Category Archives: Congress

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Biden has room on health care, though limited by Congress

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

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

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

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

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

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

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

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

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

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

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

Not in the real world, Republicans say.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

It may not look that way.

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

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

There is promise—but there are also questions.

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

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

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

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

What it means so far

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

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

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

What else to know

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

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

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


 [r1]

The conspiracy theorists are wrong: Doctors are not inflating America’s COVID-19 death toll for cash. What about Herd Immunity and Oh, those Ignorant College Students!

As the terrible fires continue to burn and Nancy Pelosi says that Mother Nature is angry with us and the political atmosphere is all about hate, I sometimes don’t know who to believe, especially when it comes to the media. Andrew Romano reported that earlier this week, Iowa Republican Sen. Joni Ernst became the first member of “the world’s greatest deliberative body” to embrace a false online conspiracy theory that seeks to minimize the danger of COVID-19 by claiming only a few thousand Americans have died from the virus — not the 185,000 reported by state and local health agencies and hospitals. 

Ernst, who described herself as “so skeptical” of the official death toll, even went so far as to echo the nonsense argument spread by QAnon and other right-wing conspiracy-mongers that medical providers who have risked their own lives and health to treat COVID-19 patients have been attributing non-COVID deaths to the virus to rake in extra cash from the federal government. 

“These health-care providers and others are reimbursed at a higher rate if COVID is tied to it, so what do you think they’re doing?” Ernst, who is facing a tight reelection race, said Monday at a campaign stop near Waterloo, Iowa, according to a report by the Waterloo-Cedar Falls Courier.

“They’re thinking there may be 10,000 or less deaths that were actually singularly COVID-19,” Ernst added in an interview with the paper. “I’m just really curious. It would be interesting to know that.”

Since Ernst is “really curious,” here are the facts.

Yes, Medicare pays hospitals more for treating COVID-19 patients — 20 percent more than its designated rate, to be exact. Incidentally, this additional payment was approved 96-0 in the U.S. Senate — including by Joni Ernst. The reason Ernst (and all of her Senate colleagues) voted for it is simple: It helped keep U.S. hospitals open and operating during a worldwide emergency.

“This is no scandal,” Joseph Antos, a scholar in health care at the conservative American Enterprise Institute, explained in a recent PolitiFact fact-check. “The 20 percent was added by Congress because hospitals have lost revenue from routine care and elective surgeries that they can’t provide during this crisis, and because the cost of providing even routine services to COVID patients has jumped.”

In other words, no one is getting rich by misclassifying COVID-19 deaths.

It’s also fair to say that fewer than 185,000 Americans have died “singularly,” as Ernst put it, from COVID-19. According to a recent update by the Centers for Disease Control and Prevention, 94 percent of patients whose primary cause of death was listed as COVID-19 were also judged to have comorbidities — secondary conditions like diabetes that often exacerbate the virus’s effects. For the remaining 6 percent, COVID-19 was the only cause listed in conjunction with their deaths.

On Sunday, President Trump retweeted a QAnon backer who falsely claimed this meant that only 6 percent of reported COVID-19 deaths — that is, 10,000 or so — were actually caused by the virus. Perhaps this “report” is what Ernst was referring to when she agreed Monday with an audience member who theorized that COVID-19 deaths had been overcounted. “I heard the same thing on the news,” she said.

Yet Twitter quickly removed the tweet for spreading false information, and for good reason.   

Despite all the innuendo, there’s nothing unusual about the way the government is counting coronavirus deaths, as we have previously explained. In any crisis — whether it’s a pandemic or a hurricane — people with preexisting conditions will die. The standard for attributing such deaths to the pandemic is to determine whether those people would have died when they did if the current crisis had never happened.

When it comes to the coronavirus, the data is clear: COVID-19 is much more likely to kill you if your system has already been compromised by some other ailment, such as asthma, HIV, diabetes mellitus, chronic lung disease or cardiovascular disease. But that doesn’t mean patients with those health problems would have died this week (or last week, or next month) no matter what. The vast majority of them probably wouldn’t have. COVID-19 was the cause of death — the disease that killed them now, and not later.

A closer look at the CDC data, meanwhile, reveals that many of the comorbidities listed by medical providers are complications caused by COVID-19 rather than chronic conditions that predated infection: heart failure, renal failure, respiratory failure, sepsis and so on.

Feverishly creating a baseless fiction from two threads of unrelated information — the additional Medicare payments and the CDC update about comorbidities — is a classic conspiracy-theorist move. But that doesn’t make it true.

“Let there not be any confusion,” Dr. Anthony Fauci, the nation’s top infectious disease expert, said Tuesday. “It’s not 9,000 deaths from COVID-19. It’s 180,000-plus deaths.”

“The point that the CDC was trying to make was that a certain percentage of [deaths] had nothing else but COVID,” Fauci continued. “That does not mean that someone who has hypertension or diabetes who dies of COVID didn’t die of COVID-19. They did.”

In reality, it’s more likely that the U.S. is undercounting rather than overcounting COVID-19 deaths. According to a recent New York Times analysis of CDC estimates, at least 200,000 more people than usual died in the U.S. between March and early August — meaning that the official COVID-19 death count, which hit 140,000 over the same period, is probably too low. 

In the Hawkeye State, COVID-19 had killed at least 1,125 as of Wednesday afternoon. Over the past week, the state has reported an average of 1,177 cases per day, an increase of 124 percent from the average two weeks earlier. Its positive testing rate has risen from 10 percent to 18.5 percent since then. 

So while Republican lawmakers such as Ernst seek to downplay the lethality of the virus, Theresa Greenfield, Iowa’s Democratic Senate candidate, seized on her opponent’s baseless claim to underscore the gravity of the situation in one of the only states in America where the pandemic is getting worse.    

“It’s appalling for you to say you’re ‘so skeptical’ of the toll this pandemic has on our families and communities across Iowa,” Greenfield tweeted Tuesday, addressing the senator. “We need leaders who will take this seriously.”

Why a herd immunity approach to COVID-19 could be a deadly disaster

Reporter Rebecca Corey noted that since the coronavirus pandemic began, herd immunity has been floated by some experts as a possible solution to the deadly virus that has so far killed over 865,000 people worldwide. 

Herd immunity is possible when enough people have contracted and become immune to a virus, providing community-wide protection by limiting the number of people who can spread it. And while the strategy is considered controversial and even downright dangerous by many public health experts, it is also reportedly gaining momentum in the White House.    

According to a report by the Washington Post, herd immunity is a strategy being pushed by Dr. Scott Atlas — a neuroradiologist with no background in infectious diseases or epidemiology who recently joined the White House as a pandemic adviser. 

Atlas denied that he had encouraged the White House to adopt a herd immunity strategy, and on Wednesday White House coronavirus task force coordinator Dr. Deborah Birx and top infectious disease expert Dr. Anthony Fauci dismissed the idea that herd immunity was under consideration. An administration official, however, told CNN that the policies being promoted by Atlas are indeed akin to a herd immunity approach.   

Ordinarily, herd immunity would be acquired through a majority of the population being vaccinated — not through immunity acquired by natural infection. 

“Normally, when we talk about herd immunity, we talk about how much of the population needs to be vaccinated,” World Health Organization (WHO) COVID-19 technical lead Dr. Maria Van Kerkhove said on Aug. 27. “If we think about herd immunity in a natural sense of just letting a virus run, it’s very dangerous because you would need a lot of people to be infected.” 

It’s still uncertain what percentage of a population would need to be immune to the virus in order to attain herd immunity. According to Johns Hopkins University, in general, the answer is 70 to 90 percent of a population, depending on how contagious the infection is. But a model published last month in the magazine Science found that the threshold needed for coronavirus herd immunity could be as low as 43 percent. 

Proponents of herd immunity have looked to emulate Sweden’s more hands-off approach; unlike most countries in Europe, the Nordic country opted out of a nationwide lockdown and kept most businesses open. 

But Sweden’s strategy didn’t entail a total return to normalcy. The Swedish government implemented a ban on gatherings of 50 people or more, and many Swedes voluntarily followed social distancing guidelines. 

Former FDA Commissioner Scott Gottlieb noted in an op-ed published on Aug. 30 that in addition to being much larger than Sweden (a country with a population the same size as North Carolina’s), the U.S. has a high rate of citizens with preexisting conditions, which can lead to a higher rate of COVID-19 complications; about 10 percent of Americans have diabetes, and 40 percent are considered obese. 

Moreover, Sweden’s pursuit of natural herd immunity doesn’t appear to be working. A study released in June by the country’s Health Agency showed that only 6 percent of Swedes had developed antibodies to the coronavirus — though a recent study from Sweden’s Karolinska Institute and Karolinska University Hospital suggests that immunity in Sweden may be higher than antibody tests indicate. 

The role of antibodies and how much of an impact they have on long-term immunity is still questionable. A U.K. study, which had not yet been peer-reviewed, found that antibodies may start to decline 20 to 30 days after the onset of COVID-19 symptoms. And a Chinese study found that antibody levels in patients who had recovered from COVID-19 fell sharply within two to three months after infection. 

Falling antibody counts may not necessarily mean waning immunity; other immune responses such as T-cells could also affect how long immunity lasts. But the case for natural herd immunity is made even more improbable by reports of coronavirus reinfections in Hong Kong, Europe and the U.S. If natural immunity is as short-lived as a few months, that wouldn’t be stable enough to provide community or nationwide protection.    

Yahoo News Medical Correspondent Dr. Dara Kass says waiting to reach the minimal number of infections needed for natural herd immunity to work would not only take longer than waiting for a vaccine (which could come before the end of the year, according to the CDC) but would also likely cost more lives. Even if only 40 percent of the U.S. population needed to contract and recover from COVID-19 to reach natural herd immunity, Kass argues, that would mean another 126 million more Americans would still need to be infected.  

“It’s taken us six months to get to 6 million infections,” Kass says. “What if we just said, let’s live life like normal? Let’s not wear masks, let’s not socially distance, let’s ride the subways and go to work. How fast could we get to 126 million infections? One year? Two years? Three years? We don’t know. But what we know is, the faster we infect people, the more people will die.” 

“We’ve seen so far 185,000 Americans die of this coronavirus with 6 million people infected,” Kass continues. “If we want to intentionally infect another 126 million Americans, that means that over 1 million more Americans would die of this virus before we infected enough people to get to any possible natural herd immunity.” 

According to a Gallup poll conducted in late July, 35 percent of Americans said they would not get a coronavirus vaccine even if it were FDA-approved and available to them at no cost. But Kass says a vaccine will likely be the key to any workable herd immunity strategy.

“The bottom line is, will herd immunity be the answer to this coronavirus pandemic? And the answer will be yes — but not natural herd immunity. We will get to herd immunity hopefully with the development of a safe, effective vaccine,” Kass says.  

“Until we have a safe and effective vaccine that is available to the hundreds of millions of Americans that still need to be exposed and recovered from this virus, we just need to continue to do the hard work, which means wear a mask, be socially distanced from people you don’t know, wash your hands multiple times a day and listen to the science.”

College Students Are Already Itching to Sue Frats Over COVID-19

So, is anyone surprised at the stupidity of college students returning to campus after this long imposed “lock-down?” Are you surprised at the number of positive COVID-19 tested students after all of their large parties?

Emily Shugerman reported that across the country, as college students return to campus with masks and hand sanitizer, fraternities and sororities are doing what they’ve always done: drinking and partying. 

At the University of Washington this summer, 137 students living in frat houses tested positive for the coronavirus after hosting raucous parties that violated their own internal guidelines. At the University of Alabama, students completed an entirely virtual rush process that ended with new members showing up in person to sorority houses, packing themselves together to take photos and then crowding the neighboring bars. The next week, the university announced more than 500 cases on campus.

For responsible students and their families, who could fall ill or have their classes canceled due to their classmates’ Greek Life antics, it all seems ripe for a lawsuit, right?

Not necessarily.

Two attorneys who specialize in litigation against frats told The Daily Beast they have received multiple inquiries from concerned students or parents wondering what their legal rights are when it comes to potential super-spreader events on their campus.

Attorney Douglas Fierberg said filing a lawsuit is absolutely an option, arguing that violating public health rules around coronavirus is no different than violating other safety rules, like a speed limit. 

“The violation of [safety rules] by someone with no excuse or justification renders them responsible for the harm that’s caused,” he told The Daily Beast. “That precedent has been around since the dawn of American jurisprudence.”

But David Bianchi, an attorney who helped draft Florida’s anti-hazing law, said it isn’t so simple. In order to win such a suit, the plaintiff would have to prove not only that the defendant acted negligently, but that the negligent behavior directly caused them harm. And in a pandemic—where the virus could be picked up anywhere from a frat house to a grocery store parking lot—that could be difficult to prove. 

“The defense lawyer will have a field day asking questions of the plaintiff about every single place they went for the seven days before the fraternity party, the seven days after the fraternity party, and they’re going to come up with a list of 50 places,” he said. “How do you prove that that’s not where they got it from?”

Bianchi said half a dozen parents called his office asking about the possibility of filing a lawsuit, and he told them not to bother.

“I call ’em like I see ’em, and I just don’t see it here,” he said.

Lawsuits against Greek organizations, for everything from wrongful death to sexual assault, are big business for personal injury attorneys. (In 2018, the parents of a freshman at Northern Illinois University won a historic $14 million settlement after their son died at a fraternity party.) 

And there’s no question that some are bracing for suits against fraternal organizations: Holmes Murphy, an independent insurance brokerage with a specialty in frats, wrote a blog post on how clients could avoid trouble.

“We’ve received many questions about whether or not a house corporation has a duty to do anything,” the post said. “This is a question that will ultimately be tested after a case and spread within a house occurs. There is certainly no shortage of lawsuits as a result of the pandemic. Ultimately, doing the right thing comes first. Start with the basics. That may be all you can do. But it is better than doing nothing.”

What’s hazier is the prospect for coronavirus lawsuits in general. Thousands of suits have been filed since the pandemic started—against schools, businesses, prisons, and pretty much anywhere else you can pick up a virus—but few have been decided. Some legislators have also pushed for laws giving businesses widespread legal immunity, in hopes of getting the economy back up and running. 

On college campuses, Fierberg said, legal actions may not happen right away—classes have only just started, and it takes time for someone to get infected, suffer a grievous injury, and find a lawyer. He predicted a rash of such suits in the next six months to a year.

“The time period that this is incubating is now,” he said. “What’s gonna happen in that experiment is yet to entirely show itself. If it comes out as Frankenstein then that’s one thing. If it comes out as something nice… well that’s a different thing.”

Why a Vaccine Won’t Be a Quick Fix for COVID-19

Medscape’s Brenda Goodman noted that nine months into the COVID-19 pandemic, we are all exhausted, stressed out, and looking for the exit, so hopes for a vaccine are high. Not only are we all stressed out but with the election only weeks away there is pressure to have a vaccine so that President Trump sees a bump in his numbers for re-election possibilities.

Numerous efforts are underway around the world to test, manufacture, and distribute billions of doses. A table maintained by the World Health Organization (WHO) lists 33 vaccines against SARS-CoV-2, the virus that causes COVID-19, currently being tested in people, with another 143 candidates in preclinical testing and I just reviewed an article which noted that there were actually 210 vaccines being studied.

The effort is so critical, the U.S. government is spending billions to make doses of vaccine that may be wasted if clinical trials don’t show them to be safe and effective. The goal of this massive operation, dubbed Warp Speed, is to deliver 300 million doses of safe and effective vaccines by January 2021.

As important as a vaccine will be, some experts are already trying to temper expectations for how much it will be able to do.

“We all hope to have a number of effective vaccines that can help prevent people from infection,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said at an Aug. 3 news briefing. “However, there is no silver bullet at the moment, and there might never be.”

Barry Bloom, PhD, an expert in infectious diseases and immunology at the Harvard T.H. Chan School of Public Health, is even more direct: The idea that a vaccine will end the pandemic just isn’t realistic.

“That’s not going to happen,” he says. First, not enough people will get the vaccine. Second, for those who do take it, the vaccine may only offer partial protection from the virus.

“I am worried about incomplete availability, incomplete protection, unwillingness of a portion of a country to be vaccinated,” Bloom says.

At least at first, not enough people will get the vaccine for the world to achieve herd immunity, or community protection. Community protection robs the virus of the chance to spread easily. It occurs when enough people become immune, either because they’ve recovered from the infection or been vaccinated against it. This high level of immunity in a population cuts the chances that someone without immunity ― say an infant or someone who can’t be vaccinated for medical reasons ― will be exposed to the virus and get sick.

Typically, the herd immunity threshold for an infection is somewhere between 70% and 90% of the population. We don’t yet know where the threshold is for COVID-19 because there are still big unanswered questions about how our bodies respond to the virus or a vaccine against it: Do most people respond in a way that protects them in the future? If so, how long does that protection typically last?

Even at the low end of the typical range for community protection ― 70% ― we’re still far short of that mark.

Recent studies checking blood samples submitted to commercial labs suggest that 5% to 10% of the population has recovered from a COVID-19 infection in the U.S. That’s just an average. The real number varies widely across the U.S., ranging from a low of about 1% in San Francisco to a high of about 20% in New York City, according to CDC data. Most of the country is still in the 3%-5% range ― still a long way from community protection against the virus.

So, most of the immunity needed to reach a level that would provide community protection would have to come from a vaccine.

“It’s not just getting a vaccine. It’s using it and using it appropriately,” Bloom says. “Vaccines don’t prevent anything. Vaccination does.”

Getting enough doses to enough people will take a while, even after a vaccine becomes available, for several reasons.

When vaccines against COVID are first approved, supplies will be tight. Initially, there may be enough doses for 10 million to 15 million people in the U.S. The first shots will be reserved for the people who need them most.

Just this week, the National Academy of Sciences came up with a draft plan for how to fairly distribute the vaccine, which would unfold in four phases. Those phases will take time to execute.

The first phase recommends that the first doses go to health care workers and first responders, with the next batch going to people with health conditions that put them at highest risk of dying from COVID, and to seniors living in group homes. Those groups make up just 15% of the population, according to the report.

Phase two, which covers about 30% of the population, calls for vaccination of essential workers at “substantially high risk of exposure,” teachers, people with health conditions that put them at moderate risk from the disease, people living in close contact with others (like prisoners and those staying in homeless shelters), and seniors who weren’t covered in phase one.

The largest chunk of the population, including children, who can be infected but may show few signs of illness, aren’t a priority until phase three, which also includes other essential workers. Phase three accounts for about 40% of the population. The last phase, everyone else, makes up about 5%.

Among those who are eligible for vaccination, not everyone is likely to agree to get one.

A recent poll by Gallup found that 35% of Americans ― or about one in three ― don’t plan on getting a COVID-19 vaccine, even if it’s free. Among the two-thirds of Americans who say they will be immunized, a large number plan to wait. A recent survey by STAT found that 71% will wait at least 9 months to get their shots.

Those numbers align with a recent poll by WebMD, which found that 73% of readers said they would wait at least 3 months to get a vaccine when one becomes available.

“I don’t find that shocking. I would think for people who are rational, wouldn’t you want to see what the data are on safety and efficacy before you made a decision?” Bloom says. “I’m worried about the 25% who, no matter what happens, won’t take the vaccine. Those are the people who really worry me.”

Vaccine hesitancy ― fear of getting any vaccine ― is growing. The WHO recently listed it as one of the top threats to global health, pointing to the recent resurgence in measles. Many countries have recently seen large outbreaks of measles. These outbreaks have been caused by an increasing number of parents refusing to vaccinate their kids.

Experts are worried that vaccine hesitancy will play a large role in whether the U.S. and other countries reach herd immunity thresholds. The Gallup poll found Republicans are less likely to be vaccinated than Democrats, and nonwhite Americans ― the group being disproportionately affected by COVID-19 infections ― are less likely to be vaccinated than whites.

Bloom and others believe that right now, we should be working on a way to overcome vaccine hesitancy.

“Policymakers have to start focusing on this,” says Robert Litan, PhD, JD, a nonresident senior fellow at the Brookings Institute.

He thinks we shouldn’t try to overcome hesitancy by forcing people to take the vaccine. Instead, he wants the government to pay people to take it ― $1,000 each, or $4,000 for a family of four.

“That’s a lot of money,” especially now with the economy sagging and so many people out of work, Litan says. “I think a thousand dollars would get a lot of people to take the shot who would otherwise not take it.”

Litan ran the numbers, looking at various scenarios of how many people would take it and how effective the vaccine might be. He says he realized not enough people would be protected to fully reopen the country.

He says he’s not sure $1,000 is the right sum, but it should be generous because if people think the amount could go up, they will wait until it does, which would defeat the purpose of the incentive.

“I can’t think of anything else,” he says. “You either have carrots or sticks, and we can’t use sticks. It won’t work.” How Well Will It Work?

Getting enough people to take it is only one piece of the puzzle. We still don’t know how well any of the shots might work, or for how long that protection lasts.

Researchers have now confirmed at least four cases of COVID-19 reinfection, proving that the virus infected the same person twice.

We still don’t know how common reinfection is, but these cases suggest that some people may need a booster dose of vaccine before they’re fully protected against the virus, says Gregory Poland, MD, an expert in immunity and vaccine responses at the Mayo Clinic in Rochester, MN.

That’s similar to the way we dole out vaccines for seasonal flu, with people urged to get the shot every year, he says.

That’s another reason it could take a while to reach herd immunity.

It’s also not clear how effective a vaccine may be.

The FDA and WHO have said that a vaccine should be at least 50% more effective than a placebo to be approved. But that could mean that a shot merely decreases how bad an infection is but doesn’t stop it. That would be an important effect, Bloom says, but it could mean that even vaccinated people would continue to spread the infection.

“If it prevents disease, but doesn’t prevent growth in the upper respiratory tract, there is a possibility there will be a group of people who will be infected and not get sick because of the vaccine but still have the virus in their respiratory tract and be able to transit,” Bloom says. “That would not be the ideal for a vaccine, but it would protect against disease and death.”

He says the first studies will probably measure how sick vaccinated people get and whether or not they need to be hospitalized.

Longer studies will be required to see if vaccinated people are still able to pass the virus to others.

How effective any vaccine may be will also depend on age. In general, older adults ― the ones who most need protection against COVID-19 ― don’t respond as well to vaccines.

Our immune systems get weaker as we get older, a phenomenon called immunosenescence.

Seniors may need specially formulated vaccines ― with added ingredients, called adjuvants ― to get the same response to vaccines that a younger person might have.

Lastly, there’s the problem of reintroduction. As long as the virus continues to spread anywhere in the world, there’s a risk that it could reenter the U.S. and reignite infections here.

That’s what happens every year with measles. In most states, more than 90% of people are vaccinated against measles. The measles vaccine is one of the most effective ever made. It gives people substantial and long-lasting protection against a highly contagious virus that can stay in the air for long periods. You can catch it by walking through the same room an infected person was in hours before.

Every year, travelers come to the U.S. carrying measles. If they go to a crowded place, like a theme park, it increases the chances that initial infection will touch off many more. As vaccine hesitancy has increased in the U.S. and around the world, those imported cases have sparked outbreaks that have been harder and harder for public health officials to extinguish, raising the risk that the measles virus could become endemic again in countries like the U.S.

For the world to be rid of COVID-19, most of the world has to be vaccinated against it. There’s an effort underway ― called COVAX ― to pay for vaccinations for poorer countries. So far, 76 of the world’s wealthier countries have chipped in to fund the effort. The U.S. has not. The Trump administration says it won’t join because of the WHO’s involvement in the effort, a move that may place the plan in jeopardy.

For all these reasons, it will probably be necessary to continue to spread out, wear masks, and be vigilant with hand hygiene to protect yourself and others for the foreseeable future.

“For now, stopping outbreaks comes down to the basics of public health and disease control,” Tedros said.

We may get a vaccine, but we will still need to be able to test enough people for the virus, warn their contacts, and isolate those who are infectious to keep the epidemic under control, or, as Tedros has urged, “Do it all.”

American life has been transformed in a few short weeks and the Cost to Economies and the Ethics in Decision Making in a Pandemic

Italy a country at the heart of the Corona virus outbreak in Europe — watched its number of cases and deaths due to the novel Corona virus astronomically leap once again, up 793 deaths with 6,557 newly confirmed cases recorded in just 24 hours.

Saturday’s jump marks the worst day for fatalities since the crisis began just four months ago. The country now counts 53,578 diagnosed infections, up 13.9 percent, with 4,825 deaths — the highest in the world.

More than 60 percent of the most recent deaths occurred in the northern region of Lombardy. Hospitals in the area have been reeling under a staggering caseload that has left intensive care beds scarce and respirators in extremely limited supply.

According to the Financial Times, 2,857 people were in intensive care in Lombardy on Saturday, up from 2,655 on Friday. The new increases come almost two weeks into a nationwide lock down in an attempt to stop the COVID-19 virus in its tracks there.

There were also 943 full recoveries tallied yesterday — another record for the country.

On Thursday, Italy was witness to yet another grim milestone in its fight against the deadly disease by overtaking China to become the country with the highest number of deaths.

On Friday the government banned the last types of outdoor exercise Italians were able to participate in under the lock down measures by deciding that running and bicycle rides were no longer permitted. In addition, the Italian military has also been dispatched to Milan to ensure that citizens follow the new lock down measures.

The Italian interior ministry reported that more than 223,633 people were inspected by the Italian police nationwide on Friday, with 9,888 people reported for breaking the lock down measures and 260 for false declarations about why they were outside.

Across the Atlantic, the number of cases in the United States has now exceeded 22,000 with more than 270 deaths. New York tops the list with at least 10,000 confirmed cases; Washington state follows with just over 1,500 cases, and California is in tow with more than 1,200.

Thus far, the global pandemic has infected more than 287,000 people and killed over 11,900. More than 90,000 people have recovered so far, mostly in China.

The Associated Press and The Financial Times contributed to this report.

I found this article in the Economist discussing what the economic influence would be from the COVID-19 pandemic. The titular conceit of “28 Days Later”, as with many contagion-style horror films, is of a man waking up after a month-long coma only to find society upended by a rampaging virus. Many Americans are experiencing something similar. On March 3rd there were just 122 confirmed cases of COVID-19—the disease currently sweeping the world—and only seven deaths. By March 17th there were 7,786 confirmed cases (even these were a sure underestimate given the dearth of testing) and 118 deaths. Twenty-eight days later, on March 31st, what might America look like?

cap.gifp-a8GHW19EK4IzY.gif“We don’t know whether we’re going to look like Italy or the provinces outside Hubei” in China where the spread of COVID-19 was fairly effectively contained, says David Blumenthal, president of the Commonwealth Fund, a health-policy think-tank. “But the likelihood is—given the slowness with which we responded to the epidemic—that we look more like Italy,” he adds. Jerome Adams, the surgeon-general, has warned of the same.

Can America’s health system cope? The structural problems that make pandemic response more difficult—lack of paid sick pay, a large uninsured population and a significant number of insured people nonetheless worried about out-of-pocket medical bills—cannot be mended overnight. Instead, public-health experts and doctors are increasingly worried about sheer capacity constraints. In China, 5% of those diagnosed needed intensive care. There are roughly 97,000 beds in intensive care units (ICUs), of which one-third are empty. Though America has relatively few total hospital beds per person compared with other countries, it ranks among the highest for ICU beds per person, with nearly three times as many as Italy.

“The real limiting factors are likely to be the ventilators or the staff,” says Greg Martin, a professor of medicine at Emory University and president-elect of the Society of Critical Care Medicine. There are roughly 50,000 physicians trained in critical care and 34,000 similarly specialized nurses and assistants. This could be insufficient in the face of hundreds of thousands of cases at peak rates of infection.

Then there is the problem of kit. In China, half of those in critical care required the use of ventilators, machines that help people breathe. There are thought to be 62,000 full-featured mechanical ventilators in the country, many of which are already in use. Older stocks of perhaps 100,000 devices—including CPAP machines used for those with sleep apnea—could be called upon if needed, but would provide only basic functions. Ramp-ups in ventilator production are being pondered, including through emergency powers given to the president under the Defense Production Act of 1950, but there has been little actual action yet. On a phone call with state governors, President Donald Trump urged “respirators, ventilators, all of the equipment—try getting it yourselves”, which could spark an unhelpful competition between states for scarce resources.

“Under almost any basic scenario, things look tough. Hospital beds will be completely full many times over if we don’t substantially spread the load,” warns Ashish Jha, director of the Global Health Institute at Harvard. To head that off, Mr Jha has called for an Italy-style national quarantine, lasting for at least two weeks, in which all non-essential businesses are closed and gatherings of more than five people are barred to give time for testing to become widespread. After a dismally slow start to testing, the numbers are finally heading up—although the best estimates come not from public-health agencies, but volunteer trackers using a Google sheet—to an estimated 12,535 tests conducted on March 17th. Given the expected scope of the disease, and the reported obstacles to people with symptoms actually getting tested, much more will be needed.

Most hospitals are making contingency plans. There are plans to add physical beds by cancelling elective surgeries that can be postponed, converting recovery rooms into added beds and building tents to house some patients. The Cleveland Clinic, a prominent hospital, says it has plans in place to add 1,000 beds of capacity within 72 hours if needed. Teams of doctors and nurses with other specialties could be conscripted into critical-care work, supervised by critical-care doctors who handle the trickiest cases—like respiratory distress coupled with organ failure in the kidneys or heart. If this is insufficient, recently retired doctors could be drafted into service. Some teaching hospitals are using simulation centers to prepare medical staff for the inevitable surge in cases.

Testing? Testing?

Whether it will come to all this is still unclear. Testing capacity remains constrained, limiting the information epidemiologists have to feed both their models and their willingness to speculate. Their policy recommendations—social distancing, closure of schools and large gatherings—are nevertheless clear. One team of researchers has concluded that an epidemic resembling that of Wuhan, where the novel Corona virus first broke out, would overwhelm hospitals many times over, while one resembling Guangzhou, a city that locked down in the early days of the virus, could be dealt with.

On March 16th, however, a team of scientists based at Imperial College London, who have been advising the British government, also published forecasts of the epidemic’s trajectory in America. As with Britain, the figures look grim. Without any mitigation, America would experience 2.2m deaths, they predict. Even in the case of some mitigation—isolation of the sick, social distancing for the elderly, but an otherwise normal society—American hospital and ICU capacity would be exceeded eight times over, and the country would be on track for at least 1.1m deaths. Averting this through “suppression”—isolation of sick, closing of schools and universities, social distancing for everyone—would require months until therapeutics or vaccines can be developed.

America is therefore turning towards suppression of the virus. Millions of pupils and university students have been sent home and left to take classes online. Mr. Trump has advised that people not congregate in gatherings of more than ten people. San Francisco and surrounding counties have issued a “shelter-in-place” order that requires 7m to remain in their homes unless necessary. New York City is expected to do the same for its 8m residents. In 22 states, bars and restaurants have been ordered to close their seating and only serve takeaway. The state of New York is setting up drive-through testing centers, starting in New Rochelle, a commuter town in Westchester County that was one of the early sites of a COVID-19 cluster, and is urging federal troops to build emergency, temporary hospital facilities. New Rochelle’s mayor says he is surviving the lock down there on “adrenalin, coffee and M&Ms”.

The goal is to increase general hospital capacity by a factor of two and ICU capacity by a factor of ten within two months. Elections have been postponed in a few states for the Democratic primary, which now seems a dull, distant affair. America’s devolved system means that the shuttering will happen at different rates in different places, but the trajectory is clear. “You want a single national response. But when the federal government completely fails, as it has so far, then you can get states and cities to step up,” says Mr. Jha.

The question is how long this can go on for. Unmitigated, the epidemic would not peak for at least another three months. Suppression can reduce the spread of the disease, as China’s experiment with locking down most of its population showed, but relaxing these measures will inevitably bring another surge in cases. Mr. Trump, who a few weeks ago was suggesting the virus was the latest hoax invented to damage him, is now warning that this could be the start of a months-long reorientation in American life. And while these extraordinary actions should smother the disease, they will also smother the economy.

The dismal economic forecasts will require further action from Congress. It spent the last week haggling over a bill that would make testing for the disease free, increase the flow of safety-net benefits and grant paid sick leave to more workers (though this provision appears to be hollowing out with every iteration). Even before that bill was finalized, Washington’s attention had already turned to the even bigger economic stimulus package that must come next. Senators, both Democrats and Republicans, are tripping over themselves issuing plans to send cash directly to American families.          

The total package, which could be worth $1trn or more, dwarfs the $100bn-or-so bill recently signed into law and every other stimulus package in history. The Trump administration has proposed sending $500bn in direct cash to taxpayers, $300bn to keep firms afloat, and $200bn to bail out critical industries like airlines. The typical partisan bickering from Congress and even from Mr. Trump has been muted. Every politician seems to now realize that the country faces an unprecedented crisis, first of public health and then of the economy, that will last for months. Whether this action will look sufficient 28 days later is, as with seemingly every aspect of the Covid-19 pandemic, deeply uncertain. ■

Ethicists agree on who gets treated first when hospitals are overwhelmed by Corona virus 

As a member of our Ethics Committee I thought that the decisions that physicians and staff in other countries were facing regarding who gets the ventilators was an interesting conundrum. This article contributed by Oliva Goldhill in her article, The Aging Effect, is a great introduction into the decisions that we may have to make here in the US. Pandemics bring ethical dilemmas into sharp, terrible focus. Around the world, hospitals have been unable to cope with the millions who need treatment for Corona virus. China created makeshift hospitals and denied treatment to those who needed non-Corona virus care; Italians wait an hour on the phone to get through to emergency services. Few countries will fare better: The United States has fewer than 100,000 ICU beds, and is expected to need a minimum of 200,000 to cope with Corona virus; the UK has just 8,200 ventilators and is getting an extra 3,800.

As health care systems are overwhelmed with more patients than they can feasibly treat, medical personnel are forced to decide who should get the available ventilators and ICU beds. Quartz spoke with eight ethicists, all of whom agreed that in such dire situations, those who have the best chance of surviving get priority. Despite the unanimity, all agreed that this decision is far from easy and should not be taken lightly.

Different moral theories, same answer

The decision to prioritize those with good survival odds is reinforced by several moral theories. Utilitarianism, for example, argues that morality is determined by the consequences of actions, and so we should strive to create the maximum good for the maximum number of people. “If we give scarce treatments to those who don’t stand to benefit (and have a high chance of dying anyway), then not only will they die, but those with higher likelihood of survival (but require ventilator support) will also die,” says Lydia Dugdale, professor of medicine and director of the center for clinical medical ethics at Columbia University. “It’s not fair to distribute scarce resources in a way that minimizes lives saved.”

A contrarian theory, which bases ethics on the social contract we would agree to if we didn’t know our status in society, arrives at the same conclusion. Joshua Parker, a trainee general practitioner (primary care doctor) who co-wrote an article on the ethics of Corona virus care for the Journal of Medical Ethics, points to philosopher John Rawls’ concept of a “veil of ignorance” as a way to determine the just action: “Behind the veil of ignorance, I am stripped of any knowledge of my position. I don’t know if I’ll be old, young, rich, poor, well, unwell, male or female; and I don’t know if I will catch COVID-19 or if I do, what resources I will need,” he writes in an email to Quartz. This thought experiment makes it easier to judge what’s fair for society as a whole. Alex John London, director of the Center for Ethics and Policy at Carnegie Mellon University, agrees: “Such agents might agree that in a pandemic, when not everyone can be saved, health care systems should use their resources to save as many lives as possible—because that is the strategy that allows each person a fair chance of being able to pursue their life plan.”

Even typically diverging ethical theories are likely to point to this conclusion. Utilitarianism, which focuses on the consequences of an action, is typically opposed to deontology, which says morality is determined by the act itself. “The deontologist might well start with a justice argument: each person is individually valuable and should have an equal chance of health care,” says Anders Sandberg, a philosopher at the Future of Humanity Institute at the Oxford University. But if this is simply impossible, then the theory doesn’t hold. “As Kant said, “ought implies can,” and if one cannot do an action it cannot be obligatory.” A deontologist approach to treat everyone equally falls short when there simply isn’t enough medical equipment to treat everyone; if some will have access and some won’t, then we have to face the question of who gets preferential treatment. And so “even the most die-hard deontologist will usually agree” that it’s wrong to treat people who are unlikely to benefit while others are in need, agrees Brian D. Earp, associate director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center.

Doctors have reckoned with the need to allocate resources in the face of overwhelming demand long before Corona virus. Dugdale points out that the New York department of health’s ventilator allocation guidelines, published in November 2015 to address the issue amid a flu epidemic, states that first-come first-serve, lottery, physician clinical judgment, and prioritizing certain patients such as health care workers were explored but found to be either too subjective or failed to save the most lives. Age was rejected as a criterion as it discriminates against the elderly, and there are plenty of cases in which an older person has better odds of survival than someone younger.

So the decision was to “utilize clinical factors only to evaluate a patient’s likelihood of survival and to determine the patient’s access to ventilator therapy.” In tie-breaking circumstances, though, they did approve treating children 17 and younger over an adult where both have an equal odds of surviving. Dugdale adds that there’s talk of applying these guidelines to address Corona virus treatment in New York.

No good answer

The dire consequences of any decision made under such extreme circumstances means that, despite agreement, the best course of action is hardly favorable. “I would say that leaving some to die without treatment is NOT ethical, but it may be necessary as there are no good options,” David Chan, philosophy professor at the University of Alabama at Birmingham, writes. “Saying that it is ethical ignores the tragic element, and it is better that physicians feel bad about making the best of a bad situation rather than being convinced that they have done the right thing.”

Rather, it’s simply the least bad option. Alternatives, such as a lottery system or prioritizing the sickest, are likely to lead to more deaths. “There is a good chance that we invest resources into patients who don’t survive, and we have thus doomed not just the patient we tried to save, but also the patient who was passed over for care, because the resources have been used up,” says Vanessa Bentley, philosophy professor at the University of Alabama at Birmingham. “Lives that could have been saved were lost.”

Although there’s broad agreement on the best approach, the nuances of applying this decision will always be difficult. Not only must doctors accurately assess and prioritize those with the best chance of survival, but there could also be times when the hospital doesn’t have enough equipment to help even those with equal odds. Italy has prioritized treatment for those with “the best chance of success” but adds as a second criterion those “who have more potential years of life.” This secondary factor is not so easily agreed upon but, in the face of Corona virus, it’s an ethical question doctors will have to face.

Governments are spending big to keep the world economy from getting dangerously sick

The help is targeted at companies and individuals. More will be needed

In the recent edition of the Economist Today it was noted a character in a novel by Ernest Hemingway once described bankruptcy as an experience that occurs “two ways: gradually, then suddenly”. The economic response to the COVID-19 pandemic has followed this pattern. For weeks policymakers dithered, even as forecasts for the likely economic damage worsened. But in the space of just a few days the rich world has shifted decisively. Many governments are now on a war footing, promising massive state intervention and control over economic activity.

The new phrase on politicians’ lips is “whatever it takes”—a line borrowed from Mario Draghi, president of the European Central Bank (ECB) in 2011-19. He used it in 2012 to convince investors he was serious about solving the euro-zone crisis, and prompted an economic recovery. Mr Draghi’s promise was radical enough. Politicians are now proposing something of a different magnitude: sweeping, structural changes to how their economies work.

There are unprecedented promises. On March 16th President Emmanuel Macron of France declared that “no company, whatever its size, will face the risk of bankruptcy” because of the virus. Germany pledged unlimited cash to businesses hit by it. Japan passed a hastily compiled spending package in February, but on March 10th supplemented it with another one that included over ¥430bn ($4bn) in spending and almost four times as much in cheap lending. Britain has said it will lend over £300bn (15% of GDP) to firms. America may enact a fiscal package worth well over $1trn (5% of GDP). The most conservative estimates of the total extra fiscal stimulus announced thus far put it at 2% of global GDP, more than was shoveled out in response to the global financial crisis of 2007-09.

That sinking feeling

In part this radical action is motivated by the realization that the Corona virus, first and foremost a public-health emergency, is also an economic one. The jaw-dropping bad economic data coming out of China hint at what could be in store for the rest of the world. In the first two months of 2020 all major indicators were deeply negative: industrial production fell by 13.5% year-on-year, retail sales by 20.5% and fixed-asset investment by 24.5%. GDP may have declined by as much as 10% year-on-year in the first quarter of 2020. The last time China reported an economic contraction was more than four decades ago, at the end of the Cultural Revolution.

Grim numbers are starting to pile up elsewhere, not so much in the official statistics, which take time to be published, as in “real-time” economic data produced by the private sector. Across the world, attendance at restaurants has fallen by half, according to OpenTable, a booking platform. International-passenger arrivals at the five biggest American airports are down by at least 30%. Box-office receipts have crumpled (see chart 2).

The disruption to international travel will hurt trade, since over half of global air freight is carried in the bellies of passenger planes. The combination of disrupted supply chains and depressed demand from shoppers should hit trade far harder than overall GDP, if the experience of the last financial crisis is anything to go by. Already, the American Association of Port Authorities, an alliance of the ports of Canada, the Caribbean, Latin America and the United States, has warned that cargo volumes during the first quarter of 2020 could be down by 20% or more from a year earlier.

Official data are now starting to drip out. The Empire manufacturing index, a monthly survey covering New York state, in March saw its steepest drop on record, and the lowest level since 2009. In February Norway’s jobless rate was 2.3%; by March 17th it was 5.3%. State-level numbers from America suggest that unemployment there has been surging in recent days.

All this is fueling grim forecasts. In a report on March 17th Morgan Stanley, a bank, estimated that GDP in the euro area will fall by an astonishing 12% year-on-year in the second quarter of the year. The Japanese economy is forecast to contract by 2% this quarter and 2% next. Most analysts see global GDP shrinking in the first half of the year, with barely any growth over 2020 as a whole—the worst performance since the financial crisis of 2007-09.

Even that is likely to prove optimistic. On March 17th analysts at Goldman Sachs noted that they had “not yet built a full lock down scenario” into their forecasts for advanced economies outside Europe. Forecasts for America, which is at an earlier stage than Europe and Asia when it comes to the outbreak, remain Panglossian; very slow growth in China and a big recession in Europe could by itself be enough to send the world’s largest economy the same way. Steven Mnuchin, America’s treasury secretary, warned this week that the country’s unemployment rate could reach 20% unless Congress passes a stimulus package. A negotiating ploy? With shopping malls emptying, factories grinding to a halt and financial markets buckling, lawmakers may be loath to challenge the claim.

Despite stomach-churning declines in GDP in the first half of this year, and especially the second quarter, most forecasters assume that the situation will return to normal in the second half of the year, with growth accelerating in 2021 as people make up for lost time. That judgment is in part informed by China’s experience. More than 90% of its big industrial firms are officially back in business. Its stock market had been one of the world’s worst performers in early February but is now the best (or rather, least bad). There remains, however, a risk that global containment and suppression of the virus will need to continue for a year or longer. If so, global economic output could be dragged down for much longer than most people expect.

Perhaps the greatest lesson of the global financial crisis was that it paid to act decisively and to act big, convincing markets and households that policymakers were serious about countering the slump. If done right, central banks and governments can end up doing a lot less than they actually promised. A pledge to bail out banks makes it less likely savers will withdraw deposits and make a rescue necessary.

This time around, central banks sprang into action. Since February the Federal Reserve has cut interest rates by 1.5 percentage points. Other central banks have followed suit. Further deep rate cuts are not possible, though; interest rates were very low long before the virus began to spread.

Let’s get fiscal

Not all central banks are acting as boldly as they can. China has room to cut interest rates—its benchmark rate is 1.5%—but has held back in part because inflation is quite high (largely as a result of African swine fever, which hit pig stocks, raising prices). Central banks could try more creative policies. On March 19th the ECB’s governing council agreed to launch a €750bn bond-buying program, covering both sovereign and corporate debt. But the real action is now taking place on the fiscal front.

Governments are falling over each other to offer bigger and better stimulus packages. All countries are spending more on health care, both in an effort to find vaccines and cures and to increase hospital capacity. However, the bulk of the extra spending is on companies and people.

Take companies first. China, where the outbreak has slowed, is now trying to get people out and buying things. Foshan, a city in Guangdong province, has launched a subsidy program for people buying cars. Some cities have started giving out coupons that can be spent in local shops and restaurants. Nanjing this month gave out e-vouchers worth 318m yuan ($45m).

Most countries, however, are in or about to enter the worst part of the outbreak. As customers dry up, many firms will go bust without government help. Calculations by The Economist suggest that 40% of consumer spending in advanced economies is vulnerable to people shunning social situations. Firms in leisure and hospitality are especially rattled. The Moor of Rannoch hotel, in about as rural a part of Scotland as it is possible to find, says its insurer will not be paying out a penny for lost custom, since COVID-19 is a new disease and thus not covered under its policy.

One approach is to reduce firms’ fixed costs, largely rent and labor. China’s finance ministry will exempt companies from making social-security contributions for up to five months. The government has also temporarily cut the electricity price for most companies by 5% and enacted short-term value-added-tax cuts. The British government has extended a one-year business-rates holiday to all companies operating in the retail, hospitality and leisure sectors. Yet for many firms, no matter how much the government helps them reduce costs, revenues are likely to fall further.

So, measures may be needed to allow firms to maintain cash flow. Many banks are offering hefty overdrafts to tide corporate clients over. To encourage banks to keep lending, Britain has promised them cheap funding and state guarantees against losses. For very small firms, many of which do not borrow at all, it is offering non-repayable cash grants of up to £25,000.

Other countries are enacting similar plans. The Japanese government is helping small firms by mobilizing its state-owned lenders to provide up to ¥1.6trn of emergency loans, much of it free of interest and collateral requirements. Small firms qualify for help if their monthly sales fall at least 15% below a normal month’s takings. Bavaria, a rich state in Germany, announced on March 16th that small and medium-sized companies with up to 250 employees could receive an immediate cash injection of between €5,000 and €30,000. The European Commission has already relaxed state-aid rules so that governments can channel help to ailing companies.

The second part of the fiscal response is about helping people, and in particular protecting them from being made unemployed or suffering a drastic drop in income if that does happen. Ugo Gentilini of the World Bank counts more than 25 countries that are using cash transfers as part of their economic response to the virus. Brazil will give informal workers, who make up roughly 40% of the labor force, 200 Reais ($38) each. Small businesses will be allowed to delay tax payments and pensioners will get year-end benefits early. Australia is instituting a one-time cash payment of A$750 ($434) to pensioners, veterans and people on low incomes.

Northern Europe has led the way on implementing policies that make it less likely firms lay off workers. Germany has relaxed the criteria for Kurzarbeit (“short-time work”), under which the state pays 60-67% of the forgone wages of employees whose hours are reduced by struggling firms. Applications are going “through the roof”, according to the federal labor agency. The use of Kurzarbeit probably halved the rise in unemployment during the recession of 2008-09. More firms are now eligible to use it, temporary workers are covered, and the government will also reimburse the social-security contributions companies make on behalf of affected workers.

Bringing home, the Danish bacon

In Denmark firms that risk losing 30% or more of their workforce will see the government pay 75% of the wages of employees who would otherwise be laid off, until June. Norway’s government has beefed up unemployment benefits, guaranteeing laid-off workers the equivalent of their full salary for the first 20 days. Freelancers whose work vanishes for more than a fortnight will get payments equivalent to 80% of their previous average income. In Sweden the state will cover half of the income of workers who have been let go, with employers asked to cover most of the rest.

So far America has passed more modest legislation. Federal funding for Medicaid, which provides health care for the poor, is likely to boost spending by about $30bn, assuming it remains in place until the end of December, reckons Oxford Economics, a consultancy. America also has a new paid-sick-leave policy for some 30m workers, including 10m who are self-employed, worth just over $100bn. But in that regard America is merely catching up with other rich countries, which have far more generous sick-leave policies. America also has fewer automatic economic stabilizers, such as generous unemployment insurance, than most other rich countries. As a result, its discretionary fiscal boost needs to be especially large to make a difference.

It might be. The Trump administration’s plan to funnel money directly to households, if approved by Congress, is the most significant policy. It bears some resemblance to a scheme that was introduced in February in Hong Kong, in which the government offered HK$10,000 ($1,290) directly to every permanent resident. Mr. Mnuchin is thought to favor a check of $1,000 per American—roughly equal to one week’s average wages for a private-sector worker—with the possibility of a second check later. Some $500bn-worth of direct payments could soon be in the post.

Some economists are leery about such a policy. For one thing, it would do little to prevent employers from letting people go, unlike the plans in northern Europe. Another potential problem, judging by Hong Kong’s experience, is administration of the plan: the territory’s finance secretary hopes to make the first payments in “late summer”, far too far away for people who lost work last week. Mr. Mnuchin promises that payments will happen much sooner.

Checkered past

America has done something similar before, with results that were not entirely encouraging. The government sent out checks in both 2001 and 2008 to head off a slowdown. The evidence suggests that people saved a large chunk of it. The psychological reassurance of a bit of extra cash could be significant for many Americans, but the sums involved are not especially impressive. Bernie Sanders, a Democratic presidential contender, is not known for his smart economic policy making, but his suggestion of $2,000 per household per month until the crisis is over is probably closer to what is required.

Indeed, more fiscal stimulus will be needed across the world, especially if measures to contain the spread of the virus fall short. After the Japanese government passes the budget for next fiscal year at the end of this month, it can begin work on a supplementary budget that takes the virus into full account. Britain’s Parliament has given Rishi Sunak, the chancellor of the exchequer, carte blanche to offer whatever support he deems necessary, without limit.

How much further can fiscal policy realistically go? Last year the 35-odd rich countries tracked by the IMF ran combined fiscal deficits of $1.5trn (2.9% of GDP). On the not-unrealistic assumption that the average deficit rose by five percentage points of GDP, total rich-country borrowing would rise to over $4trn this year. Investors have to be willing to finance that splurge. The yield on ten-year Treasury bonds, which had fallen as low as 0.5% as fears of the virus took hold and traders sought havens, has recently risen above 1%. This is probably due to firms and investors selling even their safest assets to raise cash, but might reflect some anxiety over the scale of planned government borrowing.

Jesse Watters began “Waters’ World” on Saturday by delivering a message of positivity to his audience, saying he’s sure America can overcome the devastation from the coronovirus. “The United States of America is rolling into a recession or a depression. What we do now will determine which one it’ll be. First, we have to stop the spread. You know what to do. Wash your hands, stay clean and practice social distancing,” Watters said, reminding people of the guidelines given to keep people safe from exposure to the virus.

“If you can stay inside this week, work from home if you can. Don’t fly if you don’t have to. The virus is mostly in 10 large counties. A very high percentage in New York, California and Washington state,” he continued. “Some of these areas recognize the threat and are shutting down everything. All of them need to do that.”

Watters talked about where the country stands medically and scientifically, assuring people the “brightest” are on the case. “All the brightest scientists in America [are] working around the clock to find a vaccine. Our people are the most innovative in the world,” Watters said.

The host also addressed the president’s leadership, urging him and American industry leaders to do whatever they can. “The president should be invoking every possible law and power available to him. He should be mobilizing the military and declaring war on the coronavirus. Rally the country around the mantra ‘made in America,'” Watters said. “Every American industry should have all hands-on deck. This isn’t a time for weakness. This is a time for strength.”

“Our country’s fighting an invisible enemy within our borders,” Watters added. “We’ll dull the spike and kill it if we all work together.” Watters expressed his optimism toward an American rebound. “We’ve had to come together by staying apart. I know one thing for sure, we’ll stop it and we’ll kill it and we’ll be a better country for it. Tough times are ahead,” Watters said. “The American character shining bright, loving our families and our neighbors and working nonstop to save lives. It’s now in your hands. We have a great spirit and we shall overcome.”

Italy reported a second successive drop in daily deaths and infections from a coronavirus that has nevertheless claimed more than 6,000 lives in a month.The Mediterranean country has now seen its daily fatalities come down from a world record 793 on Saturday to 651 on Sunday and 601 on Monday.

The number of new declared infections fell from 6,557 on Saturday to 4,789 on Monday. The top medical officer for Milan’s devastated Lombardy region appeared on television smiling for the first time in many weeks. “We cannot declare victory just yet,” Giuglio Gallera said. “But there is light at the end of the tunnel.”

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

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

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

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

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

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

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

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

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

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

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

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

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

So why the gridlock?

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

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

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

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

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

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

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

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

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

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

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

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

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

Obamacare, Medicare and more 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Our health data is vulnerable

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

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

Universal care is basic right

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘More illness, more sickness’

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

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

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

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

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

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

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

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

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

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

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

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

‘Public Medicare plan is withering’

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

ions of beneficiaries face.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you all believe this?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Public policy: Americans want a private option

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medical bills are fun!

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pretty much no.

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

Single-payer

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

Medicare for All

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

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

Public option

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

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

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

“Government-run” health care

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

Universal coverage

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

Medicare for All Would Save US Money, New Study Says

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Study Finds Talcum Powder Not Likely A Risk For Ovarian

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Staggering Cost of US Health Care Bureaucracy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

ObamaCare still working despite individual mandate’s repeal

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

AbbVie didn’t respond to a request for comment.

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

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

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

Teva didn’t respond to requests for comment.

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

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

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

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

Democrats ask U.S. Supreme Court to save Obamacare

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

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

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

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

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

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

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

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

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

In striking down the individual mandate, the 5th Circuit avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis. 

That means the fate of Obamacare remains in limbo. The fact that the litigation is still ongoing may make the Supreme Court, which already has a series of major cases to decide in the coming months, less likely to intervene at this stage. 

John Delaney: On health care, bold vision with pragmatism is what America needs

Pulitzer prize winning editor, Art Cullen noted that in living rooms and coffee shops across all of Iowa’s 99 counties, I am forever reminded that health care is the paramount issue facing Americans. Our current system is deeply broken, and our country needs a bold vision and a pragmatic approach for improving health care. In many ways, a candidate’s approach to health care defines their governing and leadership style. It answers important questions about their values, vision, pragmatism and management style. 

The Democratic Party should have as its true north universal access — where every American has health care coverage as a right of citizenship. We should support plans that encourage innovation — curing diseases like cancer and Alzheimer’s — and that create a framework for getting costs under control. My Better Care Plan uniquely achieves all of these goals.

Universal access needs to be realistic

Currently, only three candidates have detailed plans for universal access — Sens. Elizabeth Warren and Bernie Sanders and I. Universal access is the right answer, both morally and economically. The plans advocated by Warren and Sanders, however, call for an extreme “single-payer” system, where the government is the only provider of coverage. 

Aside from the extraordinary practical, fiscal and political issues associated with eliminating and replacing over 180 million private insurance plans, a single-payer system will massively underfund the health care system. Today, government reimbursement is dramatically less than reimbursements paid by insurance companies. Making the government the only payer in health care would underfund hospitals, particularly in rural America, resulting in hospital closures, practitioners closing up shop, and a reduction of investment in innovation.  

On the other hand, most other candidates are advocating for a “public option” as our way forward. This is a modest proposal, insufficient for the challenges of our broken health care system. A public option is simply another insurer that is government-run. It will have co-payments, deductibles, and premiums. And it relies on people choosing to sign up. While it would provide more options than are currently available in the marketplace, undoubtedly helping many, it would not address the tragedy of the uninsured in our country.

Under BetterCare we achieve the ambition of universal coverage without the negatives of a single-payer system. 

Under BetterCare, Medicare is left alone, because it works, and every American from birth to 65 (seniors are on Medicare) is auto-enrolled in a free federal health care plan that covers basic health care needs. This ensures every American has health care coverage. But unlike the single-payer Medicare for All, Americans could still choose private insurance. They could “opt out” of the BetterCare plan and buy private insurance or receive insurance from their employer. If they “opt out” they would receive a health care tax credit to offset the cost of health care they purchase or that their employer provides. 

Alternatively, they could use the BetterCare plan and enhance it with supplemental plans, similar to how Medicare beneficiaries acquire supplemental plans. BetterCare is like Medicare. It provides guaranteed coverage but allows our seniors to have supplemental plans or “opt out” and accept a Medicare Advantage Plan.  

BetterCare is similar to the plans of most developed nations that have universal coverage. As Art Cullen wrote, it provides “universal coverage while not eliminating private insurance.” By providing universal access, choice, protecting provider reimbursements, and encouraging innovation, BetterCare is bold, ambitious, practical and a political winner. Importantly, it can be fully paid for by applying the Obamacare subsidies and current federal and state Medicaid payments and by eliminating the corporate deductibility of health care.

It is bold, yet practical, and reflective of my approach to governing. As a former entrepreneur, CEO of two public companies and member of Congress, I bring a unique approach and real leadership experience, which is why I respectfully ask for your support. 

Use Simple Economics to Contain Health Care Costs

Gary Shilling wrote for Bloomberg and makes so much sense when he looked at health care costs in terms of simple economics. (Bloomberg Opinion) — Spending on U.S. health care is out of control, expanding steadily from 5% of GDP in 1960 to 18% in 2018.  There are, however, ways to curb the explosion in costs from both the demand and the supply side.

Health care costs per capita in the U.S. are almost double those of other developed countries, but life expectancy is lower than many, even South Korea, according to the CIA and Eurostat. Without restraint, costs will accelerate as more and more postwar babies age. The nonpartisan Congressional Budget Office projects Medicare spending alone will leap from 3% of GDP to 8% by 2090.

Medical costs are understandably high since the system is designed to be the most expensive possible for four distinct reasons. First, with the constantly improving but increasingly expensive modern technology, the best is none too good when your life or mine is at stake. Also, few patients have the knowledge to decide whether a recommended procedure will be medically much-less cost-effective. The medical delivery system encourages a gulf between the providers who supposedly know what’s needed and their patients who don’t.

Second, patients are quite insensitive to costs since their employers or governments pay most health care bills. And those who are privately insured want to get their money’s worth from their premiums, especially since Obamacare does not allow insurers to set premiums on a health risk basis.

Third, the pay-for-service system encourages medical providers to over-service. After my dermatologist burned off the pre-cancerous growths on my face, he wanted me back in two weeks to be sure, but also to bill another office visit.

Finally, domestic training programs and facilities for medical personnel are inadequate. As a result, many MD residents and nurses come from abroad, while medical schools of dubious quality in the Caribbean train U.S.-born physicians.

To control costs on the demand side, use the appeal of money. The importance of their health to most Americans means they will spend proportionally more on medical services than other goods and services, but they’ll think twice if it’s money they otherwise can keep. Increasing deductibles and co-payments are moving in that direction. In 1999, employees on average paid $1,500, or 22%, of $6,700 in family health coverage premiums, according to the Kaiser Family Foundation. The total rose to $26,600 in 2019, but employees’ share has climbed to $6,000, or 29%.

Medical savings accounts also make patients more aware of costs. Companies give employees a set amount of money and they can keep what they don’t spend on health care. 

Accountable Care Organizations, now authorized by Medicare, attack the fee-for-service problem. The medical providers who participate are encouraged to be efficient since they can retain part of any savings due to cost controls as long as they provide excellent care.

To increase the supply of medical personnel, American medical and nursing schools can be expanded with government help. Also, shortening the whole training process would save time and get huge student debts under control. Does a physician need a four-year bachelor’s degree before beginning medical school?

Cartels among hospital medical specialties can be attacked. Now, physicians in, say, the general surgery department limit competition by controlling who has the privileges to use their institution’s facilities.

In another development, the entrepreneurial model of a small group of MDs operating a practice is fading in the face of high costs of medical record-keeping and other regulatory requirements. Over half of physicians now work for hospitals, either on their main campuses or in satellite facilities. This may shift the emphasis of many from money to medicine. 

Limiting malpractice insurance premiums, a major outlay for medical providers, can also cut medical costs. Texas placed a $250,000 cap on non-economic damages, i.e., pain and suffering, in 2003. Texas Department of Insurance data reveals that medical malpractice claims, including lawsuits, fell by two-thirds between 2003 and 2011, and the average payout declined 22% to $199,000.

Also, average malpractice insurance premiums plunged 46%, according to the Texas Alliance for Patient Access, a coalition of health care providers and physician liability insurers. And physicians were then attracted to Texas. The Texas Medical Association reports that in the decade since malpractice awards were capped, 3,135 physicians came to the Lone Star State annually, 770 more than the average in the prior nine years.

At present, Americans basically pay the development costs of new drugs while other countries with centralized pharmaceutical-buying skip the expenses of R&D, field trials, etc., and only pay the much-lower marginal cost of production. Allowing Medicare to join Medicaid to negotiate drug prices could reduce costs if foreigners can be convinced to share development costs. Otherwise, new drug development would be curtailed. The Trump administration’s new rules that force health insurers and hospitals to publish their negotiated prices may force costs to the lowest level.

One approach that doesn’t work in easing the burden on consumers of medical costs is increasing overall government subsidies. They tend to be offset by higher costs, much as higher college tuition and fees often dissipate more scholarship aid. Ever notice that the most modern, prosperous institutions in town tend to be hospitals, hugely subsidized by governments?

Health care is critical, but that doesn’t mean its costs aren’t subjected to supply and demand. Then how do we assess the value as well as the costs and cost limitations? Are drug companies as well as insurance companies making way too much in profits by taking advantage of we the honest patients?? 

There many parts of the eventual answer to our need for a health care program which can service all at reasonable costs and each “part” needs thorough investigation and real solutions and that just addressing only one or two of these “parts” will never be sustainable!!

Physicians Get Weed Killer; Administrators Get Miracle-Gro And neither is helping, Obamacare Funding Suggestions, Andrew Lang, Year in Review and Google Searches

Last week Suneel Dhand reported that compared to a couple of years ago, very little has changed in the hospital medical community. 

In fact, I’m sure the divergence of the curves has only grown bigger, as more and more administrators are added to the ranks of healthcare. Look at what happened in Chicago where one of the fairly large hospitals fired 15 of their physicians and replaced them with 15 nurse practitioners last year, and in Texas 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners. 

Quite often in life, the answers to some of the biggest questions we have, are staring us right in the face and incredibly simple. Healthcare can never be fixed unless we radically simplify everything and strip away the unnecessary complexities in our fragmented system. The divergence of the above lines, however, actually represents so much more than just an obnoxious visual. It actually symbolizes what happens when any organization, system, or even country, becomes top-heavy and loses sight of what is happening at the front lines. And in the end, it eventually collapses under its own weight.

When this happens in America, we cannot predict, but consider this: The amount we spend on healthcare would be the 4th largest economy in the world if it stood alone (at $3.5 trillion, only China and Japan have a higher total GDP). With an aging population, increasing chronic comorbidities, and expensive new treatments, if costs are not reined in, healthcare expenditure could account for a third of the entire GDP in about 25 years. A figure that will quite simply destroy the American economy.

It would be one thing if all the administration and bureaucracy was actually resulting in an improved and more efficient healthcare system. But look around you folks. Acute physician shortages now plague every state. Millions of people find it impossible to find a primary care doctor. Certain specialties are now booking out appointments months in advance. ERs and hospitals are overflowing. And in the end, patients are still facing soaring out of pocket expenses.

The last 20 years have witnessed the consolidation and corporatization of the entire U.S. healthcare system. Sold initially as a way to reign in costs, I am yet to see any evidence that it’s done anything other than dramatically increase costs (please feel free to forward me any financial analysis if I’m wrong). And why should that be a surprise to anyone?

I’ll leave you to stare once again at the above graph for a minute or two, and take in a comment that a distinguished physician colleague of mine recently made: “It’s like the physicians have been given weed killer and the administrators have been given Miracle-Gro.”

Affordable Care Act funding in question after health insurance taxes repealed

The Cadillac Tax, Health Insurance Tax and Medical Device Tax were recently repealed, raising questions over how the Affordable Care Act will be funded in the future. Yahoo Finance’s Anjalee Khemlani joins Adam Shapiro, Julie Hyman and Dan Howley during On the Move to break it all down.

Andrew Yang Has The Most Conservative Health Care Plan In The Democratic Primary

Daniel Marans of the Huff Post pointed out that Entrepreneur Andrew Yang has had unexpected staying power in the Democratic presidential primary thanks in part to the enthusiasm for his plan to provide every American with a basic income of $1,000 a month.

But the boldness of his signature idea only serves to underscore the unambitiousness of the health care plan he released earlier this month.

In fact, Yang’s health plan, which he bills as an iteration of the left’s preferred “Medicare for All” policy, is more conservative than proposals introduced by the candidates typically identified as moderate. 

Former Vice President Joe Biden, South Bend, Indiana, Mayor Pete Buttigieg and Sen. Amy Klobuchar of Minnesota all at least call for the creation of a public health insurance option that would be available to every American. (Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts favor Medicare for All, which would move all Americans on to one government-run insurance plan ― though the two senators disagree on the timeline for implementing the idea.)

In terms of expanding health insurance coverage, Yang says on his website merely that he would “explore” allowing the employees of companies that already provide health insurance the chance to buy into Medicare. 

“We need to give more choice to employers and employees in a way that removes barriers for businesses to grow,” Yang writes.

Under Yang’s plan, people employed by businesses that do not provide insurance, or who are self-employed, would continue to purchase coverage on the exchanges created by former President Barack Obama’s Affordable Care Act.

The decision not to focus on expanding coverage distinguishes Yang dramatically from his competitors. And in the foreword to his plan, he explains that that is a deliberate choice, since enacting single-payer health care is “not a realistic strategy.”

“We are spending too much time fighting over the differences between Medicare for All, ‘Medicare for All Who Want It,’ and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives,” he writes. “We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.”

When asked about how Yang plans to expand health insurance coverage ― 27 million Americans remain entirely uninsured and millions more have insurance that is so threadbare they do not use it ― Yang’s campaign referred HuffPost to his website. 

Yang would increase health care access through reforms designed to reduce the health care system’s underlying costs, according to his campaign. On his website, he divides those reforms into six categories: bringing down the cost of prescription drugs through bulk negotiation; investing in waste-saving health care technologies; realigning medical providers’ “incentives” away from waste and abuse; increasing investment in preventive and end-of-life health care; making the provision of health care more “comprehensive”; and reducing the influence of lobbyists on the political system.

Yang implies that his rivals have sacrificed cost control in the name of expanding coverage. But when it comes to the specifics, Yang’s competitors have already gotten behind many of the ideas he is proposing ― and sometimes take them a step further. 

For example, Buttigieg has a provision in his health care plan that would prohibit “surprise billing” ― the practice of providing unwitting patients with a large bill after a medical procedure when a doctor who performed it is not in the hospital’s insurance network. Yang does not mention the practice in his health care plan.

One provision of Yang’s plan that genuinely sets him apart is his plan to encourage the replacement of the fee-for-service billing model for doctors with salaries. The latter model is supposed to cut back on duplicative practices and foster more holistic care. Other elements of his plan, such as “incentivizing” gym memberships, healthy eating and bike commuting as a form of preventive health care, have drawn eye rolls from leftists who regard the ideas as paternalistic.

First and foremost, though, many progressives are likely to find fault with Yang’s plan, because they consider his use of the term “Medicare for All” misleading. 

For months on the campaign trail, Yang claimed that he supported Medicare for All, though not the provision of Sanders’ bill ― and its companion in the House ― requiring people with private insurance to enroll in an expanded Medicare program. 

He even aired a television ad casting his commitment to the policy as a reflection of his experience as the father of a special needs child.

Yang says on his campaign website that he is still firmly committed to the “spirit” of Medicare for All. But now that he has introduced a plan of his own, that claim is harder to defend.

Yet the Yang campaign is plowing full-steam ahead with its appropriation of the term in a new 30-second ad, “Caring.”

“If my husband, Andrew Yang, is president, he’ll fight for Medicare for All with mental health coverage,” Yang’s wife, Evelyn, says in the ad. 

Fate of Obamacare uncertain amid tax repeals, lawsuits and Medicare-for-all push consider that Democrats seize on anti-Obamacare ruling to steamroll GOP in 2020

Alice Miranda Ollstein and James Arkin reported that a court ruling last week putting the Affordable Care Act further in jeopardy may provide the opening Democrats have been waiting for to regain the upper hand on health care against Republicans in 2020.

At the most recent Democratic presidential debate, candidates largely avoided discussing the lawsuit or Republicans’ years-long efforts to dismantle Obamacare, and instead continued their intra-party battle over Medicare for All.

But Senate Democrats, Democratic candidates and outside groups backing them immediately jumped on the news of the federal appeals court ruling — blasting out ads and statements reminding voters of Republicans’ votes to repeal the 2010 health care law, support the lawsuit and confirm the judges who may bring about Obamacare’s demise.

“I think it’s an opportunity to reset with the New Year to remind people that there’s a very real threat to tens of millions of Americans,” Sen. Brian Schatz (D-Hawaii) said in an interview. “We Democrats are always striving to improve the system, but, at a minimum, the American people expect us to protect what they already have.”

In 2018, Democrats won the House majority and several governorships largely on a message of protecting Obamacare and its popular protections for preexisting conditions. This year continued the trend, with Kentucky’s staunchly anti-Obamacare governor, Matt Bevin, losing to Democratic now-Gov. Andy Beshear.

The landscape in 2020 may be more challenging for Democrats than it was in 2018, when Republicans had more recently voted to repeal the Affordable Care Act. Republicans also say they now have more ammunition to push back on Democrats’ arguments with the party’s divisions over single-payer health care, which would replace Obamacare, shaping the presidential race.

Moreover, the appeals court’s ruling — which in all likelihood punted any final disposition on the case until after the 2020 elections — eliminates what some Republicans saw as a nightmare scenario: If the court had embraced a lower court ruling striking down the law in its entirety, it would have put the issue before the Supreme Court during the heat of the election, putting tens of millions of Americans’ health insurance at risk.

Still, Democrats believe they can win the political battle over health care, especially in Senate races. At least a half-dozen GOP senators are up for reelection, and Democrats need to net three seats to win back control of the chamber if they also win back the presidency. Democratic strategists and candidates are eager to run a health care playbook that mirrors that of the party’s House takeover in 2018, and say Republicans are uniquely vulnerable after admitting this year that they have no real plan for dealing with the potential fallout of courts striking down Obamacare.

Within a day of the ruling, the pro-Obamacare advocacy group Protect Our Care cut a national TV and digital ad featuring images of Sens. Susan Collins (R-Maine) and Cory Gardner (R-Colo.), warning that if the lawsuit succeeds, “135 million Americans with preexisting conditions will be stripped of protections, 20 million Americans will lose coverage and costs will go up for millions more.”

Other state-based progressive groups told POLITICO they’re readying their own ads going after individual Senate Republicans over the 5th Circuit’s ruling.

Protect Our Care director Brad Woodhouse predicts that it’s just a preview of the wave of attention the issue will get in the months ahead, as Democratic candidates and outside groups alike hammer the GOP on the threat their lawsuit poses to Obamacare.

“If there is one issue in American politics that is going to flip the Senate from Republican to Democratic in 2020, it’s this issue,” he said. “Our message is simple: President [Donald] Trump and Republicans are in court right now, suing to take away the ACA, take away your health care. And if Cory Gardner or Thom Tillis or any of them don’t think that’s an indefensible position, they should ask the 40-plus House Republicans who lost their seats in 2018.”

More than a dozen Republican state attorneys general, backed by the Trump administration, have been arguing in federal court for more than a year that Congress rendered the entire Affordable Care Act untenable when they voted as part of the 2017 tax bill to drop the penalty for not buying insurance down to zero. A district judge in Texas sided with them last year in a sweeping ruling declaring all of Obamacare unconstitutional.

Last week, an appeals court agreed that the elimination of the penalty made the individual mandate unconstitutional, but sent the case back down to the district court to decide whether any of the law could be separated out and preserved. The move all but guarantees the case won’t reach the Supreme Court until after the election, but it maintains the cloud of uncertainty hanging over the health law that experts say drives up the cost of insurance.

Though no one is in danger of losing their health coverage imminently, Democratic challengers in nearly every Senate battleground race, including Arizona, North Carolina, Maine and Iowa, jumped on the court ruling as an opportunity to attack Republicans on health care.

“Democrats have been in the fight to ensure that people across this country have access to affordable health care,” said Sen. Catherine Cortez Masto of Nevada, the chair of the DSCC. “This opinion does not help the Republicans.”

Sara Gideon, Democrats’ preferred candidate in Maine to take on Collins, called the lawsuit a “direct threat to the protections countless Mainers and Americans depend on. She has been reminding voters that Collins’ vote on the 2017 tax reform law triggered the ACA lawsuit in the first place, and she voted to confirm one of the 5th Circuit judges that recently sided with the Trump administration’s arguments against the law.

Unlike the vast majority of her GOP colleagues in the upper chamber, Collins has spoken up against the lawsuit. She has written multiple times to Attorney General Bill Bar, urging him to defend the ACA in court. Collins told POLITICO the day after the ruling that it was “significant” that the 5th Circuit judges were clearly “very uneasy with the thought of striking down the entire law” and instead sent the case back down to the lower court for reconsideration. Collins’ campaign spokesman both emphasized that she believes the government should defend the law and criticized Democrats for defending the unpopular individual mandate.

Tillis, the vulnerable North Carolina senator, said the lawsuit gave Republicans “breathing room” to find a viable replacement for Obamacare and attempted to flip the attack on Democrats by tying them to their presidential contenders.

“I think the fact that they all raised their hands and said we need Medicare for All is also raising their hands and saying the Affordable Care Act has failed,” Tillis said.

Though most of the 2020 presidential candidates have come out against Medicare for All, and more Democratic voters favor a choice between private insurance and a public option, the single-payer debate has given Republicans a potent line of attack that they’re turning to more than ever in the wake of the court’s ruling.

“Obamacare failed to lower health care costs for millions of Americans, and now Democrats want a complete government takeover of our health care system,” said Jesse Hunt, a spokesman for the National Republican Senatorial Committee. “They spent all of 2019 defending their socialist plan to eliminate employer-based health care coverage, and those problems will not subside anytime soon.”

The effectiveness of the GOP attacks will depend largely on the Democratic nominee for president — if it is someone who backs Medicare for All, it will be much more difficult for Senate candidates who don’t support the policy to separate themselves from it. But Democratic activists say they’re confident the GOP’s actions in court will sway voters more than their claims about Medicare for All.

“We can prepare for and counter those attacks by reminding voters that [Republicans are] fighting actively to take health care away,” said Kelly Dietrich, the founder and CEO of the National Democratic Training Committee, which coached more than 17,000 candidates for federal and state office in 2019. “Republicans’ ability to use fear as a tool to win elections should never be underestimated. But the antidote is to fight back just as hard.”

Year in Review: Lots of talk, not a lot of action in healthcare politics

Rachel Cohrs noted that lawmakers and regulators talked big on tackling high drug prices and surprise medical bills in 2019, but agreement on the bipartisan policies remained elusive. Some healthcare policy could be attached to a potential budget deal in December, but it is still unclear whether lawmakers will resolve funding disputes by the end of the year.

Despite major bipartisan legislative packages spearheaded by senior Senate Republican leaders, disputes over details and intense lobbying efforts have so far stalled progress in Congress. Drug makers are fighting a provision in the Senate Finance Committee’s drug pricing bill that would require them to pay back Medicare for drug price hikes faster than inflation, and providers and insurers are warring over how out-of-network medical bills should be handled.

Competing approaches to address surprise medical billing came to a head in December when a bipartisan, bicameral compromise proposal on addressing surprise medical bills emerged, but a key Senate Democrat involved in the negotiations had not signed on as of press time. Despite provider-friendly tweaks, providers still oppose the legislation and it is unclear whether House and Senate leadership have an appetite to include it in must-pass legislation.

Health reform 3.0: Early in the year, Senate health committee Chair Lamar Alexander and ranking Democrat Patty Murray released a wide-ranging plan to lower costs that addresses surprise medical bills; contract reform provisions; cost transparency; and boosting generic competition for Rx drugs. The year ended with a bipartisan, bicameral bill emerging, but at deadline it lacked Murray’s endorsement.

Reducing drug prices: Addressing drug prices was the other issue that dominated the policy landscape. Competing plans emerged, and the House passed a bill in mid-December on a party-line vote.

Grinding to a halt: House Speaker Nancy Pelosi announced a formal impeachment inquiry into President Donald Trump, which soured the prospects of a grand bargain between Trump and Pelosi on drug pricing and complicated the timeline for passing major healthcare policy.

Drug pricing was also a top priority for the Trump administration, but several marquee policy ideas have been stopped by the courts, abandoned, or are forthcoming. The White House decided to retract a prominent initiative that would have required insurers to pass manufacturer rebates directly to patients at the pharmacy counter, and a rule that would have compelled drug makers to include list prices in television advertisements is tied up in court. House Democrats passed a partisan government drug price negotiation bill, but it almost certainly will not become law.

The administration could at any time release a regulation outlining a process to allow states to import prescription drugs from Canada or move forward with a demonstration that would tie payments for physician-administered drugs in Medicare to international drug prices, but it has not yet acted on either proposal.

The 10 most-searched questions on health Reported by Sandee LaMotte of CNN

There were more questions that had people Googling in 2019.

The full list of the most-searched health questions in the United States this year also included questions about the flu, kidney stones and human papillomavirus or HPV:

  1. How to lower blood pressure
  2. What is keto?
  3. How to get rid of hiccups
  4. How long does the flu last?
  5. What causes hiccups?
  6. What causes kidney stones?
  7. What is HPV?
  8. How to lower cholesterol
  9. How many calories should I eat a day?
  10. How long does alcohol stay in your system?

NYU started to answer one of the big questions in the design of a fair healthcare system when they decided to declare their medical school tuition free. If all medical schools were tuition free the graduating doctors wouldn’t have the huge debt and they could have the opportunities to chose primary care and provide care to underserved rural and poorer communities. 

One step at a time and maybe next year Congress can really improve the health care system of our U.S.A.

And to all you interested readers out there Happy New Year! Maybe those in control will start the process of improving the delivery of affordable health care to all and not worry about their future political aspirations. What a change that would be!

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!!!

 

Whistleblower Alleges Fraud At A Large Medicare Advantage Plan In Seattle and on and on about the last Democrat Debate and more on Medicare for All

72488737_2301802426616070_6529440653267435520_nWhat a unique world we live in. Bernie Sanders, a man running for the position of President, ignores his symptoms of heart disease, has a heart attack, needs stents for his coronary arteries which are obstructed and a few weeks later is back on the difficult road to running for President. What a jerk who I am sure is ignoring his doctor’s advice, who I’m sure has discussed his post-procedure heart disease restrictions including taking stress, etc. easy for at least 6 weeks, or that what is what I would tell my patient. And this is the man who is telling us all how we should all be deciding our health care system. Unbelievable!! Now, with all the whistleblowers coming out of the woodworks, Fred Schulte points out another whistleblower. Group Health Cooperative in Seattle, one of the United States’ oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.

Teresa Ross, a former medical billing manager at the insurer, alleges that it sought to reverse financial losses in 2010 by claiming that some patients were sicker than they were or by billing for medical conditions that patients didn’t actually have. As a result, the insurer retroactively collected an estimated $8 million from Medicare for 2010 services, according to the suit.

Ross filed suit in federal court in Buffalo, N.Y., in 2012, but the suit remained under a court seal until July and is in its initial stages. The suit also names as defendants two medical coding consultants — consulting firm DxID of East Rochester, N.Y., and Independent Health Association, an affiliated health plan in Buffalo, N.Y. All denied wrongdoing in separate court motions filed late Wednesday to dismiss the suit.

The Justice Department has thus far declined to take over the case but said in a June 21 court filing that “an active investigation is ongoing.”

The whistleblower suit is one of at least 18 such cases documented by Kaiser Health News that accuses Medicare Advantage managed care plans of ripping off the government by exaggerating how sick their patients were. The whistleblower cases have emerged as a primary tool for clawing back overpayments. While many of the cases are pending in courts, five have recovered a total of nearly $360 million.

“The fraudulent practices described in this complaint are a product of the belief, common among [Medicare Advantage] organizations, that the law can be violated without meaningful consequence,” Ross alleges.

Medicare Advantage plans are a privately run alternative to traditional Medicare that often offers extra benefits such as dental and vision coverage but limits the choice of medical providers. They have exploded in popularity in recent years, enrolling more than 22 million people, just over 1 in 3 of those eligible for Medicare.

Word of another whistleblower alleging Medicare Advantage billing fraud comes as the White House is pushing to expand enrollment in the plans. On Oct. 3, President Trump issued an executive order that permits the plans to offer a range of new benefits to attract patients. One, for instance, is partly covering the cost of Apple watches as an inducement.

Group Health opened for business more than seven decades ago and was among the first managed care plans to contract with Medicare. Formed by a coalition of unions, farmers and local activists, the HMO grew from just a few hundred families to more than 600,000 patients before its members agreed to join California-based Kaiser Permanente. That happened in early 2017, and the plan is now called the Kaiser Foundation Health Plan of Washington. (Kaiser Health News is not affiliated with Kaiser Permanente.)

In an emailed statement, a Kaiser Permanente spokesperson said: “We believe that Group Health complied with the law by submitting its data in good faith, relying on the recommendations of the vendor as well as communications with the federal government, which has not intervened in the case at this time.” Ross nods to the plan’s history, saying it has “traditionally catered to the public interest, often highlighting its efforts to support low-income patients and provide affordable, quality care.”

The insurer’s Medicare Advantage plans “have also traditionally been well regarded, receiving accolades from industry groups and Medicare itself,” according to the suit.

But Ross, who worked at Group Health for more than 14 years in jobs involving billing and coding, says that from 2008 through 2010, the company “went from an operating income of almost $57 million to an operating loss of $60 million.” Ross says the losses were “due largely to poor business decisions by company management.”

The lawsuit alleges that the insurer manipulated a Medicare billing formula known as a risk score. The formula is supposed to pay health plans higher rates for sicker patients, but Medicare estimates that overpayments triggered by inflated risk scores have cost taxpayers $30 billion over the past three years alone.

According to Ross, a Group Health executive in 2011 attended a meeting of the Alliance of Community Health Plans, where he heard from a colleague at Independent Health about an “exciting opportunity” to increase risk scores and revenue. The colleague said Independent Health “had made a lot of money” using its consulting company, which specializes in combing patient charts to find overlooked diseases that health plans can bill for retroactively.

In November 2011, Group Health hired the firm DxID to review medical charts for 2010. The review resulted in $12 million in new claims, according to the suit. Under the deal, DxID took a percentage of the claims revenue it generated, which came to about $1.5 million that year, the suit says.

Ross says she and a doctor who later reviewed the charts found “systematic” problems with the firm’s coding practices. In one case, the plan billed for “major depression” in a patient described by his doctor as having an “amazingly sunny disposition.” Overall, about three-quarters of its claims for higher charges in 2010 were not justified, according to the suit. Ross estimated that the consultants submitted some $35 million in new claims to Medicare on behalf of Group Health for 2010 and 2011.

In its motion to dismiss Ross’ case, Group Health called the matter a “difference of opinion between her allegedly ‘conservative’ method for evaluating the underlying documentation for certain medical conditions and her perception of an ‘aggressive’ approach taken by Defendants.”

Independent Health and the DxID consultants took a similar position in their court motion, arguing that Ross “seeks to manufacture a fraud case out of an honest disagreement about the meaning and applicability of unclear, complex, and often conflicting industry-wide coding criteria.”

In a statement, Independent Health spokesman Frank Sava added: “We believe the coding policies being challenged here were lawful and proper and all parties were paid appropriately.”

Whistleblowers sue on behalf of the federal government and can share in any money recovered. Typically, the cases remain under a court seal for years while the Justice Department investigates.

How would Warren pay for ‘Medicare for All’? Enough evasion, it’s past time for answers.

Chris Truax points out that the last 2 months al anyone who watches the politicians suggesting that Medicare for all is the solution to the healthcare crisis has bombarded the news. Medicare for All will create winners and losers. It’s all very well to say you can’t make an omelet without breaking some eggs unless you’re the egg.

When it comes to doing things, Elizabeth Warren has a plan for everything — and she’s happy to tell you all about it. But when it comes to paying for things, I’m sorry to say, the Massachusetts senator dodges and deflects like a Donald Trump defender.

It’s estimated that “Medicare for All” will cost the federal government an extra $3 trillion a year. That’s more than $9,000 annually from every man, woman, and child in America. Despite being asked, again and again, Warren refuses to acknowledge that paying for this is going to require an across-the-board tax increase — and a pretty massive one, at that. Instead, she keeps talking about how “costs” will go down before she changes the subject to how stressful it is to have your insurance canceled when you get sick or when you have to cope with your mom having diabetes. That’s very true, I’m sure. But we’re talking fiscal policy here.

Warren To Release Plan To Pay For ‘Medicare For All’

Yuval Rosenberg of The Fiscal Times noted that now, just last week Massachusetts Sen. Elizabeth Warren said Sunday she will roll out a plan to pay for an expansive single-payer health care system in the coming weeks, promising the plan would decrease overall costs for the middle class.

“I plan over the next few weeks to put out a plan that talks, specifically, about the cost of ‘Medicare for All’ and how we pay for it,” Warren said at the end of a town hall here at Simpson College. “I will not sign a bill into law that does not reduce the cost of health care for middle-class families.”

Warren’s aides have long suggested she was studying ways to pay for the health care plan originally backed by Vermont Sen. Bernie Sanders, one of her leading rivals for the 2020 Democratic presidential nomination. In recent days, Warren has faced criticism from lower-profile candidates in the race — especially South Bend, Indiana, Mayor Pete Buttigieg and Minnesota Sen. Amy Klobuchar — for her failure to explain how she would pay for the ambitious plan, which would replace private health insurance with generous, universal coverage paid for by the federal government.

“Everybody who is running for president right now knows that families are getting crushed by the high cost of health care,” Warren told the crowd of nearly 500 people. “They also know that the cheapest possible way to make sure that everyone gets the health care that they need is Medicare for All.”

Warren’s statement came after her standard 40-minute stump speech and three questions from attendees, none of whom asked about Medicare for All. The addition appeared to be an attempt to short-circuit recent criticisms of her health care plan.

Warren has previously promised, most recently at the Oct. 15 debate, that no middle-class family would see an increase in overall health care costs. And her aides have said since at least September that she was evaluating ways to pay for Medicare for All. She does not plan to significantly alter the details of the legislation she’s co-sponsored with Sanders in the way Sen. Kamala Harris (D-Calif.) did with her own health care proposal over the summer. Warren said she had been working on the problem of how to pay for the legislation for “months and months.”

“It’s just a little more work until it’s finished,” she said.

For a campaign that has long prided itself on detailed policy proposals, releasing a plan to pay for Medicare for All — which is sure to generate intense scrutiny from the media and her rivals for the nomination — is a high-risk but likely necessary move. Whether or not a plan for Medicare for All would lower costs for the middle class would rely heavily on complicated details, including how progressive the tax system supporting the plan is and how aggressively the government is able to control the cost of health care.

Estimates of how much the plan would cost vary wildly, as do estimates of how much switching to a single-payer system would increase or decrease overall health care costs.

Buttigieg, in particular, has aggressively questioned how Warren would pay for the plan, and said she is being dishonest by not saying whether or not taxes would go up for middle-class families. Sanders has said taxes would likely go up, while overall costs would drop. But Warren has resisted the question, arguing that admitting taxes would rise is equal to accepting a dishonest Republican framing of the issue. Warren has also attacked Buttigieg’s plan for failing to cover every American, dubbing it “Medicare for all who can afford it.”

“Your signature, Senator, is to have a plan for everything. Except this,” Buttigieg said at the debate. “No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare for All plan that Senator Warren is putting forward.”

Soon, Buttigieg will get his answer.

She ended your last weekend rally asking the “people” to give her a little more time and she will announce how she proposes to pay for it. More important, is her plan, probably an increase of taxes for all, including Middle Americans, to pay for it…. realistic???? Remember, nothing in any of the political “experts” proposals are ever free. Someone, you and I, have to pay for it in some way or another!!

Winners and losers in Medicare for All

There’s a very unpleasant collectivist feel to this. It’s all very well to say you can’t make an omelet without breaking some eggs … unless you’re the egg. About 56% of Americans — more than 180 million — have private health insurance through an employer. Medicare for All would sweep that all away, whether the people who have that insurance like it or not, in the name of the common good. Perhaps worse, as Warren knows perfectly well but steadfastly refuses to admit, there are going to be winners and losers. Costs might go down in the aggregate, but individuals and families aren’t aggregates.

Elizabeth Warren’s choice: ‘Medicare for All’ purity or a path to beating Trump?

For example, Warren keeps saying that the total you pay for health care would end up being less under Medicare for All because it will eliminate out-of-pocket costs like premiums and copays. That’s an oversimplification at best, especially since she hasn’t said how she would finance this enormously expensive project.

But it is a given that everyone will pay higher taxes, and it’s older people who spend more on premiums and out-of-pocket health care costs — a lot more. Consequently, older people will be far more likely to see these higher taxes offset by a decrease in the cost of their health care. By contrast, younger people and families at healthier stages of their lives would still be paying new taxes but will see fewer benefits.

 Your Two-Minute Summary of Tuesday’s Democratic Medicare-for-All Debate

Tuesday night’s Democratic presidential debate once again highlighted the candidate’s deep divides over Medicare for All. After opening questions related to the House impeachment inquiry into President Trump, the debate quickly turned to the health care reform plan backed by Senators Elizabeth Warren and Bernie Sanders.

Warren again tried to reframe the question of whether she would raise middle-class taxes to pay for the plan. “Costs will go up for the wealthy. They will go up for big corporations. And for middle-class families, they will go down,” she said. “I will not sign a bill into law that does not lower costs for middle-class families.”

Pete Buttigieg, who last month called Warren “extremely evasive” on the tax question, pounced. “No plan has been laid out to explain how a multi-trillion-dollar hole in this Medicare for all plan that Senator Warren is putting forward is supposed to get filled in,” he said, touting his “Medicare for All Who Want It” proposal as a better alternative. “I don’t understand why you believe the only way to deliver affordable coverage to everybody is to obliterate private plans, kicking 150 million Americans off of their insurance in four short years,” he said to Warren. “Why unnecessarily divide this country over health care when there’s a better way to deliver coverage for all?”

Warren jabbed back at Buttigieg, saying his “Medicare for All Who Want It” plan is really “Medicare for All Who Can Afford It.”

Joe Biden and Amy Klobuchar, both of whom support building on the Affordable Care Act with a public option, also attacked Medicare for All as expensive and impractical. “The difference between a plan and a pipe dream is something that you can actually get done,” Klobuchar said. “And we can get this public option done.”

Sanders defended his plan — and opened the door for further attacks on Warren. “At the end of the day, the overwhelming majority of people will save money on their health care bills,” Sanders said. “But I do think it is appropriate to acknowledge that taxes will go up. They’re going to go up significantly for the wealthy. And for virtually everybody, the tax increase they pay will be substantially less than what they were paying for premiums and out-of-pocket expenses.”

Klobuchar took the opportunity to criticize Warren again. “At least Bernie is being honest here, and saying how he’s going to pay for this and that taxes are going to go up,” she said. “And I’m sorry, Elizabeth, but you have not said that, and I think we owe the American people to tell them where we will send the invoice.”

A political strategy: The attacks on Warren are widely seen as a sign that she’s now the Democratic frontrunner — and they’re likely a sign that, as tiresome as the repeated tax question might get, Warren is going to keep getting asked it by the media, Democratic rivals, and Republicans. She’s pointedly not willing to answer directly (or take the bait) and say that she will raise taxes, even as she continues to argue that overall costs under Medicare for All will go down for the middle class. Her caginess on the question suggests she thinks that higher taxes on the middle class, or the very word “taxes,” might be toxic in an election campaign against Trump. But her dodging hasn’t hurt her so far.

What the polls say: The latest Kaiser Family Foundation tracking poll found that 51% of those surveyed favor Medicare for All, while 47% oppose it. A majority of Democrats and about half of independents support a national Medicare-for-all plan, while more than 70% of Republicans oppose the idea. Support for a public option is higher, at 73%. A CBS News poll released Tuesday found that 59% of voters believe that a government-run plan should “compete with private insurance” as under a public option, while 32% said they would want it to replace private insurance. But polls have also found that support for Medicare for All or other health plans can shift significantly depending on the arguments presented.

The bottom line: Larry Levitt of the Kaiser Family Foundation reminds us that there is no simple answer to the question of ultimate costs, and that a wide variety of outcomes are possible depending on how Medicare for All is implemented. “A Medicare for all plan could be designed so that many people, including those who are middle class, pay less in taxes than they are paying now in premiums, deductibles, and copays,” Levitt tweeted Tuesday. “It depends entirely on the details.”

J&J Pulls Baby Powder From Market

FDA testing reveals chrysotile fibers in one lot of embattled product of the J&J babypowder, which the courts are suggested cause ovarian cancer.

John Gever the managing editor of the MedPage reported that Johnson  & Johnson is recalling one lot of its famous baby powder because of possible asbestos contamination, the FDA announced Friday.

“FDA testing has found that a sample from one lot of the product contains chrysotile fibers, a type of asbestos,” the agency said in a press release. “Consumers who have Johnson’s Baby Powder lot #22318RB should stop using it immediately and contact Johnson & Johnson for a refund.”

Although Johnson & Johnson agreed to initiate the recall, it stopped short of admitting that the product really was contaminated. It questioned “the integrity of the tested sample and the validity of the test results,” suggesting that it might not even be a genuine Johnson & Johnson product.

The company has consistently denied that its baby powder — on the market for more than a century — has ever been contaminated with asbestos, but the company has faced numerous lawsuits from consumers alleging that they or loved ones developed cancer because of asbestos in talc components. The baby powder is popular not only for use on babies; many women have used it to reduce “feminine odors” as well.

The FDA said it has tested some 50 cosmetic products since 2018 for asbestos contamination, including two lots of Johnson’s Baby Powder. One was negative and the other was positive. This lot of baby powder is not the first to test positive and the FDA has previously issued alerts on others.

“The FDA expects to issue the full results from this survey, including all tested products having both positive and negative results, by the end of the year,” the agency said.