Category Archives: Doctors

The Increasing Infection Rate and Tips for Running Your Practice or Your Business in a Coronavirus/Pandemic Crisis

Dr. Deborah Birx, the White House’s coronavirus response coordinator, expressed recently that 200,000 Americans could die even “if we do things perfectly.” However, the Society of Critical Care Medicine has projected that more than 960,000 people in the United States may require ventilators during the course of this pandemic. A study from the Intensive Care National Audit and Research Center in the UK gathered data from a sample of those on advanced respiratory support as treatment for COVID-19. Sixty-six percent of those patients died. If these numbers are correct, then we may see over 600,000 deaths in the United States by the time this pandemic is over, and those numbers may increase if we are unable to produce enough ventilators for our response. Each day the numbers get worse.

We need a national strategy

Local government officials across the nation are implementing curfews and extreme social distancing measures. However, in these same states, we continue to see people congregating on beaches, at parks and in other public areas. The federal government’s inability to take decisive action will lead to a wave of death that in many ways will be much worse than the disaster seen on 9/11. Federal officials have plucked the low-hanging fruit of mitigation — and now it’s time to reach deeper and enact a national quarantine.

Part of that strategy is a plan for our practices as healthcare givers and other small and medium business owners and managers. 

I found an interesting article written by Debra A. Shute included in a Medscape email. As I was reviewing the article and editing it for my use I found that during these difficult times, when businesses are being cut back or shut down that many of these suggestions can be applied to all of us in our times of financial and healthcare needs. 

We all have the same requirements as small or medium sized businesses. We want to survive, protect our businesses and our employees, assist our clients, so that when the pandemic is over, we can get back to what we do best, running our business, whatever that might be.

I was also amazed this morning when I went in to the office to take a look at what additional PPEs that I had to give to the local hospitals and clinics. I already loaded up a full SUV of gloves, surgical gowns and masks. Anyway, I noticed an office, a vein clinic, still open with at least 14 cars in their office parking lot. Is this office a necessity? I think not and what are they thinking driving from an area of increasing COVID-19 infection to our “neck of the woods” where so far, we have a low incidence of COVID-19 infection. More importantly our area has a larger population of older patients. Think of Italy and their mortality due mostly to the fact that they have the second oldest population in the world.

What is this physician thinking? Evidently the greed factor plays a role here and not the safety of her patients, her staff and yes, even herself as a physician. I am amazed and disheartened to see this idiocy in such a serious crisis.

Considerations to consider in this time of a pandemic:

  1. Do you or your practice need to continue to keep your practice doors open to see patients? Many states are mandating shutting all nonessential businesses including physician and nurse practitioner offices unless essential emergent care is needed. The same questions can be applied to most businesses if you think your business is essential and the state government hasn’t shut down with threats of jail time and fines.
  2. What patients are you going to see in this time of crisis and what are the challenges. i.e. eighty or older patients with no suspicious symptoms for the COVID-19 virus.
  3. The safety of three parts of your practice- a. your patients, b. your staff and c. you the treating practitioner.

If you need to continue to run your practice what tips can we provide? Debra Shulte, a freelance writer, summarized it in her article: 7 Tips for Running Your Practice in the Coronavirus Crisis, which appeared on the Medscape Web post. The rapidly increasing numbers of COVID-19 cases in the US raises the possibility that some physician and nurse practitioner offices will need to decide or be forced to close temporarily, as occurred in London last month as well as many areas in the U.S. Just recently, Maryland’s Governor Hogan sent out through the Health Department new regulations closing offices. So, now many practices across the country have to adjust to the way they operate, amid daily changes in this pandemic. The question is-what should you do to adapt to this new way of operating your practice?

  1. Create a Task, Practitioner and Staff Force or Core Team to Manage Change

“The readiness of medical practices to address the myriad challenges posed by this crisis has so far been a mixed bag”, said Owen Dahl, MBA, a Texas-based medical management consultant. Leadership is going to have to access what’s happening in the community, what’s happening with staff members who may or may not have the disease and may or may not have to self-quarantine.” Dahl said.

The physicians, the administrator, CEO, or managing partner should be involved in decision making as the global crisis unfolds, added Laurie Morgan, MBA, a California-based practice management consultant. And depending on the size of the practice, it may be useful to delegate specific components of this work to various department managers or other individuals in the group.

The Team should assess:

  1. Recommendations and/ or mandates from local, state, and federal governments
  2. Guidance from specialty and state medical societies
  3. How to triage patients over the phone, i.e. what questions to ask? Can they participate in Virtual visits and do they and your office have the hardware and software technology? Or can or should they be referred to an alternate site of care (culture sites).
  4. Where to send patients, if necessary, for testing?
  5. The practice’s inventory of personal protective equipment (PPE)
  6. Review of and possible revision of current infection control policies
  7. Possible collaborations within the community including hospitals, clinics and Health Departments, etc.
  8. Reimbursement policies for suspected COVID-19 triage, testing, and follow-up treatment- in office or virtually. Interestingly enough there is a new ICD-10 code for COVID-19 for coding visits and treatment.
  9. Whether some employees’ work (e.g. billing, coding) can be done remotely
  10. Options for paying personnel in the case of a temporary shutdown
  11. What’s covered and excluded by the group’s business interruption insurance
  12. Consider Postponing Nonessential Appointments

What’s more, it is critical for practices to form a strategy that does not involve bringing patients into the office, said Javeed Siddiqui, MD, MPH, an infectious disease physician, epidemiologist, and chief medical officer of TeleMed2U. “One thing we really have to recognize in this pandemic is that we don’t want people going and sitting in our waiting room. We don’t want people coming, and not only exposing other patients, but also further exposing staff. Forward triaging is going to be essential in this type of pandemic.”

One medical group, with multiple locations in Massachusetts, for example, announced to patients recently that it will postpone appointments for some routine and elective procedures, as we have done in my practice, as determined by the group’s physicians and clinical staff.

“Taking this step will help limit the number of people passing through our facilities, which will help slow the spread of illness (as recommended by the CDC),” noted in an email blast to patients.

  1. Overcommunication to Patients

With a situation as dynamic and unprecedented as this, constant and clear communication with patients is crucial. “said Morgan. “In order to be effective and get the word out, you have to be overcommunicating.”

Today’s practices have ways to communicate to keep people informed, including email, text messaging, social media patient portals, and even local television and radio.

One email or text message to the patient population can help direct them to the appropriate streams of information. Helping direct patients to updated information is critical.

In contrast, having the front desk field multitudes of calls from concerned patients ties up precious resources, according to Siddiqui. “Right now, practices are absolutely inundated, patients are waiting on hold, and that creates a great deal of frustration,” he said. Work out how to manage the crisis calls!

“We really need to take a page from every other industry in the United States, and that is secure SMS, email communication, and telehealth,” Siddiqui said. “Healthcare generally tends to be a laggard in this because so many people think, ‘Well, you can’t do that in healthcare,’ as opposed to thinking, ‘How can we do that in healthcare?”

  1. Take Advantage of Telemedicine

Fortunately, technology to interact with patients remotely is almost ubiquitous. Even for practices with little experience in this arena, various vendors exist that can get secure, HIPAA-compliant technologies up and running quickly. Many of the practice management electronic medical records systems already have the capacity for telemedicine including patient portals.

Various payers have issued guidance regarding reimbursement for telemedicine specific to COVID-19, and on March 6, Congress passed a law regarding Medicare coverage and payment for virtual services during a government-declared state of emergency. Some of the rules about HIPAA compliance in telemedicine have been eased for this emergency.

But even with well-established telemedicine modalities in place, it’s crunch time for applying it to COVID-19. “You need to find a way to have telemedicine available and use it, because depending on how this goes, that’s going to be clearly the safest, best way to care for a huge number of people,” said Darryl Elmouchi, MD, MBA, chief medical officer of Spectrum Health System and president of Spectrum Health Medical Group n Michigan.

 “What we recognize now, both with our past experience with telehealth for many years and specifically with this coronavirus testing we’ve done, is that it’s incredibly useful both for the clinicians and the patients,” Elmouchi said.

One possibility to consider is the tactic used by Spectrum, a large integrated healthcare system. The company mobilized its existing telemedicine program to offer free virtual screenings for anybody in Michigan showing possible symptoms of COVID-19. “We wanted to keep people out of our clinics, emergency rooms, and urgent care centers if they didn’t need to be there, and help allay fears,” he said.

Elmouchi said his company faced the problems that other physicians would also have to deal with. “It was a ton of work with a dedicated team that focused on this. The hardest part was probably trying to determine how we can staff it,” he said.

With their dedicated virtual team still seeing regularly scheduled virtual patients, the system had to reassign its traditional teams, such as urgent care, and primary care clinicians, to the virtual screening effort. “Then we had to figure out how we could operationalize it. It was a lot of work,” Elmouchi said.

Telemedicine capabilities are not just limited to screening patients, but can also be used to stay in touch with patients who may be quarantined and provide follow-up care, he noted.

Luckily in my practice we have used forms of telemedicine for many years either email or texts are the patient’s favorite mode of communication and virtual video chat only if necessary due the fact that my practice is a surgical practice. However, in these critical times I only want to see those needing urgent attention. If they report suspicious symptoms then we need to consider where to refer them. 

Therefore-

  • Identify COVID-19 Testing sites

Access to tests remains a problem in the U.S., but is improving by the week. Just consider the most recent announcement that they now have a test that can give results in 15 minutes. For practices that can attain the tests themselves, not in my practice, it will still require some creativity to administer them with as little risk as possible. In South Korea, for example, and increasingly in the U.S, healthcare organizations are instructing patients waiting to be tested to stay in their cars and have a practitioner wearing the proper PPE go out to patients to test them there. Alternatively, some practices may opt to have PPE-wearing staff members bring PPE to patients in their cars and then escort them to a designated testing area in the building-through the back door if noninfected patients are still being seen. I don’t recommend this last option because of the shortage of PPE equipment unless the patient is such a high risk and has multiple co-morbidities and needs a in depth exam. Here I suggest an in car rapid culture/test and if the need warrants to refer to the medical center better setup to manage the patient.

“Once in the office, you still need to isolate virus patients in any way you can,” Dahl said. “In fact, you may want a negative-pressure environment if possible, with the air being sucked out rather than circulating,” he said, adding that a large restroom with a ventilation system could be repurposed as a makeshift exam room. Here I am adamant! If you are going to see sick viral patients your practice should have negative pressure rooms. This protects the staff, other patients and you the practitioners.

Community testing sites are another possibility, my favorite option, given proper coordination with other healthcare organizations and community officials. Siddiqui has been working with several communities in which individual clinics and hospitals are unable to handle testing on their own, and have instead collaborated to create community-testing sites in tents on local athletic fields.

“One of our communities is looking at using the local college parking lot to do drive-through testing there,” he said. “We really need to embrace collaboration much more than we’ve ever done.”

 This is in fact what we have set up in our small town, using the local community college parking lots, etc.

Collaboration also requires sharing supplies and PPE, noted Dahl. “Don’t hoard them because of the shortage. Look at your inventory and make sure you can help whomever you may be sending patients to. “And if your office is falling short, Dahl advises checking with offices in your community that may be closing, such as dentists or plastic surgeons, for supplies you can purchase or simply have. I did this in my office, donating an SUV full of surgical gowns, facemasks and boxes of gloves to the hospital to deliver to whom needs them most.

The U.S. Food and Drug Administration has issued some guidance to healthcare providers about shortages of surgical masks and gowns, including advice about reusable cloth alternatives to gowns.

In addition, some hospitals have asked clinicians to keep their masks and provide guidance on how to conserve supplies. Our medical facility set up a Task Force to analyze, assess and allocate supplies calling on physicians and dentists, etc.

  • Preparing to Potentially Shut Down

A temporary closure may be inevitable for some practices. “Maybe the physician owners will not feel like they have a choice,” said Morgan. “They feel like they want to stay open for as long as they can; but if it’s not safe for patients or not safe for employees, maybe they’ll feel it’s better if they check out for a bit.” And remember if you are sick or one of your partners is sick or a member of your staff the stress becomes multiplied and, potential errors occur and everyone suffers!

Handling the financial ramifications of closure is a top priority as well, and will require a full understanding of what is and isn’t covered by the practice’s business interruption insurance. Practices that don’t have a line of credit should reach out to banks and the Small Business Administration immediately, according to Dahl and of course me. Practices that have lines of credit already may want to ask for an increase. Although the 2 trillion-dollar COVID-19 rescue bill may assist healthcare facilities. Meet and work with your account to review your financial liabilities, losses and needs for the future!

My other suggestion and that of many experts is to Apply for an SBA loan (CARES Act loan) to acquire working capital.

  • See: U.S. Small Business Administration, Disaster Loan Assistance
    Due to current traffic, non-peak hours are optimal 7pm – 7am EST.

Loan Application Checklist

Forecasting Cash Inflows for 13 Weeks

  • You may not have all of the information; however, don’t let that keep you from conducting this exercise. Use your best estimates, evaluate your forecast real-time (daily), and adjust the forecast as you go.
  • It may be easiest to start with the prior year’s weekly revenue and adjust accordingly. 
  • When determining cash inflows, consider any ongoing operations, accounts receivable, retained earnings, owner loans, and/or financial support from lenders (such as lines of credit or SBA above).
  • Decide how you will manage late fees/ waivers from your patients, customers and clients.

Forecasting Cash Obligations for 13 Weeks- Leverage your Networks. 

  • Watch and prepare for outside influences including landlords, local, state, and   federal actions
  • Determine where obligations may need to be reduced
  • Negotiate with Vendors and seek extensions* 
    – If this seems daunting, start with those you spend the most money. 
  • Negotiate with Credit Card Companies
    – Can you reduce your minimum payment or increase your line of credit?
  • Negotiate rent with Landlords 
    – Consider evaluating any lease agreements that include Force Majeure clauses (freeing both parties from liability or obligation when an extraordinary event or circumstance beyond the control of the parties) and work with your legal counsel to evaluate options and/or circumstances that may invoke this provision.
    – If you own the building, contact your lender to evaluate term extensions, etc.
  • Develop Staffing Plan with the Assistance of Legal Counsel
    – What can you afford based on your forecast? 
    – Do you need to reduce hours, reduce staff through lay-offs or furloughs? 
    – Consider job sharing options (1 staff member M, W, 2nd staff member works T, Th)

Protecting employees’ income is challenging as well. For employees who are furloughed, consider allowing them to use their sick leave and vacation time during the shutdown-and possibly let staff “borrow” not yet accrued paid time off. I went through this discussion with my staff and ended the discussion with the assurance that if we cut back hours or let people go their jobs were secure when this was all over and that I guaranteed them financial support for rent and food, etc. for however long the shutdown lasts. Our practice sets aside a savings account for emergencies.

        Considerations for Furlough/Layoff
– If you are to keep staff, identify specific job responsibilities. 
– If your staffing plan includes remote employment, which I will discuss in the next section, you may need to determine how to utilize your staff in a remote capacity. For example, can they work on updating your practice’s website and/or before & after galleries, build out social media marketing calendars, mine your practice management system, etc. More discussion will be found in the next section where I discuss working from home.

Marketing
– Determine ROI on current efforts. What’s working/what’s not/what’s the plan moving forward?

However, there’s a risk with certain jobs in a medical practice that tend to have extremely high turnover, so physicians and administrators may be reluctant to pay people too much because they don’t know for sure those employees will come back to those jobs,” Morgan said. “On the other hand, if you have had a stable team for a very long time and feel confident that those employees are going to stay, then you may make a different decision.” Therefore, if you need to cut back staff temporarily, when things stabilize you will have able and willing staff and not need to find new employees who will need to be trained, etc.

  1. Seize Work-From- Home Opportunities

“Even if the practice isn’t seeing patients, there may be opportunities for some employees, such as billers, coders and schedulers, to continue to work from home.” Morgan noted. Particularly if a practice is behind on it’s billing, a closure or slowdown is an ideal time to catch up. This measure will keep at least some people working-perhaps including some individuals who can be cross-trained to do other tasks-and maintain some cashflow when the practice needs it most.

Other remote-friendly jobs that often fall by the wayside when practices are busy include marketing tasks such as setting up or updating Google business pages, Healthgrades’s profiles, and so on, noted Morgan.  And make sure your staff has the software and hardware to support Work-from Home strategies.

“Another thing that can be even more important, and is often overlooked, is making sure health plan directories have correct information about your practice,” she added. “These are pesky, often tedious tasks that may require repeated contact with health plans to fix things-perfect to do when the office is not busy or closed.”

For administrators and billers, if the practice is able to keep paying these employees while partially or fully closed, it can also be an excellent time to do the sort of analysis that takes a lot of focused attention and is hard to do when busy. Some examples: a detailed comparison of payer performance, analysis of referral patterns, or a review of coding accuracy. Morgan suggested. 

We had an excellent opportunity to have our staff analyze our practice and plan our future move to a new facility and start packing, etc. Make use of your employees and the opportunities that you have been putting off due to your busy practice!

As with many, HIPAA is a leading concern, though it needn’t be, according to Morgan and the notification of the relaxation of some HIPAA regulations to allow various forms of communication with our patients.

Finally, as the crisis begins to abate, practices and businesses must keep working in teams to evaluate and structure an orderly return to business as usual, gleaning best practices from colleagues whenever possible. Strategize how to re-boot your practice or any of the other businesses. Consider what the world will look like when the crisis is over and plan how to rebuild and reschedule, etc.

“I would tell practices this is not a time when anyone is competing with anyone.” Said Elmouchi. The more collaboration between practices and health systems that have larger resources the better.”

I would add that the physicians and other practitioners as well as the other businesses who were forced to close need to support your staff though these difficult times and acknowledge their importance and your gratitude for their hard work and sacrifices during this crisis. Save some time AFTER the pandemic is over and there is no possibility of health risk to have lunch or dinner or just time to celebrate surviving.

As I mentioned any small or medium business can use this set of tips to survive in this tempestuous time. As the restaurants are doing, create a pickup system, or use your employees to create a delivery system to keep as many of your employees on the job. You can also evaluate your marketing and do some strategic planning. It is the time to use your staff to plan the future together and

Engage in Team building so that when the pandemic is over you will create a more effective, efficient system to deliver what ever you goal or goals are to your patients, clients or customer want and need. Be creative and this is the time to consider process improvement. 

Use the time wisely. Over communicate with your patients, clients and customers and more important your staff including document your plans and use a decision tree for staff and referral businesses including possible Web site announcements.

Also, realizing the there are many that may need federal aid/loans, if you decide that you may need assistance apply now!! And don’t let all this stress you or your staff out! Work together with your staff and your patients and network through this pandemic crisis and for the future.

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

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

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

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

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

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

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

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

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

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

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

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

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

US may pay for uninsured coronavirus patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘It is a unique virus with unique characteristics’

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

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

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

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

Older patients face the highest risk 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On guard

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

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

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

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

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

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

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

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

Here’s what you must keep in mind:

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

Preventive measures

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stay well!!

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!

Again, Democrats Spar at Debate Over Health Care, How to Beat Trump and Could Medicare for All Really Go Horribly Wrong?

 

deal549[5953]Was there anything different about last week’s Democratic debate? Bill Barrow, Will Weissert and Jill Colvin reported that the Democratic presidential candidates clashed in a debate over the future of health care in America, racial inequality and their ability to build a winning coalition to take on President Donald Trump next year.
The Wednesday night faceoff came after hours of testimony in the impeachment inquiry of Trump and at a critical juncture in the Democratic race to run against him in 2020. With less than three months before the first voting contests, big questions hang over the front-runners, time is running out for lower tier candidates to make their move and new Democrats are launching improbable last-minute bids for the nomination.
But amid the turbulence, the White House hopefuls often found themselves fighting on well-trodden terrain, particularly over whether the party should embrace a sweeping “Medicare for All” program or make more modest changes to the current health care system.
Sens. Elizabeth Warren of Massachusetts and Bernie Sanders of Vermont, the field’s most progressive voices, staunchly defended Medicare for All, which would eliminate private insurance coverage in favor of a government-run system.
“The American people understand that the current health care system is not only cruel — it is dysfunctional,” Sanders said.
Former Vice President Joe Biden countered that many people are happy with private insurance through their jobs, while Mayor Pete Buttigieg of South Bend, Indiana, complained about other candidates seeking to take “the divisive step” of ordering people onto universal health care, “whether they like it or not.”
Democrats successfully campaigned on health care last year, winning control of the House on a message that Republicans were slashing existing benefits. But moderates worry that Medicare for All is more complicated and may not pay the same political dividend. That’s especially true after Democrats won elections earlier this month in Kentucky and Virginia without embracing the program.
“We must get our fired-up Democratic base with us,” said Sen. Amy Klobuchar of Minnesota. “But let’s also get those independents and moderate Republicans who cannot stomach (Trump) anymore.”
The fifth Democratic debate unfolded in Atlanta, a city that played a central role in the civil rights movement, and the party’s diversity, including two African American candidates, was on display. But there was disagreement on how best to appeal to minority voters, who are vital to winning the Democratic nomination and will be crucial in the general election.
Sens. Kamala Harris of California and Cory Booker of New Jersey said the party has sometimes come up short in its outreach to black Americans.
“For too long, I think, candidates have taken for granted constituencies that have been a backbone of the Democratic Party,” Harris said. “You show up in a black church and want to get the vote but just haven’t been there before.”
Booker declared, “Black voters are pissed off, and they’re worried.”
In the moderators’ chairs were four women, including Rachel Maddow, MSNBC’s liberal darling, and Ashley Parker, a White House reporter for The Washington Post. It was only the third time a primary debate has been hosted by an all-female panel.
Buttigieg — who was a natural target given his recent rise in the polls to join Biden, Warren and Sanders among the crowded field’s front-runners — was asked early about how being mayor of a city of 100,000 residents qualified him for the White House.
“I know that from the perspective of Washington, what goes on in my city might look small,” Buttigieg said. “But frankly, where we live, the infighting on Capitol Hill is what looks small.”
Klobuchar argued that she has more experience enacting legislation and suggested that women in politics are held to a higher standard.
“Otherwise we could play a game called ‘Name your favorite woman president,’ which we can’t do because it has all been men,” she said.
Another memorable exchange occurred when Biden — who didn’t face any real attacks from his rivals — was asked about curbing violence against women and responded awkwardly.
“We have to just change the culture,” he said. “And keep punching at it. And punching at it. And punching at it.”
Harris scrapped with another low polling candidate: Hawaii Rep. Tulsi Gabbard, who has criticized prominent Democrats, including 2016 nominee Hillary Clinton.
“I think that it’s unfortunate that we have someone on the stage who is attempting to be the Democratic nominee for the president of the United States who during the Obama administration spent four years full time on Fox News criticizing President Obama,” Harris said.
“I’m not going to put party interests first,” Gabbard responded.
But the discussion kept finding its way back to Medicare for All, which has dominated the primary — especially for Warren. She released plans to raise $20-plus trillion in new government revenue for universal health care. But she also said implementation of the program may take three years — drawing criticism both from moderates like Biden and Buttigieg, who think she’s trying to distance herself from an unpopular idea, and Sanders supporters, who see the Massachusetts senator’s commitment to Medicare for All wavering.
Sanders made a point of saying Wednesday that he’d send Medicare for All legislation to Congress during the first week of his administration.
Booker faced especially intense pressure Wednesday since he’s yet to meet the Democratic National Committee’s polling requirements for the December debate in California. He spent several minutes arguing with Warren about the need to more appropriately tax the wealthy, but also called for “building wealth” among people of color and other marginalized communities.
“We’ve got to start empowering people,” Booker said.
Businessman Andrew Yang was asked what he would say to Russian President Vladimir Putin if he got the chance — and joked about that leader’s cordial relationship with Trump.
“First of all, I’d say I’m sorry I beat your guy,” Yang said with a grin, drawing howls of laughter from the audience.
Is Warren retreating on Medicare-for-all?
Almost one week before the fifth Democratic presidential debate, Elizabeth Warren released the latest plan in her slew of policy proposals: An outline detailing how, if elected, she would gradually shift the U.S. toward a single-payer health care system.
“I have put out a plan to fully finance Medicare for All when it’s up and running without raising taxes on the middle class by one penny,” the Massachusetts senator wrote in a post introducing the plan. “But how do we get there? Every serious proposal for Medicare for All contemplates a significant transition period.”
It was a marked shift from her previous calls to quickly bring the country toward Medicare-for-all and, notably, included similar tenets laid out in the health care proposals of more moderate candidates, like former Vice President Joe Biden and South Bend, Indiana Mayor Pete Buttigieg.
In the transition plan, Warren said she would take several steps in her first 100 days in office to expand insurance coverage, like pushing to pass a bill that would allow all Americans to either buy into a government-run program if they wanted, or keep their private insurance. It would extend free coverage to about half of the country, including children and poor families. She would also lower the eligibility age for Medicare to 50 and let young people buy into a “true Medicare-for-all” option.
“Combining the parts into a whole reveals a bit of a mess,” wrote David Dayen of The American Prospect, a progressive magazine. “After putting forward a comprehensive cost control and financing bill, Warren split that apart and asked people to accept two bruising fights to get to her purported end goal. It’s reasonable for people to see that as a bait and switch.”
Rivals portrayed the move as a retreat from one of her most high-profile positions on an issue that voters repeatedly rank as one of the most important. A campaign spokesperson for Biden called the senator’s health stance “problematic,” while Buttigieg’s spokeswoman Lis Smith criticized the latest measure as a “transparently political attempt to paper over a very serious policy problem.”
Vermont Sen. Bernie Sanders, who has wholeheartedly pledged to fight for a single-payer health system, took a swipe at Warren when accepting an endorsement on Friday from the largest nurses’ union in the country.
“Some people say we should delay that fight for a few more years — I don’t think so,” he said, according to The Washington Post. “We are ready to take them on right now, and we’re going to take them on Day One.”
The similarities come as Warren, who experienced a somewhat momentous surge in the polls, has begun to falter. In early October, her national polling climbed to 28 percent, according to a Fox News poll, but since then, her numbers have steadily declined. In the latest Iowa poll, Buttigieg pulled ahead of Warren by a staggering nine percentage points, indicating the 37-year-old could be a serious contender.
The timing of the seeming loss of campaign momentum appears to be tied to the release of her sweeping Medicare-for-all proposal at the beginning of November. Warren said it could be paid for with a series of taxes, largely via new levies on Wall Street and the ultra-wealthy (and, she’s repeatedly stressed, none on the middle class).
According to a recent poll conducted by the Kaiser Family Foundation and Cook Political Report, while universal coverage is popular with a majority of Democratic voters, almost two-thirds of voters in key swing states said a national health plan in which all Americans receive their health coverage through a single-payer system was not a good idea.
It also precludes the start of the next debate in Georgia, during which Warren will very likely face fierce criticism and scrutiny over her $20 trillion Medicare-for-all plan and remember the cost is really closer to$52-$72 trillion>
Still, Warren told reporters over the weekend that “my commitment to Medicare for All is all the way,” according to The Associated Press.
And Rep. Pramila Jayapal, the Washington Democrat who introduced the House version of the Medicare-for-all bill, called the plan a “smart approach to take on Big Pharma & private-for-profit insurance companies.”
Medicare for All’s thorniest issue is how much to pay doctors and hospitals. Any new system could become a convoluted mess if it goes wrong.
Earlier this month, Sen. Elizabeth Warren unveiled her $20.5 trillion package to finance Medicare for All, a system that would provide comprehensive health insurance to every American and virtually erase private insurance.
If its details are made reality, it would be nothing short of a sweeping transformation of the way Americans receive and pay for their medical care.
The proposal attempts to address one of the thorniest problems that any candidate pushing for a single-payer system in the US faces: how much to pay doctors and hospitals.
Dismantling the current payment structure and replacing it with another would likely require some tough trade-offs, experts say, creating winners and losers when the dust settles.
Sen. Elizabeth Warren recently unveiled details of her Medicare for All health plan, a system that would provide comprehensive health coverage to every American and virtually erase private insurance.
If its details are made reality, it would be a sweeping transformation in the way Americans get and pay for their medical care. Its the only financing model for universal coverage that a Democratic presidential candidate has rolled out in the primary so far.
It attempts to address one of the thorniest problems any candidate pushing for a single-payer system in the US faces: how much to pay the country’s doctors and hospitals. Pay them too little, and you risk wreaking havoc on their bottom line — and possibly forcing a wave of hospital closures as some critics have warned. Pay them too much, and it becomes much more expensive to finance care for everybody.
“The challenge is that when you expand Medicare to new populations, they’re going to use more healthcare,” Katherine Baicker, a health policy expert who serves as the dean of the University of Chicago Harris School of Public Policy, told Business Insider. “But that means there is going to be a substantial increase in demand for healthcare at the same time that you’re potentially cutting payments to providers.”
Warren has proposed big cuts in payments to many hospitals and doctors in her $20.5 trillion package to bring universal healthcare to the United States. Single-payer advocates argue that eliminating private insurance would lower administrative burdens on doctors and hospitals, freeing them up to treat more insured patients.
Several outside analyses of Medicare for All proposals suggest it can lead to considerable savings through negotiation of lower prices and reduced administrative spending.
The cuts in Warren’s plan are steep, because private insurers currently pay around twice as much as Medicare does for hospital care, according to research from the Center for American Progress, a liberal think tank. Warren’s reform blueprint sets them in line with the Medicare program. Doctors would be paid at the Medicare level while hospitals would be reimbursed at 110% of Medicare’s rate.
‘A recipe for shortages’
As a result, those rates would lower doctor pay by around 6.5%, according to an estimate from economists who analyzed the Warren plan. For hospitals, who are used to bigger payments from private insurers, the payments under Warren’s plan would be roughly enough to cover the cost of care, the economists said.
Baicker says the healthcare system may not be prepared to meet the rapid rise in demand, especially if payments fall at the same time.
“You’re going to see people wanting more services at the same time you pay providers less, and that’s a recipe for shortages unless something else changes,” she said.
That echoes a report from the nonpartisan Congressional Budget Office released in May. It found that setting payments in line with Medicare would “substantially” lower the average amount of money providers currently receive. “Such a reduction in provider payment rates would probably reduce the amount of care supplied and could also reduce the quality of care,” the CBO report said.
Business Insider reached out to the five largest hospital systems to ask the possible effects of lowering payment rates to Medicare levels and whether they would be prepared to weather the transition.
Only one responded: the 92-hospital Trinity Health System based in Michigan.
“Trinity Health supports policies that advance access to affordable health care coverage for all, payment models that improve health outcomes and accelerate transformation, and initiatives that enhance community health and well-being,” spokeswoman Eve Pidgeon told Business Insider.
Pidgeon said that Trinity Health welcomes the dialogue around “critical questions” of financing and access to coverage, and would “analyze Medicare for All proposals as more details emerge.”
The healthcare industry generally opposes Medicare for All
“Trinity Health has a rich tradition of honoring the voices of the communities we serve, and we will continue to dialogue around policy proposals designed to improve affordability, quality and access for all,” Pidgeon said.
The healthcare industry generally opposes Medicare for All, arguing that it would lead to hospital closures and hurt the overall quality of care for Americans.
The American Hospital Association is staunchly against it. In a statement to Business Insider, executive vice president Tom Nickels called it “a one-size -fits-all approach” that “could disrupt coverage for more than 180 million Americans who are already covered through employer plans.”
“The AHA believes there is a better alternative to help all Americans access health coverage – one built on improving our existing system rather than ripping it apart and starting from scratch,” Nickels said.
Meanwhile, the American Medical Association, the nation’s largest physician organization, came out against the single-payer system, though its membership nearly voted to overturn its opposition in June, Vox reported. The group since pulled out of an industry coalition fighting the proposal.
While many big hospitals could face payment cuts, others could benefit, particularly those that mainly serve people with low incomes or who don’t have insurance.
“If you’re a facility serving a lot of Medicaid and uninsured patients today, you might come out ahead here,” Matthew Fiedler, a health policy expert at the Brookings Institution, told Politico. “But the dominant hospitals in a lot of markets that are able to command extremely high private rates today will take a big hit. I don’t think we’d see hospitals closing, but the question is: What would they do to bring down spending?”
Chris Pope, a healthcare payment expert and senior fellow at the conservative Manhattan Institute, said fewer dollars would ultimately mean a cutback in services hospitals would be able to offer. “The less you pay, the less you’re going to get in return.”
“What would likely happen is if you give a fixed lump sum of money, they would start dialing back on access to care,” Pope told Business Insider. “You’re just not going to be able to have a scan done when you need one done.”
The impact on hospitals and doctors
I have pointed these next few points before but thought that it would be worth mentioning again. The surging cost of hospital bills has fanned consumer outrage in recent years as people struggle to afford needed care and helped elevate support for some type of government insurance plan, whether its the more incremental route allowing people to simply buy into a public insurance option or Medicare for All.
In a preview of battles to come, Congress has struggled to pass legislation addressing exorbitant and confusing hospital bills, an issue with widespread public support and bipartisan interest that the White House backed as well, the Washington Post reported in September. Its movement grinded to a halt amid an onslaught of outside spending from doctor and insurer groups.
Dr. Stephen Klasko, chief executive of the Jefferson Health hospital system in Pennsylvania, said the political debate has oversimplified the difficult decisions that would need to be taken in moving to Medicare for All.
“They haven’t been willing to talk about what you would really have to do to bring a dollar and a quarter down to a dollar,” Klasko said, referring to candidates like Warren and Sanders who back universal health coverage.
The hospital executive said that while the nation’s healthcare system is “inefficient” and “fragmented,” slashing overhead wouldn’t necessarily improve the quality of care.
“This myth that there’s these trillions of dollars of administrative costs that are out there in the ether, that’s not true. Every dollar you take away is somebody’s dollar,” Klasko said.
He added that pricing reform on the scale that Warren proposes “is doable,” though there’s likely a caveat.
“It will change how consumers interact with the healthcare system and they won’t get everything they want,” he said.
I’m not sure that Medicare for All will be the Democratic party’s continual push as the debates continue and they realize that moderation to develop a health care system will be the only way to challenge a run against President Trump. I wonder when the rest of the Democratic potential candidates realize that besides the gaffs that former Vice President Biden makes, that improving the Affordable Care Act is the only strategy that may work.
Now I want to wish all a Happy Thanksgiving and hope that we all will appreciate all that we all have and as Mister Rogers said we all need to be Kind, and be Kind and also be Kind. Enjoy you Turkey Day!

Warren’s Health Care Plan Will Cost More Than She Says; Hillary’s take on the matters and what does Medicare cover and the VA “new” system!

veteran529Tyler Cowen reported that Elizabeth Warren claims she can pay for her 10-year, $52 trillion health care plan without increasing taxes on the middle class. But both she and her critics are approaching the question wrong. What really matters is the opportunity cost of policy choices, in terms of foregone goods and services — not whether the money can be raised to pay for a chosen policy.

Consider this point in the context of Warren’s plan, which includes a complex series of health-care savings and higher taxes on the wealthy.

NOAH SMITH: Warren Tries to Make Medicare for All as Painless as Possible

One way of financing the plan is to pay doctors in hospitals lower fees (part of “saving” $2.3 trillion). There will then be fewer profitable hospitals, and fewer doctors working fewer hours because some of them might retire earlier than they otherwise would. Fewer hospitals mean they will likely increase their monopolistic tendencies, to the detriment of patients. A related plan to pay hospitals less is supposed to save another $600 billion.

The practical impact of these changes will be to deprive health-care consumers, including middle-class consumers, of goods and services. The larger point is that the real cost of any economic arrangement is not its nominal sticker price, but rather the consequences of who ends up not getting what.

Another part of the plan is to pay lower prices — 70% lower — for branded prescription drugs. That is supposed to save about $1.7 trillion, but again focus on which opportunities are lost. Lower drug prices will mean fewer new drugs are developed. There is good evidence that pharmaceuticals are among the most cost-effective ways of saving human lives, so the resulting higher mortality and illness might be especially severe.

Of course, many critics of the pharmaceutical industry downplay its role in the drug-discovery process. Regardless of the merits of those arguments, they do not show that a 70% cut in prices will leave supplies, or research and development, unchanged.

Another unstated cost of the Warren plan concerns current health-insurance customers: Many of them prefer their current private coverage to Medicare for All. Switching them into Medicare for All is an opportunity cost not covered by Warren’s $52 trillion estimates. Even if you believe that Medicare for All will be cheaper in monetary terms, tens of millions of Americans seem to prefer their current arrangements.

Warren also proposes higher taxes on corporations, capital gains, stock trades and the wealthy, as well as stronger tax enforcement — all of which is supposed to raise more than $10 trillion. Again, regardless of your position on those policies, they will diminish investment and (to some extent) consumption among the wealthy. You might not worry much about the consumption of the wealthy. But the decline in investment will lead to lower wages, less job creation, and fewer goods and services. These are all opportunity costs, for both the middle class and just about everyone else.

Supposedly $400 billion will be picked up from taxes on new immigrants, following the passage of a law legalizing millions now in the country illegally. I favor such legislation. Still, I don’t necessarily see this as a windfall. Yes, more immigrant labor will produce more goods and services. Tax revenue from this new productivity could be used in any number of ways, with universal health-care coverage just one option of many.

You might think that universal health insurance coverage is clearly the highest priority, but is it? America’s health-care sector is relatively costly and inefficient, and even major health-care legislation does not much improve health outcomes. What about investing in green energy or climate change alleviation? Private-sector job creation? Public health measures outside of the health-insurance system, such as fighting air pollution or lead? Checking California forest fires?

Even if you think health care is a human right, there are alternative policies that will benefit human health. They cannot all be carried out, at least not very well.

I don’t mean to pick on Warren. Virtually all politicians, of both parties, fall prey to similar fallacies when presenting the costs of their policies. Warren’s proposals, when all is said and done, are best viewed not as a way of paying for her program but as a series of admissions about just how expensive it would be. Whether or not you call those taxes, they are very real burdens — and many of them will end up falling on the middle class.

How Sen. Warren’s health care plan could impact 401(k)s

Senator Elizabeth Warren’s “Medicare for All” plan may impact your future nest egg. Some critics of the proposal note the presidential hopeful could potentially tax investors, which would make it more difficult to save for retirement. Edelman Financial Engines Founder Ric Edelman discusses with Yahoo Finance’s Zack Guzman, Sibile Marcellus, and ‘The Morning Brew’ Business Editor and Podcast Host, Kinsey Grant.

Hillary Clinton: Warren’s Medicare for All Plan Won’t Ever Get Enacted

Yuval Rosenberg noted that Hillary Clinton said Wednesday that she doesn’t believe Elizabeth Warren’s Medicare-for-All plan would ever become law and that there are better ways to raise revenues than Warren’s proposed wealth tax.

Asked at a New York Times conference whether she thinks the health-care plan released by Warren would ever get enacted, the 2016 Democratic presidential nominee said: “No, I don’t. I don’t but the goal is the right goal.”

In her 2016 campaign, Clinton supported a public health insurance option and rejected calls from Bernie Sanders, her rival for the Democratic nomination, for a single-payer system. On Wednesday, Clinton said she still favors a public option to build on the Affordable Care Act, which lifted insurance coverage rates to 90%. “I believe the smarter approach is to build on what we have. A public option is something I’ve been in favor of for a very long time,” she said. “I don’t believe we should be in the midst of a big disruption while we are trying to get to 100 percent coverage and deal with costs and face some tough issues about competitiveness and other kinds of innovation in health care.”

Clinton also said she supports the health care debate Democrats are having and tried to contrast that with the Republican efforts to repeal the Affordable Care Act. “Yeah, we’re having a debate on our side of the political ledger, but it’s a debate about the right issue, how do we get to health care coverage for everybody that we can afford?” Clinton said.

Warren responded on Thursday. “I’m saying, you don’t get what you don’t fight for,” she said, according to The Times. “You know, you’ve got to be willing to get out there and fight.”

On the issue of a wealth tax, another central element of Warren’s campaign, Clinton said she doesn’t understand how the proposal could work, suggesting it would be too disruptive. Clinton added that there are better ways to raise revenues, get the rich to pay more and combat inequality. “I just think there are better ways of doing it,” she said, adding that she would be in favor of raising the estate tax.

Also, Hillary Clinton called the wealth taxes proposed by Sens. Bernie Sanders and Elizabeth Warren “unworkable” and said they would be “incredibly disruptive” if enforced.

Warren health plan departs from US ‘social insurance’ idea

Ricardo Alonso-Zaldivar reported that Sen. Elizabeth Warren’s plan to pay for “Medicare for All” without raising taxes on the middle class departs from how the U.S. has traditionally financed bedrock social insurance programs. That might impact its political viability now and in the future.

While echoing her party’s longstanding call for universal health care, the Massachusetts Democrat is proposing to raise most of the additional $20.5 trillion her campaign believes would be needed from taxes on businesses, wealthy people and investors.

That’s different from the “social insurance” — or shared responsibility — the approach taken by Democratic presidents like Franklin D. Roosevelt, Harry Truman, and Lyndon Baines Johnson.

Broad financing through payroll taxes collected from workers and their employers has fostered a sense of ownership of Social Security and Medicare among ordinary Americans. That helped derail several Republican-led privatization efforts. And signs declaring “Keep Government Out Of My Medicare” proliferated during protests against President Barack Obama’s health care legislation, which scaled back Medicare payments to hospitals.

The Warren campaign says the reason programs like Social Security and Medicare are popular is that benefits are broadly shared. A campaign statement said her plan would put money now spent on medical costs back in the pockets of middle-class families “substantially larger than the largest tax cut in American history.”

But Roosevelt was once famously quoted explaining that he settled on a payroll tax for Social Security to give Americans the feeling they had a “legal, moral and political right” to benefits, thereby guaranteeing “no damn politician” could take it down.

Medicare passed under Johnson, is paid for with a payroll tax for hospital services and a combination of seniors’ premiums and general tax revenues for outpatient care and prescriptions. Truman’s plan for universal health insurance did not pass, but it would have been supported by payroll taxes.

“If you look at the two core social insurance programs in the United States, they have always been financed as a partnership,” said William Arnone, CEO of the National Academy of Social Insurance, a nonpartisan organization that educates on how social insurance builds economic security.

On Warren’s plan, “the question is, will people still look at it as an earned right, or will they say that their health care is coming out of the generosity of the wealthy?” Arnone added. His group takes no position on Medicare for All.

“It’s not an accident that Social Security is on the chopping block a lot less frequently than so-called welfare programs,” said retirement expert Charles Blahous, a political conservative and a former public trustee overseeing Social Security and Medicare finances.

With Warren’s approach, “you are going to have this clash of interests between the people paying the bills and the beneficiaries,” Blahous added. His own estimates indicate Medicare for All would cost the government about $12 trillion more over 10 years than Warren projects.

The Warren campaign downplays the role of shared responsibility and instead points to promised benefits under Medicare for All.

“Every person in America will have full health coverage, get the doctors and the treatments they need, and no more going broke over medical bills,” the campaign said in a statement. “Backed up by leading experts, Elizabeth has shown how her plan will do this by having the richest 1% and giant corporations pay a little bit more and without raising taxes on the middle class by one penny.”

Under Warren’s plan, nearly $9 trillion would come from businesses, in lieu of what they’re already paying for employees’ health care. About $7 trillion would come from increased taxes on investors, wealthy people, and large corporations. An IRS crackdown on tax evasion would net about $2 trillion. The remainder would come from various sources, including dividends of a projected immigration overhaul and eliminating a Pentagon contingency fund used for anti-terrorism operations.

Sen. Bernie Sanders’ list of options to pay for Medicare for All includes a 4% income-based premium collected from most households.

John Rother, CEO of the National Coalition on Health Care umbrella group, said he can follow Warren’s argument about making the wealthy pay, but it still looks like a hard sell.

“What is different today is the tremendous gap between the well-off and middle-class people,” he said. “In a way, it makes sense as a step toward greater equality, but it is still a little tricky politically because you don’t have that same sense that ‘this is mine, I paid into it, and therefore no one is going to take it away.'” His group has taken no position on Medicare for All.

History records that various payment options were offered for Social Security in the 1930s and FDR favored a broad payroll tax. One competing idea involved a national sales tax.

An adviser’s memo in the Social Security archives distills Roosevelt’s thinking.

“We put those payroll contributions there so as to give the contributors a legal, moral, and political right to collect their pensions and their unemployment benefits,” Roosevelt was quoted as saying.

“With those taxes in there, no damn politician can ever scrap my social security program,” he added. “Those taxes aren’t a matter of economics, they’re straight politics.”

Medicare-for-all could cause ‘enormous’ doctor shortage

Julia Limitone pointed out something I mentioned that I am concerned about in the Medicare for All plan outlined by Sen. Warren. Sen. Elizabeth Warren’s Medicare-for-all plan is a disaster and would lead to an “enormous” doctor shortage, according to FOX News medical correspondent Dr. Marc Siegel.

If Warren’s plan came to pass, doctors would be working for the government, which in turn would decide their pay, Dr. Siegel told FOX Business’ Stuart Varney.

“The government doctors will be paid up to 40 percent less,” he said on Thursday. “Many will leave the profession,”

In countries with socialized medicine doctors earn about half of what primary care doctors make in America, he said.

“I’ve interviewed an Australian physician who’s from Canada, and she’s making about 30 to 40 dollars for a visit at the most,” he said.

But even more than that, a patient wouldn’t necessarily be able to get the care they need, Siegel said.

“I have to wait a month to figure out if someone has a problem up here,” he said.

What’s more, he said, it would hit hospitals hard. Hospitals rely on private insurance to pay for research, medical students and quality care, Dr. Siegel said. Under the plan, they’d get a flat fee from the government, and would not be able to differentiate between medical centers and great care and something that’s of lower quality, he explained.

“Hospitals are going to go belly up,” he warned.

Warren’s campaign said the single-payer plan would cost the country “just under” $52 trillion.

VA launches new health care options under MISSION Act

Because we are celebrating Veterans Day I thought that I would review some of the changes in the VA healthcare system. The VA system represents a health care system that is run by the government and look where that is going…….back to the private health care system. The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ends the Veterans Choice Program and establishes a new Veterans Community Care Program.

The MISSION Act will strengthen the nationwide VA Health Care System by empowering Veterans with more health care options.

“The changes not only improve our ability to provide the health care Veterans need but also when and where they need it,” said VA Secretary Robert Wilkie. “It will also put Veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.”

Under the new Veterans Community Care Program, Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Eligibility for community care does not require a Veteran to receive that care in the community; Veterans can still choose to have VA provide their care. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria:

  1. A Veteran needs a service not available at any VA medical facility.
  2. A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands.
  3. A Veteran qualifies under the “grandfather” provisions related to distance eligibility under the Veterans Choice Program.
  4. VA cannot furnish care within certain designated access standards. The specific access standards are described below:
  • Drive time to a specific VA medical facility
  • Thirty-minute average drive time for primary care, mental health, and noninstitutional extended care services.
  • Sixty-minute average drive time for specialty care.

Note: Drive times are calculated using geomapping software.

  • Appointment wait time at a specific VA medical facility
  • Twenty days from the date of the request for primary care, mental health care, and noninstitutional extended care services, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  • Twenty-eight days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  1. The Veteran and the referring clinician agree it is in the best medical interest of the Veteran to receive community care based on defined factors.
  2. VA has determined that a VA medical service line is not providing care in a manner that complies with VA’s standards for quality based on specific conditions.

In preparation for this landmark initiative, senior VA leaders will visit more than 30 VA hospitals across the country to provide in-person support for the rollout.

The VA MISSION Act:

  • Strengthens VA’s ability to recruit and retain clinicians.
  • Authorizes “Anywhere to Anywhere” telehealth across state lines.
  • Empowers Veterans with increased access to community care.
  • Establishes a new urgent care benefit that eligible Veterans can access through VA’s network of urgent care providers in the community.

VA serves approximately 9 million enrolled Veterans at 1,255 health care facilities around the country every year. We send our military representatives-soldiers, sailors and airmen and women to fight for us and now we are arguing about how to care for them when they are injured, whether physically or mentally. Imagine if we adopt another government-run health care system??

Thank you, all you Vets for all you have done for us to keep us and our beloved country free!

 

Warren’s $52T ‘Medicare-for-all’ plan revealed: Campaign still claims no middle-class tax hikes needed and SNL

74798250_2323921837737462_2762717535395643392_nFinally, we got a view of the cost of Medicare for All plan for health care for all of us. It was so interesting that Saturday Night Live featured it on T.V. With the remarkably versatile Kate McKinnon at the helm, this weekend’s “Saturday Night Live” cold open took aim at Sen. Elizabeth Warren’s $52 trillion “Medicare-for-all” health care plan.

“I am in my natural habitat – a public school on a weekend,” McKinnon’s excitable Warren quipped at an Iowa town hall, complete with fist pumps, some “whoos” and the senator’s signature raspy voice.

She also took a moment to give former Rep. Beto O’Rourke a sendoff after he dropped out of the race last week.

“Let me know how my dust tastes,” she said.

After mentioning that she pays taxes in every state “out of principle,” she took questions from cast members playing ambivalent voters.

Asked why it took her so long to release her health care plan, McKinnon’s Warren answered, “When Bernie [Sanders] was talking ‘Medicare-for-all’, everybody was like, ‘Oh cool,’ and then they turned to me and said, ‘Fix it, Mom.’”

She added that her plan “compares favorably” to former Vice President Joe Biden’s “in that it exists.”

“No one asks how we’re going to pay for ‘Remember Obama,” she said, referring to Biden’s tendency to frequently cozy up to the former president.

She then answered a question about estimates of how much her plan would cost.

“We’re talking trillions,” she answered. “When the numbers are this big they’re just pretending.”

Warren has surged in polls recently as Biden has faded and is in the lead in a new Iowa poll.

Democratic presidential candidate Elizabeth Warren’s long-awaited “Medicare-for-all” funding plan projects the government-run health care system would cost a staggering sum of “just under $52 trillion” over the next decade, with the campaign proposing a host of new tax increases to pay for it while still claiming the middle class would not face any additional burden.

“We don’t need to raise taxes on the middle class by one penny to finance Medicare for All,” Sen. Warren, D-Mass., said in her plan — a copy of which was obtained by Fox News in advance of its release Friday.

In a tweet posted after this report was first published, Warren reiterated that pledge while asserting she can return $11 trillion to American families.

Today, I’m releasing my plan to pay for ‪#MedicareForAll. Here’s the headline: My plan won’t raise taxes one penny on middle-class families. In fact, we’ll return about $11 TRILLION to the American people. That’s bigger than the biggest tax cut in our history. Here’s how:

Some of Warren’s rivals for the nomination are unlikely to buy that claim, after having repeatedly challenged her assertions that the middle class would not be hit by tax hikes and suggested she has not been upfront with voters.

Indeed, the Joe Biden campaign said the “unrealistic plan” would leave only two options: “even further increase taxes on the middle class or break her commitment to these promised benefits.”

“The mathematical gymnastics in this plan are all geared towards hiding a simple truth from voters: it’s impossible to pay for Medicare for All without middle-class tax increases,” Deputy Campaign Manager Kate Bedingfield said in a statement.

The Warren campaign’s detailed Medicare-for-all proposal, however, insists that the costs can be covered by a combination of existing federal and state spending on Medicare and other health care — as well as myriad taxes on employers, financial transactions, the ultra-wealthy and large corporations and some savings elsewhere. Those measures are meant to pay for a projected $20.5 trillion in new federal spending. Notably, they include what is essentially a payroll tax increase on employers, something economists generally say can hit workers in the form of reduced wages.

Like Medicare-for-all’s chief Senate champion, fellow candidate Bernie Sanders, the Warren campaign argues that many of these costs already are being spent in the existing health care system by governments, employers and individuals in the form of premiums, deductibles, and other expenses.

However, unlike Sanders’ plan, Warren’s projects no new tax burden for the middle class. The Warren campaign claims those $11 trillion in individual costs would drop to “practically zero,” while the plan maintains and boosts a funding pipeline from other sources. The plan also carries a total price tag of “just under $52 trillion” over the next 10 years, or slightly less than cost projections for the current system. That factors in current and additional spending; new spending alone would be in the $20 trillion range, compared with roughly $32 trillion for Sanders’ plan.

So how would she pay for it?

Among other proposals, Warren calls for bringing in nearly $9 trillion in new Medicare taxes on employers over the next 10 years, arguing this would essentially replace what they’re already paying for employee health insurance. Further, Warren’s campaign says if they are at risk of falling short of the revenue target, they could impose a “Supplemental Employer Medicare Contribution” for big companies with “extremely high executive compensation and stock buyback rates.”

Whether some of those costs, however, still could be passed on to middle-class employees – as economists argue payroll tax costs often are – remains to be seen. As the Tax Policy Center has noted, it is assumed the “employee bears the burden of both the employer and employee portions of payroll taxes.”

Bedingfield pointed to that component in alleging the plan “would place a new tax of nearly $9 trillion that will fall on American workers.”

Warren also proposes even more taxes on the ultra-rich, expanding on her previously announced signature wealth tax, to tax more of anyone’s net worth over $1 billion (estimated to raise another $1 trillion). Warren also calls for raising capital gains tax rates for the wealthy, taxing more foreign earnings and imposing a tax on financial transactions to generate $800 billion in revenue.

Aside from those and other taxes, the campaign claims they can scrounge up $2.3 trillion with better tax enforcement and policies, as well as additional funds by reining in defense spending.

“When fully implemented, my approach to Medicare for All would mark one of the greatest federal expansions of middle-class wealth in our history,” Warren said in her plan. “And if Medicare for All can be financed without any new taxes on the middle class, and instead by asking giant corporations, the wealthy, and the well-connected to pay their fair share, that’s exactly what we should do.”

Warren has been teasing this plan for weeks, especially after some of her rivals hammered her campaign on the financing issue during the last primary debate.

“Your signature, senator, is to have a plan for everything except this,” South Bend, Ind., Mayor Pete Buttigieg memorably said during last month’s Democratic primary debate.

“No plan has been laid out to explain how a multitrillion-dollar hole in this Medicare-for-all plan that Senator Warren is putting forward is supposed to get filled in,” he charged.

Sen. Amy Klobuchar, D-Minn., also slammed Warren during that debate, saying “at least Bernie’s being honest here in saying how he’s going to pay for this and that taxes will go up. And I’m sorry, Elizabeth, but you have not said that and I think we owe it to the American people to tell them where we’re going to send the invoice.”

Sanders has openly said taxes will increase “for virtually everybody” but argued the system will ultimately cost less than what workers currently pay for premiums and other expenses.

The Warren campaign’s insistence that the middle class will be spared any such costs is likely to face sustained skepticism in the Democratic primary field.

Buttigieg reprised his criticism this week, telling Fox News that his concern about Warren’s plan “is not just the multi-trillion-dollar hole, but also the fact that most Americans would prefer not to be told that they have to abandon their private plan.”

Trump campaign communications director Tim Murtaugh also blasted Warren’s plan Friday as a “total disaster.”

“There are 52 trillion reasons why this plan is a total disaster,” Murtaugh told Fox News. “Best of luck to the fact-checkers who now have to clean up the mess.”

One Emory University health care expert recently told The Washington Post “there’s no question” a Medicare-for-all plan “hits the middle class” in some way. A new study released by the bipartisan Committee for a Responsible Federal Budget also noted it would be “impossible” to finance any such plan using only taxes on the wealthiest Americans.

Aside from the cost issues, Warren did appear to acknowledge this week that Medicare-for-all could result in substantial job losses, calling it “part of the cost issue” when confronted with an estimate that nearly 2 million jobs could be shed.

During that same interview with New Hampshire Public Radio, Warren vowed that she would “not sign any legislation into law for which costs for middle-class families do not go down.”

UPDATE 6-Democrat Warren: Medicare for All would not raise U.S. middle-class taxes ‘one penny’

As we just heard and Reuters published a report noted, Democratic U.S. presidential candidate Elizabeth Warren on Friday proposed a $20.5 trillion Medicare for All plan that she said would not require raising middle-class taxes “one penny,” answering critics who had attacked her for failing to explain how she would pay for the sweeping healthcare system overhaul.

Warren said her plan would save American households $11 trillion in out-of-pocket healthcare spending over the next decade while imposing significant new taxes on corporations and the wealthy to help finance it.

“Healthcare is a human right, and we need a system that reflects our values,” Warren wrote in a 20-page essay outlining her plan. “That system is Medicare for All.”

The proposal to remake the U.S. healthcare system will face scrutiny from Warren’s more moderate Democratic opponents, who have questioned Medicare for All’s practicality.

Warren’s proposal also calls for cuts in defense spending and passing immigration reform to increase tax revenue from newly legal Americans, two steps that would face an uphill battle in Congress. The $20.5 trillion in new spending over 10 years would increase the entire federal budget by a third.

Warren, a U.S. senator from Massachusetts, is one of 17 Democrats vying for the party’s nomination to take on Republican President Donald Trump in the November 2020 election. She is near the front of the pack in opinion polls, having closed in on former Vice President Joe Biden, the early front-runner.

Medicare for All would replace private health insurance, including employer-sponsored plans, with full government-sponsored coverage, and individuals would no longer have to pay premiums, deductibles, co-pays or other out-of-pocket costs.

It would extend Medicare, the U.S. government’s health insurance program for people 65 years and older and the disabled, to cover all Americans, including the roughly 27.5 million – 8.5% of the population – who are currently uninsured.

Warren, a former law professor, has become known for a bevy of detailed policy proposals. But she had faced criticism for not detailing how she would pay for a Medicare for All plan she backs, which was introduced in the Senate by rival Democratic candidate Bernie Sanders of Vermont.

At recent debates, Warren had refused to answer directly when asked whether she would be forced to raise middle-class taxes to cover the costs, even as Sanders acknowledged he would.

More moderate 2020 candidates such as Biden and South Bend, Indiana, Mayor Pete Buttigieg have said Medicare for All would be too disruptive and favor a more incremental approach.

‘MATHEMATICAL GYMNASTICS’

On Friday, Biden’s campaign questioned Warren’s calculations, calling them “double talk” and “mathematical gymnastics” and asserting that middle-class taxes would rise despite her vow.

“It’s impossible to pay for Medicare for All without middle-class tax increases,” said Kate Bedingfield, Biden’s deputy campaign manager. “To accomplish this sleight of hand, her proposal dramatically understates its cost, overstates its savings, inflates the revenue, and pretends that an employer payroll tax increase is something else.”

Warren, speaking to reporters in Iowa on Friday, said she was “just not sure where he (Biden) is going,” adding that her proposal and its costs were authenticated by outside experts.

“Democrats are not going to win by repeating Republican talking points and by dusting off the points of view of the giant drug companies and the giant insurance companies,” Warren said.

House of Representatives Speaker Nancy Pelosi also questioned the feasibility of enacting Medicare for All, saying in an interview with Bloomberg on Friday that Democrats should focus on expanding the Affordable Care Act, commonly known as Obamacare.

Critics like Warren note that the current U.S. healthcare system – a patchwork of private insurance often provided by employers or obtained through Obamacare marketplaces and public programs covering the poor, elderly and disabled – is the most costly in the world despite leaving tens of millions uncovered.

Medicare for All legislation stands little chance of passing Congress, where Democrats control the House and Republicans control the Senate.

The plan relies on aggressive ways of lowering healthcare costs, including major cuts in prescription drug prices and significant reductions in administrative costs by eliminating private insurers.

“She makes some assumptions about how effectively healthcare costs could be contained that may not pan out,” said Larry Levitt, a health policy expert at the Kaiser Family Foundation.

Employers would be asked to repurpose the money they currently spend on workers’ healthcare into Medicare contributions, while billionaires, high-earning investors, and corporations would face trillions of dollars in higher taxes.

In an effort to appease union leaders, some of whom have expressed skepticism about giving up hard-fought healthcare plans, Warren said employers that already offer benefits under a collective bargaining agreement could reduce their contributions if they pass the savings along to workers.

Warren released two letters supporting her calculations from several experts, including Simon Johnson, the former chief economist for the International Monetary Fund; Donald Berwick, who oversaw Medicare in the Obama administration; and Mark Zandi, the chief economist at Moody’s Analytics.

An online calculator launched by Warren’s campaign showed an average family of four with employer-provided insurance would save $12,378 per year.

Warren said with her Medicare for All plan in place, projected total healthcare costs in the United States over 10 years would be just under $52 trillion – slightly less than maintaining the current system.

Here’s How Warren Finds $20.5 Trillion To Pay For ‘Medicare For All’

Danielle Kurtslenben reported that Sen. Elizabeth Warren says paying for “Medicare for All” would require $20.5 trillion in new federal spending over a decade. That spending includes higher taxes on the wealthy but no new taxes on the middle class.

The Democratic presidential candidate released her plan to pay for Medicare for All on Friday after being dogged for months by questions of how she would finance such a sweeping overhaul of the health care system. That pressure has been intensified by the fact that Warren has made detailed proposals a central part of her brand as a candidate.

Medicare for All is a single-payer health care proposal introduced by Sen. Bernie Sanders and co-sponsored by multiple candidates in the presidential race, including Warren. It would virtually eliminate private insurance, including employer-sponsored coverage.

It also represents a political risk, as multiple polls show that introducing a public option for health insurance coverage is more popular than a Medicare for All plan that almost entirely does away with private insurance.

Here’s a look at what Warren has laid out to provide single-payer health care, including proposals to cut costs, where new revenue would come from, where funds would not be taken from and what comes next.

How Warren wants to reduce spending

Warren bases her plan off of a recent analysis from the Urban Institute, which estimated that under current law, Americans would spend $52 trillion over the next decade on health care — that includes many types of spending, from employers, individuals and all levels of government.

In that analysis, the Urban Institute calculated that under a single-payer plan that looks a lot like Medicare for All, costs would total not $52 trillion but $59 trillion over a decade, which would require $34 trillion in new federal spending.

Warren’s plan estimates that total health costs could be held to $52 trillion and that $20.5 trillion in new federal spending would be necessary.

Like Urban, Warren’s plan assumes that Medicare for All would pay doctors what Medicare pays them right now. It would also pay hospitals 110 percent of what Medicare pays right now — slightly less than Urban’s 115 percent assumption.

This question — what to pay hospitals and doctors — is a big part of what determines how much Medicare for All would cost. That’s because Medicare pays doctors and hospitals much less than private insurance.

“This plan aggressively constrains the price of health care, paying doctors, hospitals and drug companies much less,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “There would be a lot of adjustment required from hospitals and doctors as their incomes go down.” ( And I will say more about this at the end of this blog post).

Just how seismic such a shift would be would depend in part on how fast the transition is, he added.

“I think how quickly she proposes to transition to this new system will be really important because it would be very disruptive to the health care system,” Levitt said. “You know, a quick transition would be hard and potentially result in shortages or increased wait times for health care.”

Sanders calls for a four-year transition to Medicare for All — a pace that Levitt characterized as “quite quick.” In a Friday blog post spelling out her proposal, Warren said she plans to unveil her transition plan “in the weeks ahead.”

A letter from economists supporting the plan, provided by Warren’s team, argued that these payment rates would work in part because doctors and hospitals would save substantially on administrative costs. Warren’s team also says there would be ways to ensure that vulnerable hospitals, like those in rural areas, would get paid more, so they could stay in business.

Her proposal also establishes savings by projecting that Medicare for All could substantially slow medical cost growth. Warren also stipulates that state and local governments would redirect the more than $6 trillion they currently spend on Medicaid and the Children’s Health Insurance Program (CHIP) to the federal government.

Where the money would not come from

One thing that’s notable about this plan is where the revenue doesn’t come from. Warren had promised at a recent debate that she would not sign a bill that raises health care costs for the middle class.

This plan goes further: Middle-class Americans would no longer pay health premiums or copays and would also not pay new taxes to replace those costs. They would, however, pay taxes on whatever additional take-home pay they would receive from this plan. That would add $1.4 trillion in revenue, her team estimates.

This is a departure from Bernie Sanders’ ideas about how to fund Medicare for All. One of his options is a 4% tax on families earning more than $29,000. At the Democrats’ October debate, he explained that taxes would go up for many Americans under his plan.

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

Where the $20.5 trillion comes from

Employers are one of the main sources of revenue in this proposal. Warren says she would raise nearly $9 trillion here, a figure that comes from the roughly $9 trillion private employers are projected to spend over the next decade on health insurance. The idea here is that instead of contributing to employees’ health insurance, employers would pay virtually all of that money to the government.

In addition, she will boost her proposed 3% wealth tax on people with over a billion dollars to 6% and also boost taxes on large corporations. Altogether, she believes, taxes on the rich and on corporations would raise an estimated $6 trillion. An additional $2.3 trillion would come from improving tax enforcement.

But there are lingering questions about how much revenue some of these taxes would bring in or how easy it would be to impose a wealth tax in particular.

“Something like half of the wealth of the wealthiest people in America is held in privately held corporations, privately held businesses,” said Howard Gleckman, a senior fellow at the Urban-Brookings Tax Policy Center. “And it’s really hard to value those assets for tax purposes.”

Warren also includes comprehensive immigration reform as part of her plan. Giving more people a path to citizenship would mean more taxpayers, which would mean more tax revenue.

Political ramifications

While Medicare for All is Sanders’ plan, his bill does not include set methods to pay for the plan. Rather, Sanders has included “options” to pay for his health care plan. In a recent interview with CNBC, he said “we’ll have that debate” over how exactly to finance the plan.

As the candidate with “a plan for that,” as one of her slogans goes, Warren has been asked repeatedly whether her health care overhaul plan would raise taxes on the middle class. Warren repeatedly said in response that she would not raise costs for the middle class.

This proposal gives Warren an answer for the next time she is asked how she would pay for Medicare for All, and it means she can say that she wouldn’t impose new taxes on middle-class Americans.

But it also gives her opponents potential new fodder for attacks. Former Vice President Joe Biden has already come out swinging, accusing Warren of fuzzy math. In addition, his team argues that that nearly $9 trillion that employers would pay the government would ultimately hurt workers.

“To accomplish this sleight of hand, her proposal dramatically understates its cost, overstates its savings, inflates the revenue, and pretends that an employer payroll tax increase is something else,” said Biden deputy campaign manager Kate Bedingfield in a statement released Friday.

In fact, another study by a number of economists estimates the true cost of almost $70 trillion over a decade. Wow, what a spending plan and what is our national debt now? About $21 trillion and now we are going to add more and more. When does it end? And remember all the doctors and hospitals, especially rural hospitals, will be paid based on the discounted rates of Medicare. How do doctors then pay for the education debts, their overhead expenses, and their malpractice insurance fees? Interesting! Who then will be taking care of our patients?

Again I ask, where is Obamacare when we need it and how do we pay for it in the future?