Category Archives: Canadian health care

Health care spending hit $3.6 trillion in 2018 due to ACA tax, The GDP and Again My Worry Concerning Rural Hospitals

bus559National spending on health care is rising, fueled in part by the reinstatement of an Affordable Care Act tax on insurers, according to a new federal report.

Total national health expenditures last year increased by 4.6 percent to $3.6 trillion last year, the Centers for Medicare and Medicaid Services said. The U.S. spent about $11.172 per person, and national health care spending accounted for about 17.7 percent of the total U.S. economy last year, compared with 17.9 percent in 2017. It was roughly the same as in 2016.

By household, health care spending, which includes out-of-pocket spending, contributions to private health insurance premiums and contributions to Medicare through payroll taxes and premiums, also grew by 4.4 percent.

Private businesses, meanwhile, shelled out $726.8 billion on health care, a 6.2 percent increase from the year-ago period. Most of that goes toward employers’ contributions for insurance premiums. At 20 percent, it absorbed the second-largest shares of health care spending, preceded only by the federal government and households.

Overall, spending by Medicare, Medicaid, and private health insurance grew faster because of the health insurance tax; an annual fee on all health insurers intended to help fund the estimated $1 trillion cost of the ACA. Congress suspended the tax in 2017 and 2019. It was expected to raise $14.3 billion in 2018, according to the Internal Revenue Service.

“It was responsible for a significant portion of the rise we saw,” Micah Hartman, the report’s lead author, told The Wall Street Journal.

As baby boomers age, the pace of health care spending is only expected to grow. Health care’s share of the economy is projected to climb to 19.4 percent by 2027 from 17.9 percent in 2017, according to a previous CMS study cited by the Journal.

The number of uninsured Americans rose by 1 million for the second year in a row to 30.7 million in 2018. The rate of people without health insurance held steady under 10 percent.

The report could draw the ire of Democrats, who have criticized the Trump administration for its attacks on the ACA. The future of the Obama-era health law is in limbo as a panel of three federal appeals court judges weighs whether it’s unconstitutional after Republicans stripped it of the individual mandate in 2017.

Rare Dip in Healthcare’s Share of GDP in 2018

CMS report shows growth in spending on physician services fell slightly

Joyce Frieden, the News Editor of the MedPage points out that overall U.S.healthcare spending increased by 4.6% in 2018 — higher than the 4.2% growth in 2017, but still representing a slight drop in healthcare’s percentage of the nation’s gross domestic product (GDP), the Centers for Medicare & Medicaid Services (CMS) said Thursday.

The increase left the U.S. with health spending of $3.6 trillion in 2018, or $11,172 per person. Some of the spending increase was attributed to growth in private health insurance and Medicare spending due to collection of the Affordable Care Act’s health insurance tax — postponed from 2017 — which raised $14.3 billion in 2018, said Micah Hartman, a statistician in CMS’s Office of the Actuary, during a press briefing hosted by Health Affairs. (The figure for the tax revenue came from the Internal Revenue Service, not CMS.) Other growth drivers included faster growth in healthcare prices. Because the overall economy’s 5.4% growth in 2018 outpaced healthcare spending, the percentage of GDP spent on healthcare dropped slightly, from 17.9% in 2017 to 17.7% in 2018, Hartman said.

Paul Hughes-Cromwick, MA, co-director of Sustainable Health Spending Strategies at Altarum, a healthcare consulting firm here, said in an email that he found the decrease in percentage of GDP “encouraging,” but added that “we can safely predict that this will return to near 18% in 2019 with mildly accelerating health spending and weakening GDP growth.” And “despite all the talk and support for social determinants of health (SDOH) across the political spectrum, government public health activities only grew at 2.4%, the second slowest in the past 7 years (though it is expected that much SDOH activity lies outside formal public health spending).”

Jamie Hall, a research fellow in quantitative analysis at the Heritage Foundation here, said in a phone interview that the decrease in the percentage of GDP “is the first time that’s happened since before Obamacare. So it’s a good sign that some of the Trump administration policies that are oriented toward containing costs are having an effect” — things like short-term, limited-duration insurance policies and efforts to lower the cost of prescription drugs. “We’re sort of more at equilibrium and it’s somewhat more of a stable system at this point,” he said.

Growth in Spending on Physicians Declines

Spending on physician care and other clinical services increased by 4.1% in 2018, down from 4.7% the year before. This was due in part to slower growth in private health insurance, Medicaid, and “residual use and intensity” — the number and intensity of clinician visits — and was not offset by faster growth in healthcare prices, said Aaron Catlin, deputy director in the Office of the Actuary.

Healthcare prices are accelerating from an all-time low measured in 2015, Hughes-Cromwick noted. “If health care price growth returns to a historical pattern, i.e., significantly higher than economy-wide inflation, healthcare spending will definitely accelerate,” consistent with CMS’s long-run projections, he said.

The percentage of uninsured Americans grew by one million people, from 29.7 million to 30.7 million, according to CMS; that was on top of a previous one-million-person increase from 28.7 million in 2016. “We can’t track individuals, so we can’t say where those people came from and the status of their coverage before and after becoming uninsured … but we do show decreases in private health insurance and reductions in other directly purchased insurance,” said Catlin.

This increase in the uninsured “is a huge issue,” said Dan Mendelson, founder and former CEO of Avalere, a healthcare consulting firm here, in a phone interview. “The numbers are on an upward march and it will be a major electoral issue going into 2020.”

But Hall said the uninsured numbers were “quite misleading.” “Of the folks officially considered uninsured, the overwhelming majority of these folks have access to some type of coverage but have chosen not to enroll,” he said. “It’s important that folks not equate a lack of insurance with lack of access to coverage or lack of access to care.”

Private Insurance Enrollment Down

Private health insurance enrollment declined by 1.6 million people, with the drop coming primarily from those enrolled in private plans outside the ACA’s health insurance marketplaces, said Anne Martin, an economist in the Office of the Actuary. The number of enrollees who purchased employer-sponsored health insurance also fell slightly, from 175.6 million to 175.2 million. Medicare enrollment, on the other hand, grew from 57.2 million in 2017 to 58.7 million in 2018, while Medicaid enrollment also rose slightly during the same time period, from 72.1 million to 72.8 million.

Despite the enrollment drop, spending on private health insurance grew by 5.8%, to $1.2 trillion, up from 4.9% the prior year, Martin continued. “The most significant factor in insurance spending was the increase in the net cost of health insurance, which was influenced by the health insurance tax.”

Retail prescription drug spending rose by 2.5% in 2018, to $335 billion, up from a 1.4% increase in 2017. “This faster rate of growth was driven by non-price factors, such as the use and mix of drugs consumed, which more than offset a decline of 1% in prices for retail prescription drugs,” the agency said in a press release. This spending category does not take into account spending on physician-administered drugs or drugs administered in the hospital.

Home Healthcare Spending Up

“The fact that drug spending at the pharmacy is attenuating is a big deal, and it appears to be a combination of the mix of drugs being used,” Mendelson said. “It shows that consumers are using drugs more efficiently, which is good news. I think that change of behavior has been happening for quite some time; it’s durable and it’s a positive effect.”

However, he added, “The other thing is that healthcare costs are still rising much more rapidly than wages, and what it shows is that while costs have attenuated, the fact that they’re still rising faster than wages is squeezing consumers significantly … The fact we’re seeing macro[-level] progress doesn’t help the patient who is facing a $5,000 deductible and trying to figure out how to pay for their healthcare.”

In terms of personal healthcare spending, some of the largest increases were in-home healthcare (up 5.2%), durable medical equipment (up 4.7%), and dental services (up 4.6%). Spending on hospital care in 2018 rose 4.5% to $1.2 trillion, down slightly from a 4.7% increase the year before. The slower growth was attributed to a decrease in out-of-pocket hospital spending growth, decreased residual use and intensity, a slowing in inpatient days in hospitals, and a drop in the growth of hospital spending by the Defense Department.

Overall, 33% of healthcare expenditures in 2018 went for hospital care, 20% went for physician care and other clinician services, 13% to other services, 9% to retail prescription drugs, 8% to government administration and net cost of health insurance, and 5% to nursing care and continuing care retirement communities, according to the agency.

Sally Pipes: Sanders, Warren wants ‘Medicare-for-all’ like Canada – But Canadian health care is awful

Sally Pipes of the Fox News reported that the Democratic presidential candidates Sens. Bernie Sanders and Elizabeth Warren want you to believe Canada’s health care system is a dream come true. And they want to make the dream even better with their “Medicare-for-all” plans. Don’t believe them.

In truth, Canada’s system of socialized medicine is actually a nightmare. It has left hospitals overcrowded, understaffed and unable to treat some patients. Americans would face the same dismal reality if Canadian-style “Medicare-for-all” takes root here.

Canada’s health care system is the model for the “Medicare-for-all” plan that both Sanders, I-Vt., and Warren, D-Mass., embrace.

North of the border, all residents have taxpayer-funded, comprehensive health coverage. In theory, they can walk into any hospital or doctor’s office and get the care they need, without a co-pay or deductible.

Sanders and Warren would one-up Canada by providing all Americans with free prescription drugs, free long-term care, free dental care, free vision care, and free care for people with hearing problems.

Who could possibly object to all that free care?

Well, politicians in Canada object. They say even their country can’t do what Sanders and Warren want because all this free care would cost too much and cause other problems.

But for Sanders and Warren, money is no object. They can just raise taxes as higher and higher and higher. And the huge tax increases needed to fund “Medicare-for-all” would hit us all – there aren’t enough millionaires and billionaires to foot the bill.

It’s true that everyone in Canada has health coverage. But that coverage doesn’t always secure care. According to the Fraser Institute, a Canadian think tank, patients waited a median of nearly 20 weeks to receive specialist treatment after referral by a general practitioner in 2018. That’s more than double the wait patients faced 25 years ago.

In Nova Scotia, patients faced a median total wait time of 34 weeks. More than 6 percent of the province’s population was waiting for treatment in 2018.

Waiting for care is perhaps better than not being able to seek it at all. The hospital emergency department in Annapolis Royal in Nova Scotia recently announced that it would simply close on Tuesdays and Thursdays. There aren’t enough doctors available to staff the facility.

Canadians can’t escape waits like these unless they leave the country and payout of pocket for health care abroad. Private health insurance is illegal in Canada.

Private clinics in Canada are not allowed to charge patients for “medically necessary” services that the country’s single-payer plan covers. And the government has deemed just about every conceivable service “medically necessary.”

For the past decade, Dr. Brian Day, an orthopedic surgeon who runs the private Cambie Surgery Centre in British Columbia, has tried to offer Canadians a way out of the waits by expanding patient access to private clinics. He’s been battling his home province in court for a decade to essentially grant patients the ability to pay providers directly for speedier care.

During closing arguments in Day’s trial before the British Columbia Supreme Court at the end of November, Dr. Roland Orfaly of the British Columbia Anesthesiologists’ Society testified that over 300 patients in the province died waiting for surgery from 2015 to 2016 because of a shortage of anesthesiologists. And that was in just one of the province’s five regional health authorities!

Shortages of crucial medical personnel and equipment are common throughout Canada. The country has fewer than three doctors for every 1,000 residents. That puts it 26th among 28 countries with universal health coverage schemes. If current trends continue, the country will be short 60,000 full-time nurses in just three years.

In 2018, Canada had less than 16 CT scanners for every million people. The United States, by comparison, had nearly 45 per million.

These shortages, combined with long waits, can lead to incredible suffering.

In 2017, one British Columbia woman who was struggling to breathe sought treatment in an overcrowded emergency room. She was given a shot of morphine and sent home. She died two days later.

That same year, a Halifax, Nova Scotia, man dying of pancreatic cancer was left in a cold hallway for six hours when doctors couldn’t find him a bed. Yes, people must sometimes be treated on hallway floors because of severe overcrowding.

In fact, some Canadian hospital emergency rooms look like they belong in poverty-stricken Third World countries.
WBUR Radio, Boston’s NPR station, documented these terrible conditions in a story about a hospital in Nova Scotia earlier this month.

Americans who find the promise of free health care difficult to resist would do well to take a hard look north.

Sure, “Medicare-for-all” as pitched by Sanders and Warren sounds good. But the reality is far from what these two far-left candidates are promising. Like a drug that helps you in one way but causes even more serious problems, “Medicare-for-all” has dangerous side effects that can be hazardous to your health.

Rural hospital acquisitions may reduce patient services

I have already discussed the outcome of Medicare for All on physicians and especially rural hospitals. Beware, especially when we hear of what is happening already! Last week it was reported that one of the hospital systems in Chicago fired 15 physicians and hired NP’s/nurse practitioners to take over their patient care responsibilities.

Also, Carolyn Crist of Reuters noted that although hospitals can improve financially when they join larger health systems, the merger might also reduce access to services for patients in rural areas, according to a new study.

After an affiliation, rural hospitals are more likely to lose onsite imaging and obstetric and primary care services, researchers report in a special issue of the journal Health Affairs devoted to rural health issues in the United States.

“The major concern when you think about health and healthcare in rural America is access,” said lead study author Claire O’Hanlon of the RAND Corporation in Santa Monica, California.

More than 100 rural hospitals in the U.S. have closed since 2010, the study authors write.

“Hospitals in rural areas are struggling to stay open for a lot of different reasons, but many are looking to health-system affiliation as a way to keep the doors open,” she told Reuters Health by email. “But when you give up local control of your hospital to a health system, a lot of things can change that may or may not be good for the hospital or its patients.”

Using annual surveys by the American Hospital Association, O’Hanlon and colleagues compared 306 rural hospitals that affiliated during 2008-2017 with 994 nonaffiliated rural hospitals on 12 measures, including quality, service utilization, and financial performance. The study team also looked at the emergency department and nonemergency visits, long-term debt, operating margins, patient experience scores, and hospital readmissions.

They found that rural hospitals that affiliated had a significant reduction in outpatient non-emergency visits, onsite diagnostic imaging technologies such as MRI machines, and availability of obstetric and primary care services. For instance, obstetric services dropped by 7-14% annually in the five years following affiliation.

“Does this mean that patients are getting prenatal care in their community at a different location, traveling to receive prenatal care at another location of the same health system, or forgoing this care entirely?” O’Hanlon said. “Trying to figure out the extent to which the observed changes in the services available onsite at rural hospitals reflect real changes in patient access is an important next step.”

At the same time, the affiliated hospitals also experienced an increase in operating margins, from an average baseline of -1.6%, typical increases were 1.6 to 3.6 percentage points, the authors note. The better financial performance appeared to be driven largely by decreased operating costs.

Overall, patient experience scores, long-term debt ratios, hospital readmissions, and emergency department visits were similar for affiliating and non-affiliating hospitals.

“Research on these mergers has been mixed, with some suggestions they are beneficial for the community (access to capital, more specialty services, keep the hospital open) and other evidence that there are costs (employment reductions, loss of local control, increase in prices),” said Mark Holmes of the University of North Carolina at Chapel Hill, who wasn’t involved in the study.

“Mergers can have a large impact on a community, so understanding the effect on the resultant access, cost and quality of locally available services is important,” he told Reuters Health by email.

A limitation of the study is that the surveys capture affiliation broadly and don’t specifically describe the arrangements, the study authors’ note. Future studies should investigate the different types of affiliations, such as a full acquisition versus a clinically integrated hospital network, which may show different outcomes, said Rachel Mosher Henke of IBM Watson Health in Cambridge, Massachusetts, who also wasn’t involved in the study.

For instance, certain types of rural hospital affiliations may be better for the community than a full hospital closure, she said.

“However, it’s important to evaluate the potential for negative consequences for the community in terms of reduced service offerings,” she told Reuters Health by email. “New payment models such as all-payer global payments that allow rural hospitals to continue to operate independently with consistent cash flow may be an alternative to affiliation to consider.” But it may not fix the impossible especially if the system pays all at Medicare or Medicaid rates?

Next is to discuss the basis of single-payer healthcare systems and look who is back trying to hold his lead in the Democratic-run for President a guy who can’t even remember where he is, dates, or where he is going, Joe Biden!!!

 

Survey Shows that Worries about Healthcare​ Will Follow Voters into the Voting Booth, Waiting for Healthcare in Canada and Some Progress Finally!!

41715310_1709429559186696_758100051737182208_nIf anyone doubts the significance of our discussion regarding how important health care discussion is in the voters’ minds. Look at this survey! Oh, those greedy angry politicians and the mid-term elections!! The question is what are our politicians interested in?

I had an interesting conversation with a strategist for the Democratic party and she agreed with me that even if the Republicans in the House and the Senate came up with a solution to health care and or immigration that fulfilled their wants and needs, they wouldn’t approve or vote in favor of any bills until after the mid-term election to which they expected to declare their majority position.

Jenny Dean reviewed a survey, which showed that of the 37 percent of voters nationwide who planned to vote for President Donald Trump in the 2020 election, more than a third of Republicans and 37 percent of Independents said in a survey conducted by the Texas Medical Center that they would change their mind if his policies led to an increase in the uninsured. When the majority of voters across the country head to the voting booth in November and again in 2020, the politics of health care will not be far from their thoughts.

That’s the finding of the fourth annual Texas Medical Center’s national consumer survey, released Wednesday, which gauges attitudes on health issues, ranging from support of President Donald Trump’s policies to whether foods laden with fat and sugar should cost more.

“The Nation’s Pulse,” the survey questioned 5,038 people across 50 states, including 1,018 people in Texas. Respondents were both Democrats and Republicans but also included those who identified as Independent. Nearly two-thirds, or 61 percent, said they would be likely to only vote for candidates who promise to make fixing health care a priority. Additionally, the majority of voters said it was important that candidates share their views on such hot-button issues as the expansion of Medicaid. Those views held both in states that expanded Medicaid under the Affordable Care Act and in the 17 states, including Texas that did not.

Survey responses at a glance

Likelihood to only vote for a candidate who wants health care fixed:

Democrats: 68 percent

Republicans: 60 percent

Independent: 53 percent

Plan to vote for Donald Trump in 2020:

U.S (all parties).: 37 percent

Texas (all parties): 38 percent

2020 Trump voters who would change their mind if the uninsured rate rises:

Republicans: 35 percent

Independents: 37 percent

Democrats: 60 percent

Texans who support Medicaid expansion:

60 percent

Texans who support Medicare for all:

55 percent

Support lowering legal blood alcohol limit while driving to 0.0 percent:

U.S.: 46 percent

Texas: 48 percent

Think foods that lead to obesity should cost more:

U.S. 51 percent

Texas: 56 percent

Source: Texas Medical Center Health Policy Institute

Across all political parties, 60 percent of Texans favored a Medicaid expansion, according to the survey. This comes despite years of steadfast opposition from state leaders. It also closely mirrors a similar survey in June by Houston-based Episcopal Health Foundation and the Kaiser Family Foundation that found 64 percent of Texans wanted a Medicaid expansion.

But perhaps most striking was that “Medicare for All” health coverage — once politically unthinkable in Texas —found surprising favorability with 55 percent in the state saying they would support it. That compares with 59 percent nationwide, the survey found.

“With health care so expensive and increasingly unaffordable, the respondents told us that it is important to try to fix it,” said Dr. Arthur “Tim” Garson, director of the Texas Medical Center Health Policy Institute, which led the study.

While the bitter health care debate of a year ago has slipped mostly out of the headlines, it apparently has not slipped from people’s minds, political operatives from both parties said Tuesday.

Neither Glenn Smith, an Austin-based progressive consultant nor Jamie Bennett, vice president at Potomac Strategy Group, a right-leaning political consulting firm, were especially surprised when told of the survey results.

“I think (health care) is the most critical domestic issue that we face today,” said Smith, adding that worries about affordability and access are “ever-present” in people’s lives.

“Health care is a very important issue for our elected leaders to solve,” agreed Bennett in an email, “It makes up the majority of the federal budget and affects every American at some point in their lifetime. I think health care will continue to be a central issue in the mid-terms and 2020 presidential election — especially given the inaction from the federal level.”

Looking ahead to 2020, the survey zeroed in on Trump supporters. Of the 37 percent of voters nationwide who planned to vote for the president, more than a third of Republicans and 37 percent of Independents said they would change their mind if his policies led to an increase in the uninsured.

Such potential defection did not surprise Smith. “That is one of the things that could knock significant numbers from his base,” he said. Garson cautioned, though, the presidential race is still two years away. “You don’t know until Election Day what people will do,” he said,

There were differences, however, in how party affiliation affected priorities. While reducing costs was considered the highest priority across the board, Democrats listed universal coverage as next, while Republicans and Independents said affordability was the second highest priority.

In other issues, the survey found nearly half of Americans, including those in Texas, supported lowering the legal blood alcohol limit while driving to 0.0. It is currently .08 in Texas. Also, an overwhelming majority in all states wanted the age of buying tobacco products raised to 21, and more than half said that foods that lead to obesity should cost more.

The policymakers and politicians continue to point to the Canadian health care system as one that we should use as the model for our system here in the U.S.A. ’Canadians are one in a million — while waiting for medical treatment

Sally Pipes points out that Canada’s single-payer healthcare system forced over 1 million patients to wait for necessary medical treatments last year. That’s an all-time record.

Those long wait times were more than just a nuisance; they cost patients $1.9 billion in lost wages, according to a new report by the Fraser Institute, a Vancouver-based think-tank.

Lengthy treatment delays are the norm in Canada and other single-payer nations, which ration care to keep costs down. Yet more and more Democratic leaders are pushing for a single-payer system — and more and more voters are clamoring for one.

Indeed, three in four Americans now support a national health plan — and a new NBC/Wall Street Journal poll finds that health care is the most important issue for voters in the coming election.

The leading proponent of transitioning the United States to a single-payer system is Sen. Bernie Sanders, Vermont’s firebrand independent. If Sanders and his allies succeed, Americans will face the same delays and low-quality care as their neighbors to the north.

By his own admission, Sen. Sanders’ “Medicare for All” bill is modeled on Canada’s healthcare system. On a fact-finding trip to Canada last fall, Sanders praised the country for “guaranteeing health care to all people,” noting that “there is so much to be learned” from the Canadian system.

The only thing Canadian patients are “guaranteed” is a spot on a waitlist. As the Fraser report notes, in 2017, more than 173,000 patients waited for an ophthalmology procedure. Another 91,000 lined up for some form of general surgery, while more than 40,000 waited for a urology procedure.

All told, nearly 3 percent of Canada’s population was waiting for some kind of medical care at the end of last year.

Those delays were excruciatingly long. After receiving a referral from a general practitioner, the typical patient waited more than 21 weeks to receive treatment from a specialist. That was the longest average waiting period on record — and more than double the median wait in 1993.

Rural patients faced even longer delays. For instance, the average Canadian in need of orthopedic surgery waited almost 24 weeks for treatment — but the typical patient in rural Nova Scotia waited nearly 39 weeks for the same procedure.

One Ontario woman, Judy Congdon, learned that she needed a hip replacement in 2016, according to the Toronto Sun. Doctors initially scheduled the procedure for September 2017 — almost a year later. The surgery never happened on schedule. The hospital ran over budget, forcing physicians to postpone the operation for another year.

In the United States, suffering for a year or more before receiving a joint replacement is unheard of. In Canada, it’s normal.

Canadians lose a lot of money waiting for their “free” socialized medicine. On average, patients forfeit over $1,800 in lost wages. And that’s only counting the working hours they miss due to pain and immobility.

The Fraser Institute researchers also calculated the value of all the waking hours that patients lost because they couldn’t fully function. The toll was staggering — almost $5,600 per patient, totaling $5.8 billion nationally. And those calculations ignore the value of uncompensated care provided by family members, who often take time off work or quit their jobs to help ill loved ones.

Canada isn’t an anomaly. Every nation that offers government-funded, universal coverage features long wait times. When the government makes health care “free,” consumers’ demand for medical services surges. Patients have no incentive to limit their doctor visits or choose more cost-efficient providers.

To prevent expenses from ballooning, the government sets strict budget caps that only enable hospitals to hire a limited number of staff and purchase a meager amount of equipment. Demand inevitably outstrips supply. Shortages result.

Just look at the United Kingdom’s government enterprise, the National Health Service, which turns 70 this July. Today, British hospitals are so overcrowded that doctors regularly treat patients in hallways. The agency recently canceled tens of thousands of surgeries, including urgent cancer procedures, because of severe resource shortages. And this winter, nearly 17,000 patients waited in the backs of their ambulances — many for an hour or more — before hospital staff could clear space for them in the emergency room.

Most Americans would look at these conditions in horror. Yet Sen. Sanders and his fellow travelers continue to treat the healthcare systems in Canada and the UK as paragons to which America should aspire.

Sen. Sanders’s “Medicare for All” proposal would effectively ban private insurance and force all Americans into a single, government-funded healthcare plan. According to Sen. Sanders, this new insurance scheme would cover everything from regular check-ups to prescription drugs and specialty care, no referral needed — all at no charge to patients.

Americans shouldn’t fall for these rosy promises. As Canadians know all too well, when the government foots the bill for health care, patients are the ones who pay the biggest price.

Sanders was asked to respond to comments Schultz made about the plan in another interview.

Schultz recently announced that he would be leaving Starbucks and said he was considering “public service.” He said on CNBC he was concerned about the way “so many voices within the Democratic Party are going so far to the left.”

Sen. Bernie Sanders said Medicare-for-all is a “cost-effective” program.

“And I ask myself, how are we going to pay for all these things? In terms of things like single-payer or people espousing the fact that the government is going to give everyone a job, I don’t think that’s realistic,” he said.

CNN’s Chris Cuomo asked Sanders about the possibility of Schultz running as “the Left’s Trump” who may go up against the current president in 2020.

Sanders said he didn’t know Schultz but his comment was “dead wrong.”

“You have a guy who thinks that the United States apparently should remain the only major country on earth not to guarantee health care to all people,” Sanders said. “The truth of the matter is that I think study after study has indicated that Medicare for All is a much more cost-effective approach toward health care than our current, dysfunctional health care system, which is far and away the most expensive system per capita than any system on Earth.”

But there was progress made as evidenced in that the Senate finally Passes Historic Health Spending Bill and the Package includes funding for cancer, opioids, and maternal mortality

Shannon Firth a Washington Correspondent, for the MedPage, wrote that a spending bill that boosts funding for medical research while also taking aim at the opioid epidemic and maternal mortality passed the Senate on Thursday in a vote of 85-7.

The $857-billion “minibus” package bundled funding for Department of Health and Human Services (HHS) as well as for the Defense, Labor, and Education departments.

Senators Mike Lee (R-Utah), Jeff Flake (R-Ariz.), Rand Paul (R-Ky.), Bernie Sanders (I-Vt.), Pat Toomey (R-Pa.), Mike Crapo (R-Idaho) and James Risch (R-Idaho) voted against the bill.

Attention now turns to the House of Representatives, which has not yet acted on a bill to fund HHS. Congress faces a Sept. 30 deadline to enact a funding package to avoid a shutdown of the affected departments.

What’s in It?

The legislation provides $2 billion in additional funding for the National Institutes of Health (NIH), including $425 million for Alzheimer’s research and $190 million for cancer research. It also maintains current levels of CDC spending for cancer screening and early detection programs, as well as for the agency’s Office of Smoking and Health.

Also woven into the package: $3.7 billion for behavioral and mental health programs targeting opioid addiction — an increase of $145 million over the FY2018 budget — including $1.5 billion in State Opioid Response Grants from the Substance Abuse and Mental Health Services Administration; $200 million to increase prevention and treatment services in Community Health Centers; and $120 million to address the epidemic’s impact in rural areas through support for rural health centers. The bill also dedicates $50 million to programs aimed at tackling maternal mortality.

Sen. Patty Murray (D-Wash.) lauded the investment in ending maternal mortality in a press statement.

“It is completely inexcusable that mothers are more likely to die in childbirth in our country than any other country in the developed world, and long past time we treated this issue like the crisis it is,” she said.

New Push for Research

Sen. Roy Blunt (R-Mo.), speaking on the Senate floor Thursday, blasted the short shrift given to NIH from 2003 to 2015.

Should this bill become law, the agency will see a nearly 30% increase in its reserves — from $30 billion to $39 billion, he added.

Already, heightened funding since 2015 has driven efforts to develop new vaccines, rebuild a human heart using a patient’s own cells, and identify new nonaddictive painkillers — “the holy grail of dealing with the opioid crisis” — said Sen. Lamar Alexander (R-Tenn.), chairman of the Health Education Labor and Pensions Committee, during a committee hearing on Thursday.

In addition, NIH Director Francis Collins, MD, Ph.D., said at the hearing that the new monies will let the agency award 1,100 new grants to first-time investigators through the Next Generation Researchers Initiative — the largest number to date.

On the Senate floor, Sen. Ed Markey (D-Mass.) stressed the importance of NIH funding to curb the costs of health care, especially of Alzheimer’s disease.

“If we do not find the cure for Alzheimer’s by the time we reach the year 2050, the budget at Medicare and Medicaid for taking care of Alzheimer’s patients will be equal to the defense budget of our country,” he said.

“Obviously, that is non-sustainable,” Markey noted.

U.S. taxpayers currently spend $277 billion on patients with Alzheimer’s disease. By 2050, that figure is projected to grow to $1.1 trillion, Blunt noted.

Also Wrapped In… 

The minibus package also included the following:

  • $1 million for HHS to develop regulations stipulating that drug companies include the price of the drug in any direct-to-consumer advertisements — an idea supported by HHS Secretary Alex Azar
  • Full funding for the Childhood Cancer STAR Act which involves collecting medical specimens and other data from children with the hardest to treat cancers, and supports research on the challenges pediatric cancer survivors encounter within “minority or medically underserved populations”
  • The requirement that the HHS Secretary provide an update on rulemaking related to information-blocking, as mandated in the 21st Century Cures Act
  • Funds “Trevor’s Law,” which seeks to enhance collaboration among federal, state, and local agencies and the public in investigating possible cancer clusters
  • Mandates that CDC report on the Coal Workers Health Surveillance Program, which targets black lung disease among coal miners

An amendment from Paul aimed at defunding Planned Parenthood failed in a vote of 45-48.

Docs, Wonks Weigh In

Stakeholders in medicine applauded the Senate’s work.

“[T]his bill will enable the nation’s medical schools and teaching hospitals, which perform over half of NIH-funded extramural research, to continue to expand our knowledge, discover new cures and treatments, and deliver on the promise of hope for patients nationwide,” said Darrell Kirch, MD, president and CEO of the Association of American Medical Colleges, in a press statement.

These new NIH monies will also help support “well-paying jobs across the country, strengthen the economy … and make America more competitive in science and technology,” Kirch said; he urged the House to pass a similar measure as quickly as possible.

The American Heart Association also applauded the Senate’s bipartisan achievement.

“Sustained funding for the NIH is critical to ensuring the nation’s standing as a global leader in research. Even more importantly, it opens an abundance of possibilities in pioneering research that could help us conquer cardiovascular disease, the no. 1 killer in America and around the world,” said Ivor Benjamin, MD, president of the AHA.

Members of the right-leaning Heritage Foundation, however, were disappointed.

“The bill fails to make any program reforms or policy recommendations to address Obamacare. Congress still needs to provide relief to the millions suffering under Obamacare’s reduced choices and higher costs,” said a Heritage report issued Wednesday.

The departments to be funded by the minibus package account for more than 60% of discretionary federal spending for 2019, so there was some positive movement on the health care system despite our political dysfunction. Where do we go next?