pressing needs in this epidemic,” he says, “than telehealth availability.”

15 Italian tourists test positive for Covid-19, India springs into battle mode

Niharika Sharma reported that fifteen Italian tourists in India have been reportedly tested positive for the dreaded coronavirus, perhaps finally bringing home the full scale of the seriousness of the global health crisis to the country.

This is besides the six others who have been diagnosed with Covid-19 across the country, prompting India to take massive preventive measures.

The Italian tourists have been quarantined at a camp of the paramilitary, Indo-Tibetan Police Force, media reports said.

Fear and anxiety gripped India’s national capital region (NCR) after a 45-year-old man was diagnosed with the novel coronavirus infection in the city yesterday (March 3). This prompted authorities to step up the vigil.

Over 40 people in Delhi NCR, who came in contact with the patient, are under surveillance. Another 13 people have been screened in Uttar Pradesh’s Agra where he visited his family.

The man who self-reported at Delhi’s Ram Manohar Lohia Hospital had organised his son’s birthday party at Hyatt Regency on Feb. 28. The five-star hotel has asked staffers, who were on duty that day, to stay at home. “The hotel has also started to conduct daily temperature checks for all colleagues and contractors when they enter and exit the building,” the hotel said in a statement yesterday (March 3).

The school in Noida where the infected man’s son attended classes has been shut for the rest of the week, and five students are being screened.

Besides the Delhi man, an Italian tourist, and a person in Hyderabad, who travelled from Dubai to Bengaluru on Feb. 20 on an IndiGo flight, have also tested positive for the virus. ”We’re following all prescribed Airport Health Organisation guidelines,” IndiGo said in a statement yesterday. The airline has asked its four cabin crew who were on the aircraft to stay at home.

On guard

Authorities appear to be working overtime to track the footprints of all the patients and screen everyone who came in contact with them. “Our officers even visit the homes individually, taking necessary precautions, to check listed people for symptoms,” an official of the Integrated Disease Surveillance Programme (IDSP) under the health ministry told Hindustan Times on condition of anonymity. “For asymptomatic people, home quarantine for a stipulated period of time is good enough, but those who develop symptoms are moved to a hospital as per protocol.”

But the process could be tedious as the 69-year-old Italian tourist, who was tested positive in Jaipur on March 3,had travelled to six districts in India before arriving at Rajasthan. He and his wife, who has also tested positive, were part of a 21-member group, which landed in Delhi on Feb. 21. The rest of the group is in Agra, according to a Hindustan Times report.

The health ministry has now issued a travel advisory, suspending all regular visas/e-visas granted on or before March 3 to nationals of Italy, Iran, South Korea, and Japan, who have not yet entered India. The advisory also suspends visa on arrival issued until March 3 to Japanese and South Korean nationals who have not yet entered India.

The government has also made it mandatory for passengers entering India from other countries affected by coronavirus to fill forms with personal details and travel history to the health and immigration officials at 21 airports across the country and 12 major and 65 minor seaports.

Aviation watchdog Directorate General of Civil Aviation has also asked carriers to ensure that adequate protective gears like surgical masks and gloves are available in flight for passengers.

In Delhi, the Kejriwal government has reserved 230 beds in isolation wards at 25 hospitals and also sent advisories to schools mentioning precautions to tackle the situation.

On March 3, the information ministry asked all private radio and TV channels to give “adequate publicity” to the travel advisory issued by the health ministry in the wake of the coronavirus outbreak.

The health ministry has also launched a series of TV commercials as part of its awareness program against the outbreak.

Here’s what you must keep in mind:

In addition, the Narendra Modi government has asked the army, the navy and the air force to prepared quarantine facilities for over 2,500 in coming days, as per the sources quoted by various media reports.

Preventive measures

Several events, where foreign delegates were expected to participate, have been cancelled or postponed.

The Indian Navy called off a multilateral naval exercise that was scheduled from March 18 in Visakhapatnam due to coronavirus. Around 30 countries were expected to take part in the event.

On March 3, Chinese smartphone maker Xiaomi said it is cancelling all upcoming on-ground launch events in India to reduce exposure risk in the wake of Covid-19.

Italy could have more than 100,000 coronavirus cases, expert warns

Reporter Will Taylor of the Yahoo News noted that Italy could have more than 100,000 cases of coronavirus, an expert has revealed.

Professor Neil Ferguson, of Imperial College London’s faculty of medicine, said he estimates there are “at least” 50,000 to 100,000 cases of the virus in the country, which is one of the worst affected by the virus.

Italy has 2,500 confirmed cases and has suffered 79 deaths.

Prof Ferguson told the BBC’s Today programme that he expects to see measures to tackle the virus rolled out in a matter of days.

“[Italy has] I think it’s over 50 deaths now,” he said, “so those people were probably infected three weeks ago, and for every person who dies we think there might be 100, maybe even 200 people infected.

“The lethality of this virus is not completely determined but it’s in that order… so the epidemic is probably doubling every week or so in Italy, so when you put those numbers together, we’d estimate somewhere between 50,000 and 100,000 cases at the moment in Italy.

“At least, it could even be higher, cases may still be being missed even in severe cases.”

He said the UK is “several weeks” behind Italy and is in an earlier stage of an epidemic.

Authorities will be looking to slow the spread of the virus to try to relieve pressure on health systems and the UK government yesterday announced measures to tackle the virus.

Prof Ferguson said screening air passengers is imperfect and pointed out that Spanish flu spread around the world in the days before commercial air travel.

His figures mean the total number of Italy’s cases could outstrip the total number confirmed worldwide. Just over 93,000 have been reported globally as of Wednesday morning.

After mainland China – where the virus originated – South Korea is the next worst hit with 5,328 confirmed cases and 28 deaths.

Iran reports 77 deaths from its 2,300 officially reported cases.

A Coronavirus Guide for Older Adults (And Their Family Advocates)

Jeffrey Kluger noted that it’s hard enough getting old, what with all of the creeping ailments—diabetes, COPD, dementia, heart disease—that come along with age. Now add a novel coronavirus to the mix. There are more than 91,000 COVID-19 cases and 3,100 deaths as of writing, but the virus doesn’t hit all demographics equally hard—and seniors are the most vulnerable.

A late February study in the Journal of the American Medical Association showed that children 10 and under accounted for just 1% of all COVID-19 cases, for example, while adults in the 30-79 age groups represented a whopping 87%. The World Health Organization (WHO) found something similar in China, with 78% of patients falling between the ages of 30 and 69.

The older you get, the likelier you are not only to contract a SARS-CoV-2 infection (the virus that causes COVID-19), but to suffer a severe or fatal case. One study out of China found that the average age of COVID-19 patients who developed acute respiratory distress syndrome—a severe shortness of breath often caused by fluid in the lungs and requiring a ventilator—is 61. As early as January, Chinese health authorities were already reporting that the median age range for people who died of the disease was 75.

“Older people are more likely to be infected, especially older people with underlying lung disease,” says Dr. Teena Chopra, medical director of infection prevention and hospital epidemiology at Wayne State University. “For this population, mortality rates for COVID-19 are about 15%.”

In this sense, COVID-19 behaves a lot like seasonal flu. From 70% to 85% of all flu deaths and 50% to 70% of flu-related hospitalizations occur among people in the 65-plus age group, according to the United States Centers for Disease Control and Prevention (CDC). The 2002-2003 SARS outbreak similarly proved lethal for more than 50% of people over 60 who contracted the disease..

None of this is a surprise of course. With their higher risk of underlying health conditions, older people are already under physical stress, and their immune systems, even if not significantly compromised, simply do not have the same “ability to fight viruses and bacteria,” says Dr. Steven Gambert, professor of medicine and director of geriatrics at the University of Maryland School of Medicine.

What’s more, seniors’ risk of exposure to any pathogen is often higher than that of other adults. There are 48 million seniors overall in the U.S., and while only about 3% of them reside in assisted living facilities, that still factors out to more than 1.4 million already at-risk people living in communal environments in which disease can spread quickly.

“People living in long care facilities have common meetings, they share common rooms,” says Chopra. Common meetings and common rooms can too often mean common pathogens.

In the event of coronavirus infection in a residential facility, Gambert says, those living there should avoid communal rooms and even meals, and, if possible, eat in their own rooms.

Even older people living at home face communal risks, since many of them regularly visit community senior centers, which are great places for socialization and provide a means to stay active and engaged, but can serve as pathogenic petri dishes. Gambert recommends being proactive in these situations, asking the staff of the senior center if they have had any cases of coronavirus, and if so, avoid those facilities.

The health system itself may be playing a significant role in putting seniors at risk. People with multiple medical conditions typically visit multiple specialists, and every such visit means entering a health care environment that can be teeming with viruses and bacteria. For now, Chopra advises older patients to postpone doctor visits that aren’t absolutely essential, like “their annual eye visit. Dental cleaning can be avoided too.” Telemedicine—conducting doctor visits that don’t require hands-on treatment online—can be helpful too, as can e-prescribing, with drugs being delivered straight to patients, sparing them exposure to pharmacies.

Staying current on vaccines—especially flu and pneumonia—can also be critical. Patients—or their family advocates—should ask doctors if they are up to date on their vaccines, or if they need a booster, especially since vaccine formulations change and improve over time. “If you haven’t had a pneumonia vaccine now is the time to get one,” says Gambert. “Even if you have had one in the past, ask your primary care provider if you need a newer one.”

Finally, it’s important to remember that the way COVID-19 presents itself in a younger person is not always the way it presents itself in someone who’s older. “Old people may not get a fever so just checking their temperature may not reveal the infection,” says Gambert.

Instead, he says, families and seniors should be alert for “atypical presentation” of COVID-19. A fall or forgetfulness, for example, might be a sign of infection, even if other, more common symptoms aren’t in evidence. “Any reason you don’t feel the same as you usually do should not be dismissed,” Gambert says.

The coronavirus epidemic is not going away any time soon. That means continued vigilance for our own health and special vigilance for that of seniors. The people who looked after us when we were younger need the favor returned now that they are older.

AOC says that ensuring access to free coronavirus testing and treatment is ‘absolutely’ an ‘argument for Medicare for All’

According to Joseph Zeballos-Roig AOC told the Huffington Post that the government is taking steps to guarantee free coronavirus testing and medical treatment.

“What this crisis has taught us is that, our health care system and our public health are only as strong as the sickest person in this country,” she told the outlet.

Concerns are increasing that the expensive nature of American healthcare could discourage people from seeking medical treatment if they are infected with the coronavirus.

Democratic Rep. Alexandria Ocasio-Cortez said in an interview published Tuesday that ensuring free coronavirus testing and medical treatment is “absolutely” an “argument for Medicare for All.”

The New York congresswoman told the Huffington Post that if the government took steps to guarantee public access to testing and treatments by paying for it, “then what makes coronavirus different from so many other diseases, particularly ones that are transmissible?”

“What this crisis has taught us is that, our health care system and our public health are only as strong as the sickest person in this country,” she told the outlet.

Medicare for All is the signature plan of Sen. Bernie Sanders, a leading Democratic presidential candidate that Ocasio-Cortez has thrown her support behind. It would provide comprehensive health coverage and do away with deductibles, premiums, and other out-of-pocket spending. Private insurance would be eliminated as well.

As of Wednesday, the coronavirus has infected more than 94,000 people in at least 80 countries beyond China, its point of origin. The death toll from the respiratory disease it causes, COVID-19, has killed more than 3,200 people, mostly in China. There are at least 128 confirmed cases in the US.

Over the last week, concerns have mounted that the skyrocketing costs of healthcare could form a barrier discouraging people from getting tested and receiving treatment for the virus.

Business Insider recently analyzed the medical bill of a Miami resident who tested negative for the coronavirus but still racked up a $1,400 in costs, though he was insured. The majority of it came from an emergency room visit.

The Trump administration announced on Monday it was reviewing what products and services it would cover for coronavirus under Medicare and Medicaid, the two biggest federal health insurance programs.

Vice President Mike Pence said a day later the programs would insure diagnostic testing, making it free for patients. But it was not immediately clear what additional medical care would be paid for by the government.

“People who are subject to cost sharing — they are less likely to use medical care, even if they need it,” John Cogan, a health-law expert at the University of Connecticut, previously told Business Insider.

The White House is also reportedly considering reimbursing hospitals and doctors for treating uninsured coronavirus patients. In 2018, 27.5 million Americans had no health insurance, an increase from 25.2 million the year before.

The Most Common Coronavirus Symptoms to Look Out for, According to Experts Coronavirus symptoms are similar to those associated with the flu.

Unless you get a lab test, you can’t really distinguish between coronavirus COVID-19 and a typical cold or the flu. Dr. Wesley Long, Houston Methodist Director of Diagnostic Microbiology The severity of coronavirus

symptoms varies from person to person, Dr. Long notes. In more serious cases, the infection may lead to pneumonia, severe acute

respiratory syndrome, kidney failure, and even death, says Dr. Neal Shipley. Those most at risk of severe illness from coronavirus include the very young, the very old, and people with generally weakened or impaired immune systems. It’s difficult to pinpoint how long it takes

for coronavirus symptoms to appear. “The generally accepted window from exposure to onset of symptoms is 2-14 days,” says Dr. Long. To be clear, there’s still a lot that experts don’t know about COVID-19. And, you can only contract it if you’ve come into contact with someone who already has it.

So, rather than cause continual promotion of more fear we should all be prepared using good hand washing, cleaning surfaces with appropriate products, if you are sick seek assistance with your medical physician or nurse practitioner offices regarding the need to be tested, etc. The question looms out there, not if you will become sick with this virus, but when and how you care for yourself!

Stay well!!

What the Trump budget says about the administration’s health priorities; The Dems and Bloomberg and More on the Corona Virus

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As Michael Bloomberg continues to attempt to buy the Primaries and the Elections let us look at Trump’s new budget and its effect on health care. University of Pennsylvania Assistant Professor of Public Policy, Simon F. Haeder reported that the Trump administration recently released its budget blueprint for the 2021 fiscal year, the first steps in the complex budgetary process.

The final budget will reflect the input of Congress, including the Democratic House of Representatives, and will look significantly different.

However, budget drafts by presidential administrations are not meaningless pages of paper. They are important policy documents highlighting goals, priorities and visions for the future of the country.

As a health care expert, I find the vision brought forward by the Trump administration deeply concerning. Cuts to virtually all important health-related programs bode ill for nations future. To make things worse, ancillary programs that are crucial for good health are also on the chopping block. To be sure, most of the proposed damage will find it hard to pass muster with Congress. Yet given the nation’s ever-growing debt Congress may soon be amenable to rolling back the nation’s health safety net.

Rolling back the ACA and the safety net

To no one’s surprise, some of the biggest cuts in the proposed budget focus on health care programs. The budget document uses a number of terms to disguise its true intentions. Yet a closer look indicates that terms like “rightsizing government,” “advancing the President’s health reform vision,” “modernizing Medicaid and the Children’s Health Insurance Program,” and “reforming welfare programs” all come down to the same end result: cuts to the safety net.

One of the main targets remains the Affordable Care Act, or ACA. In 2017, after several failed attempts to repeal and replace the ACA, the Trump administration has scaled back its open hostility. Instead of asking directly to repeal the ACA, this year’s budget proposal calls for initiatives to “advance the president’s health reform vision,” by cutting more than half a trillion dollars from the budget.

These initiatives come on top of actions the Trump administration has already taken to roll back the Affordable Care Act, including the repeal of the individual mandate penalty, severely limiting outreach and enrollment efforts, and creating a parallel insurance market by expanding the roles of short-term, limited duration and association health plans.

The Trump administration has also targeted Medicaid, the nation’s largest safety net program serving mostly low-income Americans, pregnant women, children, the disabled and those in need of long-term care, as well as its cousin, the Children’s Health Insurance Program. Overall “modernization” for these two programs alone would entail cuts of almost US$200 billion.

Medicare, the program serving America’s seniors, technically would not undergo significant restructuring. However, “streamlining” and “eliminating waste” would reduce the program by more than half a trillion dollars or 6%. All put together, cuts to the ACA, Medicaid and Medicare will exceed a trillion dollars over a decade. Coverage losses, mostly affecting lower-income Americans, would range in the millions of dollars.

Health is more than just medical care

In the U.S, we often equate health with access to medical care. However, researchers have long recognized that medical care contributes only about 10% to 20% to the health of individuals.

One crucial component of good health is access to education. However, the Trump budget includes cuts of more than $300 billion across the entire education spectrum from Head Start to grants that support college education. This just doesn’t make any sense!

Access to food and nutrition also plays a major role in maintaining good health. However, two programs providing important food security to millions of Americans would face significant cuts. For one, the Supplemental Nutrition Assistance Program (SNAP), which supplements food budgets for 34 million Americans with an annual budget of $58 billion, is slated for $22 billion in cuts over a decade. There are also cuts exceeding $2 billion over a decade to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which reaches more than 6 million Americans with an annual budget of $6.4 billion.

Cuts to nutritional benefits would be further compounded by a 15.2% reduction to the Department of Housing and Urban Development. The department provides a range of housing assistance programs to needy individuals. Moreover, the Temporary Assistance for Needy Families (TANF) program which provides cash benefits to needy families, faces 10% in cuts. Again, this doesn’t make any sense!

A healthy environment and access to clean air and water unquestionably are crucial to living a healthy life. However, the proposed budget would trim spending on the agency tasked with protecting the nation’s environment, the Environmental Protection Agency, by more than 40%, or $36 billion.

A myriad of public health crises has been slowly but steadily harming communities all across the country. Much of the attention has been garnered by the devastating opioid crisis. More recently, the coronavirus and the seasonal flu epidemic have caught the headlines. Yet, there are countless other epidemics harming communities around the country including syphilis, hepatitis C and gonorrhea. Yet the nation’s major public health agency, the Centers for Disease Control, would see its budget decline by 9%.

The Trump administration is also proposing to significantly reduce funding for health-related research programs. One target is the National Science Foundation, which would see a reduction by 6.5%. Moreover, the National Institutes of Health, the nation’s premier medical research agency, is set for 7.2% in cuts. Both agencies play crucial roles in positioning the nation to tackle current and future health challenges. Do any of these budget cuts make any sense?

A blueprint for the future?

Since the Kennedy administration, taxes have generally been cut and only rarely increased. Particularly large tax cuts under the George W. Bush administration, without commensurate budget cuts, have created a systemic imbalance in the federal budget. This imbalance was further exacerbated by the recent tax cuts under the Trump administration.

So far, we have been able to stall the eventual reckoning because of strong economic growth and our ability to borrow heavily. Eventually, it seems inevitable that this massive imbalance will catch up with us.

Faced with the choice to either raise taxes or cut programs, Congress may choose the latter. With defense spending largely untouchable, health programs and other social support systems will likely bear the brunt.

Democrats Get Personal on Healthcare

Shannon Firth reported that the Democratic presidential candidates engaged in one of the most brutal and bruising fights to date, attacking each other’s integrity and physical fitness while still reserving time to tear into each other’s healthcare plans.

The debate took place in Las Vegas, with caucuses in Nevada only a few days away, and was broadcast by NBC/MSNBC.

Ahead of the debate, Sen. Bernie Sanders of Vermont, was leading nearly every poll according to RealClearPolitics.

In addition to Sanders, participants included former New York City Mayor Mike Bloomberg, Sen. Elizabeth Warren of Massachusetts, former Vice President Joe Biden, former South Bend, Indiana, Mayor Pete Buttigieg, and Sen. Amy Klobuchar of Minnesota.

Sanders’ health came under scrutiny in the wake of his October 2019 heart attack and stent placements.

When asked whether he would offer voters “full transparency” around his medical records, he was quick to point out that Bloomberg also has two stents. Sanders then said he had released the “full report” of his heart attack and decades of records from the attending physicians on Capitol Hill. (Last month, though, cardiologist Anthony Pearson, MD, noted that the recent report didn’t include Sanders’ left ventricular ejection fraction, a key indicator of cardiac function.)

In addition, two “leading Vermont cardiologists” had also released reports stating that he is “more than able to deal with the stress and the vigor of being president of the United States,” Sanders said, challenging anyone who doubts his stamina to “follow me around the campaign trail.”

Buttigieg quipped that Sanders was in “fighting shape,” but continued to stress the need for transparency.

When President Obama was in office the standard, he was to release “the read out” after a physical. While President Trump lowered that bar, Buttigieg said it should be raised.

“I am certainly prepared to get a physical, put out the results,” he said, “and I think everybody here should be willing to do the same.”

‘A PowerPoint,’ a ‘Post-It,’ and a ‘Good Start’

When it came to healthcare reform plans, Warren took aim at each of the other candidates.

Buttigieg has a “slogan” dreamed up by consultants, she said. “It’s not a plan, it’s a PowerPoint,” referring to Buttigieg’s “Medicare for All Who Want It.”

Buttigieg’s plan, which includes a public option, would initially preserve the role of private insurers, but later serve as a “glide path to Medicare for All.”

She likened Klobuchar’s plan, which also involves a public option, to a “a Post-It Note, ‘Insert plan here,'” then she took aim at Sanders’ more comprehensive plan. Although she had endorsed it in the first debate, this time she called it merely “a good start” that leaves gaping holes in how it would be implemented.

As candidate’s hands shot, with each rebuke, signaling a request to defend themselves, Warren shared her own vision for healthcare reform.

“[W]e need as much help for as many people as quickly as possible and bring in as many supporters as we can. And if we don’t get it all the first time,” presumably here she’s referring to a complete transition to a single-payer system, “… take the win and come back into the fight and ask for more,” Warren said.

Medicare for All has been a particular point of contention in Nevada, where the powerful Culinary Workers Union has been vocal in opposing any plan that takes away its members’ negotiated healthcare coverage. (The union declined to endorse any candidates in the state’s caucuses.) Asked about it in Wednesday’s debate, Sanders said, “I will never sign a bill that will reduce the healthcare benefits that they have, we will only expand it for them, for every union in America and for the working class of this country.”

Buttigieg, however, suggested that Sanders hadn’t been listening. “This idea that the union members don’t know what’s good for them is the exact kind of condescension and arrogance that makes people skeptical of the policies we’ve been putting forward.”

At another point, Biden took a shot at Bloomberg for having attacked the Affordable Care Act during a 2010 speech.

Bloomberg countered that he was in fact “a fan” of the landmark law. “I was in favor of it, I thought it didn’t… go as far as we should,” he said.

Now, his position is that Obamacare should be preserved and strengthened. “We shouldn’t just walk away and start something that is totally new, untried. People depend on this,” he said. One of his first moves as president would be to “bring back those things” that President Trump eliminated.

Other features of Bloomberg’s plan include a public option, caps on healthcare prices, and elimination of “surprise medical bills.” The overall goal is to achieve universal coverage while preserving private insurance.

Bloomberg To Grieving Family: Elderly Cancer Patients Are Too Expensive

Peter Hasson of the National Interest reported that Billionaire and Democratic presidential candidate Michael Bloomberg said in a 2011 video that elderly cancer patients should be denied treatment in order to cut health care costs.

“All of these costs keep going up, nobody wants to pay any more money, and at the rate we’re going, health care is going to bankrupt us,” said Bloomberg, who was then New York City’s mayor.

“We’ve got to sit here and say which things we’re going to do, and which things we’re not, nobody wants to do that. Y’know, if you show up with prostate cancer, you’re 95 years old, we should say, ‘Go and enjoy. Have a nice [inaudible]. Live a long life. There’s no cure, and we can’t do anything.’ If you’re a young person, we should do something about it,” Bloomberg said in the video.

“Society’s not ready to do that yet,” he added.

Bloomberg made the comments while visiting a grieving family whose brother had died after reportedly waiting 73 hours in an emergency room.

His presidential campaign didn’t return a request for comment.

The New York billionaire has faced increased scrutiny over past statements as he has continued to rise in Democratic primary polls.

Fake Facts Are Flying About Coronavirus. Now There’s A Plan to Debunk Them

We have been hearing all sorts of information regarding the Corona Virus and I thought that I would share some of the Fake Facts and some of the truths. Malaka Gharib reported that the coronavirus outbreak has sparked what the World Health Organization is calling an “infodemic” — an overwhelming amount of information on social media and websites. Some of it’s accurate. And some is downright untrue.

The false statements range from a conspiracy theory that the virus is a man-made bioweapon to the claim that more than 100,000 have died from the disease (as of this week, the number of reported fatalities is reported at 2,200-plus).

WHO is fighting back? In early January, a few weeks after China reported the first cases, the U.N. agency launched a pilot program to make sure the facts about the newly identified virus are communicated to the public. The project is called EPI-WIN — short for WHO Information Network for Epidemics.

“We need a vaccine against misinformation,” said Dr. Mike Ryan, head of WHO’s health emergencies program, at a WHO briefing on the virus earlier this month.

The Coronavirus Outbreak
What you should know

Where the virus has spread
Coronavirus 101
Coronavirus FAQs

While this is not the first health crisis that has been characterized by online misinformation — it happened with Ebola, for example — researchers are especially concerned because this outbreak is centered in China. The world’s most populous country has the largest market of Internet users globally: 21% of the world’s 3.8 billion Internet users are in China.

And fake news can spread quickly online. A 2018 study from Massachusetts Institute of Technology found that “false news spreads more rapidly on the social network Twitter than real news does.” The reason, say the researchers, may be that the untrue statements inspire strong feelings such as fear, disgust and surprise.

This dynamic could cause fake coronavirus cures and treatments to fan out widely on social media — and as a result, worsen the impact of the outbreak, says Bhaskar Chakravorti, dean of global business at the Fletcher School at Tufts University. Over the past decade, he has been tracking the effect of digital technology on issues such as global health and economic development.

The rumors offer remedies that have no basis in science. One untrue statement suggests that rubbing sesame oil on the skin will block the coronavirus.

If segments of the public turn to false treatments rather than follow the advice of trusted sources for avoiding illness (like frequent hand-washing with soap and water), it could cause “the disease to travel further and faster than it ordinarily would have,” says Chakravorti.

There could be a political agenda behind the fake coronavirus news as well. Countries that are antagonistic toward China could try to hijack the conversation in hopes of creating chaos and eroding trust in the authorities, says Dr. Margaret Bourdeaux, research director for Harvard Belfer Center’s Security and Global Health Project.

“Disinformation that specifically targets your health system or your leaders who are trying to manage an emergency is a way of destroying, undermining, disrupting your health system,” she says.

In the instance of vaccines, Russian bots have been identified as fueling skepticism about the effectiveness of vaccination for childhood diseases in the U.S.

The World Health Organization’s EPI-WIN team believes that the countermeasure for misinformation and disinformation is simply to tell the truth.

It works rapidly to debunk unjustified medical claims on social media. In a series of bright blue graphics posted on Instagram, EPI-WIN states categorically that neither sesame oil nor breathing in the smoke of fire or fireworks will kill the new coronavirus.

Part of this truth-telling strategy involves enlisting large-scale employers.

The approach, says Melinda Frost, an officer on the EPI-WIN team, is based on the idea that employers are the most trusted institution in society, a finding reflected in a 2020 study on global trust from the public relations firm Edelman: “People tend to trust their employers more than they trust several other sources of information.”

Over the past few weeks, Frost and her team have been organizing rounds of conference calls with representatives from Fortune 500 companies and other multinational corporations in sectors such as health, travel and tourism, food and agriculture, and business.

The company representatives share questions that their employees might have about the coronavirus outbreak — for example, is it safe to go to conferences? The EPI-WIN team gathers the frequently asked questions, has their experts answer them within a few days, and then sends the responses back to the companies to distribute in internal newsletters and other communication.

Because the information is coming from their employer, says Frost, the hope is that people will be more likely to believe what they hear and pass the information on to their family and community.

Bourdeaux at Harvard calls this approach a “smart move.”

It borrows from “advertising techniques from the 1950s,” she adds. “They’re establishing the narrative before anybody else can. They are going on offense, saying, ‘Here are the facts.’ “

WHO is also collaborating with tech giants like Google, Twitter, Facebook, Pinterest and TikTok to limit the spread of harmful rumors? It’s pursuing a similar tactic with Chinese digital companies such as Baidu, Tencent and Weibo.

“We are asking them to filter out false information and promote accurate information from credible sources like WHO, CDC [the U.S. Centers for Disease Control and Prevention] and others. And we thank them for their efforts so far,” said Dr. Tedros Adhanom Ghebreyesus, director-general of WHO, in a briefing earlier this month.

Google and Twitter, for example, now actively bump up credible sources such as WHO and the CDC in search results for the term “coronavirus.” And Facebook has deployed fact-checkers to remove content with false claims or conspiracy theories about the outbreak. Kang-Xing Jin, head of health at Facebook, wrote in a statement about one such rumor that it has eliminated from its platform: that drinking bleach cures coronavirus.

Chakravorti applauds WHO’s coordination with the digital companies — but says he’s particularly impressed with Facebook’s efforts. “This is a radical departure from Facebook’s past record, including its controversial insistence on permitting false political ads,” he wrote in an op-ed in Bloomberg News.

[Facebook and Twitter did not respond to requests from NPR for comments. Facebook is one of NPR’s financial sponsors.]

Still, there is no silver bullet to fighting health misinformation. It has become “very, very difficult to fight effectively,” says Chakravorti of Tufts University.

A post making a false claim about coronavirus can just “jump platforms,” he says. “So you might have Facebook taking down a post, but then the post finds its way on Twitter, then it jumps from Twitter to YouTube.”

In addition to efforts by WHO and other organizations, individuals are doing their part.

On Wednesday, The Lancet published a statement from 27 public health scientists addressing rumors that the coronavirus had been engineered in a Wuhan lab: “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin …. Conspiracy theories do nothing but create fear, rumors and prejudice that jeopardize our global collaboration in the fight against this virus.”

Dr. Deliang Tang, a molecular epidemiologist at Columbia University’s Mailman School of Public Health, says his friends from medical school and his research colleagues in China find it difficult to trust Chinese health authorities, especially after police reprimanded the eight Chinese doctors who warned others about a pneumonialike disease in December.

As a result, Tang’s network in China has been looking to him and others in the scientific community to share information.

Since the outbreak began, Tang says he has been answering “30 to 50 questions a night.” Many want to fact-check rumors or learn about clinical trials for a potential cure.

“My real work starts at 7 p.m.,” he says — morning in China.

And the latest news on the Corona virus: Coronavirus update: 80,238 cases, 2,700 deaths; CDC warns Americans to prepare for disruption

And: Harvard scientist predicts coronavirus will infect up to 70 percent of humanity

Red and Blue America see eye-to-eye on one issue: the nation’s health care system needs fixing and What is Missing in Medicare for All and What is Stressing Us All?

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USA TODAY’s Jayne O’Donnell noted that Health care is one of the most divisive issues of the 2020 presidential campaign, with candidates disparaging insurers and polarizing labels creating deep divisions even among Democrats. But remove the buzzwords from the policies, and voters who will decide the election aren’t so far apart in their own positions, new research shows. But remember what I have been questioning for the last at least 6 months- with all the concern why hasn’t neither the Republicans nor the Democrats have done anything when they had control, i.e. had the majorities in the House or the Senate? And will Mike Bloomberg come to the Democrats’ recur and solve everyones’ problems?

Regardless of party affiliation, nearly everyone wants to see the nation’s health care system improved, and a majority want big changes. That includes people for whom the system is working well, and those who may be political opposites.

That’s the big picture finding of a new Public Agenda/USA TODAY/Ipsos survey of Americans’ attitudes on health care. The survey is part of the Hidden Common Ground 2020 Initiative, which seeks to explore areas of agreement on major issues facing the nation.

The nationally representative survey of 1,020 adult Americans 18 years and older was conducted December 19-26, 2019. It has a margin of error of plus or minus 3.3 percentage points.

The survey removed politically charged language such as “Medicare for All” and “Obamacare” and simply explained the basics of health care approaches in an effort to capture voters’ true opinions.

“There’s the making of a public conversation about this and it does not need to be around ideology,” said Will Friedman, president of Public Agenda, a nonpartisan, nonprofit research and public engagement organization. “People just aren’t so set on what they want.”

The sharpest divides were on the size of government and taxes.

In general, Democrats were more comfortable with a larger role for the federal government, such as the single-payer government insurance program also called Medicare for All, or a public option.

Instead of saying “public option” though, pollsters asked respondents how strongly they agreed with the concept of a new federal health insurance program that gives people a new choice beyond the current private insurance market.

Any adult could buy into the program on a sliding scale, they were told, and 48% were in favor. A survey released last week by the nonpartisan Kaiser Family Foundation found similar support, with the same percentage of Americans favoring such an option.

When described in general terms, 46% of respondents said they would support market-based plans and 45% could back Medicare for All-type plans.

Five goals were rated by more than 90% of those surveyedas very or somewhat important: making health care more affordable for ordinary Americans; lowering the cost of prescription drugs; making sure people with preexisting medical conditions can get affordable health insurance; covering long-term care for the elderly and disabled; and making sure all communities have access to enough doctors and hospitals.

So why the gridlock?

“There are these sort of flashpoints with politicized terminology that send people to their partisan corners,” said former Vermont Gov. Jim Douglas, a Republican who is on the board of the bipartisan, nonprofit United States of Care. “If we avoid them, we’re going to be more successful.”

John Greifzu, a survey respondent and school janitor in Fulton, Illinois, used to be a Democrat and “almost middle of the road.” Now, after being a single father of three children until his recent marriage, health insurance costs have made him distrust his party.

His wife is “paying an arm and a leg” — up to a third of a paycheck — for “bottom of the barrel” insurance that comes with a $2,000 deductible through her retail job. And even on the Medicaid plans that cover his children, there are things that aren’t covered, he said.

Greifzu watched his insurance costs rise as it became offered to the unemployed.

“I work hard for what I’ve got,” said Greifzu. “I’m not going to give up more money for people who don’t do anything.”

Emily Barson, United States of Care’s executive director, said the survey “validates our worldview … that people agree more than the current political rhetoric would have you believe.”

It also shows success at the state level is particularly promising, Barson added.

Before the midterm congressional elections, some Republican members of Congress avoided unscripted town halls with voters as concerns rose about the fate of the Affordable Care Act and protections for people with preexisting conditions. In states, Douglas said governors and state officials can’t avoid voters — or each other.

State officials need to get elected too, but “more importantly, we (states) have to balance our budgets every year,” said Douglas, now a political science professor at Middlebury College.

Friedman noted, however, that voters made it clear in their responses that they don’t want policymakers to leave health care issues to the states. When queried on the specifics, respondents said they didn’t want moving from state to state to make health care any more complicated.

“In terms of the overarching solution, the public would like to see it solved nationally,” he said.

Larry Levitt, senior vice president at the Kaiser Family Foundation, said most of all it’s clear voters want something done about the prices they pay.

“Americans across the political spectrum desperately want relief from health care costs,” Levitt said, “and at some point they’re going to hold political leaders to account for not delivering.”

Obamacare, Medicare and more

The findings from the Public Agenda/USA TODAY/Ipsos poll are part of an election-year project by USA TODAY and Public Agenda. The Hidden Common Ground initiative explores areas of agreement on major issues facing the nation.

The survey of 1,020 adult Americans 18 years and older was taken December 19-26, 2019. It has a margin of error of plus or minus 5.7 percentage points for Democrats, plus or minus 6.2 percentage points for Republicans and plus or minus 5.7 percentage points for independents.

The Hidden Common Ground project is supported by the John S. and James L. Knight Foundation, the Charles Koch Foundation and the Rockefeller Brothers Fund. The Kettering Foundation serves as a research partner to the Hidden Common Ground initiative.

Cost of health care, lack of data security stress us out. It’s time to claim our rights.

USA TODAY opinion contributor, Jane Sarasohn-Kahn reported that Americans are stressed out about health care.

Whether it concerns costs, access to treatment or ability to navigate the system, the American Psychological Association, in its 2019 Stress in America survey, found that 69% of people in the United States say health care is a major source of stress in their life.

We’re also stressed about privacy and data security. We live with a patchwork quilt of laws but no overarching protection that allows us to control our personal information.

As Americans, we need to demand our health citizenship. What does this mean? That people claim health care and data privacy as civil rights.

Polls show that most Americans, from top income earners to people living with much less, believe that it’s unfair for wealthier people to have access to better health care.

In an election year where there seems to be little consensus, two issues on which most American voters agree is the need to lower prescription drugs costs and to protect patients with preexisting conditions. These are priorities that cross party lines in 2020.

What’s driving this cross-party consensus? It’s the reality of patients spending increasingly higher amounts of household income on high-deductible health plans, medical services and prescription drugs. Forcing patients to have more financial “skin in the game” has led millions of Americans to forgo care altogether or to self-ration care by not getting recommended tests and not filling prescriptions.

The second driver for the declaration of health citizenship is the urgent need to protect our personal health information.

In 1996, when the Health Insurance Portability and Accountability Act was enacted, the introduction of the iPhone was 11 years away. The internet was dial up to AOL, CompuServe and Prodigy. And per-capita spending on health care averaged $3,759 (in 2018, it was $11,172).

Health care in 2020 is digitally based, with most physicians and hospitals in America using electronic health records and providers conducting care online via web-based services. Health care is quickly moving to the home, to our cars and even inside our bodies with implants. Wearable technology, remote health monitoring and mobile apps increasingly support our self-care and shared-care with clinicians.

Our health data is vulnerable

Those interactions create new data points. So do daily interactions with our phones and retail purchases. That information, when mashed up with our health care data, can be used to predict our health status, identify emergent conditions like a heart attack or stroke, and customize medications for patients.

But the data generated by our daily lives, outside of HIPAA-covered entities such as doctors, hospitals and pharmacies, is not for the most part covered by existing laws. We are exposed to third-party brokers who monetize our data without telling us how it’s used and without sharing the revenue they make from our personal information.

Universal care is basic right

What would a new era of health citizenship look like? Every American would be covered by a health plan — however we fashion it.

Universal health care, American-style, could come in many forms, including through proposals under debate during the election cycle. All residents in our peer nations in the Organization for Economic Cooperation and Development enjoy some form of health care plan. Most of these countries spend less on health care per person and realize better health outcomes.

One reason is that those nations spend more per person on social factors that help determine a person’s health.

Education, for example, is a major predictor of people’s health. Sir Angus Deaton and Anne Case’s research into the “deaths of despair” in America identified lack of education as a risk factor. Lawmakers need to “bake” health into food and agriculture, transportation, housing and education policies to improve the health of all Americans regardless of income or education levels.

We also need to help people understand the growing role of data in everyday life. Virtually everyone leaves digital dust in the use of mobile phones, credit cards and online transactions. Our peers in Europe enjoy the privacy protection afforded by the General Data Protection Regulation, which defends the “right to be forgotten.” In the United States, we lack laws that sufficiently protect our personal data.

Voting is part of health citizenship, too. The Stress in America survey cited the 2020 presidential election as a major source of Americans’ stress. Let’s make the act of voting a part of our pursuit of good health’

Medicare for All is really missing the point’: Experts say program needs work

Ken Alltucker of USA TODAY, reported that when Robert Davis’ prescription medication money ran out weeks ago, he began rationing a life-sustaining $292,000-per-year drug he takes to treat his cystic fibrosis.

Tuesday, the suburban Houston man and father of two got a lifeline in the mail: a free 30-day supply of a newer, even more expensive triple-combination drug with an annual cost of $311,000.

The drug will bring him relief over the next month, but he’s uncertain what will happen next. Although the 50-year-old has Medicare prescription drug coverage, he can’t afford copays for it or other drugs he must take to stay healthy as he battles the life-shortening lung disorder.

Davis is among millions of Americans with chronic disease who struggle to pay medical bills even with robust Medicare benefits. More than one in three Medicare recipients with a serious illness say they spend all of their savings to pay for health care. And nearly one in four have been pressured by bill collectors, according to a study supported by the Commonwealth Fund.

As Democratic presidential candidates Elizabeth Warren, Bernie Sanders and others tout “Medicare for All” to change the nation’s expensive and inequitable health care system, some advocates warn the Medicare program is far from perfect for the elderly and disabled enrolled in it.

The word “Medicare” was mentioned 17 times during Wednesday night’s debate in the context of a national health plan or a public option people could purchase. However, there’s been little to no discussion among the candidates in debates about the actual status of the health program that covers about 60 million Americans.Ad

One in two Democrats and Democrat-leaning independents want to hear more about how candidates’ plans would affect seniors on Medicare, making it the top health-related concern they’d like candidates to discuss, according to a Kaiser Family Foundation poll released Wednesday.

“We fear the debate about ‘Medicare for All’ is really missing the point,” says Judith Stein, director of the Center for Medicare Advocacy. “What most people don’t know is the current Medicare program has a lot of problems with it. We need to improve Medicare before it becomes a vehicle for a broad group of people.”

Medicare for All faces broad political challenges. About 53% support a national Medicare for All plan, but that support drops below 50% with more details about paying taxes to support a single-payer system, according to the Kaiser poll.

Nearly two in three moderate voters in Michigan, Minnesota, Pennsylvania and Wisconsin are skeptical of a plan to use Medicare as a vehicle for comprehensive health coverage, another Kaiser and Cook Political Report poll released this month shows. A group funded by pharmaceutical companies, health insurers and hospitals has lobbied against Medicare for All, and a survey released by HealthSavings Administrators reported participating employers oppose the plan.

This month, Warren released more details about her health plan, calling for a public option within the first 100 days of her presidency. She said it was not a retreat from Medicare for All, even as a Des Moines Register/CNN/Mediacom Iowa Poll showed her support in Iowa dropped to 16%.

Stephen Zuckerman is a health economist and co-director of the Urban Institute Health Policy Center. He says the Medicare for All proposals expand coverage beyond what Medicare beneficiaries get.

“If you hear about Medicare for All, you might think it’s the current Medicare program for all people,” Zuckerman said. “But that’s not what the Medicare for All proposals are presenting. They are looking at plans that are far more generous, in terms of the benefits they cover and to some extent the cost sharing.”

The fundamental promise of Medicare for All builds on a public program that works well for adults over 65 and people who are unable to work because of disability. Although Medicare rates high in satisfaction among most who have it, a portion of people who need frequent, expensive care struggle financially.

The Commonwealth Fund-supported survey of 742 Medicare beneficiaries reported 53% of those with “serious illness” had a problem paying a medical bill. The study defined serious illness as one requiring two or more hospital stays and three or more doctor visits over three years.

Among these seriously ill patients, the most common financial hardship involved medication. Nearly one in three people reported a serious problem paying for prescriptions. People had problems paying hospital, ambulance and emergency room bills, according to the survey.

Eric Schneider, a Commonwealth Fund senior vice president for policy and research, says the survey’s findings show seriously ill Medicare recipients face “significant financial exposure.

“The expectation is that people would be relatively well-covered under Medicare,” Schneider says. “We’re seeing it has gaps and holes, particularly considering the level of poverty many elderly still live in.”

‘More illness, more sickness’

Davis, the Houston-area man, has rationed expensive but critical modulator drugs, which seek to improve lung function by targeting defects caused by genetic mutations.

When he ran out of the drug Symdeko last November, he coughed up blood, had digestive problems and was hospitalized for a week. This month, he took half the amount he was prescribed, hoping he’d have enough pills to last through the year.

“It alters my breathing a lot,” Davis says. “I’m more congested. I start slowing down, more illness, more sickness.”

Davis has Medicare prescription coverage, but he couldn’t afford Symdeko’s $1,200 monthly copay. He needs to pay an additional $600 each month for a less expensive drug, pulmozyme, which breaks down and clears mucus from his lungs. The medication he takes is critical to keep his lungs functioning and to limit infections.

A private foundation offers copay assistance up to $15,000 each year, a threshold Davis reached this month. Like a year ago, as rent, food and utility bills took most of his disability income, the math didn’t work. He could no longer afford drugs when the foundation’s annual help ran out.

A 30-day supply of the newer drug, Trikafta, was provided by the drug’s manufacturer free of charge. Davis worries he will run into the same problem when he’s again forced to cover a copay he can’t afford.

His Medicare coverage is sufficient for doctor visits and hospital stays, but he says drug costs for cystic fibrosis patients are “out of control.”

“Research is expensive – I understand that,” Davis says. “They are making lifesaving drugs that very few cystic fibrosis patients can afford and that a lot of insurance plans will balk at.”

Vertex Pharmaceuticals, the company that makes Symdeko and Trikafta, says the drugs’ list prices are appropriate.

“Our CF medicines are the first and only medicines to treat the underlying cause of this devastating disease and the price of our medicines reflect the significant value they bring to patients,” the company says in a statement.

Vertex provides financial assistance to patients such as Davis who need the company’s medications.

“Our highest priority is making sure patients who need our medicines can get them,” the company says. “Every patient situation is different, and our (patient-assistance) team works individually with patients who are enrolled in the program to evaluate their specific situations and determine what assistance options are available.”

‘Public Medicare plan is withering’

Advocates such as Stein want presidential candidates to address Medicare’s coverage gaps and other challenges mill

ions of beneficiaries face.

The Commonwealth Fund survey did not report whether participants had traditional Medicare plans or Medicare Advantage plans, which are administered by private insurance companies such as Aetna or UnitedHealthcare. The report did not ask participants whether they had supplemental insurance, which covers out-of-pocket medical expenses not capped by Medicare.

People on Medicare typically have robust coverage for hospital stays and doctor charges. But even with “Part D” prescription drug coverage, Davis and others who must take expensive drugs are responsible for copays.

“What is happening is the public Medicare program is withering,” Stein says. “The private, more expensive, less valuable Medicare Advantage program is being pumped up.”

More than one-third of Americans choose private Medicare plans, which entice consumers through add-on services such as vision and dental coverage and perks such as gym memberships. A survey commissioned by the Better Medicare Alliance, which is backed by the private insurance industry, reported 94% of people in private Medicare plans are satisfied with their coverage.

Private Medicare plans restrict the network of available doctors, hospitals and specialists people can see. Traditional Medicare plans allow people to see any doctor or hospital that takes Medicare.

Stein says tailored networks can be problematic for seniors who travel out of state and encounter a medical emergency.

She says private plans frequently change doctors and hospital networks from year to year. Such frequent network changes can surprise Medicare recipients and force them to switch doctors.

“There’s too much confusion, too little standardization,” Stein says. “The inability, when you are really ill or injured, to get the care where you want it and from whom you want it, I think that is completely lost in the discussion.”

This month, President Donald Trump signed an executive order “protecting and improving” Medicare, but some worry it could push more consumers into private plans and lead to more expensive medical bills. Among other things, the order calls for Medicare to pay rates closer to those paid by private insurers. Medicare typically pays doctors less than what private commercial plans pay.

The federal rules based on the executive order haven’t been finalized, so it’s unclear how it might be implemented.

The executive order “doesn’t seem all that well thought out,” Zuckerman says. Raising Medicare’s payment rates to be on par with private insurance would make the program more expensive and potentially financially vulnerable, he says.

“Public opinion wants to see that program preserved,” Zuckerman says. “At a minimum, I don’t think anyone wants to see Medicare contract.”

US health care system causing ‘moral injury’ among doctors, nurses

Megan Henney of FOX Business noted that the emphasis on speed and money — rather than patient care — in emergency medicine is leading to mass exasperation and burnout among clinicians across the country.

According to a new report published by Kaiser Health News, a model of emergency care is forcing doctors to practice “fast and loose medicine,” including excessive testing that leaves patients burdened with hefty medical bills; prioritizing speed at the cost of quality care and overcrowding in hospitals, among other issues.

“The health system is not set up to help patients,” Dr. Nick Sawyer, an assistant professor of emergency medicine at the University of California-Davis, told Kaiser Health. “It’s set up to make money.”

In October, a 312-page report published by the National Academy of Medicine, a non-profit organization based in Washington, D.C., found that up to half of all clinicians have reported “substantial” feelings of burnout, including exhaustion, high depersonalization and a low sense of personal accomplishment.

Physician burnout can result in increased risk to patients, malpractice claims, clinician absenteeism, high employee turnover and overall reduced productivity. In addition to posing a threat to the safety of patients and physicians, burnout carries a hefty economic cost: A previous study published in June by the Annals of Internal Medicine estimated that physician burnout costs the U.S. economy roughly $4.6 billion per year, or $7,600 per physician per year.

Physicians suffering from burnout are at least twice as likely to report that they’ve made a major medical error in the last three months, compared to their colleagues, and they’re also more likely to be involved in a malpractice litigation suit, the report found. Each year, about 2,400 physicians leave the workforce — and the No. 1 factor is burnout.

The authors of the report, who spent 18 months studying research on burnout, found that between 35 and 54 percent of nurses and doctors experience burnout. Among medical students and residents, the percentage is as high as 60 percent.

“There is a serious problem of burnout among health care professionals in this country, with consequences for both clinicians and patients, health care organizations and society,” the report said.

But the issue in emergency medicine goes beyond burnout. A 2018 report published by Drs. Wendy Dean and Simon Talbot found that physicians are facing a “profound and unrecognized threat” to their well-being: moral injury.

The term “moral injury” was first used to describe soldiers’ response to war and is frequently diagnosed as post-traumatic stress. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”

At the crux of moral injury in physicians is their inability to consistently meet patient’s needs, a symptom of a health-care environment that’s increasingly focused on maximizing profit that leaves clinicians trapped between navigating an ethical path or “making a profit from people at their sickest and most vulnerable.”

“The moral injury of health care is not the offense of killing another human in the context of war,” Dean and Talbot wrote. “It is being unable to provide high-quality care and healing in the context of health care.”

In the one year since they published their paper, Dean and Talbot sparked an international conversation among health care professionals about the moral foundations of medicine, receiving a flood of responses.

“All of us who work in health care share, at least in the abstract, a single mission: to promote health and take care of the ill and injured. That’s what we’re trained to do,” they wrote. “But the business of health care — the gigantic system of administrative machinery in which health care is delivered, documented, and reimbursed — keeps us from pursuing that mission without anguish or conflict.”

And as I am watching the New Hampshire Primary results I am amazed that Bernie is heading the Dems, as they are saying, based on his push for Medicare for All. Just a flawed proposal and evidently there are many that believe this Socialist. I am truly worried.

More Patients Insured in U.S. and More Can’t Afford Doctors but May-be Americans Don’t Really Want Medicare for All — They Want Japa-nese Health Care and the American College of Physicians

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As the Democrat presidential candidates argue about Medicare for All as well as alternate programs I still wonder if Americans really know what they want for a health care plan at all. Rapport of Reuters Health noted that A growing number of Americans find it too expensive to see doctors even though more people have health insurance, a U.S. study suggests. But just wait Bernie Sanders is going to give us all free health care, free education, free everything, which the big businesses will pay for. Really?

Over the past two decades, the proportion of adults without insurance dropped to 14.8% from 16.9%, the study found. But during this same period, the proportion of adults unable to afford doctor visits climbed from 11.4% to 15.7%.

Out-of-pocket costs made doctors too expensive for the uninsured, but costs also kept people with coverage from seeing physicians even when they had chronic medical conditions requiring regular checkups.

“The quality of private health insurance is getting worse, and the cost of healthcare is rising significantly,” said lead study author Dr. Laura Hawks of the Cambridge Health Alliance and Harvard Medical School in Boston.

“We know that private health insurance plans increasing rely on high premiums, high-deductible health plans . . . high copays and other forms of cost-sharing,” Hawks said by email. “All these create financial barriers.”

For the study, researchers examined survey data collected from 1998 to 2017 by the Centers for Disease Control and Prevention. They wanted to see how access to care changed after the Affordable Care Act (ACA) was implemented 2014.

The proportion of adults 18 to 64 years old who couldn’t afford to see a doctor climbed slowly from 1998 to 2009, then rose more rapidly for several years before improving with the passage of the ACA, researchers report in JAMA Internal Medicine. But even after the ACA took effect, the proportion of adults able to afford checkups never returned to 1998 levels.

Affordability worsened across all racial and ethnic groups, and nearly all income groups, the study found.

Among the uninsured, the proportion of adults unable to afford physician visits climbed from 32.9% to 39.6% during the two-decade study period.

For people with health benefits, the proportion unable to pay for doctor visits rose from 7.1% to 11.5%.

The inability to see a doctor because of costs rose for people with many common chronic health problems including heart disease, high cholesterol and alcohol use disorders.

The study didn’t look at how shifts in the affordability of physician checkups might directly affect health outcomes.

One limitation of the analysis is that researchers lacked data on the affordability of prescription medications, which can also impact health as well as how often people need to see doctors.

“We knew that uninsured adults are much more likely than insured adults to avoid seeing a doctor due to cost, and uninsured adults with chronic conditions such as diabetes or heart disease are much less likely to get regular check-ups,” said Dr. John Ayanian, director of the Institute for Healthcare Policy and Innovation at the University of Michigan in Ann Arbor, who wrote an editorial accompanying the study.

Still, the results underscore that the ACA hasn’t insured everyone who needs coverage or made care affordable for all Americans, Ayanian said by email.

This means patients who struggle to pay for checkups need to ask for help.

“For people with chronic conditions such as diabetes, high blood pressure, or heart disease who have difficulty affording their ongoing care, I recommend they speak to their doctor and pharmacist about ways to save costs, including reduced fees for office visits or switching to less expensive generic medications,” Ayanian said. “Community health centers or hospital clinics may also have special programs to provide care for free or reduced fees for lower-income patients who are uninsured or who have high levels of medical debt.”

Japan provides a model for Americans who want a system that covers everyone with no mandate and no new middle-class taxes

Jon Wallker noted that Bernie Sanders has made a habit of pointing out how much less other countries pay for health care. Throughout the Democratic debates, the Vermont senator repeatedly claimed that the United States is “spending twice as much per capita on health care as any other nation.”

Sanders of course doesn’t mention that his plan wouldn’t come anywhere close to cutting our health care spending in half — doing so would require bringing salaries for doctors and hospital workers down to international norms. His omission is no surprise: Too often, American politicians rely on superficial comparisons with other nations to promote their health care agendas. Moderate Democrats often claim Obamacare should resemble the Swiss health care system, though in reality Obamacare lacked all the regulations that make that system function. Conservatives frequently try to scare people by pointing to highly selective stories of wait times in Canada or Britain, while ignoring the infinite wait time caused by not being able to afford care here.

If we look honestly at all the health care systems in the world to find the one which most closely aligns with voters’ desires, we would probably end up with the Japanese model. It is not the system anyone would design from scratch. It is a relatively complex system that evolved over decades to fit the needs, changing dynamics, and political trade-offs of the country. But for that very reason, it might most closely satisfy Americans’ seemingly endlessly contradicting opinions on reform.

Japan has more than 3,000 insurance plans, yet the benefit is not nearly the costly mess it is in the United States.

The Japanese health care system is based on employer- or union-provided insurance, just like the American one. People not covered by employer insurance are covered by government plans. Seniors basically have their own special coverage. The poor and disabled have special subsidies. Cumulatively, Japan has over 3,000 insurance plans, yet the benefit is not nearly the costly mess it is in the United States.

The thousands of plans in the U.S. individually negotiate with thousands of providers for millions of different prices. This drives up prices and creates massive administrative waste. In Japan, everything is highly standardized by the federal government. All plans need to cover the same set of benefits, reimburse providers the same amounts, use the same forms, and so on. Japanese employers can provide extra benefits on top of the standard baseline and what you pay depends partly on your employer’s risk pool, like in the U.S., but overall the difference between the plans is minor. As a result, Japan’s administrative spending is below that of many single-payer countries like Canada.

In practice, the Japanese system doesn’t seem much different than single-payer systems: In Japan, large companies set money aside in special accounts, and the government then tells them how to pay hospitals. In single-payer systems, large companies have to give money to a special government account, which then gives it to hospitals. However, the difference has real political implications.

Rhetorically, American politics is weirdly obsessed with people “losing their employer health insurance,” but we rarely ever talk about how insurance changes almost every year, usually for the worse: higher deductibles, new narrower networks, more co-pays, and so on. Only 44% of Americans say they would prefer a system mostly run by the government and 68% have a favorable view of employer coverage. Yet, at the same time, insurance regulations the government puts on employer coverage are very popular.

This employer coverage also solves the funding problem which plagues reform efforts. Americans don’t seem to understand or simply don’t care just how much they indirectly pay for employer insurance. The type of broad new taxes needed to pay for Medicare for All tend to be very unpopular. Even with very favorable wording, polling by YouGov found just 32% supported paying for Medicare for All with a tax on income over $29,000. (Proponents of M4A claim the net savings from no premiums or coinsurance would outweigh the cost of new taxes.) Even in deep blue Vermont, once local Democrats saw the size of the taxes needed to replace employer premiums — an 11.5% payroll tax and a new income tax of up to 9.5% — they declared their single-payer plan politically infeasible.

The same poll found a per-employee fee proposed by Sen. Elizabeth Warren to get around this anti-tax problem polls better, with 50% yes and 31% no. Yet what is consistently even more popular is just mandating all employers provide quality insurance, like Japan does. That polls at 69% support.

The Japanese model also provides a solution for Americans’ seemingly conflicting desires for a system that features no new middle-class taxes, no individual mandate, and yet covers everyone. In Japan, people without employer insurance need to buy coverage from their local government. Premiums are subsidized for those with lower incomes. If you don’t pay for insurance, though, there is no direct penalty, except when you do reenter the system you can be made to pay back premiums. Basically, if there is some small group of recalcitrants who want to try to avoid health insurance altogether, just let them and charge them when they do seek treatment.

There are two main ways Japan controls cost. The first is standardized cost-sharing. There are no deductibles, but people have a 30% coinsurance up to a monthly limit. There is no gatekeeping or preauthorization, but if you go to a specialist without a referral, you need to pay extra. Cost-sharing is one mechanism Americans have already come to accept for decades.

The other main tool is the that government aggressively sets low uniform prices with doctors, hospitals, and drug makers. This is why it works. This is also the part of the Japanese system which would generate the greatest industry opposition in the United States — as would Medicare for All for the same reasons. And even a decent Medicare buy-in would likely end up a de facto benchmark rate for providers.

All adopting a Japanese type of system would require is for the U.S. to take what it is currently doing and heavily standardize it. The biggest change would be scrapping the individual non-employer-based market to put everyone on a government plan, but the individual market is the least popular part of our system anyway. The majority of people with employer insurance would still have their same “private coverage,” with the same branding, but now cheaper and better. It would be the least disruptive system to copy, and it even has a precedent here. Hawaii has mandated every employer provide standardized, affordable, high-quality insurance since 1974, thanks to a special waiver from federal laws that prevent other states from copying Hawaii’s model.

The price of the lack of disruption, though, is not addressing many of the financing fairness issues we rarely talk about. Companies with younger workers would still pay less than companies with older workers. People living in high-cost localities would still pay higher premiums than people in low-cost areas. The overall funding would remain roughly as regressive as it currently is.

Polling shows even Democratic voters rank lowering drug prices, lowering what people pay, and ending surprise billing as bigger priorities than Medicare for All. And it is not clear people who claim they favor Medicare for All actually want the level of change it would cause. Polling shows 68% of Democrats incorrectly believe that under Medicare for All people would be allowed to keep their employer coverage, and 61% of Democrats believe the employers/individuals would continue to pay premiums, according to a poll this year by the Kaiser Family Foundation.

Meanwhile, moderate Democrats like Joe Biden are offering voters more layers of complexity instead of simple solutions. Instead of just directly mandating all employer coverage be as good and affordable as his proposed public option, Biden simply allows every worker to run the complicated cost calculations themselves to decide if their employer plan is a worse deal for them than the public option. While Japan automatically ensures your coverage is good, Biden makes that task a yearly burden for employees — which is deeply problematic since only 4% of Americans understand basic insurance terms.

It is possible adopting a Japanese-style health care system might even be the fastest way to Medicare for All. South Korea created universal health care via a system very similar to Japan in 1989 and then in 2000 decided to move to a true single-payer system. Of course “have the federal government set prices, heavily regulate employer insurance so it acts basically like Medicare, and making buying subsidized Medicare quasi-optional for everyone else,” isn’t the catchiest slogan. So, it is unlikely voters will ever hear about a path that could give them what they seem to want championed.

ACP Backs Single-Payer Healthcare

Alicia Ault noted that The American College of Physicians (ACP) is backing both a single-payer system and a public option that retains private insurance as the best ways to ensure that all Americans have healthcare.

The ACP’s endorsement comes as part of a broad proposal to overhaul the US healthcare system, published today in the Annals of Internal Medicine.

Rather than continue to react to others’ proposals, the ACP decided, “we are going to stick our necks out and put forward what we think is a better way,” Bob Doherty, ACP senior vice president for governmental affairs and public policy, told Medscape Medical News.

It is a break from previous ACP policy — which never explicitly backed single payer — and with other physician organizations, including the American Medical Association and the American Academy of Family Physicians, both of which have declined to back a single-payer healthcare system.

The ACP’s board of regents endorsed the overhaul proposal in November, and Doherty said he was confident that it had the backing of the majority of the organization’s 159,000 internists and medical students.

Physicians for a National Health Program (PNHP) applauded the ACP’s policy shift.

“For a century, most US medical organizations opposed national health insurance,” PNHP cofounders Steffie Woolhandler, MD, and David Himmelstein, MD, write in an Annals editorial. “The endorsement by the American College of Physicians (ACP) of single-payer reform marks a sea change from this unfortunate tradition,” they say.

No Political Endorsement

The ACP timed its announcement to come just before the first major presidential primary contests in Iowa (February 3) and New Hampshire (February 11), but the organization is not backing any candidate’s healthcare proposal.

“We know that election years, particularly presidential election years, create an opportunity to engage in discussion about the future of public policy,” Doherty said, adding that healthcare, and in particular affordability, rank among voters’ top concerns.

After examining health systems in a dozen countries and reviewing policies that have been proposed for the United States, the ACP decided that both single payer and a public option would increase universal coverage, one of the ACP’s long-stated policy goals.

“For us to say single payer is the only way to achieve universal coverage is just not consistent with the evidence,” Doherty said. The coverage goal can also be achieved with a public option, “provided that you had enough marketplace regulation of private insurance that would be competing with the public program,” and if there was automatic enrollment for people who did not have private insurance, Doherty said.

Negotiate Payment Rates

Unlike Democratic presidential candidate Elizabeth Warren’s plan to pay for her Medicare for All plan by pegging physician and hospital pay to Medicare rates, the ACP said that would not work.

“There would have to be a process to negotiate for established rates that would be sufficient to ensure that physicians would participate in the program,” Doherty said.

As part of its multipronged overhaul, the ACP is also proposing an elimination of copays and deductibles for high-value services such as primary care, and also for patients with chronic diseases.

A renewed emphasis on primary care would create savings, the ACP posited in its call to action and the four papers outlining its positions on how to overhaul the health system.

“We believe that American health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and under invests in public health; spending too much on administration at the expense of patient care; and fosters barriers to care for and discrimination against vulnerable individuals,” said ACP President Robert M. McLean, MD, MACP, in a statement.

I believe that the ACP has some interesting reasonable solutions as well as my opinion that President Obama and his experts came up with a great plan except for financial sustainability. As a country we have to realize that any sustainable program will be costly and the cost will be shared by all. Do we all really want Bernie or Elizabeth to be our presidents to drive our country to the edge and convert to socialism? Wake up America!

‘I owe the American people an apology’: A former healthcare executive says he’s sorry for devising the biggest argument against Medicare for All and Some Additional Thoughts

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As the politicians are getting ready for the Senate impeachment trial, I realize how much time has been wasted on non-health care, non-immigration, non-education improvement, non-environmental issues. Both parties, Democrats and Republicans have wasted and multiple millions of our taxpayer dollars. Pathetic. These are the people that we voter for to do our bidding…improve our lives. Instead they fight and embarrass all of us. Pathetic!

And again, what about Medicare for All? Zeballos-Roig noted that Wendell Potter, a former health insurance executive and now pro-Medicare for All activist, apologized for his role in designing the biggest argument against industry reform in a New York Times op-ed published Tuesday.

He was referring to the idea of choice, or put another way, the freedom of Americans to pick their own health insurance plans and which doctors they want to see.

The activist called it “a PR concoction,” one filling him with “everlasting regret.”

A former executive at a prominent health insurance company had one thing to say recently: I’m sorry.

Wendell Potter, once a vice president for corporate communications at Cigna and now a pro-universal healthcare activist, laid out his apology in the New York Times on Tuesday for crafting one of the biggest arguments used against the creation of a single-payer system in the United States.

He was referring to the idea of choice, or put another way, the freedom of Americans to pick their own health insurance plans and which doctors they want to see.

It’s a common argument the health industry employs to oppose any attempt to change the system. Most recently, its spearheaded a multimillion-dollar effort to throttle proposals for Medicare for All, which would enroll everyone in the US onto a government insurance plan and virtually eliminate the private insurance sector.

“When the candidates discuss health care, you’re bound to hear some of them talk about consumer ‘choice,'” Potter wrote, referring to the Democratic primary field. “If the nation adopts systemic health reform, this idea goes, it would restrict the ability of Americans to choose their plans or doctors, or have a say in their care.

He called it “a good little talking point,” effective at casting any reform proposal expanding the government’s role in healthcare as drastically damaging.

But Potter said that defense was ultimately “a P.R. concoction,” and one that filled him with “everlasting regret.”

“Those of us in the insurance industry constantly hustled to prevent significant reforms because changes threatened to eat into our companies’ enormous profits,” Potter wrote.

Potter resigned his position at Cigna in 2008. And he testified to Congress a year later about the practices of an industry that “flouts regulations” and “makes promises they have no intention of keeping.” He’s since become a leading reform advocate.

Get this, the activist said in the Times op-ed that healthcare executives were well aware their insurance often severely limited the ability of Americans to personally decide how they accessed and received medical care, unless they wanted to pay huge sums of money out of their own pockets.

Do you all believe this?

“But those of us who held senior positions for the big insurers knew that one of the huge vulnerabilities of the system is its lack of choice,” Potter said. “In the current system, Americans cannot, in fact, pick their own doctors, specialists or hospitals — at least, not without incurring huge ‘out of network’ bills.”

The “choice” talking point, Potter wrote, polled well in focus groups that insurers set up to test their messaging against reform plans, leading them to adopt it.

Now he is shocked to see an argument that he had a hand in engineering used among Democrats battling to claim their party’s nomination to face off against President Trump in the 2020 election — and Potter says the insurers likely see it as a huge victory for them.

“What’s different now is that it’s the Democrats parroting the misleading ‘choice’ talking point — and even using it as a weapon against one another,” Potter wrote. “Back in my days working in insurance P.R., this would have stunned me. It’s why I believe my former colleagues are celebrating today.”

One of the biggest divides among Democratic candidates is on health reform.

The progressive wing of the party, led by Sen. Bernie Sanders, largely supports enacting Medicare for All. So does Sen. Elizabeth Warren, though she’s tempered her rhetoric backing it in the last few months after rolling out her own universal healthcare plan and drawing criticism for its hefty $20.5 trillion price tag.

Moderates like former Vice President Joe Biden and South Bend Mayor Pete Buttigieg are pushing to create an optional government insurance plan for Americans instead. They’ve argued that a single-payer system could kick millions of Americans off their private insurance and restrict their ability to manage their care — echoing the line of attack used by the healthcare industry.

Potter had a warning for voters as they head to the polls in this year’s election.

“My advice to voters is that if politicians tell you they oppose reforming the health care system because they want to preserve your ‘choice’ as a consumer, they don’t know what they’re talking about or they’re willfully ignoring the truth,” Potter wrote in the op-ed. “Either way, the insurance industry is delighted. I would know.”

Humana CEO talks M&A, government-controlled health care

More from another healthcare executive. Reporter Chris Larson noted that Louisville-based Humana Inc. — a giant in the health insurance market — expects its long-term success to be based in providing health services to keep its members from needing more care.

Humana CEO Bruce Broussard said as much — and much more — on Monday in two appearances at the J.P. Morgan Healthcare Conference in San Francisco.

Appearing beside Humana Chief Financial Officer Brian Kane, the duo answered a wide range of questions (which you can hear for yourself here). Below are a few takeaways from their remarks.

Humana’s core business is expected to grow despite market leader status

Administering Medicare Advantage, a privately administered version of the federal health plan Medicare, is at the heart of Humana’s (NYSE: HUM) business: it has about 4.1 million members on individual or group Medicare Advantage plans, according to the company’s latest financial disclosure.

One analysis shows that Humana holds about 18 percent of the Medicare Advantage market, the second largest share in the nation.

Presentation moderator Gary Taylor, a managing director and senior equity analyst with J.P. Morgan, noted that continued growth in a market-leading position is not typical and noted that continued growth in the Medicare Advantage business is possible because more seniors are using it rather than traditional Medicare.

Taylor said that about one-third of Medicare enrollees are on Medicare Advantage plans. Broussard said that he expects that portion to grow to one-half in the next seven to 10 years.

“We’re seeing just both a great consumer attraction, but, more importantly, great health outcomes by being able to serve someone more holistically,” Broussard said.

Broussard added that Humana’s growth in Medicare Advantage depends on brand recognition and customer experience. He added he expects that the company can grow along with the popularity of Medicare Advantage in the Midwest and Texas specifically.

Public policy: Americans want a private option

Some Democratic presidential candidates say they would push for expanded health benefits from the government while others — notably Vermont Senator and presidential hopeful Bernie Sanders — want to see private insurance eliminated altogether. Broussard largely downplayed the likelihood that these proposals would become policy.

He referred to polling, the company’s experience and the increased popularity of Medicare Advantage — a privately administered version of a government health plan — as proof that people want private options in health care.

Humana’s M&A plans will focus on clinical capabilities

Broussard said clinical capabilities were key to the company’s success and later added that its merger and acquisition activity would largely focus on that.

“What we see long term is the ability to compete in this marketplace will be really determined on your clinical capabilities — helping members stay out of the health care system as well as what we’ve done in past in managing costs in the traditional managed care way,” Broussard said.

Broussard added later in the presentation: “As we think about growth, we really think about how do we build the health care services side more. We’ll still buy plans especially on the Medicaid side and the markets that we want to be in. But for the most part, I think our capital deployment is expanding the capabilities we have.”

He added that there are only a few options for additional blockbuster mergers in the health care industry given the current regulatory environment.

Humana was the subject of such a merger a few years ago with Hartford, Connecticut-based Aetna Inc. But that deal fell apart and Aetna has since merged with Woonsocket, Rhode Island-based CVS Health Inc.

Humana was party to a $4.1 billion acquisition that took Louisville-based Kindred Healthcare private and separated Kindred At Home into a standalone entity.

How an insured pro athlete ended up with $250,000 in medical debt

With all the concern regarding patients without health care insurance that there are people with insurance who due to the complexities of the system still end up with huge bills sometimes ending in bankruptcies. In the U.S., going bankrupt because of medical bills and debt is something that doesn’t just happen to the unlucky uninsured, but also to people with insurance.

Though health plans have an “out of pocket max” – the most you’d be required to pay for medical services in a given year – that’s no guarantee that number will ensure a safety net.

This is what pro cyclist Phil Gaimon discovered after a bad crash in Pennsylvania last June that left him with his collarbone, scapula, and right ribs broken. The bills totaled $250,000.

“I have good insurance,” Gaimon told Yahoo Finance. “I pay a lot of money for it. I just haven’t gotten good explanations for any of this.”

Gaimon pays $500 a month for a plan with a $10,000 deductible, and is fighting the bills.

This type of medical debt isn’t uncommon. The Kaiser Family Foundation, a healthcare think tank, has reported that insurance can be incomplete and that the complexity of the system often leaves people seeking treatment in financial hardship. In a survey KFF found that 11% of consumers with medical bill problems have declared bankruptcy, and cited the medical bills as at least a partial contributor. Another report found that medical problems contributed to 66.5% of all bankruptcies. (Currently, there’s some legislation addressing surprise billing issues.)

Gaimon was taken by ambulance to the nearest hospital after his crash. Unfortunately, it turned out to be an out-of-network hospital. Gaimon told Yahoo Finance that he thought it would be okay, because the emergency nature could be seen as an extenuating circumstance. His insurer, Health Net, has an appeals process for situations like that.

Gaimon figured the no-other-option aspect of the situation would solve the problems, and believed it enough to post on Instagram soon after that people should donate to No Kid Hungry, a children’s food insecurity charity, rather than a GoFundMe for his bills.

“I said, ‘Hey, I crashed, what would you donate to my GoFundMe if i didn’t have health insurance? Take that money and give it to this instead,’” said Gaimon. “We raised around $40,000 in 48 hours.”

The $103,000 raised in the next few months would have taken a big chunk out of his medical bills, but Gaimon has no regrets. “Someone out there needs more help than I do,” he said.

Medical bills are fun!

It’s hard to comparison shop when you’re in physical pain

Things may have been easier if it would have been possible for Gaimon to steer the ambulance towards an in-network hospital. But an ambulance isn’t a taxi — it’s a vehicle designed to bring a patient to health care providers in the least amount of time possible.

Also consider that Gaimon, as he put it, was in “various states of consciousness” following his accident — hardly in a position to check which hospitals are in his insurer’s network.

Gaimon may be able to win the appeals process with his insurer for the out-of-network hospital. But that’s just the beginning of his insurance woes.

The cyclist’s scapula break was complex enough to require a special surgeon, and Gaimon said the hospital was unable to find someone capable.

“I was laying in the hospital for three days hitting the morphine,” Gaimon said. Multiple times a potential surgeon would come to examine him only to say that they weren’t up to the task.

After multiple cycles of fasting before a surgery only to be told that the surgeons couldn’t operate, Gaimon took matters into his own hands. Eventually he found a surgeon in New York to do it, and even though it was out-of-network as well, he figured the fact that there was seemingly no other alternative would mean his insurer would cover the surgery.

So the track race didn’t go very well. Broken scapula, collarbone, 5 ribs, and partially collapsed lung. What if I told you that I don’t have health insurance? Would you donate do help me out? How much?

Okay well I do have health insurance and I’m fundamentally alright, so I ask you to take that money and give it to @ChefsCycle @nokidhungry who need it more than I do. I’m in a lot of pain and this is all I can think to cheer me up. Link in profile and updates as I have them. Xo

Six months later, Gaimon finds out that it did not, and is fighting the charges. He’s hired a lawyer to help, as has had mixed results with the system so far.

“No one talks prices until it’s over — that’s the other horrible flaw,” he said.

Gaimon said that he’s numb to things at this point, though he doesn’t know what will happen.

“Ultimately I’m going to have to negotiate with that hospital, or the health insurance will choose to cover,” said Gaimon. “Or they’ll have to sue me and I’ll go bankrupt — the traditional way you deal with medical stuff.”

Gaimon’s sarcasm aside, sky-high health care costs are a central issue in the current presidential election and a frequent talking point for Democratic candidates. In this week’s Democratic debate, Sen. Bernie Sanders highlighted the issue. “You’ve got 500,000 people going bankrupt because they cannot pay their medical bills,” Sanders said. “We’re spending twice as much per capita on health care as do the people of any other country.”

The whole ordeal has shown Gaimon how fragile the healthcare system really is.

“The whole idea that you could be in a car accident and you wake up in a hospital and owe $100,000 — and that could happen to anyone — that’s a ridiculously scary thing,” he said. “I was making no decisions, I was on drugs, and in fetal-position-level pain. Every decision was made to live. And then you emerge and you’re financially ruined.”

Medicare for All? A Public Option? Health Care Terms, Explained

Now, a review of some of the terms that we keep discussing. As I complete a chapter in my new book, I thought that it would worth taking the time to review some of the terms. Yahoo Finance’s Senior writer, Ethan Wolff-Mann reported that if the last few Democratic presidential debates are any guide, tonight’s will likely delve into health care proposals. Do voters know what we’re talking about when we talk about various plans and concepts, including “Medicare for All?” Or any of the other health policy terms that get thrown around?

Pretty much no.

According to one poll from the Kaiser Family Foundation, 87% of Democrats support “Medicare for All,” while 64% of Democrats support “single-payer health care.” Here’s the catch — those two phrases describe almost the same thing. The language in this debate is murky, confusing and hugely consequential. So, we’re laying out some key terms to help you keep up.

Single-payer

This is a kind of health care system where the government provides insurance to everyone. Think about it as if you’re a doctor: a patient comes in, and you treat them. Who’s paying you for that care? Under our current system, it could be a variety of payers: state Medicaid programs, Medicare, or a private insurance company like Aetna or Cigna or Blue Cross and Blue Shield — each with different rates and different services that they cover. Instead, under the single-payer model, there’s just one, single payer: the government.

Medicare for All

If single-payer is fruit, Medicare for All is a banana. In other words, single-payer is a category of coverage, and Medicare for All is a specific proposal, originally written by presidential candidate Sen. Bernie Sanders (as he often reminds us). It envisions the creation of a national health insurance program, with coverage provided to everyone, based on the idea that access to health care is a human right. Private health insurance would mostly go away, and there would be no premiums or cost-sharing for patients.

Important note: it would not actually just expand Medicare as it exists now for all people (as you might guess from the name). Medicare doesn’t cover a whole lot of things that this proposed program would cover, like hearing and vision and dental and long-term care.

Public option

The idea of a “public option” was floated back in 2009 when the Affordable Care Act was being debated. The idea is that along with the private health insurance plans that you might have access to through your employer or through the individual insurance exchanges, there would be an option to buy into a government-run insurance program, like Medicare. Private insurance would still exist, but people could choose to get a government insurance plan instead.

There are many kinds of public option proposals, and different presidential candidates have their own ideas on how it would work, whether it’s lowering the age for Medicare access or creating a new program that’s not Medicare or Medicaid that people could buy into, among others. The idea is that the government might be able to offer a more affordable option for people, which could push down prices in the private insurance world.

Pete Buttigieg’s plan — “Medicare for All Who Want It” — is his version of a public option. And Elizabeth Warren announced November 15 that she’d start with a public option plan before trying to push the country toward Medicare for All.

“Government-run” health care

Many opponents of Medicare for All and other health proposals use the term “government-run” as a dig against them, including President Trump. (Sometimes the term “socialized medicine” is used as well.) In the U.K. and some other places, the government doesn’t just pay people’s health care bills, it also owns hospitals and employs doctors and other providers — that’s a government-run health care system. The single-payer concept being discussed in this country’s presidential campaign would not operate like that — the industry would still be mostly private, but the government would pay the bills. How the government would generate the money to pay those bills is subject to debate.)

Universal coverage

This isn’t a plan, it’s a goal that everyone has health insurance — that health insurance coverage is universal. The Affordable Care Act made a system for states to expand Medicaid and created the individual health insurance exchanges, , both of which significantly cut down on the number of uninsured people, but currently 27 million Americans do not have health insurance, and the rate of people who lack insurance is rising. Most Democratic presidential candidates would like to achieve universal coverage — the debate is about the best approach to get there.

Medicare for All Would Save US Money, New Study Says

Reporter Yuval Rosenberg, The Fiscal Times noted that a Medicare for All system would likely lower health care costs and save the United States money, both in its first year and over time, according to a review of single-payer analyses published this week in the online journal PLOS Medicine. You have to read on to understand the flimsy data and weak argument to try to convince us all to adopt the Medicare for All program, especially those of us who really know the reality of living with a Medicare type of healthcare program and the reality of restrictions in needed care for the patients.

The authors reviewed 18 economic analyses of the cost of 22 national and state-level single-payer proposals over the last 30 years. They found that 19 of the 22 models predicted net savings in the first year and 20 of 22 forecast cost reductions over several years, with the largest of savings simplified billing and negotiated drug prices.

“There is near-consensus in these analyses that single-payer would reduce health expenditures while providing high-quality insurance to all US residents,” the study says. It notes that actual costs would depend on the specifics features and implementation of any plan.

The peer-reviewed study’s lead author, Christopher Cai, a third-year medical student at the University of California, San Francisco, is an executive board member of Students for a National Health Program, a group that supports a single-payer system.

Questions about methodology: “This might be the worst ‘academic’ study I’ve ever read,” tweeted Marc Goldwein, head of policy at the Committee for a Responsible Federal Budget. “It’s a glorified lit review of 22 studies – excluding 6 of the most important on the topic and including 11 that are redundant, non-matches, or from the early 90s.” The results would look quite different if the authors had made different choices about what analyses to include in their review.

What other studies have found: Other recent analyses have been far less conclusive about how health care spending might change under a single-payer system. The nonpartisan Congressional Budget Office said last year that total national health care spending under Medicare for All “might be higher or lower than under the current system depending on the key features of the new system, such as the services covered, the provider payment rates, and patient cost-sharing requirements.”

An October analysis by the Urban Institute and the Commonwealth Fund, meanwhile, found that a robust, comprehensive single-payer system would increase national health spending by about $720 billion in its first year, while federal spending on health care would rise by $34 trillion over 10 years. But a less generous single-payer plan would reduce national health spending by about $210 billion in its first year. Remember the costs that Elizabeth Warren spouted?? $52 trillion over a decade! Can we all afford this?

Progress On Lung Cancer Drives Historic Drop In U.S. Cancer Death Rate, Obamacare and More Numbers

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First some good news, which in today’s boiling kettle we all need. Cancer death rates in the United States took their sharpest drop on record between 2016 and 2017, according to an analysis by the American Cancer Society.

Richard Harris reported that the cancer death rates in the U.S. have been falling gradually for about three decades, typically about 1.5% a year. But during the latest study period, the cancer mortality rate dropped 2.2%, “the biggest single-year drop ever,” says Rebecca Siegel, scientific director for surveillance research at the cancer society.

“It seems to be driven by accelerating declines in lung cancer mortality,” Siegel says. That’s “very encouraging, because lung cancer is the leading cause of cancer death in the U.S., causing more deaths than breast, colorectal and prostate cancers combined.”

“This is unambiguously good news,” says Dr. H. Gilbert Welch, senior investigator with the Center for Surgery and Public Health, at Brigham and Women’s Hospital in Boston. He was not involved in the analysis.

What’s behind the decline? In part, smoking rates have fallen steadily, which means the biggest risk factor for lung cancer has fallen appreciably. New cancer treatments are also playing a role, Siegel says.

Advanced lung cancer, however, remains deadly. People diagnosed with lung cancer that has spread elsewhere in the body have only a 5% chance of surviving for five years. And many smokers and former smokers are not following the advice to get screened with a low-dose CT scan to catch cancer early.

In fact, a recent study found that only 4.4% of people eligible for this screening test (which under the Affordable Care Act is available at no cost) actually got screened in 2015. Nearly twice as many people instead got a test that has been found to be unsuited as a screen for lung cancer: a chest X-ray.

And others who didn’t fit the U.S. Preventive Services Task Force recommendations took the CT screening test anyway. “The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to the USPSTF recommendations,” the study notes.

Screening for cancer has played a controversial role in cancer trends. Mammography and the PSA blood test for prostate cancer do identify some cancers early, when treatment is usually more effective. But the tests also identify many growths that would never turn deadly — a phenomenon called “overdiagnosis.”

A paper published in the New England Journal of Medicine in October delves into that issue to help distinguish between cancer trends that are true improvements and trends simply due to changes in screening practices.

That issue plays out in the latest statistics. The reported number of prostate cancers surged in the 1980s as doctors started detecting it with the PSA test. That led to treating many prostate cancers that would never have turned deadly. Even so, the test caught a lot of cancers, and the death rate from prostate cancer fell at about 4% per year.

No longer. “The rapid declines in death rates over the past couple of decades actually halted,” Siegel says.

Siegel says that’s partly because reduced PSA screening, while preventing many unnecessary treatments, is also finding fewer treatable cancers. “I think there is a big need for a better test,” she says.

That plateau doesn’t surprise Welch, at Brigham and Women’s, who agrees that it might be time to reevaluate screening for prostate cancer. “I think we’ve gotten about the decline we’re going to get from screening and treatment,” he says. Some types of prostate cancer are more treatable than others and with recent improvements, he says, “we’ve gotten the low-hanging fruit.”

Improvements in cancer treatment are apparent when it comes to melanoma, a skin cancer that’s far less common than prostate or lung cancer. The new statistics show that melanoma death rates have been dropping by 7% per year. The report attributes this largely to anti-cancer drugs called checkpoint inhibitors and other new drugs. Some 92% of people diagnosed with this cancer are still alive five years later (compared with 19% of those diagnosed with lung cancer).

While the report measures trends in cancer rates (which are measured as deaths per 100,000 people), that’s not the same as tracking the actual number of cancer cases and deaths. Cancer is mostly a disease of older people, and the U.S. population is aging rapidly. So, while rates are declining, the absolute number of cancer deaths is not.

“We have more than 600,000 deaths from cancer in this country every year, and that number continues to grow,” Siegel says.

And with treatments getting progressively more expensive, that’s a challenge not just for individuals but for the entire health care system.

A detailed analysis of the statistics is being published Wednesday in CA: A Cancer Journal for Clinicians.

Study Finds Talcum Powder Not Likely A Risk For Ovarian

And some more god news Patti Neighmond noted that in recent years, women have taken talcum powder manufacturers to court over concerns that the use of the product in the genital area could cause ovarian cancer. Now, a new study finds no meaningful association between using talc-based or other powders and ovarian cancer.

Researchers from NIH’s National Institute of Environmental Health Sciences and the National Cancer Institute conducted the largest study to date of genital powder use and ovarian cancer. The study, published Tuesday in JAMA, used data from 252,745 women who answered questions about whether they used powder on their genitals. This was a pooled analysis of four large studies gathering data about the frequency and length of time women used the powder.

According to epidemiologist Katie O’Brien who headed the study, women report applying the powder either directly on their genital area or on sanitary napkins, tampons, underwear or diaphragms. O’Brien doesn’t know exactly which type of powder women used. It could have been talcum powder alone, cornstarch alone or a combination of both.

The research finds that women who had ever used powder had an 8% increased risk of ovarian cancer compared to those who never used it. “That is not a statistically significant increase” says O’Brien. And she adds that this increase needs to be understood in context. Ovarian cancer is very rare and the lifetime risk of getting it is 1.3% so an increase of 8% to that is “small.” O’Brien says it represents an estimated 0.09% increase in risk by age 70.

But among the subset of women who had their uterus and fallopian tubes intact, their increased risk of ovarian cancer from using powder in their genital area was 13% — which is an estimated 0.15% increase in risk by age 70 and is still considered a very small increase.

Unlike most other studies of talc and ovarian cancer, which focused on women already diagnosed with cancer, this study was prospective, and asked about powder use before study subjects had developed ovarian cancer. This means the study is free from recall bias, says O’Brien. It removes the likelihood that study subjects “search for reasons why they have ovarian cancer, and may over-report certain things they have heard may be associated with it.”

Rates of powder use have declined over the last 50 years, yet it remains a routine practice for some women, says Dr. Dana Gossett, a professor of obstetrics and gynecology at the University of California, San Francisco. She wrote an editorial accompanying the study but was not involved in the study itself.

“Women have used powders for genital hygiene for decades to absorb odor and moisture,” she says.

Earlier investigations of an association between the use of talc-containing powders for genital hygiene and epithelial ovarian cancer risks have provided inconsistent results, says Gossett and have resulted in an “ongoing controversy.” Concerns have been raised about possible contamination of mineral talc with asbestos, a known cancer risk. Most powder products include some mineral talc.

Researchers say it’s been hypothesized that the powder could induce an inflammatory response by irritating epithelial ovarian tissue or fallopian tubes directly which, in turn, could set off a cascade of increased oxidative stress levels, DNA damage and cell division, all of which could contribute to carcinogenesis.

Gossett says the new study finding “doesn’t really support any association [of powder use with ovarian cancer].”

“No study can ever say definitively what the cause of cancer is, but this study at least shows there’s not a substantial increase in ovarian cancer risk,” she says.

The study has several limitations. Researchers were not able to document how frequently or how long women used powder nor were they able to identify exactly what ingredients were in the powder. It also included mostly white women. Anecdotally, black women are more likely to use baby powder.

Obstetrician Gossett says the study findings should be “reassuring to women that if they are choosing to use powders on their genitals that they’re not doing something horrendous.”

Gossett also notes that due to the very small number of cancer cases in the data, the study was “underpowered.” She suggests that future analyses would be strengthened by focusing on women with intact reproductive tracts, with particular attention to timing and duration of exposure to powder in the genital area.

In the meantime, since there’s no medical reason to use talcum powder, researcher O’Brien suggests women weigh perceived benefit with possible risk. Study participants will continue to be followed to track ovarian cancer development in the future, she says.

The Staggering Cost of US Health Care Bureaucracy

Yuval Posenberg, reporter for the Fiscal Times, wrote that seemingly everyone has a horror story to tell about dealing with the bureaucracy of the U.S. health care system, from mundane matters like medical records to financial fights over surprise medical bills or insurance claims.

Those individual experiences come at a high collective cost, according to a new study published in the Annals of Internal Medicine: U.S. health insurers and providers spent $812 billion on administration in 2017, representing more than a third of national health expenditures, or double the 17% percent that Canada spends under its single-payer system. The U.S. administrative costs translate to nearly $2,500 per person — or almost five times as high as in Canada.

“The gap in health administrative spending between the United States and Canada is large and widening, and it apparently reflects the inefficiencies of the U.S. private insurance–based, multipayer system,” the study’s authors conclude. “The prices that U.S. medical providers charge incorporate a hidden surcharge to cover their costly administrative burden.”

The study finds that U.S. could have saved more than $600 billion in 2017 if it were able to cut its administrative costs to match Canada’s. “The difference between Canada and the U.S. is enough to not only cover all the uninsured but also to eliminate all the copayments and deductibles, and to amp up home care for the elderly and disabled,” Dr. David Himmelstein, a professor at the CUNY School of Public Health at Hunter College and co-author of the study, told Time. “And frankly to have money left over.”

Why it matters: This isn’t the first study to show that the U.S. system has higher administrative costs than other countries, but it is the first major study calculating those system-wide costs in almost two decades. The spending disparity detailed in the study “could challenge some assumptions about the relative efficiency of public and private healthcare programs,” writes Melissa Healy of the Los Angeles Times. “It could also become a hot political talking point on the American campaign trail as presidential candidates debate the pros and cons of government-funded universal health insurance.”

A steep rise in U.S. costs: Administrative costs have grown in both the U.S. and Canada over the last 20 years, but the increase in the United States has been much higher, mostly as the result of insurance overhead. “The study showed that private insurers contributed to most of the increase in administrative costs between 1999 and 2017,” Modern Healthcare’s Rachel Cohrs reports. “Of the 3.2 percentage point increase in administrative costs as a share of overall health spending, 2.4 percentage points were due to the expanding role that private insurers have assumed in Medicare and Medicaid.”

The insurance industry response: America’s Health Insurance Plans, a group representing private health insurance companies, told the Los Angeles Times that government-run systems aren’t as efficient as private ones, citing a recent report by the Medicare Payment Advisory Commission, an independent body that advises Congress, that found that private Medicare Advantage plans deliver benefits at 88% of the cost of traditional Medicare. “Study after study continues to demonstrate the value of innovative solutions brought by the free market,” AHIP said in its statement. “In head-to-head comparisons, the free market continues to be more efficient than government-run systems.”

The researchers are single-payer advocates: Himmelstein and one of his co-authors, Dr. Steffie Woolhandler, also of the CUNY School of Public Health at Hunter College, have long advocated for a single-payer health-care system in the United States. They co-founded the group Physicians for a National Health Program and have been unpaid policy advisors to Sen. Bernie Sanders and have coauthored research manuscripts with Sen. Elizabeth Warren. Both senators are calling for a transition to a single-payer Medicare-for-All system. But the researchers say that their conclusions in the new study are based on the data — and that their estimates of U.S. administrative costs are likely conservative.

“It’s actually the data that guided us to the solution, the solution didn’t give rise to the data,” Himmelstein said, according to Modern Healthcare.

Himmelstein also says that, while it may be possible to reduce administrative costs without switching to a single-payer system, the benefits would be much smaller. “We could streamline the bureaucracy to some extent with other approaches, but you can’t get nearly the magnitude of savings that we could get with a single payer,” he told Time.

‘Obamacare’ mandate: hot for lawyers, ho-hum to consumers

Ricardo Alonso-Zaldivar of the Associated Press reported that the repeal of an unpopular fine for people without health insurance has had little impact on “Obamacare” sign-ups or premiums, a gap between the real world and legal arguments from conservatives again challenging the Affordable Care Act.

The 10-year-old law has proved more resilient than its creators or detractors imagined, even as the Supreme Court considers whether to take up the latest effort to roll it back.

Opponents argue that the constitutionality of the entire 900-page law hinges on the now-toothless penalty for not having health insurance. Collected as a tax by the IRS, the penalty was intended to enforce the law’s “individual mandate” that Americans be insured. A previous Republican-led Congress set the fines to $0, effective last year.

“We’ve gotten a lot of evidence by now about what the market looks like without a mandate penalty, and on the whole it looks pretty stable, which is surprising because that’s not what most people would have expected when the ACA was being written,” said Cynthia Cox, who directs research on the health law for the nonpartisan Kaiser Family Foundation.

A Kaiser study released this week found that removal of the penalty pushed premiums up about 5% going into 2019, but the bottom line was a wash because of other factors. Insurers appeared to be making healthy profits.

The penalty was thought to be critical when the law was being written in 2009-2010. The idea was to nudge healthy people to sign up, helping keep premiums in check. But Cox said there’s no indication that healthy people have dropped out in droves. In one telling statistic, the Kaiser study found that average hospital days per 1,000 people enrolled dipped slightly in 2019, even after the penalty was eliminated.

Partial sign-up numbers for 2020 released Wednesday by the government point to stability. Nearly 8.3 million people enrolled in the 38 states served by the federal HealthCare.gov website. That’s down only about 2% from last year, when one additional state was using HealthCare.gov. A final count including that state — Nevada — and others that run their own sign-up efforts is expected by the spring.

The insurance mandate was the central issue when the Supreme Court first upheld the health care law in 2012, over a year before HealthCare.gov opened for business.

Chief Justice John Roberts cast the key vote in that 5-4 decision. He found that Congress lacked constitutional authority to require that Americans have health insurance. But because Congress has broad powers to levy taxes, Roberts ruled that a tax on people who did not purchase coverage offered them was constitutional. That allowed the law to survive what’s still seen as its most serious legal challenge.

Kathleen Sebelius, health secretary for President Barack Obama, said in 2012 that it was generally accepted that the insurance mandate was part of a three-legged stool key to stable markets. The other two legs were taxpayer-provided subsidies for premiums and a guarantee that patients with preexisting medical conditions could no longer be turned down or charged more.

“It was thought that the trade-off for changing the rules on preexisting conditions would have to be … some penalty incentive so you would get healthy people in the pool, along with not-healthy people,” Sebelius said. “What became clear when the law went into effect (in 2014) is that the subsidies in many ways provided a greater incentive for people get health insurance.”

Those subsides are designed so that low- and moderate-income households only spend a fixed percentage of their incomes on premiums, shielding consumers from high sticker prices.

Cox agreed that the law’s “carrots” seem to have made more of a difference than its “stick.”

Fast-forward to 2018 and a coalition of conservative states led by Texas won a lower court decision that the insurance mandate was still critical, in a legal and constitutional sense.

U.S. District Court Judge Reed O’Connor in Texas ruled that by zeroing out the tax penalty, Congress rendered the insurance mandate unconstitutional, and without it the entire health law must fall. President Donald Trump agreed.

Recently, a federal appeals court in New Orleans agreed with O’Connor that an unenforceable insurance mandate is unconstitutional. But the appeals court sent the case back to him to see whether other parts of the law can stand.

Defending the law, a coalition of Democratic-led states, along with the U.S. House, appealed to the Supreme Court, seeking a fast-track decision amid this year’s presidential election. The court has asked lawyers for the conservative states to respond by Friday on the timing question.

University of Michigan law professor Nicholas Bagley said the stability of the health insurance markets exposes “the artificiality” of the conservatives’ argument.

“It really goes to show how ridiculous it is to claim that Congress understood the mandate to be so essential that if it were to be red-lined out, the rest of the law would have to fall,” said Bagley.

Not so fast, said Andrew Schlafly, a lawyer representing groups siding with Texas and the other GOP-led states opposing the law.

“The question is not whether in reality (the ACA) can work without the mandate,” said Schlafly. “The test is whether it was intended to work without the mandate.

“Theory does matter to these Supreme Court justices,” he added, “and they do take theory seriously.”

ObamaCare still working despite individual mandate’s repeal

Megan Henney noted that one year after Republicans repealed the Affordable Care Act’s individual mandate, President Barack Obama’s signature health care law remains surprisingly stable and profitable for insurers.

When Republicans gutted the ACA in the 2017 Tax Cuts and Jobs Act, eliminating the provision that required Americans to either buy health insurance or pay a fine, critics warned that decision would cause younger and healthier people to flee from the marketplace, leaving sicker, more expensive patients, remaining and causing the market to enter a “death spiral.”

But a report released by the Kaiser Family Foundation on Monday found that despite the removal of the mandate, those fears are largely unfounded.

Individual enrollment fell by 5 percent between the first quarter of 2018 and 2019, but the relatively modest growth in claims costs at the beginning of 2019 indicates that enrollment declines and policy changes did not cause healthy individuals to flee the market. In fact, the average number of days enrollees spent in a hospital in the first nine months of 2019 was slightly lower than inpatient days in the previous four years.

“Results from the first nine months of 2019 suggest that the individual market remains profitable and stable despite the effective repeal of the individual mandate,” the analysis said.

A key measure of insurers’ financial strength, margins — the average amount by which premium income exceeds claims costs per each enrollee in a given month — are the healthiest they’ve been in nearly eight years. (Insurer financial performance dipped slightly at the end of 2019, but the margins remained higher than all other previous years through 2017).

“These data suggest that insurers in this market remain on average financially healthy,” the report said.

The report comes amid attacks by Republicans and President Trump on arguably the biggest legislative accomplishment of the Obama administration.

Most recently, the U.S. Court of Appeals for the Fifth Circuit, in the case of Texas v. Azar, struck down the individual mandate as unconstitutional, though it did not invalidate the rest of the law, leaving its fate, once again, in limbo. The ruling was issued almost exactly one year after Judge Reed O’Connor in Fort Worth, Texas, struck down the entire law.

A coalition of Democratic states, led by California Attorney General Xavier Becerra, has made it clear that it intends to challenge the appeals court decision by petitioning the Supreme Court to take the case.

The ultimate outcome of the lawsuit will affect millions of Americans, and the repeal of the 9-year-old law could leave up to 32 million people without health insurance by 2026, according to a Congressional Budget Office report from 2017 about the effects of repealing the ACA.

I’m still confused as to why Bernie Sanders and Elizabeth Warren are pushing Medicare for All and not fixing the ACA/Obamacare. Let’s see with tomorrow’s debate whether we get and more suggestions. Moreover, why hasn’t the Republicans when they had the majority on the House and the Democrats now that they have control in the House, why no one party has tried hard to fix the healthcare problem. Politics and more political “strategies” continue to get in the way of the real solution.

Drug prices rise 5.8% on average in 2020, Obamacare and True Economics and the opinions of Delaney!

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The Holidays are finally over and Rudolf was just arrested for assaulting his teammate reindeers for calling him names and laughing at him. Was this a hate crime??? Oh, how sensitive these days!! Poor, poor Rudolf!

As I was picking up a prescription today I was reminded of this article, one copy sent to me by a friend, I then went to pay for the prescription with my GoodRx card though which I was given an 80% discount. This brings up the question how will we all be able to pay for the future drugs with their outrageous prices?

It also brings up the question, how do organizations like GoodRx and Singlecare give people the discount. And what is the true value of prescription drugs and what prices should be charged in order for the always-profitable pharmaceutical companies to make an acceptable profit and what is an acceptable profit?

Consider this report published in MarketWatch by Jared S. Hopkins.

Pharmaceutical companies started 2020 by raising the price of hundreds of drugs, according to a new analysis, though the increases are relatively modest this year as scrutiny grows from patients, lawmakers and health plans.

Pfizer Inc. led the way, including increasing prices by over 9% on more than 40 products. The drug industry traditionally sets prices for its therapies at the start of the year and again in the middle of the year.

More than 60 drugmakers raised prices in the U.S. on Wednesday, according to an analysis from Rx Savings Solutions, which sells software to help employers and health plans choose the least-expensive medicines. The average increase was 5.8%, according to the analysis, including increases on different doses for the same drug.

The average is just below that of a year ago, when more than 50 companies raised the prices on hundreds of drugs by an average of more than 6%, according to the analysis.

Pfizer said that 27% of the drugs Pfizer sells in the U.S. will increase in price by an average of 5.6%. More than 90 of the New York-based company’s products rose in price, according to the Rx Savings Solutions analysis. Among them are Ibrance, which sold nearly $3.7 billion globally through the first nine months last year, and rheumatoid arthritis therapy Xeljanz.

A Pfizer spokeswoman said that nearly half of its drugs whose prices went up are sterile injectables, which are typically administered in hospitals, and the majority of those increases amount to less than $1 per product dose.

Pfizer’s largest percent increases, 15%, are on its heparin products, which are generic blood thinners typically administered in hospitals.

Pfizer said the heparin increases are to help offset a 50% increase in the cost of raw materials and expand capacity to meet market demand. The company said it is monitoring the global heparin supply, which has been challenged by the impact of African swine flu in China, as the drug is derived from pig products and disruption could lead to a shortage. Pfizer said that its U.S. heparin supply is not sourced from China.

Overall, the increases by drugmakers Wednesday affect “list prices,” which are set by manufacturers, although most patients don’t pay these prices, which don’t take into account rebates, discounts and insurance payments. Drugmakers have said prices are increased in conjunction with rebates they give to pharmacy-benefit managers, or PBMs, in order to be placed on the lists of covered drugs known as formularies.

In fact, drugmakers have said that their net prices have declined because of large rebates to PBMs, which negotiate prices in secret with their clients, such as employers and labor unions.

Pfizer said its price increases will be offset by higher rebates paid to insurers and middlemen. The company said the net effect on revenue growth in 2020 will be 0%, which is the same percentage expected for 2019. The company said the average net price of its drugs declined by 1% in 2018.

In 2018, Pfizer was assailed by President Trump after the company raised the prices on some 40 drugs. Pfizer temporarily rolled back the increases, but raised prices again later.

In Washington, Republicans and Democrats in the U.S. Congress have drawn up proposals for lowering drug costs, while the Trump administration recently introduced a plan for importing drugs from Canada.

“Prices go up but demand remains the same,” said Michael Rea, CEO of Rx Savings Solutions. Clients of the Overland Park, Kan., company include Target Corp. and Quest Diagnostics Inc. “Without the appropriate checks and balances in place, this is a runaway train. Consumers, employers and health plans ultimately pay the very steep price.”

While some increases in his firm’s analysis were steep, most product prices rose by less than 9%.

AbbVie Inc. raised the price of rheumatoid arthritis treatment Humira, the world’s top-selling drug, by 7.4%, according to the analysis. Through the first nine months of 2019, Humira sales totaled nearly $11 billion.

AbbVie didn’t respond to a request for comment.

GlaxoSmithKline PLC raised the prices on more than two dozen different therapies, although none by more than by 5%. That includes its shingles vaccine, Shingrix, which sold about $1.7 billion globally in the first nine months of 2019.

A Glaxo spokeswoman confirmed the increases and said net prices for its U.S. products fell about 3.4% on average annually the past five years.

Other major companies that raised prices included generic drugmaker Teva Pharmaceutical Industries Ltd., which raised the price of more than two dozen products, but none by more than 6.4%, according to the analysis. Sanofi S.A. raised prices on some of their therapies, but none by more than 5%, while Biogen Inc. took increases that didn’t exceed 6%, including on multiple-sclerosis therapy Tecfidera.

Teva didn’t respond to requests for comment.

A Sanofi spokeswoman confirmed the increases and said that the changes are consistent with its pledge to ensure price increases don’t exceed medical inflation. A Biogen spokesman confirmed the price changes and said adjustments are made to products for which it continues to invest in research, and otherwise increases follow inflation.

In addition to Pfizer’s increases on heparin, companies increased prices for several therapies by more than 10%, according to the analysis.

Cotempla XR-ODT, which is approved in the U.S. to treat attention-deficit hyperactivity disorder in children between 6 and 17 years old, increased by more than 13% to $420 for a month supply. The therapy is sold by Neos Therapeutics Inc., based in Grand Prairie, Texas.

Representatives for Neos didn’t respond to requests for comment.

Democrats ask U.S. Supreme Court to save Obamacare

Lawrence Hurley of Reuters reported that the Democratic-controlled U.S. House of Representatives and 20 Democratic-led states asked the Supreme Court on Friday to declare that the landmark Obamacare healthcare law does not violate the U.S. Constitution as lower courts have found in a lawsuit brought by Republican-led states.

The House and the states, including New York and California, want the Supreme Court to hear their appeals of a Dec. 18 ruling by the New Orleans-based 5th U.S. Circuit Court of Appeals that deemed the 2010 law’s “individual mandate” that required people to obtain health insurance unconstitutional.

The petitions asked the Supreme Court, which has a 5-4 conservative majority, to hear the case quickly and issue a definitive ruling on the law, formally called the Affordable Care Act, by the end of June.

Texas and 17 other conservative states – backed by President Donald Trump’s administration – filed a lawsuit challenging the law, which was signed by Democratic former President Barack Obama in 2010 over strenuous Republican opposition. A district court judge in Texas in 2018 found the entire law unconstitutional.

“The Affordable Care Act has been the law of the land for a decade now and despite efforts by President Trump, his administration and congressional Republicans to take us backwards, we will not strip health coverage away from millions of Americans,” New York Attorney General Letitia James said.

Obamacare, considered Obama’s signature domestic policy achievement, has helped roughly 20 million Americans obtain medical insurance either through government programs or through policies from private insurers made available in Obamacare marketplaces. Republican opponents have called it an unwarranted government intervention in health insurance markets.

Congressional Republicans tried and failed numerous times to repeal Obamacare. Trump’s administration has taken several actions to undermine it.

In 2012, the Supreme Court narrowly upheld most Obamacare provisions including the individual mandate, which required people to obtain insurance or pay a financial penalty. The court defined this penalty as a tax and thus found the law permissible under the Constitution’s provision empowering Congress to levy taxes.

In 2017, Trump signed into law tax legislation passed by a Republican-led Congress that eliminated the individual mandate’s financial penalty. That law means the individual mandate can no longer be interpreted as a tax provision and therefore violates the Constitution, the 5th Circuit concluded.

In striking down the individual mandate, the 5th Circuit avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis.

That means the fate of Obamacare remains in limbo. The fact that the litigation is still ongoing may make the Supreme Court, which already has a series of major cases to decide in the coming months, less likely to intervene at this stage.

John Delaney: On health care, bold vision with pragmatism is what America needs

Pulitzer prize winning editor, Art Cullen noted that in living rooms and coffee shops across all of Iowa’s 99 counties, I am forever reminded that health care is the paramount issue facing Americans. Our current system is deeply broken, and our country needs a bold vision and a pragmatic approach for improving health care. In many ways, a candidate’s approach to health care defines their governing and leadership style. It answers important questions about their values, vision, pragmatism and management style.

The Democratic Party should have as its true north universal access — where every American has health care coverage as a right of citizenship. We should support plans that encourage innovation — curing diseases like cancer and Alzheimer’s — and that create a framework for getting costs under control. My Better Care Plan uniquely achieves all of these goals.

Universal access needs to be realistic

Currently, only three candidates have detailed plans for universal access — Sens. Elizabeth Warren and Bernie Sanders and I. Universal access is the right answer, both morally and economically. The plans advocated by Warren and Sanders, however, call for an extreme “single-payer” system, where the government is the only provider of coverage.

Aside from the extraordinary practical, fiscal and political issues associated with eliminating and replacing over 180 million private insurance plans, a single-payer system will massively underfund the health care system. Today, government reimbursement is dramatically less than reimbursements paid by insurance companies. Making the government the only payer in health care would underfund hospitals, particularly in rural America, resulting in hospital closures, practitioners closing up shop, and a reduction of investment in innovation.

On the other hand, most other candidates are advocating for a “public option” as our way forward. This is a modest proposal, insufficient for the challenges of our broken health care system. A public option is simply another insurer that is government-run. It will have co-payments, deductibles, and premiums. And it relies on people choosing to sign up. While it would provide more options than are currently available in the marketplace, undoubtedly helping many, it would not address the tragedy of the uninsured in our country.

Under BetterCare we achieve the ambition of universal coverage without the negatives of a single-payer system.

Under BetterCare, Medicare is left alone, because it works, and every American from birth to 65 (seniors are on Medicare) is auto-enrolled in a free federal health care plan that covers basic health care needs. This ensures every American has health care coverage. But unlike the single-payer Medicare for All, Americans could still choose private insurance. They could “opt out” of the BetterCare plan and buy private insurance or receive insurance from their employer. If they “opt out” they would receive a health care tax credit to offset the cost of health care they purchase or that their employer provides.

Alternatively, they could use the BetterCare plan and enhance it with supplemental plans, similar to how Medicare beneficiaries acquire supplemental plans. BetterCare is like Medicare. It provides guaranteed coverage but allows our seniors to have supplemental plans or “opt out” and accept a Medicare Advantage Plan.

BetterCare is similar to the plans of most developed nations that have universal coverage. As Art Cullen wrote, it provides “universal coverage while not eliminating private insurance.” By providing universal access, choice, protecting provider reimbursements, and encouraging innovation, BetterCare is bold, ambitious, practical and a political winner. Importantly, it can be fully paid for by applying the Obamacare subsidies and current federal and state Medicaid payments and by eliminating the corporate deductibility of health care.

It is bold, yet practical, and reflective of my approach to governing. As a former entrepreneur, CEO of two public companies and member of Congress, I bring a unique approach and real leadership experience, which is why I respectfully ask for your support.

Use Simple Economics to Contain Health Care Costs

Gary Shilling wrote for Bloomberg and makes so much sense when he looked at health care costs in terms of simple economics. (Bloomberg Opinion) — Spending on U.S. health care is out of control, expanding steadily from 5% of GDP in 1960 to 18% in 2018. There are, however, ways to curb the explosion in costs from both the demand and the supply side.

Health care costs per capita in the U.S. are almost double those of other developed countries, but life expectancy is lower than many, even South Korea, according to the CIA and Eurostat. Without restraint, costs will accelerate as more and more postwar babies age. The nonpartisan Congressional Budget Office projects Medicare spending alone will leap from 3% of GDP to 8% by 2090.

Medical costs are understandably high since the system is designed to be the most expensive possible for four distinct reasons. First, with the constantly improving but increasingly expensive modern technology, the best is none too good when your life or mine is at stake. Also, few patients have the knowledge to decide whether a recommended procedure will be medically much-less cost-effective. The medical delivery system encourages a gulf between the providers who supposedly know what’s needed and their patients who don’t.

Second, patients are quite insensitive to costs since their employers or governments pay most health care bills. And those who are privately insured want to get their money’s worth from their premiums, especially since Obamacare does not allow insurers to set premiums on a health risk basis.

Third, the pay-for-service system encourages medical providers to over-service. After my dermatologist burned off the pre-cancerous growths on my face, he wanted me back in two weeks to be sure, but also to bill another office visit.

Finally, domestic training programs and facilities for medical personnel are inadequate. As a result, many MD residents and nurses come from abroad, while medical schools of dubious quality in the Caribbean train U.S.-born physicians.

To control costs on the demand side, use the appeal of money. The importance of their health to most Americans means they will spend proportionally more on medical services than other goods and services, but they’ll think twice if it’s money they otherwise can keep. Increasing deductibles and co-payments are moving in that direction. In 1999, employees on average paid $1,500, or 22%, of $6,700 in family health coverage premiums, according to the Kaiser Family Foundation. The total rose to $26,600 in 2019, but employees’ share has climbed to $6,000, or 29%.

Medical savings accounts also make patients more aware of costs. Companies give employees a set amount of money and they can keep what they don’t spend on health care.

Accountable Care Organizations, now authorized by Medicare, attack the fee-for-service problem. The medical providers who participate are encouraged to be efficient since they can retain part of any savings due to cost controls as long as they provide excellent care.

To increase the supply of medical personnel, American medical and nursing schools can be expanded with government help. Also, shortening the whole training process would save time and get huge student debts under control. Does a physician need a four-year bachelor’s degree before beginning medical school?

Cartels among hospital medical specialties can be attacked. Now, physicians in, say, the general surgery department limit competition by controlling who has the privileges to use their institution’s facilities.

In another development, the entrepreneurial model of a small group of MDs operating a practice is fading in the face of high costs of medical record-keeping and other regulatory requirements. Over half of physicians now work for hospitals, either on their main campuses or in satellite facilities. This may shift the emphasis of many from money to medicine.

Limiting malpractice insurance premiums, a major outlay for medical providers, can also cut medical costs. Texas placed a $250,000 cap on non-economic damages, i.e., pain and suffering, in 2003. Texas Department of Insurance data reveals that medical malpractice claims, including lawsuits, fell by two-thirds between 2003 and 2011, and the average payout declined 22% to $199,000.

Also, average malpractice insurance premiums plunged 46%, according to the Texas Alliance for Patient Access, a coalition of health care providers and physician liability insurers. And physicians were then attracted to Texas. The Texas Medical Association reports that in the decade since malpractice awards were capped, 3,135 physicians came to the Lone Star State annually, 770 more than the average in the prior nine years.

At present, Americans basically pay the development costs of new drugs while other countries with centralized pharmaceutical-buying skip the expenses of R&D, field trials, etc., and only pay the much-lower marginal cost of production. Allowing Medicare to join Medicaid to negotiate drug prices could reduce costs if foreigners can be convinced to share development costs. Otherwise, new drug development would be curtailed. The Trump administration’s new rules that force health insurers and hospitals to publish their negotiated prices may force costs to the lowest level.

One approach that doesn’t work in easing the burden on consumers of medical costs is increasing overall government subsidies. They tend to be offset by higher costs, much as higher college tuition and fees often dissipate more scholarship aid. Ever notice that the most modern, prosperous institutions in town tend to be hospitals, hugely subsidized by governments?

Health care is critical, but that doesn’t mean its costs aren’t subjected to supply and demand. Then how do we assess the value as well as the costs and cost limitations? Are drug companies as well as insurance companies making way too much in profits by taking advantage of we the honest patients??

There many parts of the eventual answer to our need for a health care program which can service all at reasonable costs and each “part” needs thorough investigation and real solutions and that just addressing only one or two of these “parts” will never be sustainable!!

Physicians Get Weed Killer; Administrators Get Miracle-Gro And neither is helping, Obamacare Funding Suggestions, Andrew Lang, Year in Review and Google Searches

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Last week Suneel Dhand reported that compared to a couple of years ago, very little has changed in the hospital medical community.

In fact, I’m sure the divergence of the curves has only grown bigger, as more and more administrators are added to the ranks of healthcare. Look at what happened in Chicago where one of the fairly large hospitals fired 15 of their physicians and replaced them with 15 nurse practitioners last year, and in Texas 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners.

Quite often in life, the answers to some of the biggest questions we have, are staring us right in the face and incredibly simple. Healthcare can never be fixed unless we radically simplify everything and strip away the unnecessary complexities in our fragmented system. The divergence of the above lines, however, actually represents so much more than just an obnoxious visual. It actually symbolizes what happens when any organization, system, or even country, becomes top-heavy and loses sight of what is happening at the front lines. And in the end, it eventually collapses under its own weight.

When this happens in America, we cannot predict, but consider this: The amount we spend on healthcare would be the 4th largest economy in the world if it stood alone (at $3.5 trillion, only China and Japan have a higher total GDP). With an aging population, increasing chronic comorbidities, and expensive new treatments, if costs are not reined in, healthcare expenditure could account for a third of the entire GDP in about 25 years. A figure that will quite simply destroy the American economy.

It would be one thing if all the administration and bureaucracy was actually resulting in an improved and more efficient healthcare system. But look around you folks. Acute physician shortages now plague every state. Millions of people find it impossible to find a primary care doctor. Certain specialties are now booking out appointments months in advance. ERs and hospitals are overflowing. And in the end, patients are still facing soaring out of pocket expenses.

The last 20 years have witnessed the consolidation and corporatization of the entire U.S. healthcare system. Sold initially as a way to reign in costs, I am yet to see any evidence that it’s done anything other than dramatically increase costs (please feel free to forward me any financial analysis if I’m wrong). And why should that be a surprise to anyone?

I’ll leave you to stare once again at the above graph for a minute or two, and take in a comment that a distinguished physician colleague of mine recently made: “It’s like the physicians have been given weed killer and the administrators have been given Miracle-Gro.”

Affordable Care Act funding in question after health insurance taxes repealed

The Cadillac Tax, Health Insurance Tax and Medical Device Tax were recently repealed, raising questions over how the Affordable Care Act will be funded in the future. Yahoo Finance’s Anjalee Khemlani joins Adam Shapiro, Julie Hyman and Dan Howley during On the Move to break it all down.

Andrew Yang Has The Most Conservative Health Care Plan In The Democratic Primary

Daniel Marans of the Huff Post pointed out that Entrepreneur Andrew Yang has had unexpected staying power in the Democratic presidential primary thanks in part to the enthusiasm for his plan to provide every American with a basic income of $1,000 a month.

But the boldness of his signature idea only serves to underscore the unambitiousness of the health care plan he released earlier this month.

In fact, Yang’s health plan, which he bills as an iteration of the left’s preferred “Medicare for All” policy, is more conservative than proposals introduced by the candidates typically identified as moderate.

Former Vice President Joe Biden, South Bend, Indiana, Mayor Pete Buttigieg and Sen. Amy Klobuchar of Minnesota all at least call for the creation of a public health insurance option that would be available to every American. (Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts favor Medicare for All, which would move all Americans on to one government-run insurance plan ― though the two senators disagree on the timeline for implementing the idea.)

In terms of expanding health insurance coverage, Yang says on his website merely that he would “explore” allowing the employees of companies that already provide health insurance the chance to buy into Medicare.

“We need to give more choice to employers and employees in a way that removes barriers for businesses to grow,” Yang writes.

Under Yang’s plan, people employed by businesses that do not provide insurance, or who are self-employed, would continue to purchase coverage on the exchanges created by former President Barack Obama’s Affordable Care Act.

The decision not to focus on expanding coverage distinguishes Yang dramatically from his competitors. And in the foreword to his plan, he explains that that is a deliberate choice, since enacting single-payer health care is “not a realistic strategy.”

“We are spending too much time fighting over the differences between Medicare for All, ‘Medicare for All Who Want It,’ and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives,” he writes. “We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.”

When asked about how Yang plans to expand health insurance coverage ― 27 million Americans remain entirely uninsured and millions more have insurance that is so threadbare they do not use it ― Yang’s campaign referred HuffPost to his website.

Yang would increase health care access through reforms designed to reduce the health care system’s underlying costs, according to his campaign. On his website, he divides those reforms into six categories: bringing down the cost of prescription drugs through bulk negotiation; investing in waste-saving health care technologies; realigning medical providers’ “incentives” away from waste and abuse; increasing investment in preventive and end-of-life health care; making the provision of health care more “comprehensive”; and reducing the influence of lobbyists on the political system.

Yang implies that his rivals have sacrificed cost control in the name of expanding coverage. But when it comes to the specifics, Yang’s competitors have already gotten behind many of the ideas he is proposing ― and sometimes take them a step further.

For example, Buttigieg has a provision in his health care plan that would prohibit “surprise billing” ― the practice of providing unwitting patients with a large bill after a medical procedure when a doctor who performed it is not in the hospital’s insurance network. Yang does not mention the practice in his health care plan.

One provision of Yang’s plan that genuinely sets him apart is his plan to encourage the replacement of the fee-for-service billing model for doctors with salaries. The latter model is supposed to cut back on duplicative practices and foster more holistic care. Other elements of his plan, such as “incentivizing” gym memberships, healthy eating and bike commuting as a form of preventive health care, have drawn eye rolls from leftists who regard the ideas as paternalistic.

First and foremost, though, many progressives are likely to find fault with Yang’s plan, because they consider his use of the term “Medicare for All” misleading.

For months on the campaign trail, Yang claimed that he supported Medicare for All, though not the provision of Sanders’ bill ― and its companion in the House ― requiring people with private insurance to enroll in an expanded Medicare program.

He even aired a television ad casting his commitment to the policy as a reflection of his experience as the father of a special needs child.

Yang says on his campaign website that he is still firmly committed to the “spirit” of Medicare for All. But now that he has introduced a plan of his own, that claim is harder to defend.

Yet the Yang campaign is plowing full-steam ahead with its appropriation of the term in a new 30-second ad, “Caring.”

“If my husband, Andrew Yang, is president, he’ll fight for Medicare for All with mental health coverage,” Yang’s wife, Evelyn, says in the ad.

Fate of Obamacare uncertain amid tax repeals, lawsuits and Medicare-for-all push consider that Democrats seize on anti-Obamacare ruling to steamroll GOP in 2020

Alice Miranda Ollstein and James Arkin reported that a court ruling last week putting the Affordable Care Act further in jeopardy may provide the opening Democrats have been waiting for to regain the upper hand on health care against Republicans in 2020.

At the most recent Democratic presidential debate, candidates largely avoided discussing the lawsuit or Republicans’ years-long efforts to dismantle Obamacare, and instead continued their intra-party battle over Medicare for All.

But Senate Democrats, Democratic candidates and outside groups backing them immediately jumped on the news of the federal appeals court ruling — blasting out ads and statements reminding voters of Republicans’ votes to repeal the 2010 health care law, support the lawsuit and confirm the judges who may bring about Obamacare’s demise.

“I think it’s an opportunity to reset with the New Year to remind people that there’s a very real threat to tens of millions of Americans,” Sen. Brian Schatz (D-Hawaii) said in an interview. “We Democrats are always striving to improve the system, but, at a minimum, the American people expect us to protect what they already have.”

In 2018, Democrats won the House majority and several governorships largely on a message of protecting Obamacare and its popular protections for preexisting conditions. This year continued the trend, with Kentucky’s staunchly anti-Obamacare governor, Matt Bevin, losing to Democratic now-Gov. Andy Beshear.

The landscape in 2020 may be more challenging for Democrats than it was in 2018, when Republicans had more recently voted to repeal the Affordable Care Act. Republicans also say they now have more ammunition to push back on Democrats’ arguments with the party’s divisions over single-payer health care, which would replace Obamacare, shaping the presidential race.

Moreover, the appeals court’s ruling — which in all likelihood punted any final disposition on the case until after the 2020 elections — eliminates what some Republicans saw as a nightmare scenario: If the court had embraced a lower court ruling striking down the law in its entirety, it would have put the issue before the Supreme Court during the heat of the election, putting tens of millions of Americans’ health insurance at risk.

Still, Democrats believe they can win the political battle over health care, especially in Senate races. At least a half-dozen GOP senators are up for reelection, and Democrats need to net three seats to win back control of the chamber if they also win back the presidency. Democratic strategists and candidates are eager to run a health care playbook that mirrors that of the party’s House takeover in 2018, and say Republicans are uniquely vulnerable after admitting this year that they have no real plan for dealing with the potential fallout of courts striking down Obamacare.

Within a day of the ruling, the pro-Obamacare advocacy group Protect Our Care cut a national TV and digital ad featuring images of Sens. Susan Collins (R-Maine) and Cory Gardner (R-Colo.), warning that if the lawsuit succeeds, “135 million Americans with preexisting conditions will be stripped of protections, 20 million Americans will lose coverage and costs will go up for millions more.”

Other state-based progressive groups told POLITICO they’re readying their own ads going after individual Senate Republicans over the 5th Circuit’s ruling.

Protect Our Care director Brad Woodhouse predicts that it’s just a preview of the wave of attention the issue will get in the months ahead, as Democratic candidates and outside groups alike hammer the GOP on the threat their lawsuit poses to Obamacare.

“If there is one issue in American politics that is going to flip the Senate from Republican to Democratic in 2020, it’s this issue,” he said. “Our message is simple: President [Donald] Trump and Republicans are in court right now, suing to take away the ACA, take away your health care. And if Cory Gardner or Thom Tillis or any of them don’t think that’s an indefensible position, they should ask the 40-plus House Republicans who lost their seats in 2018.”

More than a dozen Republican state attorneys general, backed by the Trump administration, have been arguing in federal court for more than a year that Congress rendered the entire Affordable Care Act untenable when they voted as part of the 2017 tax bill to drop the penalty for not buying insurance down to zero. A district judge in Texas sided with them last year in a sweeping ruling declaring all of Obamacare unconstitutional.

Last week, an appeals court agreed that the elimination of the penalty made the individual mandate unconstitutional, but sent the case back down to the district court to decide whether any of the law could be separated out and preserved. The move all but guarantees the case won’t reach the Supreme Court until after the election, but it maintains the cloud of uncertainty hanging over the health law that experts say drives up the cost of insurance.

Though no one is in danger of losing their health coverage imminently, Democratic challengers in nearly every Senate battleground race, including Arizona, North Carolina, Maine and Iowa, jumped on the court ruling as an opportunity to attack Republicans on health care.

“Democrats have been in the fight to ensure that people across this country have access to affordable health care,” said Sen. Catherine Cortez Masto of Nevada, the chair of the DSCC. “This opinion does not help the Republicans.”

Sara Gideon, Democrats’ preferred candidate in Maine to take on Collins, called the lawsuit a “direct threat to the protections countless Mainers and Americans depend on. She has been reminding voters that Collins’ vote on the 2017 tax reform law triggered the ACA lawsuit in the first place, and she voted to confirm one of the 5th Circuit judges that recently sided with the Trump administration’s arguments against the law.

Unlike the vast majority of her GOP colleagues in the upper chamber, Collins has spoken up against the lawsuit. She has written multiple times to Attorney General Bill Bar, urging him to defend the ACA in court. Collins told POLITICO the day after the ruling that it was “significant” that the 5th Circuit judges were clearly “very uneasy with the thought of striking down the entire law” and instead sent the case back down to the lower court for reconsideration. Collins’ campaign spokesman both emphasized that she believes the government should defend the law and criticized Democrats for defending the unpopular individual mandate.

Tillis, the vulnerable North Carolina senator, said the lawsuit gave Republicans “breathing room” to find a viable replacement for Obamacare and attempted to flip the attack on Democrats by tying them to their presidential contenders.

“I think the fact that they all raised their hands and said we need Medicare for All is also raising their hands and saying the Affordable Care Act has failed,” Tillis said.

Though most of the 2020 presidential candidates have come out against Medicare for All, and more Democratic voters favor a choice between private insurance and a public option, the single-payer debate has given Republicans a potent line of attack that they’re turning to more than ever in the wake of the court’s ruling.

“Obamacare failed to lower health care costs for millions of Americans, and now Democrats want a complete government takeover of our health care system,” said Jesse Hunt, a spokesman for the National Republican Senatorial Committee. “They spent all of 2019 defending their socialist plan to eliminate employer-based health care coverage, and those problems will not subside anytime soon.”

The effectiveness of the GOP attacks will depend largely on the Democratic nominee for president — if it is someone who backs Medicare for All, it will be much more difficult for Senate candidates who don’t support the policy to separate themselves from it. But Democratic activists say they’re confident the GOP’s actions in court will sway voters more than their claims about Medicare for All.

“We can prepare for and counter those attacks by reminding voters that [Republicans are] fighting actively to take health care away,” said Kelly Dietrich, the founder and CEO of the National Democratic Training Committee, which coached more than 17,000 candidates for federal and state office in 2019. “Republicans’ ability to use fear as a tool to win elections should never be underestimated. But the antidote is to fight back just as hard.”

Year in Review: Lots of talk, not a lot of action in healthcare politics

Rachel Cohrs noted that lawmakers and regulators talked big on tackling high drug prices and surprise medical bills in 2019, but agreement on the bipartisan policies remained elusive. Some healthcare policy could be attached to a potential budget deal in December, but it is still unclear whether lawmakers will resolve funding disputes by the end of the year.

Despite major bipartisan legislative packages spearheaded by senior Senate Republican leaders, disputes over details and intense lobbying efforts have so far stalled progress in Congress. Drug makers are fighting a provision in the Senate Finance Committee’s drug pricing bill that would require them to pay back Medicare for drug price hikes faster than inflation, and providers and insurers are warring over how out-of-network medical bills should be handled.

Competing approaches to address surprise medical billing came to a head in December when a bipartisan, bicameral compromise proposal on addressing surprise medical bills emerged, but a key Senate Democrat involved in the negotiations had not signed on as of press time. Despite provider-friendly tweaks, providers still oppose the legislation and it is unclear whether House and Senate leadership have an appetite to include it in must-pass legislation.

Health reform 3.0: Early in the year, Senate health committee Chair Lamar Alexander and ranking Democrat Patty Murray released a wide-ranging plan to lower costs that addresses surprise medical bills; contract reform provisions; cost transparency; and boosting generic competition for Rx drugs. The year ended with a bipartisan, bicameral bill emerging, but at deadline it lacked Murray’s endorsement.

Reducing drug prices: Addressing drug prices was the other issue that dominated the policy landscape. Competing plans emerged, and the House passed a bill in mid-December on a party-line vote.

Grinding to a halt: House Speaker Nancy Pelosi announced a formal impeachment inquiry into President Donald Trump, which soured the prospects of a grand bargain between Trump and Pelosi on drug pricing and complicated the timeline for passing major healthcare policy.

Drug pricing was also a top priority for the Trump administration, but several marquee policy ideas have been stopped by the courts, abandoned, or are forthcoming. The White House decided to retract a prominent initiative that would have required insurers to pass manufacturer rebates directly to patients at the pharmacy counter, and a rule that would have compelled drug makers to include list prices in television advertisements is tied up in court. House Democrats passed a partisan government drug price negotiation bill, but it almost certainly will not become law.

The administration could at any time release a regulation outlining a process to allow states to import prescription drugs from Canada or move forward with a demonstration that would tie payments for physician-administered drugs in Medicare to international drug prices, but it has not yet acted on either proposal.

The 10 most-searched questions on health Reported by Sandee LaMotte of CNN

There were more questions that had people Googling in 2019.

The full list of the most-searched health questions in the United States this year also included questions about the flu, kidney stones and human papillomavirus or HPV:

How to lower blood pressure
What is keto?
How to get rid of hiccups
How long does the flu last?
What causes hiccups?
What causes kidney stones?
What is HPV?
How to lower cholesterol
How many calories should I eat a day?
How long does alcohol stay in your system?

NYU started to answer one of the big questions in the design of a fair healthcare system when they decided to declare their medical school tuition free. If all medical schools were tuition free the graduating doctors wouldn’t have the huge debt and they could have the opportunities to chose primary care and provide care to underserved rural and poorer communities.

One step at a time and maybe next year Congress can really improve the health care system of our U.S.A.

And to all you interested readers out there Happy New Year! Maybe those in control will start the process of improving the delivery of affordable health care to all and not worry about their future political aspirations. What a change that would be!

Musings of a Doc with an MBA

Business strategy and healthcare

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The 10 most-searched questions on health Reported by Sandee LaMotte of CNN