Category Archives: Beto O’Rourke

Medicare for All Discussion Spirals Into Squabble; and What about Obamacare?

Screen Shot 2019-07-07 at 8.30.22 PM.png Those of you that were able to stick it out and watch the latest Democrat debates were observers to the shouting match, which erupted between Biden and Castro. I really wonder whether any of the candidates understand health care and what they are all proposing as the solutions!

Shannon Firth the Washington Correspondent for MedPage noted that whether Americans really want a Medicare for All health system, what it would cost, and who among the remaining Democratic presidential candidates has the best plan might have made a thoughtful discussion at Thursday night’s third debate. Americans didn’t see much of that, however.

Instead, the event quickly devolved into personal squabbling that often left the moderators’ and each others’ questions unanswered.

It was the first debate to include only 10 candidates, due to more rigid qualifying requirements set by the Democratic National Committee.

Participants included former Vice President Joe Biden, Sen. Cory Booker (D-N.J.), South Bend, Indiana, Mayor Pete Buttigieg, former Housing and Urban Development Secretary Julián Castro, Sen. Kamala Harris (D-Calif.), Sen. Amy Klobuchar (D-Minn.), former Rep. Beto O’Rourke (D-Texas), Sen. Bernie Sanders (I-Vt.), Sen. Elizabeth Warren (D-Mass.), and businessman Andrew Yang.

Biden led in most polls ahead of the debate, although Warren tied with him in one, and Sanders beat him in another, according to RealClearPolitics.

Paying for Medicare for All

It was Biden, the front-runner, who took the first shot at his opponents when asked whether Sanders’ Medicare for All bill, which Warren also supports, was “pushing too far beyond” what the Democratic party wants.

Biden said voters themselves would decide what the Democratic party wants.

“I know that the senator says she’s for Bernie,” said Biden of Warren. “Well, I’m for Barack,” he said, referring to former President Barack Obama and his landmark Affordable Care Act. “I think the Obamacare worked,” Biden declared.

His plan would “replace everything that’s been cut [under President Trump], add a public option,” and guarantee affordable insurance for everybody. He said it would cost $740 billion. “It doesn’t cost $30 trillion,” he said, alluding to Sanders’ 10-year plan.

“That’s right, Joe,” Sanders responded, confirming his plan would cost that much. But he quickly added, the “status quo over 10 years will be $50 trillion.”

“Every study done shows that Medicare for All is the most cost-effective approach to providing healthcare,” Sanders asserted.

He stressed that his plan would “eliminate all out of pocket expenses, all deductibles, all copayments,” and that no American would pay more than $200 for prescription drugs under his bill.

Biden said that, under his plan, the most an individual would pay out-of-pocket would be $1,000. Under Sanders’ plan, a middle-class individual with three kids would ultimately pay $5,000 more for insurance and 4% more on income taxes.

ABC anchor George Stephanopoulos pressed Warren on whether she would raise taxes for the middle class in order to fund a full Medicare for All plan.

“On Medicare for All, costs are going to go up for wealthier individuals and costs are going to go up for giant corporations, but for hardworking families across this country, costs are going to go down,” Warren replied, without addressing the tax question directly.

Biden also argued that his own plan would not take away health insurance from the 160 million people satisfied with what they have now. Klobuchar, who also wants to keep private insurance available, also attacked Sanders’ and Warren’s plan, suggesting an estimated 149 million Americans would lose their commercial health insurance in 4 years.

“I don’t think that’s a bold idea, I think it’s a bad idea,” Klobuchar said.

“I’ve actually never met anybody who likes their health insurance company,” Warren shot back, to hearty applause.”I’ve met people who like their doctors. I’ve meet people who like their nurses. I’ve met people who like their pharmacists… What they want is access to healthcare.”

Sanders pointed out, too, that 50 million Americans change or lose health insurance every year, when they quit, lose or change jobs, or their employers change policies.

Shouting match

But the substantive debate may not linger in memory as much as a shouting match between Biden and Castro over one aspect of the former vice president’s plan and his statements about it.

The quarrel was short-lived but sent Twitter aflutter for hours. Viewers wondered whether Castro’s remarks were a veiled critique of Biden’s age — Biden is 76, Castro is 44 — as well as whether the criticisms were fair or true.

Castro told ABC News in a post-debate interview, “I wasn’t taking a shot at his age.”

Harris had tried earlier, without much success, to steer the debate toward the candidates’ differences from President Trump, rather than each other.

“Everybody on this stage … is well-intentioned and wants that all Americans have coverage and recognizes that right now 30 million Americans don’t have coverage,” she said. “So, let’s talk about the fact that Donald Trump came into office and spent almost the entire first year of his term trying to get rid of the Affordable Care Act. We all fought against it and then the late, great John McCain, at that moment at about 2 o’clock in the morning, killed his attempt to take healthcare from millions of people in this country.”

That did not put an end to the current administration’s efforts to end the ACA, however, and Harris pointed to the Department of Justice’s moves in court to have it declared unconstitutional.

“But let’s focus on the end goal, if we don’t get Donald Trump out of office, he’s gonna get rid of all of it,” she said.

The other Democrats, however, let the subject drop.

Disabled Activist Calls Out Kamala Harris Over Huge Holes Sen. Kamala Harris (D-Calif.) is holding steadfast in her belief that her version of “Medicare for All” is indeed “the best,” as she said during an August forum.

But, the presidential hopeful’s unwavering defense of her self-drafted health care plan didn’t deter progressive activist, lawyer and author Ady Barkan from pointing out what he found to be glaring flaws in her proposal.

In a nine-minute video capturing his discussion (below) with Harris released on Monday, Barkan, who was diagnosed with ALS in 2016, took Harris to task when he asked her why she was using the phrase “Medicare for All” to describe her plan, when to him, it sounded more like something “closer to a combination of private and public options rather than a single-payer ‘Medicare For All.’”

Unlike Sen. Bernie Sanders’ (I-Vt.) single-payer bill that Harris had previously supported, the California senator’s proposal would give Americans the option of keeping their private health insurance plans. Harris’ plan also includes a 10-year transitory period to phase out privatized insurance, which critics say is too long.

In response, Harris explained that with her plan, “everybody will be covered … and it will be a Medicare system” in which private insurers “have to be in our system … and it will be by our rules.”

That’s when Barkan decided to share why he thinks Sanders’ single-payer bill — which senators and presidential hopefuls Elizabeth Warren of Massachusetts, Cory Booker of New Jersey, and Kirsten Gillibrand of New York also support — is the best approach for reforming the country’s health care system.

Under Harris’ plan, Barkan said, “millions of people like me will still be denied care by their for-profit insurance company” during the 10-year transition period and possibly afterwards. Because of this, Barkan said he believes that people “will avoid getting needed care because of high co-pays and deductibles.”

In his opinion, Sanders’ single-payer plan would drive down “billions of dollars per year in administrative and billing costs,” which are a result of the for-profit system.

“That will not happen if providers still have to bill numerous insurance companies,” he added.

“Finally, there is the political reality,” Barkan concluded. “The insurance industry is going to do everything it can to block any of these proposals, including yours, which means the only way to win is with a huge grassroots movement, and from what I can see, that enthusiasm only exists for ‘Medicare for All.’ So, where am I wrong?”

In response, Harris said that with her “Medicare for All” plan, on Day 1, “you can get into the system of ‘Medicare for All’ and have a public plan, you don’t have to do a private plan. It’s your choice.”

Harris’ answer echoed what she has said in the past of her plan, but many people on Twitter still seemed to enjoy watching Barkan make compelling arguments about what he considered to be holes in her bill.

Doctors alarmed by Trump’s health care plan but confused by Democratic presidential candidates’ plans

Alexander Nazaryan pointed out that a day before Democratic presidential candidates converged here for a primary debate, a half-dozen doctors affiliated with the Committee to Protect Medicare and Affordable Care, a progressive group, held a rally to denounce President Trump and Republicans for what they charged were harmful proposals to strip Americans of health care coverage.

“We are here in Houston because the world is watching,” said Dr. Rob Davidson, the Michigan-based founder of the committee. “The world is watching to see whether the United States, the most powerful country in the world, is going to choose affordable, quality care or they’re going to peel back the social safety net from the elderly, the sick and the middle class.”

He said that Trump administration decisions — such as repealing the Affordable Care Act’s individual mandate — had led to 7 million people losing their health care coverage.

At the same time, some of those doctors expressed confusion and even dismay with Democratic plans. That suggested that while many in the medical community do oppose Trump’s plan to repeal and replace the ACA, they are ambivalent about the plans of his political opponents. And they hoped that, when it came time to debate on Thursday night, those candidates would offer substance instead of platitudes.

“I have to be honest, out of all the politicians I hear talk about health care,” said Davidson, “I don’t know that any of them quite have the grip on it that doctors have.”

Doctors, though, are hardly in agreement. A few, though not many, supported Trump’s ultimately unsuccessful 2017 effort to repeal the ACA, which was President Barack Obama’s signature legislative accomplishment. The American Medical Association has come out against a fully federalized health care system, the proposal of Vermont senator and presidential candidate Bernie Sanders. Some doctors, though, do believe that such a fix is not just possible but necessary.

“I don’t want a single-payer for all of America,” said Dr. Lee Ben-Ami, a Houston family practice doctor who is also affiliated with a local progressive group but was speaking as a private individual. She said she was “a little worried” about the Democratic Party moving toward the Sanders plan, even as she said it was necessary to provide health care to uninsured Americans. Centrist candidates like Sen. Michael Bennet of Colorado have offered such proposals, with a public option, but even though that was regarded as a radical solution during the Obama administration, many progressives now see it as a conservative concession.

Such friction could spell trouble for Democrats, who in the 2018 midterm congressional elections successfully ran on protecting health care from cuts by Republicans. At the time, a tight focus on preserving the ACA allowed for victories even in unlikely districts like the 14th in Illinois, a Republican stronghold won by Lauren Underwood, a first-time candidate who was trained as a nurse. Her opponent had voted to repeal the ACA as a House member.

Even though the doctors at the Houston rally expressed dismay at the Trump administration’s approach to health care, there was no explicit endorsement of a Democratic policy. “I’m very unclear what some of the Democrats believe,” said Ben-Ami, speaking to Yahoo News before the rally. “We’ve got some people saying ‘Medicare for all,’ and what does that mean? And then I have some Democrats where I can’t pinpoint their policy.”

Davidson also lamented the lack of specifics from candidates. “I hope we get more into the weeds” during Thursday’s debate, he told Yahoo News. He hoped candidates avoid “little sound bites that play well on the news.”

Those present at the rally agreed that any Democratic president would be a better custodian of the nation’s complex medical system than Trump. Davidson noted that Republicans have spoken to the president about cutting Medicare as a “second-term project,” should he win reelection next November.

The doctors held their rally on the edge of the Texas Medical Center, the largest such facility in the world. The center is home to the M.D. Anderson Cancer Center — where immunologist James P. Allison was recently awarded a Nobel Prize — as well as five dozen other institutions. At the same time, 22 percent of Houston residents are uninsured, according to the Urban Institute.

Just the day before the rally on Houston’s vast medical campus, Texas was found to be “the most uninsured state in the nation,” as the Texas Tribune put it, describing just-released statistics from the U.S. Census Bureau. The ACA allowed Texas to expand Medicaid, but it was one of 14 states — almost all of them controlled by conservative governors and legislatures — to decline the federal government’s help. That prevented 1.8 million Texans from receiving coverage, Ben-Ami said on Thursday.

Dr. Pritesh Gandhi, an Austin doctor who is running for Congress, agreed that any plan would be better than Trump’s: “Physicians could care less about the semantics of plans.”

Gandhi said he would endorse any Democrat who would push for the uninsured to have insurance. “All we want is for folks who don’t have insurance to get insurance,” he said.

Most Democrats want that too, even if they are deeply divided about how to get there.

Poll of the Day: Democrats Increasingly Favor Obamacare

Yuval Rosenberg of the Fiscal Times reviewed a poll showing that more than eight in 10 Democrats — 84% to be precise — say they view the Affordable Care Act favorably in the latest Kaiser Family Foundation tracking polls. That’s the largest share of Democrats supporting the law in the nine years the tracking poll has been conducted. (Overall, 53% of Americans view the law favorably.) Support for the law among Democrats has risen 11 percentage points since President Trump took office.

The poll also finds that 55% of Democrats and Democratic-leaning independents say they’d prefer a candidate who wants to build on the ACA to expand coverage and lower costs, while 40% say they’d prefer a candidate who wants to replace the law with a national Medicare-for-All system.

Majorities across party lines agree that Congress’s top health care priorities should be lowering prescription drug costs, maintaining protections for patients with pre-existing conditions and reducing what people pay for care. But a partisan split emerges when people are asked to choose whether it’s more important for lawmakers to make sure all Americans have health insurance or to lower health care costs.

Screen Shot 2019-09-15 at 11.33.13 PM.png

CDC, states update number of cases of lung disease associated with e-cigarette use, or vaping. What is going to take us all to ban these e-cigarettes at least from our youth. How many kids’ death does it take?

Media Statement

CDC today announced the updated number of confirmed and probable cases of lung disease associated with e-cigarette product use, or vaping. The new case count is the first national aggregate based on the new CDC definition developed and shared with states in late August.

Cases

As of September 11, 2019, 380 confirmed and probable cases of lung disease associated with e-cigarette product use, or vaping, were reported by 36 states and the U.S. Virgin Islands.
The previous case count released by CDC was higher because it reported possible* cases that were still under investigation by states. The current number includes only confirmed** and probable*** cases reported by states to CDC after classification.
CDC is no longer reporting possible cases or cases under investigation and states have recently received the new CDC case definition to classify cases. The classification process requires medical record review and discussion with the treating healthcare providers. The current number is expected to increase as additional cases are classified.
CDC will continue to report confirmed and probable cases as one number because the two definitions are very similar and this is the most accurate way to understand the number of people affected.

*A possible case is one still under investigation at the state level.

**A confirmed case is someone who recently used an e-cigarette product or vaped, developed a breathing illness, and for whom testing did not show an infection. Other common causes of illness have been ruled out as the primary cause.

***A probable case is someone who recently used an e-cigarette product or vaped, developed a breathing illness, and for whom some tests have been performed to rule out infection. Other common causes of illness have been ruled out as the primary cause.

Deaths

Six total deaths have been confirmed in six states: California, Illinois, Indiana, Kansas, Minnesota, and Oregon.

What the CDC is doing

CDC is currently coordinating a multistate investigation. In conjunction with a task force from the Council for State and Territorial Epidemiologists and affected states, interim outbreak surveillance case definitions, data collection tools, and a database to collect relevant patient data have been developed and released to states.

CDC continues to provide technical assistance to states, including working closely with affected states to characterize the exposures and the extent of the outbreak.

CDC is providing assistance in epidemiology, disease surveillance, pathologic consultation, clinical guidance development, and communication.

CDC also continues to work closely with the Food and Drug Administration (FDA) to collect information about recent e-cigarette product use, or vaping, among patients and to test the substances or chemicals within e-cigarette products used by case patients.

So, we can still see that there are really no solutions to the health care problem. Even the Republicans who had the majorities in both the House and the Senate made any headway, even though they promised to come up with a solution. The President also keeps on promising a solution, but nowhere do I see any progress. As you all my have figured out Medicare for All is not the correct solution unless there are clarity on realistic financing, tort reform and how to provide financial assistance for medical education. Help!!

More to come in this discussion.

Fact Check: Are there ‘more gun deaths by far’ in America than any other country? And what is the GOP going to do about IT?

Leave a reply

Screen Shot 2019-08-26 at 9.19.29 PM This is another very long post but gun violence and the solutions need to be center stage going forward. We in health care see the results of gun violence every day in our hospitals, ERs, and offices. Texan Beto O’Rourke joined nine other Democrats on stage in Detroit on Tuesday for the second round of debates in the Democratic presidential primary contest. All of the candidates made questionable statements — take a look at some fact-checking from the night — including O’Rourke, who was asked to respond to a comment about gun violence from Montana Gov. Steve Bullock.

Bullock said that Washington, D.C., “is captured by dark money” and political influence from the likes of the NRA and Koch Industries, making it hard for lawmakers to tackle issues like gun safety.

“That’s the way we’re actually going to make a change on this, Don, is by changing that system,” Bullock said, addressing moderator Don Lemon of CNN. “And most of the things that folks are talking about on this stage we’re not going to address until we kick dark money and the post-Citizens United corporate spending out of these elections.”

Lemon asked O’Rourke to respond to Bullock’s point.

“How else can we explain that we lose nearly 40,000 people in this country to gun violence, a number that no other country comes even close to, that we know what all the solutions are, and yet nothing has changed?” O’Rourke said. “It is because, in this country, money buys influence, access and, increasingly, outcomes.”

We assumed O’Rourke was talking about the number of gun deaths in the United States in the past year, a figure supported by federal data. But is O’Rourke right that no other country comes close to the number of deaths by gun violence in the United States? We took a look.

By Chris Nichols on Tuesday, August 6th, 2019 at 5:32 p.m.

Following the recent mass shootings in Gilroy, California and El Paso, Texas, and just hours before a separate mass shooting in Dayton, Ohio, California Democratic Sen. Dianne Feinstein made a sweeping statement about the number of guns and gun deaths in America.

“There are more guns in this country than people and more per capita than any other country in the world. And there are more gun deaths by far,” Feinstein, a strong advocate for gun control, said on Twitter on Aug. 3, 2019. “I continue to hope that opponents of commonsense gun reform laws will come to their senses and join the effort to save lives.”

Sen. Dianne Feinstein, D-CA, posted this tweet on Aug. 3, 2019.

As of early this week, 22 people were killed in the El Paso shooting, nine in Dayton and three in Gilroy. The suspected gunmen in Dayton and Gilroy also died.

We examined each part of Feinstein’s statement but found we couldn’t place a Truth-O-Meter rating on the first two parts because there’s no official count on the number of guns in America and there are competing estimates on how many exist.

We did place a rating on the last portion about America having “more gun deaths by far” than any other country.

We’ll provide analysis on each piece of Feinstein’s statement below.

Feinstein on guns

First, here’s some background on the senator. In 1994, she authored the Federal Assault Weapons Ban, which was signed by President Bill Clinton. It prohibited the manufacture of 19 specific kinds of military-style, semi-automatic firearms, often called assault weapons.

It also banned the manufacture and sale of gun magazines that hold more than 10 bullets.

The bill expired in 2004 after efforts to extend it failed in Congress.

Its restrictions did not apply to any semi-automatic weapons or magazines made before the ban’s effective date: Sept. 13, 1994.

Feinstein has remained an advocate for gun control. In February of this year, she introduced a bill that would pay for states to create their own extreme-risk protection laws, also known as red flag laws.

Those would allow family members to petition for a court order to “grant law enforcement the authority to temporarily take weapons from dangerous individuals who present a threat to themselves or others,” according to Feinstein’s office.

California, Maryland, and Florida have already enacted similar laws.

“There are more guns in this country than people”

There are no official count of the number of firearms in the United States, only widely varying estimates, as PolitiFact has reported in the past.

As the Pew Research Center has observed: “Gun ownership is one of the hardest things for researchers to pin down.”

We found estimates as low as 265 million civilian guns in the U.S. in January 2015 — to as high as 393 million in a report last year.

Researchers say estimates can include guns that no longer work, leading to an overcount. Meanwhile, some survey respondents will understate the number of guns they own, leading to an undercount.

With no definitive tally, we decided not to place a rating on this portion of Feinstein’s statement.

“More (guns) per capita than any other country in the world”

This second part of the claim is generally on the right track, whether looking at the high estimates for guns in America or the lower ones. But again it relies on a topic for which there’s no settled data.

Taking the estimate of 393 million civilian firearms, there would be 120.5 guns for every 100 residents in the United States. As The Washington Post reported, that’s twice the per capita rate of the next-highest nation, Yemen, with just 52.8 guns per 100 residents.

Using the lower estimate of 265 million guns in 2015 would still produce about 83 guns for every 100 Americans that year.

While this part of Feinstein’s claim is likely more accurate, the per capita rate doesn’t mean all Americans own guns. Instead, gun ownership is concentrated among a minority of the US population — as surveys from the Pew Research Center and General Social Survey suggest, according to the Post.

“More gun deaths by far” in the United States?

This part of Feinstein’s statement is not supported. We found the United States experiences more firearm injury deaths than other countries of similar socioeconomic standing. But that’s not what Feinstein claimed. She suggested it had “more gun deaths by far” than any other country.

In 2017, Brazil had the most overall gun deaths of any country at 48,493, including homicides, suicides and unintentional gun deaths, according to a June 2018 report by the University of Washington’s Institute for Health Metrics and Evaluation.

The United States had the second most overall gun deaths at 40,229, though it had the highest suicide by a gun total of any nation, at nearly 25,000. Data from the report showed Brazil had the most overall gun deaths at least from 2015 through 2017.

“Yes, Brazil is highest by number” for overall gun deaths, the study’s author, Professor Moshen Naghavi, said by email.

“We believe 2018 and 2019 will be higher,” Naghavi said in a follow-up phone interview, citing decisions made by Brazil’s new president to make firearms more accessible.

Feinstein’s office did not respond to our request for information supporting this portion of her statement.

PolitiFact Texas fact-checked a similar claim last week by former Rep. Beto O’Rourke and rated it Mostly False. O’Rourke said at the Democratic presidential debate in Detroit that “we lose nearly 40,000 people in this country to gun violence, a number that no other country comes even close to.” It cited the University of Washington study and noted that more than a dozen countries had more firearm deaths per capita than the United States in 2016.

Our rating

Sen. Dianne Feinstein claimed, “There are more guns in this country than people and more per capita than any other country in the world. And there are more gun deaths by far.”

We could not place a rating on the first two parts because there are no official count of guns in America, only widely varying estimates.

The last part of her statement, however, is not supported. A recent study showed Brazil, not the United States, had the most overall gun deaths of any country over the last several years. America, however, had the highest total of suicides by firearm of any nation.

In the end, she was wrong that there are “more gun deaths by far” in the United States than any other country in the world. Here are two charts/tables with data.

Screen Shot 2019-08-25 at 12.25.22 AM

Screen Shot 2019-08-25 at 12.26.10 AM

We rate that portion of her claim False.

FALSE – The statement is not accurate.

America’s gun culture in charts

Two mass shootings within 24 hours, leaving 31 people dead, has once again brought the spotlight on gun ownership in the United States.

An attack on a Walmart store in El Paso, Texas on Saturday left 20 dead, while nine died in a shooting in Dayton, Ohio on Sunday.

But where does America stand on the right to bear arms and gun control?

What do young people think about gun control?

Screen Shot 2019-08-25 at 9.19.30 PM

When looking at the period before the Parkland school shooting in 2018, it is interesting to track how young people have felt about gun control.

Support for gun control over the protection of gun rights in America is highest among 18 to 29-year-olds, according to a study by the Pew Research Centre, with a spike after the Orlando nightclub shooting in 2016. The overall trend though suggests a slight decrease in support for gun control over gun rights since 2000.

Pew found that one-third of over-50s said they owned a gun. The rate of gun ownership was lower for younger adults – about 28%. White men are especially likely to own a gun.

How does the US compare with other countries?

I included two charts in the previous discussion and here are two more.

About 40% of Americans say they own a gun or live in a household with one, according to a 2017 survey, and the rate of murder or manslaughter by firearm is the highest in the developed world. There were almost 11,000 deaths as a result of murder or manslaughter involving a firearm in 2017.

Screen Shot 2019-08-26 at 12.23.00 AM

Homicides are taken here to include murder and manslaughter. The FBI separates statistics for what it calls justifiable homicide, which includes the killing of a criminal by a police officer or private citizen in certain circumstances, which are not included.

In about 13% of cases, the FBI does not have data on the weapon used. By removing these cases from the overall total of gun deaths in the US, the proportion of gun-related killings rises to 73% of homicides.

Who owns the world’s guns?

While it is difficult to know exactly how many guns civilians own around the world, by every estimate the US with more than 390 million is far out in front.

Screen Shot 2019-08-26 at 12.24.42 AM

Switzerland and Finland are two of the European countries with the most guns per person – they both have compulsory military service for all men over the age of 18. The Finnish interior ministry says about 60% of gun permits are granted for hunting – a popular pastime in Finland. Cyprus and Yemen also have military service.

How do US gun deaths break down?

There have been more than 110 mass shootings in the US since 1982, according to the investigative magazine Mother Jones.

Up until 2012, a mass shooting was defined as when an attacker had killed four or more victims in an indiscriminate rampage – and since 2013 the figures include attacks with three or more victims. The shootings do not include killings related to other crimes such as armed robbery or gang violence.

The overall number of people killed in mass shootings each year represents only a tiny percentage of the total number.

Screen Shot 2019-08-26 at 12.26.23 AM

Figures from the Centers for Disease Control and Prevention show there were a total of more than 38,600 deaths from guns in 2016 – of which more than 22,900 were suicides. Suicide by firearm accounts for almost half of all suicides in the US, according to the CDC.

A 2016 study published in the American Journal of Public Health found there was a strong relationship between higher levels of gun ownership in a state and higher firearm suicide rates for both men and women.

Attacks in the US become deadlier

The Las Vegas attack in 2017 was the worst in recent US history – and eight of the shootings with the highest number of casualties happened within the past 10 years.

Screen Shot 2019-08-26 at 12.28.07 AM

What types of guns kill Americans?

Military-style assault-style weapons have been blamed for some of the major mass shootings such as the attack in an Orlando nightclub and at the Sandy Hook School in Connecticut.

Dozens of rifles were recovered from the scene of the Las Vegas shooting, police reported.

Screen Shot 2019-08-26 at 12.29.28 AM

A few US states have banned assault-style weapons, which were totally restricted for a decade until 2004.

However, most murders caused by guns involve handguns, according to FBI data.

How much do guns cost to buy?

For those from countries where guns are not widely owned, it can be a surprise to discover that they are relatively cheap to purchase in the US.

Among the arsenal of weapons recovered from the hotel room of Las Vegas shooter, Stephen Paddock were handguns, which can cost from as little $200 (£151) – comparable to a Chromebook laptop.

Screen Shot 2019-08-26 at 12.31.13 AM

Assault-style rifles, also recovered from Paddock’s room, can cost from around $1,500 (£1,132).

In addition to the 23 weapons at the hotel, a further 19 were recovered from Paddock’s home. It is estimated that he may have spent more than $70,000 (£52,800) on firearms and accessories such as tripods, scopes, ammunition, and cartridges.

Who supports gun control?

US public opinion on the banning of handguns has changed dramatically over the last 60 years. Support has shifted over time and now a significant majority opposes a ban on handguns, according to polling by Gallup.

But a majority of Americans say they are dissatisfied with US gun laws and policies, and most of those who are unhappy want stricter legislation.

Screen Shot 2019-08-26 at 12.33.23 AM

Some states have taken steps to ban or strictly regulate ownership of assault weapons. Laws vary by state but California, for example, has banned around 75 types and models of an assault weapon.

Screen Shot 2019-08-26 at 12.35.02 AM

Some controls are widely supported by people across the political divide – such as restricting the sale of guns to people who are mentally ill, or on “watch” lists.

Screen Shot 2019-08-26 at 12.37.11 AM

But Republicans and Democrats are much more divided over other policy proposals, such as whether to allow ordinary citizens increased rights to carry concealed weapons – according to a survey from Pew Research Center.

Who opposes gun control?

The National Rifle Association (NRA) campaigns against all forms of gun control in the US and argues that more guns make the country safer.

It is among the most powerful special interest lobby groups in the US, with a substantial budget to influence members of Congress on gun policy.

Screen Shot 2019-08-26 at 12.39.28 AM

In total, about one in five US gun owners say they are members of the NRA – and it has especially widespread support from Republican-leaning gun owners, according to Pew Research.

In terms of lobbying to influence gun policy, the NRA’s spending jumped from about $3m per year to more than $5m in 2017.

The chart shows only the recorded contributions to lawmakers published by the Senate Office of Public Records.

The NRA spends millions more elsewhere, such as on supporting the election campaigns of political candidates who oppose gun controls.

GOP Waits to See if Trump Will Protect It From the NRA Before Moving on Gun Laws

Sam Brodey Noted that just over a week since mass shootings in El Paso, Texas, and Dayton, Ohio, Senate Republicans are waiting to see if President Trump walks away from the issue again or forces their hand before trying to do anything about potentially expanding background checks for gun purchases.

He’s walked away before. Following the Parkland school massacre last year, the president promised that he was “going to be very strong on background checks,” only to retreat after holding private meetings with National Rifle Association officials at the White House. The NRA, a key ally of Trump’s, has spent big money lobbying against background-checks expansion legislation, and last week reminded him of its staunch opposition.

After the latest shootings, Trump told reporters that there is great “appetite” on the Hill to finally get something done on background checks but his GOP allies in the Senate are holding off, unwilling to burn political capital with the gun lobby and conservative-base voters on the issue if Trump isn’t going to burn some of his.

However, the president’s prior inaction, and the media coverage he incurred for it, may force him to make at least a slightly harder run at background checks this time around, even if only in his messaging and bluster. Two people who’ve spoken to the president in recent days say that he has referenced, during conversations about how he could possibly bend the NRA to his will in this case, his annoyance at media coverage of his post-Parkland about-face that suggested he was all talk and no action on the issue, and easily controlled by the NRA. One of the sources noted that Trump’s aversion to being seen as “controlled” by anyone or any organization makes it much more likely that the president will dwell on the issue for longer than he did last year.

Trump’s influence could well make or break legislation, since Republicans are unlikely to support anything without his blessing but will be just as hesitant to immediately reject a bill he puts his full support behind.

“Many Hill Republicans are waiting to see what Trump will get behind,” said a Senate GOP aide. “He gives them political cover. I don’t think you’re going to see any one bill or one proposal get any momentum until the President publicly endorses it.”

Senate Majority Leader Mitch McConnell (R-KY) said on Thursday that he and the president are actively discussing possible avenues for gun legislation. “He’s anxious to get an outcome and so am I,” said McConnell on a radio show in Kentucky.

The GOP leader stressed that the president was open to a discussion on gun legislation, from background checks to “red flag” bills: “Those are two items that for sure will be front and center as we see what we can come together on and pass.”

A spokesman for McConnell declined to elaborate on the Senate leader’s conversations with the president.

Democrats aren’t holding their breath, given that McConnell won’t call the Senate back from its recess for gun bills and that Trump has backtracked before on the issue after outcry from pro-gun factions of his base.

Democratic aides have been mindful of Sean Hannity’s reaction to the background checks push, since Trump’s position has been known to change based on the broadcasts or private counsel of Hannity and other top Fox personalities.

White House aides are similarly waiting on Trump, and talking up how he’s also been reaching out across the aisle to find a potential solution, even if nobody knows what that would look like yet. “The president has been actively talking to Republicans and Democrats on the matter of background checks, and just being able to have meaningful, measurable reforms that don’t confiscate law-abiding citizens’ firearms without due process, but at the same time keep those firearms out of people who have a propensity toward violence,” Kellyanne Conway, Trump’s White House counselor, said on this week’s Fox News Sunday.

One of those Democratic politicians, Sen. Joe Manchin (D-WV), said in a call with reporters on Wednesday he had spoken to the president twice since the shootings in Dayton and El Paso and that he was “committed to getting something done.”

While “everything is on the table,” Manchin said, Trump’s sign-off on any plan will be key to getting it through the Senate. The proposal introduced by Sen. Pat Toomey (R-PA) and Manchin in the months after the massacre at Sandy Hook elementary made modest adjustments to background check system by extending checks to gun shows and internet sales, but exempted gun transactions between friends and family members. It also provided additional funding to states to put critical information into the National Instant Criminal Background Check System in order to prevent people who should not have guns from obtaining them, and created a commission to study the causes of gun violence.

It’s a bill that’s failed twice, once in 2013 and again after the mass shooting in a San Bernardino office park in 2015. Both times it drew very limited support from Republican senators.

Asked what had changed since the last time the bill failed on the Senate floor, Manchin said, “The political will wasn’t there.”

Manchin said he was told by some colleagues who opposed the bill that they really didn’t object to the substance of the bill but they weren’t convinced the “Obama administration wouldn’t go further [and try] taking more of their guns away from them.”

Manchin said he tried to explain that would be unconstitutional, but to no avail.

Some Trump allies say that this president, given his record and rhetoric, might have just enough credibility among Second Amendment enthusiasts to drag them along, if he so chooses.

“If only Nixon could go to China, then maybe only Trump can address the chasm between gun owners and those who want gun control,” Michael Caputo, a former Trump campaign adviser, told The Daily Beast. “He’s so strong on the Second Amendment he can truly do something to make a change when it comes to these mass shootings.”

Caputo, who in 2013 and 2014 advised Trump on pro-gun voters and the NRA when the celebrity businessman was weighing a run for New York governor, said that even years ago, “We talked about mass shootings and what that means to the United States, and the importance [to voters] of the Second Amendment, and I know the president has been thinking about this issue for a long time: How you balance gun rights versus gun atrocities.”

Trump’s former adviser added, “If the president pursues broader background checks… perhaps it’s because he knows that is something only he can do. He may lose the support of some of the most pro-gun members of his base, but the vast majority of us understand there are some reasonable measures to be taken.”

I will be very interested to see what happens in D.C. when Congress comes back from their vacation. Will they all together come up with realistic guns laws without the concern for the NRA? That includes the President and yes, both parties in both houses!

Medicare for All, funding and ‘impossible promises’ deeply divide Democrats during 2020 debate; and How Many More Shootings of Innocent people Can Our Society Tolerate?

Leave a reply

promise312 What a horrible week it has been! The debates were an embarrassment for all, both Democrats as well as everyone else. Who among those twenty who were on stage, spouting impossible strategies, attacking each other and in general making fools of themselves.

But the worst was the mass shootings this past weekend. Why should anybody be allowed to own assault weapons? We all need to finally do something about this epidemic of mass shootings. How many more innocent people do we have to lose before the Republicans, as well as the Democrats and our President, work together to solve this problem.

As the President of the American Medical Association stated:

“The devastating gun violence tragedies in our nation this weekend are heartbreaking to physicians across America. We see the victims in our emergency departments and deliver trauma care to the injured, provide psychiatric care to the survivors, and console the families of the deceased. The frequency and scale of these mass shootings demand action.

“Everyone in America, including immigrants, aspires to the ideals of life, liberty, and pursuit of happiness. Those shared values – not hatred or division – are the guiding light for efforts to achieve a more perfect union.

“Common-sense steps, broadly supported by the American public, must be advanced by policymakers to prevent avoidable deaths and injuries caused by gun violence. We must also address the pathology of hatred that has too often fueled these mass murders and casualties.”

Brittany De Lea when reviewing the Democrat presidential hopefuls noted that Democratic contenders for the 2020 presidential election spent a sizable amount of time during the second round of debates detailing the divide over how the party plans to reform the U.S. health care system – while largely avoiding to address how they would pay for their individual proposals.

Massachusetts Sen. Elizabeth Warren dodged a point-blank question from moderators as to whether middle-class families would pay more in taxes in order to fund a transition to a Medicare for All system.

Instead, she said several times that “giant corporations” and “billionaires” would pay more. She noted that “total costs” for middle-class households would go down.

Independent Vermont Sen. Bernie Sanders said during the first round of Democratic debates in Miami that taxes on middle-class families would rise but added that those costs would be offset by lower overall health care costs. Warren seemed to refer to this plan of action also.

Sanders and Warren quickly became targets on the debate stage for his proposed plan, which she supports, to transition to a Medicare for All system where there is no role for private insurers.

Former Maryland Congressman John Delaney (and even though I am not a big fan of Mr. Delaney, he is the only one that makes any sense with regard to health care) said Sanders’ plan would lead to an “underfunded system,” where wealthy people would be able to access care at the expense of everyone else. He also said hospitals would be forced to close.

Delaney asked why the party had to be “so extreme,” adding that the Democrats’ health care debate may not be so much about health care as it was an “anti-private sector strategy.” In his opening statement, he appeared to throw jabs at Sanders and Warren for “impossible promises” that would get Trump reelected.

Former Texas lawmaker Beto O’Rourke said taxes would not rise on middle-class taxpayers, but he also does not believe in taking away people’s choice for the private insurance they have.

Minnesota Sen. Amy Klobuchar said there needed to be a public option, as did former Colorado Gov. John Hickenlooper.

South Bend, Indiana, Mayor Pete Buttigieg thought the availability of a public alternative would incentivize people to walk away from their workplace plans.

Earlier this week, California Sen. Kamala Harris unveiled her vision for a transition to a Medicare for All system over a 10-year phase-in period, which called for no tax increase on families earning less than $100,000. She instead said a Wall Street financial transaction tax would help fund the proposal.

Harris is scheduled to appear during Wednesday’s night debate in Detroit, alongside former Vice President Joe Biden whose campaign has already criticized her health care plan.

Health care comes in focus, this time as a risk for Democrats

Ricardo Alonso-Zaldivar reported that the Democratic presidential candidates are split over eliminating employer-provided health insurance under “Medicare for All.”

The risk is that history has shown voters are wary of disruptions to job-based insurance, the mainstay of coverage for Americans over three generations.

Those divisions were on display in the two Democratic debates this week, with Sens. Bernie Sanders and Elizabeth Warren calling for a complete switch to government-run health insurance for all. In rebuttal, former Vice President Joe Biden asserted, “Obamacare is working” and promised to add a public option. Sen. Kamala Harris was in the middle with a new Medicare for All concept that preserves private insurance plans employers could sponsor and phases in more gradually. Other candidates fall along that spectrum.

The debates had the feel of an old video clip for Jim McDermott, a former Democratic congressman from Washington state who spent most of his career trying to move a Sanders-style “single-payer” plan and now thinks Biden is onto something.

“There is a principle in society and in human beings that says the devil you know is better than the devil you don’t know,” said McDermott, a psychiatrist before becoming a politician. “I was a single-payer advocate since medical school. But I hit every rock in the road trying to get it done. This idea that you are going to take out what is known and replace it with a new government program — that’s dead on arrival.”

Warren, D-Mass., was having none of that talk Monday night on the debate stage. “Democrats win when we figure out what is right, and we get out there and fight for it,” she asserted.

Confronting former Rep. John Delaney, D-Md., a moderate, Warren said, “I don’t understand why anybody goes to all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for. … I don’t get it.”

Here’s a look at options put forward by Democrats and the employer-based system that progressives would replace:

MEDICARE FOR ALL

The Medicare for All plan advocated by Sanders and Warren would replace America’s hybrid system of employer, government and individual coverage with a single government plan paid for by taxes. Benefits would be comprehensive, and everybody would be covered, but the potential cost could range from $30 trillion to $40 trillion over 10 years. It would be unlawful for private insurers or employers to offer coverage for benefits provided under the government plan.

“If you want stability in the health care system, if you want a system which gives you freedom of choice with regard to doctor or hospital, which is a system which will not bankrupt you, the answer is to get rid of the profiteering of the drug companies and the insurance companies,” said Sanders, a Vermont senator.

BUILDING ON OBAMACARE

On the other end is the Biden plan, which would boost the Affordable Care Act and create a new public option enabling people to buy subsidized government coverage.

“The way to build this and get to it immediately is to build on Obamacare,” he said.

The plan wouldn’t cover everyone, but the Biden campaign says it would reach 97% of the population, up from about 90% currently. The campaign says it would cost $750 billion over 10 years. Biden would leave employer insurance largely untouched.

Other moderate candidates take similar approaches. For example, Colorado Sen. Michael Bennet’s plan is built on a Medicare buy-in initially available in areas that have a shortage of insurers or high costs.

THE NEW ENTRANT

The Harris plan is the new entrant, a version of Medicare for All that preserves a role for private plans closely regulated by the government and allows employers to sponsor such plans. The campaign says it would cover everybody. The total cost is uncertain, but Harris says she would not raise taxes on households making less than $100,000.

“It’s time that we separate employers from the kind of health care people get. And under my plan, we do that,” Harris said.

Harris’ plan might well reduce employer coverage, while Sanders’ plan would replace it. Either would be a momentous change.

Job-based coverage took hold during the World War II years, when the government encouraged employers and unions to settle on health care benefits instead of wage increases that could feed inflation. According to the Congressional Budget Office, employers currently cover about 160 million people under age 65 — or about half the population.

A poll this week from the nonpartisan Kaiser Family Foundation underscored the popularity of employer coverage. Among people 18-64 with workplace plans, 86% rated their coverage as good or excellent.

Republicans already have felt the backlash from trying to tamper with employer coverage.

As the GOP presidential nominee in 2008, the Arizona Sen. John McCain proposed replacing the long-standing tax-free status of employer health care with a tax credit that came with some limits. McCain’s goal was to cut spending and expand access. But Democrats slammed it as a tax on health insurance, and it contributed to McCain’s defeat by Barack Obama.

“The potential to change employer-sponsored insurance in any way was viewed extremely negatively by the public,” said economist Douglas Holtz-Eakin, who served as McCain’s policy director. “That is the Achilles’ heel of Medicare for All — no question about it.”

These Are the Health-Care Questions That Matter Most

Max Nisen then noted that Health care got headline billing at both of this week’s second round of Democratic presidential debates. Unfortunately for voters, neither was very illuminating.

The biggest culprit was the format. Jumping between 10 candidates every 30 seconds made any substantive debate and discussion impossible. The moderators also deserve blame; they asked myopic questions intended to provoke conflict instead of getting any new information. And the candidates didn’t exactly help; there was a lot of sniping and not a lot of clear explanation of what they wanted to do.

The next debates may well be an improvement, as a more stringent cutoff should help to narrow the field and give candidates added time to engage in thoughtful discourse. Regardless, here are the issues that matter, and should be at the heart of any discussion:

The issue of how candidates would propose paying for their various health-care plans has been framed in the debates by the question, “Will you raise middle-class taxes?” That’s a limited and unhelpful approach. Raising taxes shouldn’t be a yes or no question; it’s a trade-off. Americans already pay a lot for health care in the form of premiums, deductibles, co-payments, and doctor’s bills. Why is that regressive system, which rations care by income, different or better than a more progressive tax? Insurer and drug maker profits, both of which got airtime at the debates, are only a part of the problem when it comes to America’s high health costs. The disproportionately high prices Americans pay for care are a bigger issue. What we pay hospitals and doctors, and how we can bring those costs down, are crucial issues that the candidates have barely discussed. What’s their plan there? The first round of debates saw the moderators ask candidates to raise their hands if they would eliminate private health coverage. Round two did essentially the same thing without the roll call. The idea of wiping out private insurance seems to be a flashpoint, but there doesn’t seem to be as much interest in questioning the merits of the current, mostly employer-based system. It’s no utopia. Americans unwillingly lose or change employer coverage all the time, and our fragmented system does an awful job of keeping costs down. People who support eliminating or substantially reducing the role of private coverage deserve scrutiny, but so do those who want to retain it. What’s so great about the status quo?

Screen Shot 2019-08-05 at 12.14.52 AM

As the field narrows, voters need specifics. A chunk of the field has been remarkably vague. Answers to these questions could offer some clarity:

For Senator Elizabeth Warren: Are there any differences between your vision of “Medicare for All” and Senator Bernie Sanders’s? There’s wiggle room here; his plan is more expansive (and expensive) than single-payer systems in countries like Canada. For Senator Kamala Harris: What will your plan cover and how much will it cost? The skeletal outline of Harris’s plan lacks details on premiums and what patients would have to pay for out of pocket. She didn’t clarify matters at the debate. For former Vice President Joe Biden: Will people with access to employer insurance be eligible for subsidies in your public option plan? If the answer is no or restrictive, his public option could have a relatively limited impact. It the answer is yes, his $750 billion cost estimate should head to the dustbin. For the morass of candidates who pay lip service to Medicare for All but want to keep private insurance but don’t have a specific plan: What exactly do you want?

Health care is the most important issue for Democrats, according to polling. We need to find a way to have a discussion that does it justice.

Democrats’ Health-Care Feud Eclipses Message That Won in 2018

So, what have we learned from these debates? John Tozl realizes that in the four evenings of Democratic presidential debates since June, one phrase appeared for the first time on Wednesday: “pre-existing conditions.”

New Jersey Senator Cory Booker uttered it in his remarks on health care, chiding fellow Democrats for their infighting as Republicans wage a legal battle to undo the Affordable Care Act, which prohibits insurers from charging people more for being sick.

“The person who is enjoying this debate the most tonight is Donald Trump,” he said. “There is a court case working through the system that’s going to gut the Affordable Care Act and actually gut protections on pre-existing conditions,” Booker said, citing litigation in which the Trump administration and Republican-controlled states seeking to strike down Obamacare.

Over two nights this week, the 20 candidates spent at least an hour fiercely arguing over health-care plans, most of which are significantly more expansive than what the party enacted a decade ago in the Affordable Care Act. It’s a sign of how important the issue will be in the bid to unseat Trump, and how the party’s position has shifted leftward.

In November, Democrats won control of the House on the strength of their message to protect people with pre-existing conditions. That provision, a fundamental change to America’s private insurance market, is central to the ACA, the party’s most significant domestic policy achievement in a generation.

Booker’s attempt to unify his fractious colleagues against their common opponent stood out, because most of the discussion of health care, which kicked off the debate as it did on Tuesday, but the party’s divisions into sharp focus.

Biden v. Harris

Senator Kamala Harris of California and former Vice President Joe Biden tried to discredit each other’s proposals. Biden says he wants to build on the Affordable Care Act while expanding access to health insurance through a public insurance option.

Harris, in a plan, unveiled this week, likewise favors a public option but wants to sever the link between employment and health insurance, allowing people instead to buy into public or private versions of Medicare, the federal health-care program for seniors.

Harris took Biden to task over a plan that fails to insure everyone, saying his plan would leave 10 million people without insurance.

“For a Democrat to be running for president in America with a plan that does not cover everyone, I think is without excuse,” she said.

Biden accused Harris of having had “several plans so far” and called her proposal a budget-buster that would kick people off health plans they like.

“You can’t beat President Trump with double-talk on this plan,” he said.

Other candidates split along similar lines, with Colorado Senator Michael Bennet saying Harris’s proposal “bans employer-based insurance and taxes the middle class to the tune of $30 trillion.”

New York Mayor Bill de Blasio argued for a more sweeping approach, like the Medicare for All policies embraced by Senators Bernie Sanders and Elizabeth Warren.

“I don’t understand why Democrats on this stage are fear-mongering about universal health care,” he said. “Why are we not going to be the party that does something bold, that says we don’t need to depend on private insurance?”

How Bold?

The question any candidate will eventually have to answer is how bold a plan they believe voters in a general election want.

In 2018, Democrats running for Congress attacked Republicans for trying to repeal the ACA and then, when that failed, asking courts to find it unconstitutional. Scrapping the law would mean about 20 million people lose health insurance.

About two-thirds of the public, including half of Republicans, say preserving protections for people with pre-existing conditions is important, according to polls by the Kaiser Family Foundation, a nonprofit health research group.

More than a quarter of adults under 65 have pre-existing conditions, Kaiser estimates.

But that message has been mostly absent from the primary debates, where health-care talk highlights the divisions between the party’s progressive left-wing and its more moderate center.

Warren and Sanders weren’t on stage Wednesday, but their presence was looming. They’re both leading candidates and have deeply embraced Medicare for All plans that replace private insurance with a government plan. Bernie is an idiot, especially in his come back that he knows about Medicare for All since he wrote the bill. He has no idea of the far-reaching effect of Medicare for all. Our practice just reviewed our payments from Medicare over the last few years as well as the continued discounts that are applied to our services and noted that if we had to count on Medicare as our only health care payer that we as well as many rural hospitals would go out of business.

I refer you all back to John Delaney’s responses to the Medicare for All discussion. In the middle of a vigorous argument over Medicare for All during the Democratic debate tonight, former Representative John Delaney pointed out the reason he doesn’t support moving all Americans onto Medicare: It generally pays doctors and hospitals less than private-insurance companies do.

Because of that, some have predicted that if private insurance ends, and Medicare for All becomes the law of the land, many hospitals will close, because they simply won’t be able to afford to stay open at Medicare’s rates. Fact-checkers have pointed out that while some hospitals would do worse under Medicare for All, some would do better. But Delaney insisted tonight that all the hospital administrators he’s spoken with have said they would close if they were paid at the Medicare rate for every bill.

Whichever candidate emerges from the primary will have to take their health plans not just to fervent Democrats, but to a general electorate as well.

More on Medicare

If you remember from last week I reviewed the inability of our federal designers to accurately estimate the cost of the Medicare program and the redesign expanding the Medicaid programs mandating the states expand their Medicaid programs to provide comprehensive coverage for all the medically needy by 1977.

The additional provision of the 1972 legislation was the establishment of the Professional Standards Review Organizations (PSROs), whose function it was to assume responsibility for monitoring the costs, degree of utilization, and quality of care of medical services offered under Medicare and Medicaid. It was hoped that these PSROs would compel hospitals to act more efficiently. In keeping with this set of goals, in 1974 a reimbursement cap was instituted that limited hospitals from charging more than 120 percent of the mean of routine costs in effect in similar facilities, a limit eventually reduced to 112 percent named as Section 223 limits. But despite these attempts at holding down costs, they continued to escalate inasmuch as hospitals were still reimbursed on the basis of their expenses and the caps that were instituted applied only to room and board and not to ancillary services, which remained unregulated.

Now think about the same happening on a bigger scale with the proposed Medicare for All. Those that are proposing this “Grand Plan” need to understand the complexities issues, which need to be considered before touting the superiority of such a plan. Otherwise, the plan will fail!! Stop your sputtering arrogance Bernie, Kamala, and Elizabeth, etc. Get real and do you research, your homework before you yell and scream!!!!!!

More to Come!

The Democrats’ Gamble on Health Care for the Undocumented; but What About Our Own Citizens and Medicare?

Leave a reply

health298 Several 2020 candidates are proffering moral and policy arguments for providing coverage, but the politics of the move are another matter. “We” are now worried more about the undocumented immigrants than our own citizens? This is really an indication as to the idiocy seeping into all aspects of our society, especially during this competitive race for the Presidency.

Ronald Brownstein reported that anxiety spiked among many centrist Democrats when all 10 presidential candidates at a recent debate raised their hand as if pledging allegiance, to declare they would support providing health care to undocumented immigrants. The image, which drew instant ridicule from President Donald Trump on Twitter, seemed to encapsulate the primary’s larger lurch to the left during the early stages of the 2020 race, which has unnerved many moderates.

But opinion among the candidates on this polarizing question is actually much more divided than that moment suggested. And that division underscores a larger point: While the most left-leaning positions in the Democratic field have attracted the most attention in the race so far, it’s far from certain the party will pick a nominee who embodies them.

Led by Senator Bernie Sanders, nearly a half-dozen 2020 Democrats have embraced a clear position of offering full access to health-care benefits. Others, including former Vice President Joe Biden, the nominal front-runner, oppose full benefits, although that wasn’t apparent at the debate. The latter group would allow undocumented immigrants to purchase coverage through the exchanges established by the Affordable Care Act, but only with their own money. That approach would cover far fewer people, but also potentially create much less exposure to Republican counterattacks.

“If we are saying that we can put them into the pools and they can buy on the exchange, I don’t think voters are going to flip out on that because there is no subsidy,” says Matt Bennett, the executive vice president for public affairs at Third Way, a leading organization of Democratic centrists. “But I think beyond that gets pretty dicey.”

This debate affects millions of people. The Kaiser Family Foundation, using census data, has estimated that 47 percent of the country’s roughly 11 million undocumented immigrants are uninsured, compared with one-fourth of legally present immigrants and about one-tenth of American citizens. Similarly, the Urban Institute places the number of uninsured undocumented immigrants at nearly 4.9 million, or about one-sixth of the total population of uninsured people in America.

The case for expanding their health-care access rests on financial, public health, and moral arguments. Supporters contend that it’s cheaper to provide access to medical care upfront, rather than deal with health crises in emergency rooms; that allowing the undocumented to go untreated increases health risks for legal residents who come in contact with them; and that it is unjust to let people face health threats without care, regardless of their status. As Biden put it in a recent interview with CNN, “How do you say, ‘You’re undocumented. I’m going to let you die, man’? What are you going to do?” The counterargument, meanwhile, is that it’s unfair to ask taxpayers to subsidize their care, and that covering the undocumented will act as a “magnet” to incentivize more immigration.

Emergency rooms must provide aid to all who need it. But polls have consistently found that most Americans resist offering public benefits to the undocumented beyond that. In a recent CNN survey, Americans by a solid 3–2 margin said that “health insurance provided by the government” should not be available to immigrants here illegally. The idea faced resistance across a wide array of constituencies, including several that Democrats rely on: Just over half of college-educated white voters, half of young adults ages 18 to 34, and more than two-fifths of nonwhites said they opposed providing coverage for the undocumented. At the same time, three-fifths of voters who identified as Democrats or lean Democratic said they support the idea.

This mixed result leaves the 2020 candidates balancing competing political and policy considerations as they confront the question. In the process, they have reopened a debate that extends back to the consideration of the ACA during former President Barack Obama’s first year in office.

The original version of the ACA, passed by the Democratic-controlled House in November 2009, allowed undocumented immigrants to purchase insurance on the law’s exchanges with their own money. But it denied them eligibility for the subsidies the law established to help the uninsured afford such coverage, and it maintained their exclusion from Medicaid, which the ACA expanded to cover more of the working poor.

The Democratic-controlled Senate—and the Obama White House—would not even go as far as to allow them to buy into the exchanges. Republicans and conservatives had seized on the charge that the ACA would provide the undocumented with benefits as one of their talking points against the proposed law; when Republican Representative Joe Wilson of South Carolina famously yelled “You lie” at Obama during his 2009 speech to Congress about his health-care proposal, it was in response to Obama’s insistence that the law would not cover those in the U.S. illegally.

To a degree that’s been largely forgotten today, passing the ACA was a herculean political challenge. Presidents Bill Clinton, Richard Nixon, and Harry Truman had all failed to pass universal-coverage bills; indeed, none of them had even advanced their proposal as far as a floor vote in either chamber. Within the Obama administration, resolving the issue of health coverage for the undocumented was widely viewed as one brick too many on the load.

Rahm Emanuel, who directed the legislative fight for the ACA as Obama’s chief of staff, recalled in an interview that pressure for covering the undocumented never developed “in any concerted way,” and that “no one seriously demanded it.” Neera Tanden, who served as a senior adviser to former Health and Human Services Secretary Kathleen Sebelius, remembered the debate inside the administration in similar terms. “I don’t remember considering this at all,” said Tanden, now the president of the Center for American Progress, a leading liberal think tank. The “whole issue was a lot more toxic then.”

The final ACA bill that Obama signed into law, on March 2010, completely excluded undocumented immigrants from the system. Even when Obama later instituted the Deferred Action for Childhood Arrivals program to block the deportation of young people brought into the country illegally by their parents, the administration denied them access to benefits under the ACA, notes Eric Rodriguez, the vice president for policy and advocacy at UnidosUS, a leading Latino group.

Toward the end of 2016, the Obama administration had an opportunity to reconsider at least one aspect of that policy. California passed legislation allowing the undocumented to buy coverage on state-run exchanges with their own money (without any public subsidy) and requested a waiver from the federal government to implement the policy. Anthony Wright, the executive director of the advocacy group Health Access California, which helped pass the law, said the state argued that opening up the exchanges made sense because as many as 70 percent of undocumented Californians were in “blended” families that included American citizens. “The argument we made was … isn’t there a benefit to allowing the whole family to buy into coverage at the same time? Rather than to tell these families we can cover the kid and maybe the mother, but the father has to go to buy coverage from a broker independently?” Wright recalled in an interview.

The issue was never resolved. The state submitted its waiver request too late in 2016 for the Obama administration to rule before it left the office. Once Trump took control, California withdrew its request because he was virtually certain to reject it.

Hillary Clinton had moved the party’s position in a more inclusive direction during the 2016 campaign, although her policy didn’t attract nearly as much attention as the hand-raising moment at last week’s debate. Clinton ran, essentially, on House Democrats’ initial proposal in the early days of the ACA debate: that the undocumented should be allowed to buy coverage on the exchanges, though without any subsidies to help.

Three years later, the current slate of candidates seems to have significant differences in how they would treat the undocumented, even if, as a group, they have moved beyond the Obama administration’s more cautious position on the ACA. Biden and Senator Michael Bennet of Colorado, both of whom raised their hand at the debate last month, are taking a similar position to House Democrats’ in 2009 and Clinton’s in 2016: In addition to opening the ACA exchanges to the undocumented, they would also allow them to buy into the new public insurance option they would create through an expanded Medicare system. But they would still deny the undocumented any public assistance. Biden, in his CNN interview, put greater emphasis on expanding federally funded community-health clinics as a means of delivering more health care to undocumented immigrants than he has on offering them insurance.

At the other pole of the debate is Sanders’s Medicare for All proposal, which would entitle the undocumented to the same health-care services as anyone else in America. The actual language of the bill is less definitive: It says that while “every individual who is a resident of the United States is entitled to benefits for health care services under this Act,” the federal government will promulgate regulations for “determining residency for eligibility purposes.” But in response to a health-care questionnaire from The New York Times, Sanders unequivocally included the undocumented in his system: “Medicare for All means just that: all. Bernie’s plan would provide coverage to all U.S. residents, regardless of immigration status,” his campaign wrote.

In response to my questions, the campaigns of Senators Kamala Harris of California, Elizabeth Warren of Massachusetts, and Cory Booker of New Jersey said they would provide full benefits to the undocumented; so would former Housing and Urban Development Secretary Julián Castro.

South Bend, Indiana, Mayor Pete Buttigieg made a passionate case for covering the uninsured during last month’s debate, but his campaign would not specify his exact plan for doing so, particularly whether he would subsidize coverage with public dollars. Former Representative Beto O’Rourke of Texas likewise would not nail down his position on that point.

“This issue is one of many reasons Beto believes that comprehensive immigration reform must be a top priority,” Aleigha Cavalier, his national press secretary, said in a statement. “Because our laws rightly require hospitals to provide care to everyone, the cost of care for uninsured individuals is currently shifted onto other consumers. Therefore, it is in everyone’s interest to provide a pathway for obtaining insurance, whether through the ACA, a new universal healthcare program, or on the private market.”

The rub for both health-care and immigration advocacy groups seems to be the matter of public subsidies. What has become the more centrist position—of allowing undocumented people to purchase coverage on their own—generates mixed feelings: The advocates consider it a valuable gesture, but little more than that, because so few could afford health coverage without assistance.

Wright, for instance, says, “any step toward inclusion is a positive one.” But he notes that when California offered its coverage proposal to the Obama administration, his group estimated that probably fewer than 30,000 of the estimated 1.5 to 2 million uninsured undocumented immigrants in California could afford to buy coverage.

Rodriguez stressed the limited practical impact of the position Biden and Bennet are endorsing now. “If you don’t have subsidies, there is no affordability to get into the system,” he says. “Symbolism these days are still important. The fact that all the candidates raised their hands [to cover the undocumented], that’s not insignificant. But what would be meaningful is proposals that would enable families [to] afford coverage.”

California pushed the debate into another front this week. Governor Gavin Newsom signed a budget that makes California the first state to cover undocumented young adults ages 19 to 26 under its Medicaid program; the state had already extended eligibility to undocumented children under 18 and to pregnant women.

Wright noted that the expansion was, from a cost perspective, a relatively small component of a much larger package, one that focused on providing middle-class families more financial help to afford health care. That linkage, he argues, is the key to winning public acceptance for greater aid to the undocumented.

“There will always be a group of folks who are animated by the immigration issue and that just might be something they are opposed to, period,” he said, basing his analysis on focus groups and polls his group has conducted in California. “But if they see an effort to help people broadly, most people don’t begrudge others being helped as part of that process.”

With either modest steps—or big leaps—toward providing undocumented immigrants health coverage, that may be exactly the wager Democrats are placing in 2020.

The poll of The Day: Faith in Trump’s Phantom Health Care Plan

Yuval Rosenberg of the Fiscal Times noted that American voters aren’t quite sure what to make of the latest lawsuit seeking to strike down the Affordable Care Act.

While legal experts have largely dismissed the lawsuit, now before a federal appeals court, as meritless, a new Morning Consult survey of 1,988 registered voters finds a much more divided electorate.

Nearly half of voters, 44%, say the GOP-led lawsuit isn’t likely to bring down Obamacare, compared to 37% who say it might. Those views fall along predictably partisan lines:

Screen Shot 2019-07-14 at 9.50.04 PM.png More surprising is that voters who expect the ACA to be overturned express a fairly high level of confidence that President Trump has a plan to replace it. The GOP has thus far failed to come to a consensus about how to replace Obamacare, and Trump has yet to reveal a promised health care plan. Yet 60% of voters who think Obamacare may be struck down are confident the administration has a plan of its own, including 87% of Republicans.

Analysts and pundits have warned that, if the lawsuit were to succeed, it would be a disaster for Republicans — and GOP lawmakers have shown little desire to grapple with a health care overhaul again before the 2020 elections.

The Morning Consult poll also found that voters are increasingly placing responsibility for the state of the U.S. health care system on Trump — and half of the voters say the system has gotten worse over the past decade. Screen Shot 2019-07-14 at 9.46.48 PM

And now back to our discussion on the history of Medicare:

The benefits that the various states were required to provide recipients were:

Inpatient hospital care (other than in an institution for tuberculosis or mental disease),
Outpatient hospital services
Laboratory and x-ray services
Nursing facility services for those over the ages of twenty-one (and, after July 1, 1970, to home health services
Physicians” services, regardless of the location of treatment.

Also, the states could underwrite many other services such as physical therapy, dental care, diagnostic, preventive, and rehabilitative services, and the cost of prescribed drugs, dentures, prosthetic devices, and eyeglasses. Those elderly that were insured by Medicare but were also eligible because of the incomes for Medicaid had their hospital deductibles and copayments paid by Medicaid.

The Johnson administration then went on in 1967 to propose amendments to the Social Security program that included extending Medicare benefits to the disabled who were otherwise eligible for cash payments. To pay for this extension, a higher earnings base on which Medicare taxes would be levied was recommended. So, from then on the current $6,600, the amount as to rise to $7,800 in 1968, to $9,00 in 1971, and in 1974 and thereafter would rise to $10,800.

However, despite the strong support from the Johnson administration, the House Ways and Means Committee voted to defer consideration of the extension in light of the substantial costs associated with the amendment. The administration tried to present the case that the medical costs for each disabled beneficiary would be about the same as those associated with Medicare recipients over the age of 65. But a study released while the bill was before the committee indicated that in fact, these costs would be about two and a half to three times as high.

And to no one’s surprise looking at healthcare today, following the first year of operation of the Hospital Insurance program that its costs significantly exceeded the estimates put forward by the program’s proponents. You have to remember that the main purpose of enacting a national health insurance bill had been, after all, to encourage greater use of health care facilities by the elderly. It was therefore not surprising that with the measure’s passage there should have been an increased demand for hospital and medical services. However, not only was there greater utilization of medical facilities on the part of those covered by the Medicare program, but there followed a far higher increase in the prices of covered services than had been expected. Congress reviewed the data and increased the contribution schedule along the lines suggested by the administration despite its not having incorporated the disabled among the program’s beneficiaries.

By 1972 the costs associated with Medicare had increased at such a rate that even the administration and Congress were expressing concern. What followed was a number of studies to examine the causes and I will discuss this more next week. So, imagine the passage of Medicare for All and the true costs!!

I have finally decided that our society is crazy and I probably have said this before. I was reading about Nike’s decision to not sell the sneakers with the Betsy Ross flag on the back of the shoe because Mr. Kaepernick decided that the flag was racist. Did the company realize that Betsy Ross was a Quaker and that Quakers were Abolitionists who helped ban slavery in England? Also, Quakers were vital to the American Underground Railroad to free slaves. Objecting to the Betsy Ross flag, because it represents slavery, shows complete and utter ignorance of history!!

More next week!

Musings of a Doc with an MBA

Business strategy and healthcare

Category Archives: Beto O’Rourke

Medicare for All Discussion Spirals Into Squabble; and What about Obamacare?

CDC, states update number of cases of lung disease associated with e-cigarette use, or vaping. What is going to take us all to ban these e-cigarettes at least from our youth. How many kids’ death does it take?

Fact Check: Are there ‘more gun deaths by far’ in America than any other country? And what is the GOP going to do about IT?

Medicare for All, funding and ‘impossible promises’ deeply divide Democrats during 2020 debate; and How Many More Shootings of Innocent people Can Our Society Tolerate?

The Democrats’ Gamble on Health Care for the Undocumented; but What About Our Own Citizens and Medicare?