Category Archives: Doctors

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?

 

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

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

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

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

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

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

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

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

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

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

Paying for Medicare for All

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Shouting match

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

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

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

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

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

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

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

The other Democrats, however, let the subject drop.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Poll of the Day: Democrats Increasingly Favor Obamacare

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

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

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

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

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

Media Statement

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

Cases

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

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

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

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

Deaths

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

What the CDC is doing

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

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

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

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

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

More to come in this discussion.