Category Archives: Doctors

Rise in health uninsured may be linked to immigrants’ fears but still they get free health care. Health care cost without insurance and another medical school offers free tuition!

hydrant442[3418]As I caught a ride from the San Diego airport to my hotel in Little Italy, I heard my driver relate to me her and her family’s woes regarding health care. She and her husband were planning of leaving California just as soon as their youngest son finished high school. And they were very tired of the ever-increasing taxes and fees. She was most annoyed that the illegal immigrant families would get free health care and her husband and she can’t afford basic health care. But they have found a way to use urgent care clinics to cover their needs. Alonso-Zaldivar noted that when the Census Bureau reported an increase in the number of people without health insurance in America, it sent political partisans reaching for talking points on the Obama-era health law and its travails. But the new numbers suggest that fears of the Trump administration’s immigration crackdown may be a more significant factor in the slippage.
Overall, the number of uninsured in the U.S. rose by 1.9 million people in 2018, the agency reports this past week. It was the first jump in nearly a decade. An estimated 27.5 million people, or 8.5% of the population, lacked coverage the entire year. Such increases are considered unusual in a strong economy.
The report showed that a drop in low-income people enrolled in Medicaid was the most significant factor behind the higher number of uninsured people.
Hispanics were the only major racial and ethnic category with a significant increase in their uninsured rate. It rose by 1.6 percentage points in 2018, with nearly 18% lacking coverage. There was no significant change in health insurance for non-Hispanic whites, blacks and Asians.
“Some of the biggest declines in coverage are coming among Latinos and noncitizens,” said Larry Levitt of the nonpartisan Kaiser Family Foundation, who tracks trends in health insurance coverage. “These declines in coverage are coming at a time when the Trump administration has tried to curb immigration and discourage immigrants from using public benefits like Medicaid.”
Health care is the defining issue for Democrats vying for their party’s 2020 presidential nomination. Candidates wasted no time in Thursday’s debate highlighting the split between progressives such as Sens. Bernie Sanders and Elizabeth Warren , who favor a government-run system for all, including people without legal permission to be in the country, and moderates like former Vice President Joe Biden. He supports building on the Affordable Care Act and adding a new public plan option, open to U.S. citizens and legal residents.
Although the candidates did not dwell on the uninsured rate, Democratic congressional leaders have said the census figures show the administration’s “sabotage” of the Obama health law.
The administration issued a statement blaming the law’s high premiums, unaffordable for solid middle-class people who do not qualify for financial assistance. “The reality is we will continue to see the number of uninsured increase until we address the underlying issues in Obamacare that have failed the American people,” the statement said.
While the report found an increase in the uninsured rate among solid middle-class people the Trump administration wants to help, there was no significant change in employer coverage or in plans that consumers purchase directly. Those are the types of health insurance that middle-class workers tend to have. Other patterns in the data pointed to an immigration link.
Health economist Richard Frank of Harvard Medical School said the data “suggest that we are dealing with immigration health care crisis potentially in some unexpected ways.” Frank was a high-ranking health policy adviser in the Obama administration.
The uninsured rate for foreign-born people, including those who have become U.S. citizens, also rose significantly, mirroring the shift among Hispanics.
Frank noted that immigrant families often include foreign-born and native-born relatives, “and you can imagine the new approach to immigration inhibiting these people from doing things that would make them more visible to public authorities,” such as applying for government health care programs.
Immigrants’ fears may also be part of the reason for a significant increase in the number of uninsured children in 2018, said Katherine Hempstead, a senior health policy expert with the nonpartisan Robert Wood Johnson Foundation, which works to expand coverage. Among immigrant children who have become citizens, the uninsured rate rose by 2.2 percentage points in 2018, to 8.6%. The increase was greater among kids who are not citizens.
“There are a lot of kids eligible for public coverage but not enrolled because of various things that make it less comfortable for people to enroll in public coverage,” said Hempstead.
The administration’s “public charge” regulation, which could deny green cards to migrants who use government benefits such as Medicaid was finalized this year. But other efforts to restrict immigration, including family separations at the U.S.-Mexico border, were occurring in the period covered by the report.
“People are interpreting ‘public charge’ broadly and even though their kids are eligible for Medicaid because they were born in this country, they are staying away,” said Hempstead. Children’s coverage often follows their parents’ status.
Other factors could also be affecting the numbers:
—The report found a statistically significant increase in solid middle-class people who are uninsured. Health care researcher and consultant Brian Blase, who until recently served as a White House adviser, said it appears to reflect people who cannot afford high ACA premiums. Blase said Trump policies rolled out last year should provide better options for this group. The changes include short-term health insurance plans, health reimbursement accounts and association health plans.
—Experts are debating the impact of a strong job market on the decline in Medicaid enrollment. It’s possible that some Medicaid recipients took jobs that boosted their earnings, making them ineligible for benefits. But if those jobs did not provide health benefits, then the workers would become uninsured. The Census Bureau report showed no significant change in workplace coverage.
Physicians Struggle to Care for Migrants on U.S.-Mexico Border
Elizabeth Hlavinka, Staff writer for MedPage spoke with physicians providing care to migrants in border cities and points out the experiences of providers in El Paso Texas. These stories are evidence of the increasing health care problem facing the migrants and the health care workers attempting to care for the large population.One was the experience of a 17-year-old girl who came into his clinic dizzy, fatigued, and dehydrated, but Carlos Gutierrez, MD, expected that, knowing she’d recently traveled 2,000 miles from Guatemala.
He told her to drink plenty of water to stay hydrated. She had just been released from a detention center and the next part of her journey would begin the following day, traveling east to stay with relatives.
But then she mentioned the diabetes medication she started taking back home, which she stopped before starting her trip.
Alarmed she would go into diabetic ketoacidosis without insulin, Gutierrez checked her blood sugar. It was 700 mg/dL, enough to send her into a coma or worse if she went any longer without treatment.
“It just goes to show that if you had adequate personnel, something like that should have been picked up,” Gutierrez told MedPage Today. “How can you ignore this condition that is deadly if you don’t treat it aggressively?”
Many doctors and healthcare providers have been drawn in by the border crisis, hoping to provide relief to patients in need. Although recent immigration policies have led to dwindling numbers of refugees in the U.S., federal detention center deaths have been reported, and physicians in El Paso contacted by MedPage Today described troubling cases in which medical care was lacking.
The Guatemalan teenager is one of hundreds of patients Gutierrez has seen as a volunteer for Annunciation House, a non-profit organization in El Paso that provides hospitality services to migrants released from detention who are seeking asylum.
There was also the 10-year-old child with congenital adrenal hyperplasia who’d gone without hydrocortisone for a week, and dozens of adults have presented with blood pressure readings upwards of 200/120 mm Hg as a result of not having their hypertension medication, Gutierrez said.
Why Care Goes Awry?
When migrants crossing the border are apprehended by Customs and Border Protection (CBP), their belongings — including belts, shoelaces, and medication — are confiscated. Migrants are not intended to stay in CBP custody for more than 72 hours, just enough time to allow for initial processing before they are transferred to detention centers run by Immigration and Customs Enforcement (ICE).
All ICE detainees then undergo an initial screening, and those whose medications have been confiscated can be issued new prescriptions, an ICE official told MedPage Today. They also get a comprehensive physical exam within two weeks of arrival, and their belongings are returned to them upon release, he said.
But parts of a medical history can be lost in translation if migrants speak less common native languages and are relying on a child as a translator. In other situations, migrants could be released before they get their medication, causing them to go days without it.
Ramon Villaverde, a medical student and Annunciation House volunteer, said migrants may also withhold medical information for fear that revealing health conditions could keep them in detention longer.
“There is this thing looming over their heads, an uncertainty, and because of this uncertainty they might not be comfortable enough to approach these physicians under the facilities,” Villaverde told MedPage Today. “That’s one of the most significant obstacles to providing care.”
An ICE official told MedPage Today that their detention centers staff registered nurses, mental health providers, physician assistants, nurse practitioners, and a physician. There are currently about 200 contract medical providers at CBP facilities, a spokesperson said.
One July job posting for an ICE physician got widespread media attention for stating applicants should be “philosophically committed to the objectives of the facility,” and required physicians to sign nondisclosure agreements upon hiring.
Challenges to Continuity of Care
ICE is required to keep medical records that can be made available to outside healthcare providers once migrants are released, but physicians treating migrants who have been released from detention say they struggle to communicate with providers operating within facility walls.
As a result, patient handoffs are far from seamless, said José Manuel de la Rosa, MD, who also volunteers with Annunciation House, specifically when providers don’t communicate about medications that are needed.
“We’re set up to provide medication to migrants, but we don’t hear about [the need] until they’ve been off medication for two or three days and are beginning to get ill,” he said. “That kind of access to the centers would really help our process.”
As a result, providers are left to gauge what’s happening on the inside, by evaluating the conditions the migrants present with, said Roberto “Bert” Johansson, MD, another Annunciation House volunteer.
Lisa Ayoub-Rodriguez, MD, a pediatrician at a local hospital, has cared for 20 to 30 children hospitalized while in immigration custody since January.
In the winter months, many came in with respiratory problems, pneumonia, or influenza, all of which were complicated by a state of dehydration, she said.
Others were admitted for prolonged refractory seizures due to missing doses of medication. One child, for example, required combination therapy and came into the hospital with a new filled prescription of one medication, but was missing the other, she said.
Hardest on Children
It’s unclear whether pediatricians are staffed at CBP or ICE facilities, but 130,000 family units have been detained in the 2019 fiscal year to date — more than a 300% increase from the same time period in the previous fiscal year.
Because some illnesses present more subtly in children, EMT-trained personnel or even general practitioners may miss certain conditions upon an initial screening, Johansson said.
For example, last year, two children died from sepsis — one bacterial case and the other stemming from influenza — both of which could have initially presented with symptoms similar to the common cold, he said.
“When you look at both of these cases, there was a failure to recognize what could happen,” Johansson said.
Mark Ward, MD, vice president of the American Academy of Pediatrics Texas Chapter, was permitted to have a planned and supervised visit to two McAllen, Texas, CBP facilities in the Rio Grande Valley in June. He also toured a center run by Catholic Charities that provides care for recently released migrants.
At the non-profit, he came across a 16-month-old girl with congenital heart problems who had recently been released from detention with her mother. But her condition had been missed in the screening, such that by the time she arrived at the shelter, she was having heart failure and had to be taken to the ICU.
In May, a 10-year-old girl from El Salvador who crossed the border alone in March also had congenital heart defects, and ultimately died after being passed from hand to hand and undergoing a series of complications. She was one of six migrant children to die while in U.S. custody.
“The CBP is a policing agency and they’re not there to take care of children, so it’s not surprising they aren’t capable of doing a great job of it,” Ward told MedPage Today. “Really the focus is, we’ve got children in U.S. custody who have done nothing wrong, and they should be treated well, in a way that doesn’t damage their health.”
Becoming a Silent Problem?
CBP apprehensions along the border peaked in May at 144,255, but those numbers have been decreasing in recent months, with just 64,000 apprehended in August.
In the fall, physician volunteers treated thousands of migrants each day in more than 25 makeshift clinics across El Paso, including rented out rooms in the Sol y Luna hotel. But today, there are two main centers in operation: one known as Casa Oscar Romero and another large, newly converted warehouse called Casa del Refugiado.
Part of the reason there are fewer migrants on this side of the border is the Migrant Protection Protocol or “Remain in Mexico” policy, which was implemented in January. This policy sends individuals who enter the U.S. illegally, as well as certain asylum seekers, back to Mexico to wait for the duration of their immigration proceedings.
As of Sept. 1, some 42,000 people had been returned to Mexico under the policy, including more than 13,000 asylum seekers who were sent to Juárez. Moreover, only a certain number of asylum claims can be taken up in the U.S. per day, a process known as “metering.”
Taken together, these policies have caused the overflow of migrants traveling into the U.S. to pile up on the Mexican side of the border.
“Right now, we’re in the eye of the hurricane,” Johansson said. “Remain in Mexico has reduced the number of immigrants in the U.S., but they’re still there.”
Most recently, the U.S. Supreme Court endorsed another Trump administration restriction that turns away migrants coming from Central American countries, where the vast majority begin their journey, unless they’ve already applied for asylum before entering the U.S.
Ayoub-Rodriguez said she’s concerned that fewer patients in El Paso means more in Mexico who may not have adequate access to care.
“I’m worried that now it’s becoming a silent problem, that people won’t pay attention and the kids will still suffer without the voice,” Ayoub-Rodriguez told MedPage Today. “That’s my biggest fear — that the harm is still happening and we just aren’t seeing it.”

Wait, Health Care Costs HOW Much Without Insurance?!
Alice Oglethorpe reviewed some of the numbers for those having health insurance but is there an advantage? You might think the financial benefit of having health insurance is mostly tied to major moments—your appendix bursts, you break a leg snowboarding, you’re having a baby—but that’s really just the tip of the bill-lowering iceberg.
Having insurance can also help bring down what you have to pay for everyday: things like that flu shot you’ve been meaning to get or the throat culture you need to rule out strep. Ready for the most surprising part? This is true even if you’re nowhere near hitting your deductible and have to pay the entire bill yourself.
The behind-the-scenes sale
Here’s how it works: “Every hospital and doctor’s office has something called a charge master, which is a list of rates they charge for every single procedure,” says David Johnson, CEO of 4 Sight Health, a thought leadership and advisory company based in Chicago. “But those amounts are somewhat made up, and almost nobody pays them.”
That’s because insurance companies negotiate with the hospitals and doctor’s offices in their network to come up with their own lower rates for literally every procedure. It’s why you tend to see a discount on any doctor’s bill you get—even if you’re responsible for the whole thing because you haven’t hit your deductible yet.
One thing to keep in mind: Those discounted rates are only for in-network doctors and hospitals. Even if you have health insurance, you’ll end up paying the higher master charge rate if you go out-of-network.
While the price the insurance company negotiates can vary (they tend to be about half of the charge master cost), one thing tends to be certain: Anyone who doesn’t have insurance is going to end up paying a ton more. “If you don’t have coverage, it defaults to the charge master rate,” says Johnson. It’s no wonder one out of five uninsured people skip treatment because of cost.
Watch your wallet
All of this can add up quickly, even if you aren’t getting anything too major done. While it’s impossible to say what your cost for different procedures would be with insurance (that changes based on everything from where you live and who your insurer is to your deductible and co-insurance rates), here are some of the average charge master rates for common procedures in the U.S., according to an International Federation of Health Plans report:
• MRI: $1,119
• Cataract surgery: $3,530
• Day in the hospital: $5,220
• Giving birth: $10,808
• Appendix removal: $15,930
• Knee replacement: $28,184
Did someone say free?
On top of the discount you get just for having an insurance plan, there are some procedures and visits that are absolutely free if you have insurance. That’s right: They don’t cost a dime. These services fall under the umbrella of preventive care, and after the Affordable Care Act was passed, they became fully covered for anyone with insurance.
Unfortunately, if you don’t have coverage, you’re stuck paying for them. Here’s how much these otherwise-free services might run you:
• Flu shot: This life-saving vaccine will run you about $40 at your local Rite-Aid pharmacy.
• Screenings for diabetes and cholesterol: CityMD, a chain of urgent care facilities in New York, New Jersey, and Washington, offers these services for about $125 to $200, plus additional lab fees.
• Annual wellness visits: On average, this costs $160, according to a John Hopkins study.
• HPV vaccine: You need this shot twice, and it will cost you about $250 each time, according to Planned Parenthood.
• Birth control pills: The monthly packs will add up to $240 to $600 a year.
The bottom line: With the average employer-sponsored plan costing you $119 a month, that $1,400 or so a year will pay for itself in just a few doctor’s visits or prescriptions. And if something serious happens—like a sprained ankle or a suspicious mole your dermatologist wants to remove—you know you’re covered.
Cornell medical school to offer full scholarships for students who qualify for financial aid
Ryan W. Miller a writer for USA Today wanted us to know some positive news regarding progress in the goal for a financial sustainable education system for the education of our physicians. More future doctors at Cornell University’s medical school, just like the program designed at NYU medical school, will graduate debt-free after the university announced Monday that it would eliminate loans for its students who qualify for financial aid.
Weill Cornell Medicine’s new program will replace federal and school loans in students’ financial aid packages with scholarships that cover tuition, housing and other living expenses.
The program is set to begin this academic year, “then every year thereafter in perpetuity,” the school said in a statement.
Multiple donations that total $160 million will fund the new financial aid policy, Cornell said, though additional fundraising will be needed to ensure the program can continue.
“It is with extraordinary pride that we are able to increase our support of medical education for our students, ensuring that we can welcome the voices and talents of those who are passionate about improving human health,” Augustine M.K. Choi, the school’s dean and provost for medical affairs at Cornell University, said in a statement.
Sanders’ student loan plan: What’s different about Bernie Sanders’ student loan plan? It would help more rich people
More than half of Weill Cornell Medicine medical students qualified for financial aid last academic year, the school said. Based in New York City, the institution’s cost of attendance averages $90,000 a year.
First-year students in the Class of 2023 who qualify for aid will have loans replaced by scholarships for the entirety of their education, and returning students will have their loans replaced this year and the years moving forward, Cornell said.
Like most universities, Cornell uses a formula to determine how much students and their families can contribute to the cost of attendance. Only need-based scholarships will be used to meet the remaining amount, the school said.
Students in a joint M.D.-Ph.D. program will receive full tuition and stipends for living expenses from the National Institutes of Health and Weill Cornell Medicine.
Cornell joins a growing list of medical schools that offer similar programs. Last year, as I mentioned, New York University announced all medical students would receive full-tuition scholarships. Columbia University offers a program similar to Cornell’s to replace loans with scholarships. The University of California-Los Angeles offers a full ride for 20% of its students.
Several top universities offer similar loan-free financial aid for undergraduates.
The issue of mounting debt has increasingly plagued medical students. According to the Association of American Medical Colleges, about three-quarters of medical students take out loans for their education, resulting in a median debt level at graduation of about $200,000.
So, we need some way to either pay for the migrant population’ heath care needs, how it would be financed as well as to decide on the best immigration policy for our country!
Also, as I have mentioned before none of this will be accomplished while the parties and the President are at war and the next Presidential election will not settle any of these issues unless we can all work together! At least Bidden is not following the herd with their Medicare for All solution. But what is his solution….Obamacare or a modification of it?

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

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

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

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

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

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

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

Paying for Medicare for All

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Shouting match

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

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

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

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

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

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

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

The other Democrats, however, let the subject drop.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Poll of the Day: Democrats Increasingly Favor Obamacare

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

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

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

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

Media Statement

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

Cases

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

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

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

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

Deaths

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

What the CDC is doing

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

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

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

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

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

More to come in this discussion.