Category Archives: Medicare for All

What the New Democratic House majority might actually pass on health care; and It Looks Like VA Healthcare Maybe Improving!

 

 

18670832_1206383419491315_6469395384583311089_nI had prepared two posts for tonight and wanted to hold off on the recent shootings until next week as we digest what the effect really is in our country and the future strategies. Now let’s discuss the effect of the election and in looking at the House Democrats, who have a lot to figure out on their signature issue.

Healthcare carried House Democrats to victory on Election Day. But what now?

Remember my past post reminding the Republicans the importance of healthcare in the midterm elections? We, it looks like it was an important factor in the outcomes of the “wave”. Dylan Scott spent some time looking at his prediction of what the new majority will bring to our health care system. In interviews this fall with half a dozen senior House Democratic aides, health care lobbyists, and progressive wonks, it became clear the party is only in the nascent stages of figuring out its next steps on health care.

The new House Democratic majority knows what it opposes. They want to stop any further efforts by Republicans or the Trump administration to roll back and undermine the Affordable Care Act or overhaul Medicaid and Medicare.

But Democrats are less certain about an affirmative health care agenda. Most Democrats campaigned on protecting preexisting conditions, but the ACA has already done that. Medicare-for-all is energizing the party’s left wing, but nobody expects a single-payer bill to start moving through the House. Drug prices offer the rare opportunity for bipartisan work with Senate Republicans and the Trump White House, but it is also a difficult problem with few easy policy solutions — certainly not any silver bullet that Democrats could pull out of the box and pass on day one, or even month one, of the next Congress.

Winning a House majority to ensure Obamacare’s safety is an important turning point after so many years in which health care hurt Democrats much more than it helped.

But the path forward for the party on their signature issue is surprisingly undefined.

The likely first item on the Democratic agenda: Obamacare stabilization

Democrats do have some ideas, of course. Democratic aides emphasized the various investigations they could launch into Trump’s health department, not only looking into any efforts by the White House to sabotage Obamacare but also focusing on more obscure issues like Medicare payment rates.

But wonky oversight inquiries probably aren’t the big-ticket item that new Democratic members and their voters are looking for, especially heading into the 2020 presidential election.

After campaigning in defense of Obamacare, warning about Republicans rolling back preexisting conditions protections and the Trump administration’s sabotage of the health care law, a bill to stabilize the Obamacare insurance markets would be the obvious first item for the new Democratic majority’s agenda.

Several sources pointed to a bill by Democratic Reps. Richard Neal (MA), Frank Pallone (NJ), and Bobby Scott (VA) — who have been serving as the top Democrats on leading health care-related committees — as the likely starting point. The plan is designed to build off Obamacare’s infrastructure to expand federal assistance while reversing the recent Republican efforts to undermine the law.

That bill would expand Obamacare’s premium subsidies, both by extending federal assistance to more people in lifting the current eligibility cutoff and by increasing the size of the tax credits people receive. It would also bolster the cost-sharing reduction subsidies that people with lower incomes receive to reduce their out-of-pocket costs while extending eligibility for those subsidies to people with higher incomes.

The Pallone-Neal-Scott bill would reverse the Trump administration’s recent regulations intended to funnel more people to insurance plans that are not required to meet all of Obamacare’s rules for preexisting conditions. It would also pump more money back into enrollment outreach, cut by the Trump administration, and establish a new program to compensate insurers for high-cost patients, with the hope of keeping premiums down.

Two things stick out about this bill: It would be the most robust expansion of Obamacare since the law first passed, and it is just narrow enough that, with a few sweeteners for Senate Republicans, it could conceivably have a chance to pass. Democrats are waiting to see how the GOP majority in the upper chamber reacts to losing the House.

“Undoing sabotage and bringing stabilization to the ACA markets, that’s something we should really be thinking about,” one House Democratic aide told me. “It depends on what kind of mood the Republicans are in. Maybe they’ll say that actually now that the tables are turned, we should probably sit down.”

Senate Republicans and Democrats did come very close to a narrow, bipartisan deal — it wasn’t even as robust as the Pallone-Neal-Scott bill — to stabilize Obamacare in 2017. It fell apart, ostensibly after a tiff over abortion-related provisions, but that near miss would be the reason for any optimism about a bipartisan deal on the divisive health care law.

Then again Senate Republicans might have no interest in an Obamacare compromise after gaining some seats. Democrats would still likely work on stabilization to send a message to voters on health care ahead of the 2020 campaign.

Shoring up Obamacare is a good start, but what next?

In the case, the Pallone-Neal-Scott bill might be a nice starting point — no Democrat really disagrees about whether they should help the law work better in the short term — but it still lacks any truly ambitious provisions. It is just about as narrowly tailored as an Obamacare stabilization bill offered by Democrats could be, a fact that aides and activists will privately concede.

Missing are any of the bolder policy proposals animating the left. Not even a hint of Medicare-for-all single-payer health care, which is or isn’t a surprise, depending on how you look at it.

Medicare-for-all is quickly becoming orthodoxy among many in the party’s progressive grassroots, and a single-payer bill proposed this Congress in the House (similar to the one offered by Bernie Sanders over in the Senate) has 123 sponsors.

But House Democratic leaders probably don’t want to take up such a potentially explosive issue too soon after finally clawing back a modicum of power in Trump’s Washington.

Still, the current stabilization bill doesn’t even include a Medicare or Medicaid buy-in, the rebranded public option that never made it into Obamacare but would allow Americans to voluntarily join one of the major government insurance programs. It is an idea that even the more moderate Democratic members tend to support, and polls have found three-fourths of Americans think a Medicare buy-in is a good idea.

The plain truth is House Democrats haven’t reached a consensus yet about what they want to do to cover more Americans. They agree Obamacare was an important first step, and they agree the status quo is unacceptable. But the exact mechanism for achieving those goals — single-payer, a robust public option, or simply a buffed-up version of Obamacare — is still very much up for debate.

“People will want to do something, but any further action is going to be a consensus-building process,” a senior House Democratic aide told me. “Democrats have lots of different ideas on how to continue working to reduce the uninsured.”

That is all well and good, but few issues are exciting the Democratic grassroots right now like Medicare-for-all. During the midterm campaigns, Democratic candidates and even grassroots leaders were happy to let those words mean whatever voters wanted them to mean. For some people, it meant single-payer; for others; it might mean a Medicare buy-in or something more limited.

The unreservedly progressive members who were just elected to Congress will only wait so long before they start pressing Democratic leaders to take more aggressive steps to pick up one of their top campaign issues. That pressure will only intensify as the 2020 presidential campaign heats up and Democrats debate what kind of platform they should run on as they seek to take back the White House.

For now, Democrats have tried to put off a difficult debate and focus on what unites them. But the debate is still coming.

The riddle of high drug prices still needs to be solved too

Even with Obamacare and preexisting conditions mobilizing Democratic voters this year, prescription drug prices remain a top concern for many Americans. That’s another area where Democrats know they want to act but don’t know yet exactly what they can or should do.

The issue could be an opening for serious dealmaking: Trump himself has attacked big pharma since his presidential campaign. His administration has actually launched some interesting initiatives to rein in drug costs — approving a record number of generic drugs, trying to even the playing field between America and foreign countries — that have some policy wonks intrigued, even if the impact is still to be determined.

Democrats have mostly stuck to slamming Trump for feigning to act on drug prices while cozying up to the drug industry. But it’s a top priority for both parties, and there could be some room for compromise. One progressive policy wonk thought a drug prices bill might actually be the first Democratic priority. It helps that drug prices are a populist issue that the new House majority might really be able to pass a bill on.

But first, Democrats have to figure out what exactly they are for — and what would actually make a difference.

The rallying cry for Democrats on drug prices has been letting Medicare directly negotiate prices with drug manufacturers, a proposal that Trump also embraced as a candidate, though he has since softened as president. The problem is the Congressional Budget Office doesn’t think Medicare negotiations would save any money unless the government is willing to deny seniors coverage for certain medications. But adding such a provision would surely invite attacks that Democrats are depriving people’s grandparents of the medications they need.

There are a lot of levers to pull to try to reduce drug prices: the patent protections that pharma companies receive for new drugs, the mandated discounts when the government buys drugs for Medicare and Medicaid, existing hurdles to getting generic drugs approved, the tax treatment of drug research and development. Lawmakers and the public view pharmacy benefits managers, the mysterious middlemen between health insurers and drugmakers, skeptically.

But none of those are silver bullets to lower prices, and they will certainly invite pushback from the politically potent pharmaceutical lobby, focused on the concerns about how much cracking down on drug companies to discourage them from developing new drugs. Democrats also don’t know yet what specific policies could win support from Senate Republicans or the Trump White House.

“How do you take this gargantuan Chinese menu of things and figure out how things fit together in a way that stem some of the abuses?” is how one Democratic aide summarized the dilemma.

It is a problem bedeviling Democrats on more than just drug prices. Health care was a winner on election night this year, and it has always been a priority for Democrats. Now they just need to figure out what to do.

Because tomorrow is Veterans Day I thought that I would include this article.             After A Year Of Turmoil, New VA Secretary Says ‘Waters Are Calmer’ 

Quil Lawrence in his Twitter post reported on a wide-ranging interview with NPR, Secretary of Veterans Affairs Robert Wilkie said his department is on the mend after a tumultuous 2018.”I do think it is better because the turmoil of the first half of this year is behind us, the waters are calmer. We’re not where we need to be, but we’re heading in that direction,” he said.

Early in Donald Trump’s presidency, the VA was considered an island of stability in an unpredictable administration.

Secretary David Shulkin was a hold-over from the Obama administration, already familiar with the VA’s massive bureaucracy. Bipartisan reforms moved through Congress with relative speed, and Trump could point to a list of legislative accomplishments.

But the president fired Shulkin last March after weeks of intrigue during which VA political appointees plotted openly to oust him. Trump’s first nominee to replace Shulkin, Rear Adm. Ronny L. Jackson, sank under accusations of misconduct (which are still being investigated by the Pentagon).

Numerous high-ranking officials left the department, and records showed that friends of the president outside of government – who weren’t even veterans – had been lobbying Trump at Mar-a-Lago on how to run the VA.

After a stint as acting VA secretary, Robert Wilkie was confirmed by the Senate last July. Since then, Wilkie says he’s been “walking the post,” visiting as many VA facilities as he can. And he’s reached the same conclusion as many of his predecessors.

“I have been incredibly impressed by the caliber of VA employee I’ve encountered everywhere, from Alaska to Massachusetts to Florida,” Wilkie told NPR’s, Steve Inskeep.

“I have no quarrel with the quality of medical care our veterans receive. My biggest problem is actually getting them into the system so that they can receive that care, which means the problems are primarily administrative and bureaucratic,” said Wilkie, himself a veteran of the Navy and a current Air Force reservist, who counts generations of veterans in his family.

“I am the son of a Vietnam soldier. I know what happened when those men and women came home,” Wilkie said. “So that is incredibly important to me.”

Wilkie is navigating an important moment for the VA – while Congress has already passed major reforms, he’s the one who has to implement them. And plenty of political controversy hides in the details.

The VA Mission Act of 2018 was signed into law in June. It’s intended to consolidate about a half-dozen programs The VA uses to buy veterans private healthcare at a cost of billions of dollars, into one streamlined system.

Critics fear that leaning too much on private care will bleed the VA’s own medical centers, and lead to a drop in quality there – and amounts to a starve-the-beast strategy of privatization.

Wilkie says that won’t happen and is not President Trump’s goal, but he has yet to present a budget for expanded private care to the White House and to Congress.

“You’re not going to privatize this institution. I certainly have never talked about that with anyone in this administration,” Wilkie said.

Wilkie also maintains that he has had little contact with the group of outside advisers who meet with the president at Mar-a-Lago, including CEO of Marvel Comics Ike Perlmutter and Florida doctor Bruce Moscowitz. Records show they had extensive communication with the previous VA secretary, sometimes influencing policy decisions.

“I met with them when I was visiting the West Palm Beach VA – my first week as acting (secretary), and have not had any meetings with them ever since that day,” Wilkie said. “I’ll be clear. I make the decisions here at the department, in support of the vision of the president.”

Despite rumors that Wilkie would clear out many of the Trump political appointees who clashed with former secretary Shulkin, he said he didn’t expect more staffing changes.

The one notable departure is Peter O’Rourke, who was acting secretary for two months while Wilkie went through the confirmation process. O’Rourke clashed repeatedly with Congress and the VA’s inspector general. Wilkie himself cited a Wall Street Journal reports that O’Rourke is poised to go and said he’s “on leave.”

“I think there will be an announcement soon about a move to another department in the federal government – I know that he’s looking for something new,” said Wilkie, “He’s on leave.”

Another major new plan that Wilkie must implement is a $10 billion, 10-year plan to make the VA’s medical records compatible with the Pentagon’s.

He once again mentioned his father’s experience as a wounded combat vet.

“He had an 800-page record, and it was the only copy, that he had to carry with him for the rest of his life. He passed away last year,” said Wilkie.

“One of the first decisions I made as the acting secretary was to begin the process of creating a complete electronic healthcare record that begins when that young American enters the military entrance processing station to the time that that soldier, sailor, airman, Marine walks into the VA.”

But that process has actually been underway for a decade – with little to show and about a billion dollars already spent on the effort. The non-partisan Government Accountability Office says it’s in part because neither the Pentagon nor the VA was put in charge of the effort — which is still the case. Wilkie says he has signed an agreement with the Pentagon to jointly run it with clear lines of authority.

“I think we’ll have more announcements later in the year when it comes to one belly-button to push for that office,” he said.

As for staff shortages, another perennial complaint at the VA, Wilkie acknowledged there are 35- to 40,000 vacancies at the agency.

“We suffer from the same shortages that the private sector and other public health services suffer from, particularly in the area of mental health,” he said.

New legislation passed this year gives Wilkie the authority to offer higher pay to medical professionals.

“I’m using it to attract as many people as we can into the system,” said Wilkie

But Wilkie also added that he was shocked, upon taking the post, that it’s not clear how many additional people are needed – because it’s not even clear how many people are working at VA.

“I had two briefings on the same day and two different numbers as to how many people this agency employs.”

Wilkie says he’s in the process of finding out the answer to that question, and many others, as he starts his second 100 days in office.

And to end this post I must include this note. I was raised in the Bronx, New York and are truly embarrassed to acknowledge that the new Congresswoman Cortes-Ortes who was elected, and not sure how when you look at her qualifications and knowledge. But more, she is a socialist and expects everything to be given to all and the government will foot the bill and now listen to this.

Alexandria Ocasio-Cortez, new youngest Congresswoman, says she can’t afford D.C. apartment

Ashley May, a reporter for the USA TODAY noted that the upset primary win in New York by Alexandria Ocasio-Cortez is a huge moment for the Democratic Party because it shows the left-wing base is energized heading into the midterms, according to AP National Politics Reporter Steve Peoples. (June 27) AP

Alexandria Ocasio-Cortez, the youngest woman elected to Congress in the midterm elections, is struggling to pay rent, according to a recent interview.

Ocasio-Cortez, 29, told The New York Times she’s not sure how she will be able to afford an apartment in Washington, D.C., without a salary for three months in an interview published online Wednesday.

She told the Times she has some savings from her job earlier this year as a bartender at a Union Square restaurant, and she’s hoping that will hold her over. Living without a paycheck is something she said her and her partner tried to plan for, but it’s a hardship that’s still “very real.”

“We’re kind of just dealing with the logistics of it day by day, but I’ve really been just kind of squirreling away and then hoping that gets me to January,” she told the Times.

Ocasio-Cortez is a New York activist and Democrat who will represent the 14th Congressional district, which covers the Bronx and Queens.

Thursday, she pointed to her lack of income as a reason why some people are not able to work in politics.

“There are many little ways in which our electoral system isn’t even designed (nor prepared) for working-class people to lead,” she said.

She said she hopes she can change that.

Yes, and now if she plays her cards right she has a job, paying better than any job that she is really qualified for life.

Buck it up Ocasio-Cortez, live outside of DC and take public transportation like most people do!

How did you fund your campaign? I don’t want to hear your sob story and yes I am ashamed that the borough of the Bronx has you for their representative. What a joke! You said that when you got to DC you were going to sign a whole lot of bills and laws to make things better. Do you even know anything about the process and have you ever taken a Civics course. You are in for some big surprises… called reality!

On a better note-Happy Veterans Day and thank you all who have served in our military and those who are still out there helping to make this world a better place to live and protecting our freedoms.

 

State of Health: Boston Doc Sees State Rep Run as a Way to Help Patients. Healthcare and the Mid Terms and a Summary of the Issues

45112654_1770213053108346_4596023887606579200_nNow that the Mid Term elections are upon us I can honestly state that I am somewhat ambivalent regarding the outcome. I’m pretty sure that the Democrats are going to claim the majority in the House and maybe the Republicans will hold onto the Senate. But to what end. The fighting will go on and probably nothing will get done. The Republicans have no one to blame but themselves for losing the House majority. Where was their leadership and don’t point fingers at the President? His leadership roles could be questioned but the big issue is that leader Ryan, although I like him was no leader as well as so many Republican Congressmen and women deciding to retire at such an important time and therefore not supporting their President.

The Democrats have disgusted me with their horrible behavior and attacks and playing the blame game Their leadership just sickens me during these last 2 years and them look who we have to run for the Presidency, again members who truly have made things worse, not better and not even trying to negotiate, be civil and spouting lies and attacks. As I said both parties have sunken to new lows in their behavior. I wish that we did have a significant Third Party for whom I would vote for. Again it holds your nose and vote.

Our friend, Joyce Frieden the News Editor of MedPage reported that Healthcare is expected to be a major issue in the November election — not just in Congress but also in the states. With that in mind, MedPage Today is profiling several candidates for statewide office who are focusing on healthcare issues. In our third and final profile, we speak with Jon Santiago, MD (D), an emergency room physician who is running for the Massachusetts House of Representatives.

Jon Santiago, MD, saw it firsthand every day. “I work in an ER at Boston Medical Center and it’s a great job,” Santiago said in an interview with MedPage Today. “It’s a job I love in a hospital I’ve wanted to work at since I was a kid.”

Naturally, Santiago, a fourth-year emergency medicine resident, tackles difficult problems as an emergency physician — including gunshot wounds, strokes, and heart attacks. “I live for those exciting moments, but you begin to realize that working in an ER, you’re taking care of a lot of social issues — poverty, racism, sexism, and lack of economic opportunity or housing — that ultimately manifest in some kind of medical condition, and that’s when we treat them.”

“We’ll literally or figuratively put a Band-Aid on them … but it’s not until we solve the social determinants of health that we begin to [really] solve their problem,” he continued. “That’s why I decided to run for office.”

Opioid ‘Ground Zero’

As a public hospital, Boston Medical Center is “ground zero” for the opioid epidemic, both in the city and the state, Santiago said. He cited the example of Long Island, an island near Boston that houses a number of homeless shelters and recovery services. “There was a bridge to an island near Boston that overnight had to be shut down because it was dangerous, so in a matter of days, we had to move about 400 people into the [South End] neighborhood, many of whom were homeless and had substance use disorder. It really changed the community.”

In addition, for those people that had to be moved, “their continuity of care stopped, and as a result, people died … My run for office is really for these patients I take care of who need the help, but also for significant quality-of-life issues in the community.”

Santiago noted that with its many world-class healthcare facilities, Boston is considered the “healthcare capital of the state, if not the country and the world.” But the state also has its own healthcare challenges — Massachusetts’ Medicaid program, known as MassHealth, takes up 40% of the state budget. “And Massachusetts likes to pride itself that we were the first to pass health care reform, providing universal coverage, but that doesn’t mean healthcare is affordable or accessible.”

For example, “MassHealth doesn’t cover everything; there is always talk of cutting certain services,” said Santiago. “Just this past year, the governor threatened to knock out about 140,000 people from MassHealth to save money.”

Technically, the coverage rate in the state is 97%, but “the question is, if you look at what people pay for the administration of private healthcare, the costs are significantly more than a public provider would have,” he said, noting that Medicare’s administrative cost is about 10%. “Other developed countries are able to provide more cost-effective healthcare with … better outcomes.”

Santiago supports single-payer universal health care coverage for all state residents through a “Medicare for all” system. The first step toward that goal, he said, would be to study single-payer and compare the current system to what single-payer would look like “and if it would save money, I would pursue that because what we have is not really sustainable.”

An Unlikely Winner

Santiago was an unlikely winner in the Democratic primary race in his district. “I beat a 36-year incumbent who was the majority leader, the fourth highest-ranking person in the state,” he said. “What people were looking for [was] people to provide political leadership on issues that matter, and when it comes to the opioid epidemic, people were looking for solutions.” Santiago attributes his victory to a very grassroots strategy. “I personally knocked on 8,000 doors; we knocked on every door in the district. If you talk to people and listen to them, you’re better able to serve their needs.”

“The person representing this district — the center of the epidemic — should be a leader on this issue,” he continued. “Massachusetts Avenue they call the ‘Methadone Mile’ here; I live close to that. The Boston Medical Center emergency department is located there, and as an emergency department provider, it gives me initial insight into what is going on, on the ground.”

He gave an example of how, 3 years ago, his experience helped him change the law. “In my first year as a doctor, with the prescription drug monitoring program (PDMP), if someone comes in with back pain, you check to see whether they have previously been given an opioid prescription — if they have, it’s a red flag. I tried to look [at the PDMP] during my first year as a doctor, and I couldn’t access the website. I turned to my attending and he said, ‘Only attendings can.'”

But since the residents do much of the work at the hospital, “I said, ‘This doesn’t make sense,'” said Santiago. “I got the doctors together and we started a petition to provide access [to the PDMP] to the residents who do all the work. I got the petition started, met with the Boston Globe, and they covered it; we met with the governor’s staff and they changed the law overnight. Within a week or so, residents across the state were able to access the PDMP.”

Post-Election Plans

If Santiago wins the election, “my plan is to continue working as an ER doctor because I think one job really informs the other,” he said. “One job really keeps you close to the community and the issues neighbors face day in and day out, and working as a state representative addresses those issues in the policy arena.” A total of 14 8-hour shifts per month are considered full-time; Santiago said he planned to work one to two shifts a week during the legislative session, “and I’d be the only physician [legislator] in the capital as well.”

Public service is nothing new to Santiago, who served as a Peace Corps volunteer in the Dominican Republic and is currently a captain in the Army Reserve. “I graduated from college and wanted to join the military, but I was not enthusiastic about the Iraq War,” he explained. “I wanted to serve my country, so I joined the Peace Corps … I told myself that if I became a doctor I would join the Army Reserve so I could serve in that capacity.” The reserves are pretty flexible since they only require one weekend a month and 2 weeks a year, and if you do deploy it’s only for 3 months, he added. “But they’re very flexible with you if you’re a doctor.”

In Trump midterms, one GOP congressman bets re-election on healthcare

Reporter Susannah Luthi noted that Rep. Peter Roskam (R-Ill.), in the final sprint for his congressional life, wants to talk about Medicare red tape. The message is a big deal in his hospital-dominated district that headquarters the state’s largest system, Advocate Health Care. His health subcommittee chairmanship for the powerful House Ways and Means Committee positions him to push measures that resonate when hospitals attribute 25% of their spending, or about $200 billion per year, to paperwork.

But while policy specifics may matter for his committee work and for the business of healthcare, analysts are skeptical they can prevail over the “Trump effect”—widespread rejection of the president by moderate suburban Republicans, which makes elections in places like the Illinois 6th District a national more than a local referendum.

Roskam now lags in the polls behind his Democratic challenger Sean Casten, a clean energy entrepreneur who has harnessed local opposition to President Donald Trump to pull ahead of a six-term congressman of a district that was designed as a GOP stronghold.

Questioning the 80/20 rule for healthcare

The 80/20 rule in health care underlies much of the common thinking about population health. Many value-based strategies about health care costs or utilization use this rule to describe the distribution of health care spending. Is the 80/20 rule accurate today? We analyzed recent data to find out.

He’s also struggling to make another national healthcare message local.

The term “pre-existing conditions” is headlining the cycle. The tagline has become particularly effective in light of the GOP state attorneys general lawsuit to strike down the Affordable Care Act. The Trump administration sided with the lawsuit, specifically asking the courts to overturn the provisions around community rating and other cover requirements that prohibit insurers from charging more for people with expensive, pre-existing conditions.

Roskam voted with most of his party for the GOP effort to repeal and replace the ACA, and Casten has been pounding him for it.

But on a rainy Friday in early October, as he toggled between campaign events and representational duties that involved a deep dive into CMS pay rules for disabled adults in the community, Roskam stuck with his policy line. He said this still matters in what he described as his “solution-oriented” district.

“My observation is that if the ACA were doing what it’s purported to do, the district wouldn’t be restless and they’d be quick to turn the page,” Roskam said. “But they are restless and there is a sense of vulnerability that’s out there and it’s largely financial.”

Then he pivoted to what he has been working on as a congressman: the Medicare Red Tape Relief project that culminated in a report late this summer, which he believes is more relevant for bringing costs down.

“The country feels stuck in a debate [over Obamacare] and it’s ready to get out of the ditch of the debate,” Roskam said. “It’s well litigated where both sides are on the ACA. And these continuous declarations—most people don’t find a level of connection. Which is why the red-tape relief effort resonates. ‘Yes, I get that, my doctor is looking at a screen half the time he’s with me. That’s not the way it used to be.'”

But that’s not the focus in this race. After millions of dollars in advertising from both sides, Roskam is trailing by five points in the latest FiveThirtyEight poll. The nonpartisan Cook Political Report rates the race as “lean Democratic” as Casten pummels Roskam’s record of voting 94% of the time for Trump’s agenda.

The flip is emblematic of what’s happening in moderate suburbs that voted for Hillary Clinton in 2016, said David Wasserman, House editor of Cook Political Report. That’s when Roskam cruised to a double-digit victory even though Clinton beat Trump by seven points in his district.

Casten, whose core issue is climate change, wasn’t necessarily the strongest Democratic candidate for the district, Wasserman added. He wasn’t the favorite in his primary and even Democratic strategists complain about his bombastic style. But none of this may matter.

“Roskam has failed to make the race a referendum on Casten, and it’s become about Trump and Roskam,” Wasserman said.

In Roskam’s case, there are also state-based headwinds: a deeply unpopular GOP governor who is motivating Democratic voters in the state, and a GOP president who is unpopular in a prosperous GOP district.

“If Peter wins, it’s because people are willing to look at him as someone who is independent of Trump and has been a good representative of the district,” a longtime GOP Illinois strategist said.

At a Casten sit-down with local members of the Illinois Alliance for Retired Americans as the group endorsed him, the dissatisfaction with healthcare played out in condemnations of Roskam’s 2017 vote to repeal the ACA. They talked about denials of care by insurers through pre-authorizations they didn’t understand, their fears about the future of coverage for pre-existing conditions, and Medicare’s solvency.

Kim Johnson, a retired state worker who is taking care of two of her grandchildren, said that one granddaughter was born with a heart condition and blasted Roskam for his 2017 vote saying that if he “had his way, she’ll have no insurance.”

But the status quo is also not enough, Johnson added, noting that she wants to see “universal healthcare.”

“I just want to see something,” she said. “I want to see something improve. We are a much better country than what our benefits are.”

Casten reiterated his support for the ACA and said he wants to look at a public option through an expansion of Medicare or Medicaid or both.

But he has steered clear of the more progressive Democratic positions. He criticized the Medicare for All proposal of Sen. Bernie Sanders (I-Vt.) as “irresponsible” and said it made him nervous. At the table of retirees, Casten also defended the for-profit nature of the U.S. system, which he said drives the right incentives for efficiency.

He has also drawn a hard line about what he thinks about Republicans, and about working with them. “On almost everything we are arguing about, there are no areas for compromise,” specifically on the confirmation of Justice Brett Kavanaugh to the Supreme Court, climate change and voting rights, Casten told a group of nursing home residents in one event.

Roskam recently ranked as the 25th most bipartisan House member out of 435 lawmakers, is banking on his district rejecting that approach. Issues like Medicare fraud and Medicare solvency matter, he said, but big policy pushes need buy-in from both Democrats and Republicans and work needs to be incremental.

Roskam has blasted Casten’s campaign speech—and his active Twitter feed—as Trump-like. But in the last stretch of the race, the rhetoric has intensified, thanks to the millions of dollars raised for ads that are barraging the district and even its surrounding counties. Campaign signs blanket lawns and the roads connecting this leafy, prosperous district.

James, a nursing home resident who had attended Casten’s event there and who declined to give his last name, said that what he will be watching for this election is what it will say about voters’ views of Trump.

“Are people catching on with what Trump is doing?” James said. “Everybody’s got a right to vote—that’s a good thing and a bad thing. Hopefully, people will catch on to what’s going on.”

Healthcare and the midterms: I’ve got you covered

Healthcare is top of mind for many 2018 midterm voters. As they select state and federal representatives, many ballots also include measures for Medicaid expansion, provider pay and other key healthcare issues. Federal policy on the future of the Affordable Care Act, drug prices and immigration reform will also affect the healthcare industry. I thought that I would use this article to summarize the MidTerm issues.

Modern Healthcare has been tracking how policy changes and discussion could affect the midterm elections. A change in House or Senate party control or governors’ races can tilt the scale on many hotly contested healthcare issues. Here we’ve rounded up our coverage on the upcoming midterm election.

Midterm elections 2018 at a glance

2018 elections: The future of healthcare could be purple: In the lead-up to the midterms, Democrats appear poised for gains in Republican-controlled legislatures and governor’s mansions, which could push the states to make the healthcare compromises that Washington can’t.

In Trump midterms, one GOP congressman bets re-election on healthcare: In an intense congressional race in the Chicago suburbs, hospital ally Rep. Peter Roskam (R-Ill.) is running on an anti-regulatory healthcare message. But in a referendum election about Trump, how will that play?

The 115th Congress on the State of Healthcare: Modern Healthcare’s 115th Congress on the State of Healthcare is a featured collection of commentaries from lawmakers and healthcare organization leaders. Included in this collection of Congressional commentaries are six editorials from U.S. Senators and eight House Representatives across both party lines.

Data Points: Healthcare tops the polls as midterms loom: The all-important 2018 midterm elections are less than two months away. As special elections and primaries, this summer has proven, healthcare continues to be a hot-button issue.

Editorial: Healthcare PACs voting for incumbent protection: Many Democratic congressional hopefuls are making healthcare their top talking point for the upcoming midterm elections, which is not surprising given the low unemployment rate. The early donations from political action groups lean toward the incumbents.

House Speaker Ryan to retire with a mixed legacy on health policy: House Speaker Paul Ryan’s upcoming retirement from Congress after leading the GOP’s charge to repeal the Affordable Care Act leaves his party in a challenging place on health care messaging ahead of the 2018 midterm elections.

Status of Medicaid expansion states and work requirements

Bullish post-election Medicaid expansion outlook may not match end result: Although a new report predicts 2.7 million people in nine states could soon become eligible for Medicaid, expansion could look very different state by state.

Medicaid expansion on the prairie: Nebraska’s ballot initiative heads to the polls: Four years into Obamacare, the majority of Nebraska voters support Medicaid expansion, a key measure on their midterm ballot. But even pro-expansion hospitals are taking a cautious view of how much it will impact the rural bottom line.

Verma touts Medicaid work requirement successes, despite coverage loss: CMS Administrator Seema Verma insisted that Medicaid work requirements are working as intended to move people out of poverty, despite criticism that they’re doing more harm than good.

Medicaid blues: Hospitals, insurers wage a political battle over managed-care dollars: Medicaid, the 50-year-old federal-state health coverage plan for the poor, has devolved into a political inter-industry feud in the impoverished Mississippi Delta. What does the fight foretell about the Medicaid industry and how it treats the nation’s poorest?

Could deep-red Miss. expand Medicaid? 2019 will tell: A Mississippi state senator has introduced a bill to expand Medicaid every year since Obamacare went into effect, but so far it’s been off the table. The 2019 governor’s race could change the picture.

Close governor races could decide future of Medicaid: Advocates say the single biggest factor in expanding Medicaid in balky states has been the election of a governor who supports it.

Editorial: Want people off Medicaid? Give them more access to it: New research found those who gained coverage through Michigan’s Medicaid expansion faced fewer debt problems, fewer evictions, and bankruptcies, and saw their credit scores rise just years after enrolling for coverage.

Wisconsin can impose Medicaid work requirements, time limits, but not drug testing: The CMS on Wednesday gave Wisconsin permission to impose work requirements on beneficiaries. It’s the first state to receive a green light for the policy without expanding Medicaid. The agency rejected the state’s mandatory drug testing proposal.

Tennessee joins push for Medicaid work requirements: Tennessee is the fourth state this month to introduce a work requirement proposal for its Medicaid enrollees. Officials there believe it has a better chance of CMS approval than other non-expansion states due to its coverage policies for adults.

House Democrats press HHS for Medicaid work requirement records: Two top Democrats on the House Oversight Committee want to subpoena the Trump administration’s documents around its Medicaid work requirement policy. HHS officials haven’t responded to their previous requests for information.

Healthcare reform issues

Senate Dems fail to block Trump’s policy on short-term health insurance: Wisconsin Democrat Sen. Tammy Baldwin’s forced vote to overturn the Trump administration’s plan for short-term health insurance failed in a tie, although the Democrats gained one Republican ally.

Senate Republicans in talks with Verma to expedite states’ 1332 waivers: The Senate’s two top GOP proponents for individual market exchange stabilization measures are in talks with CMS Administrator Seema Verma about making 1332 state innovation waivers easier to obtain.

Affordable Care Act:

Editorial: The midterm elections will decide the fate of the ACA: If the GOP maintains control of the entire government, the nation’s health insurance marketplace would look a lot like the one that existed before passage of the Affordable Care Act.

Judge skeptical of ACA’s standing without effective individual mandate penalty: In a U.S. district court Wednesday, a federal judge had hard questions for Democratic state attorneys general who argued that the ACA can stand even with a zeroed-out tax penalty.

ACA court case causing jitters in D.C. and beyond: A lawsuit aiming to overturn the Affordable Care Act goes before a conservative Texas judge Sept. 5. The health insurance industry and GOP lawmakers are bracing for the potential fallout.

Uncertainty could spook insurance markets as DOJ decides not to defend ACA: The Department of Justice has asked a federal court to invalidate three key Obamacare coverage mandates, siding with a red state lawsuit against the Affordable Care Act and spurring new uncertainty for the 2019 individual market.

Republicans weigh electoral calculus on reviving ACA repeal push: Both Republican and Democratic political observers see a narrow possibility for yet another Obamacare repeal drive this year, given intense pressure from conservatives and the urgent GOP need to fire up right-wing voters to maintain their control of Congress in this fall’s elections.

Pre-existing conditions:

Pre-existing conditions drive state attorney general campaigns: Democratic candidates in state attorney general races have leveraged their party’s national campaign strategy around coverage of pre-existing conditions. They’re trying to beat Republican incumbents who are suing to end Obamacare.

Will Republicans keep their new promises on pre-existing condition protections?: Despite congressional GOP candidates’ promises, health policy analysts doubt whether victorious Republicans would move to replace those ACA protections with equally strong measures to cover people with health conditions as part of repeal legislation.

Tight Iowa congressional races key on pre-existing condition protections: The battle over pre-existing condition protections has become particularly heated in two toss-up House races in Iowa, even as unregulated Farm Bureau health plans that can use medical underwriting will go on sale Nov. 1.

GOP senators propose new protections for challenged ACA provisions: As the country heads toward midterm elections and red states look to overturn Obamacare in the courts, Republican senators have introduced a bill to preserve some of the law’s most popular provisions.

Medicare for all:

Verma argues ‘Medicare for all’ would cause physician shortage: In a speech to insurers, CMS Administrator Seema Verma claimed patients would struggle to find a doctor if the U.S. implements “Medicare for all.”

‘Medicare for all’ proves to be a tricky issue for Democrats: Progressive Democrats want to wrestle “Medicare for all” into their party’s platform. But Democratic strategists and the results of recent primaries say the country isn’t ready for it yet.

Drug prices in America

Editorial: Drug price controls? A good idea, but don’t bet on it: Once the heat of the campaign dissipates, a majority in both parties will remain susceptible to their main argument that high prices are necessary to promote innovation.

The fate of Trump’s Part B drug cost plan may depend on the Dems winning House: Trump’s Medicare Part B drug cost plan could move forward, particularly if Democrats win control of the House.

New CMS pay model targets soaring drug prices: The Trump administration’s first mandatory CMS pay model is projected to save taxpayers and patients $17.2 billion over five years by shifting Medicare Part B drugs to price levels more closely aligned with what other countries pay.

340B showdown: Big pharma, hospitals squaring off in lobbying fight: Hospitals have adopted a take-no-prisoners approach in the fight with Big Pharma over the 340B drug discount program. Can this strategy hold as Congress, oversight agencies, the courts and the Trump administration ratchet up scrutiny of the program?

Midterms 2018 ballot measures

Editorial: Medicaid expansion, dialysis, staffing ratios get grassroots push: Grassroots activism is behind both good and bad trends in policy. Consumer coalitions are behind Medicaid expansion ballot measures in several states, while other coalitions are pinpointing dialysis policy and staffing ratios.

Nurse-to-patient staffing ratios in Massachusetts

Mandated nurse-to-patient ratios spark high costs, few savings: Massachusetts voters in November will determine whether mandated staffing ratios for registered nurses will go into effect Jan. 1. Implementing the ratios could cost providers $676 million to $949 million per year.

Data Points: A state-by-state look at nurse-to-patient staffing ratios: As nurse-to-patient ratios are debated on both coasts, projections show a few states may not be able to meet future demand for registered nurses.

Dialysis ballot measure in California:

Dialysis Cos. dole out more than $100M to beat Calif. ballot measure: With just a few weeks to go until November’s elections, the dialysis industry has raised more than $105 million to defeat a ballot measure that would cap their profits at 15% of direct patient-care costs.

Calif. governor vetoes dialysis reimbursement cap: Dialysis giants DaVita and Fresenius won a major victory in California as Democratic Gov. Jerry Brown vetoed a bill that would have slashed and capped their reimbursement rates.

Impact of immigration on healthcare

Children’s hospitals bear the largest brunt of Trump immigration crackdown: Children’s hospitals could see their revenue dip if increased anti-immigration sentiment from the Trump administration causes an exodus from Medicaid. Chronically ill children on Medicaid primarily go to these facilities for their hospital stays.

Clinics catering to immigrants take a hit from White House policy: Healthcare providers who care for refugees are faced with the financial strain of having fewer new patients as a result of the Trump administration’s limits on immigration.

Healthcare groups blast proposed rule penalizing immigrants for using public benefits: The Department of Homeland Security published a proposed rule that would allow immigration officials to consider legal immigrants’ use of public health insurance, nutrition and other programs as a strongly negative factor when applying for legal permanent residency.

Immigrant detention crisis could yield a profit for some providers and payers: The influx of immigrant children under HHS’ care translates into big contracts for providers charged with the children’s medical treatment.

Trump’s immigrant healthcare rule could hurt low-income populations: The Trump administration reportedly is nearing completion of a new immigration rule that health care providers and plans fear will harm public health and their ability to serve millions of low-income children and families.

What do U.S. immigration policies mean for the healthcare workforce?:

There’s been a drop in the number of foreign-born medical graduates applying for residencies in the U.S. at the same time that the country struggles with physician staffing shortages. Industry stakeholders worry the decline comes from recent efforts to stem immigration.

So, everybody hold your noses, do your research and VOTE! We’ll see what happens Tuesday!

FACT CHECK: Trump’s False Claims On ‘Medicare For All’ and Yes the Senate defeats a ​measure to overturn Trump expansion of non-ObamaCare plans, but now back to Pre-Existing Conditions

19657154_1241634215966235_4531903697739664365_nI think that I mentioned that an important issue for the Mid-Term elections was going to be healthcare and last week look how health care was treated. Peter Sullivan wrote that the Senate on last Wednesday defeated a Democratic measure to overrule President Trump’s expansion of non-ObamaCare insurance plans as Democrats seek to highlight health care ahead of the midterm elections.

The Democratic measure would have overruled Trump’s expansion of short-term health insurance plans, which do not have to cover people with pre-existing conditions or cover a range of health services like mental health or prescription drugs.

It was defeated on an extremely narrow, mostly party-line 50-50 vote, with Sen. Susan Collins (R-Maine) voting with Democrats in favor of overturning the short-term plans.

Republicans argue the short-term plans simply provide a cheaper option alongside more comprehensive ObamaCare plans.

Democrats forced the vote ahead of the midterms in an attempt to put health care front and center in the campaign. Democrats said Republicans voting to keep in place these “junk” insurance plans that do not have to cover pre-existing conditions was another example they can use to paint the GOP as wrong on health care.

“In a few short weeks the American people will head to the polls where they can vote for another two years of Republican attempts to gut our health-care system, or they can vote for Democratic candidates who will safeguard the protections now in place and work to make health care more affordable,” Senate Democratic Leader Charles Schumer (N.Y.) said on the Senate floor Wednesday.

Sen. Lamar Alexander (R-Tenn.), the chairman of the Senate Health Committee, forcefully pushed back, saying short-term plans provide a cheaper option than ObamaCare and if people want full ObamaCare plans with all the protections, they can still have them.

With short-term plans, Alexander said the message is “you can pay less with less coverage and at least you will have some insurance.”

“But our Democratic friends will say, ‘Oh no, we don’t want to do anything that will lower the cost of insurance,’” Alexander added.

Health-care experts say the short-term plans pose a risk of siphoning healthy people away from ObamaCare plans, leading to an increase in premiums for those remaining in the ObamaCare plans.

“The rule threatens to split and weaken the individual insurance market, which has provided millions of previously uninsured people with access to quality coverage since the health care law went into effect,” a range of patient groups, including the American Cancer Society and American Heart Association, said in a joint statement this week opposing the Trump administration’s short-term plans rule.

The rules that Democrats seek to overturn, which the Trump administration finalized in August, lifted a three-month restriction on short-term plans, allowing them to last up to a year. Critics say this makes the plans not really “short-term” at all.

“Our constituents deserve more options, not fewer,” Senate Majority Leader Mitch McConnell (R-Ky.) said Wednesday. “The last thing we should do is destroy one of the options that are still actually working for American families.”

Scott Horsley mentioned that USA Today published an opinion column by President Trump Wednesday in which the president falsely accused Democrats of trying to “eviscerate” Medicare while defending his own record of protecting health care coverage for seniors and others.

The column — published just weeks ahead of the midterm elections — underscores the political power of health care to energize voters. But it makes a number of unsubstantiated claims.

Here are 5 points to know

1. The political context: Healthcare has emerged as a dominant issue on the campaign trail in the run-up to the November elections. According to the Wesleyan Media Project, which tracks congressional advertising, health care was the focus of 41 percent of all campaign ads in September, outpacing taxes (20 percent), jobs (13 percent) and immigration (9 percent). Democrats are particularly focused on health care, devoting 50 percent of their ads to the issue, but health care is also a leading issue in Republican commercials (28 percent), second only to taxes (32 percent).

Perhaps sensing that Democrats are gaining traction, Trump has decided to go on the attack, targeting the Democratic proposal known as “Medicare for All.”

2. Cost of the plan: Trump claims that expanding the federal government’s Medicare program would cost$32.6 trillion over a decade. But as Business Insider reports, that would actually be a discount compared with the nation’s current health care bill.

Trump’s figure was calculated by the libertarian Mercatus Center, but he fails to note that total health care spending under Medicare for All would be about $2 trillion less over the decade than currently projected. The federal government would pay more, but Americans, on the whole, would pay less.

Remember that the U.S. already spends far more per person on health care than does any other country. And when you count the tax break for employer-provided insurance, the federal government already pays about two-thirds of this bill. But because of the fragmented private insurance system, the government gets none of the efficiency or buying power that a single-payer system would provide.

3. Health care rationing: Trump claims — with no supporting evidence — that “the Democratic plan would inevitably lead to the massive rationing of health care Doctors and hospitals would be put out of business. Seniors would lose access to their favorite doctors. There would be long wait lines for appointments and procedures. Previously covered care would effectively be denied.”

The detailed implementation of any single-payer plan would, of course, be subject to substantial negotiation. But the Medicare for All bill drafted by Sen. Bernie Sanders, I-Vt., states explicitly that “Nothing in this Act shall prohibit an institutional or individual provider from entering into a private contract with an enrolled individual for any item or service” outside the plan.

4. Pre-existing conditions: Trump notes that as a candidate, he “promised that we would protect coverage for patients with pre-existing conditions.” In fact, Trump and his fellow Republicans tried — unsuccessfully — to repeal the Affordable Care Act, which guarantees insurance coverage for people with pre-existing conditions. GOP plans would leave it up to the states to craft alternative protections. In addition, Republican attorneys general have sued to overturn Obamacare’s protections, and the Trump administration has declined to defend them.

America’s Health Insurance Plans, the trade group for the insurance industry, warns that ending the Obamacare guarantee could result in hardship for the estimated 130 million Americans under 65 with pre-existing conditions.

“Removing those provisions will result in renewed uncertainty in the individual market, create a patchwork of requirements in the states, cause rates to go even higher for older Americans and sicker patients, and make it challenging to introduce products and rates for 2019,” AHIP said in a statement in June.

5. The strength of Medicare: Trump wrote that “Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare. Likewise, Democrats would gut Medicare with their planned government takeover of American health care.”

He is repeating a claim that was widely debunked during the 2012 election. The Affordable Care Act actually strengthened the solvency of Medicare, but it has since been weakened again by the GOP tax cut.

The president is trying to play on the fears of seniors — who vote in large numbers — with the claim that any effort to improve health security for younger Americans must come at their expense. But that is a false choice.

Donald Trump: Democrats ‘Medicare for All’ plan will demolish promises to seniors

Our dear President recently stated “the Democrats want to outlaw private health care plans, taking away freedom to choose plans while letting anyone cross our border. We must win this.”

Throughout the year, we have seen Democrats across the country uniting around a new legislative proposal that would end Medicare as we know it and take away benefits that seniors have paid for their entire lives.

Dishonestly called “Medicare for All,” the Democratic proposal would establish a government-run, single-payer health care system that eliminates all private and employer-based health care plans and would cost an astonishing $32.6 trillion during its first 10 years.

As a candidate, I promised that we would protect coverage for patients with pre-existing conditions and create new health care insurance options that would lower premiums. I have kept that promise, and we are now seeing health insurance premiums coming down.

I also made a solemn promise to our great seniors to protect Medicare. That is why I am fighting so hard against the Democrats’ plan that would eviscerateMedicare. Democrats have already harmed seniors by slashing Medicare by more than $800 billion over 10 years to pay for Obamacare. Likewise, Democrats would gut Medicare with their planned government takeover of American health care.

The Democrats’ plan threatens America’s seniors

The Democrats’ plan means that after a life of hard work and sacrifice, seniors would no longer be able to depend on the benefits they were promised. By eliminating Medicare as a program for seniors, and outlawing the ability of Americans to enroll in private and employer-based plans, the Democratic plan would inevitably lead to the massive rationing of health care. Doctors and hospitals would be put out of business. Seniors would lose access to their favorite doctors. There would be long wait lines for appointments and procedures. Previously covered care would effectively be denied.

In practice, the Democratic Party’s so-called Medicare for All would really be Medicare for None. Under the Democrats’ plan, today’s Medicare would be forced to die.

The Democrats’ plan also would mean the end of choice for seniors over their own health care decisions. Instead, Democrats would give total power and control over seniors’ health care decisions to the bureaucrats in Washington, D.C.

The first thing the Democratic plan will do to end choice for seniors is to eliminate Medicare Advantage plans for about 20 million seniors as well as eliminate other private health plans that seniors currently use to supplement their Medicare coverage.

Next, the Democrats would eliminate every American’s private and employer-based health plan. It is right there in their proposed legislation: Democrats outlaw private health plans that offer the same benefits as the government plan.

Americans might think that such an extreme, anti-senior, anti-choice and anti-consumer proposal for government-run health care would find little support among Democrats in Congress.

Unfortunately, they would be wrong: 123 Democrats in the House of Representatives — 64 percent of House Democrats —, as well as 15 Democrats in the Senate, have already formally co-sponsored this legislation. Democratic nominees for governor in Florida, California, and Maryland are all campaigning in support of it, as are many Democratic congressional candidates.

Democrats want open-borders socialism

The truth is that the centrist Democratic Party is dead. The new Democrats are radical socialists who want to model America’s economy after Venezuela.

If Democrats win control of Congress this November, we will come dangerously close to socialism in America. Government-run health care is just the beginning. Democrats are also pushing massive government control of education, private-sector businesses and other major sectors of the U.S. economy.

Every single citizen will be harmed by such a radical shift in American culture and life. Virtually everywhere it has been tried, socialism has brought suffering, misery, and decay.

Indeed, the Democrats’ commitment to government-run health care is all the more menacing to our seniors and our economy when paired with some Democrats’ absolute commitment to ending enforcement of our immigration laws by abolishing Immigration and Customs Enforcement. That means millions more would cross our borders illegally and take advantage of health care paid for by American taxpayers.

Today’s Democratic Party is for open-borders socialism. This radical agenda would destroy American prosperity. Under its vision, costs will spiral out of control. Taxes will skyrocket. And Democrats will seek to slash budgets for seniors’ Medicare, Social Security, and defense.

Republicans believe that a Medicare program that was created for seniors and paid for by seniors their entire lives should always be protected and preserved. I am committed to resolutely defending Medicare and Social Security from the radical socialist plans of the Democrats. For the sake of our country, our prosperity, our seniors and all Americans — this is a fight we must win.

And now the Vulnerable Republicans throw ‘Hail Mary’ on pre-existing conditions

Jessie Hellman reported that just recently dozens of vulnerable House Republicans have recently signed on to bills or resolutions in support of pre-existing conditions protections, part of an eleventh-hour attempt to demonstrate their affinity for one of ObamaCare’s most popular provisions.

Thirty-two of the 49 GOP incumbents in races deemed competitive by the nonpartisan Cook Political Report have backed congressional measures on pre-existing conditions in the past six weeks, according to an analysis by The Hill.

The moves, coming in the final weeks of the midterm campaign cycle, mark a course reversal for members of a party that for years railed against ObamaCare, also known as the Affordable Care Act (ACA), and called for its repeal.

Now, facing the threat of a “blue wave” and an onslaught of health-care attacks from Democratic candidates, vulnerable Republicans are running ads on pre-existing conditions and co-sponsoring measures that critics deride as meaningless.

The congressional resolutions are “a quick Hail Mary for a list of endangered incumbents,” said Thomas Miller, a resident fellow at the right-leaning American Enterprise Institute, and co-author of “Why ObamaCare is Wrong for America.”

“They’re intended to provide at least some legislative cover in the event that they can read the polls and know there’s been a stampede of support for the broad-brushed pre-existing conditions protections similar to those in the ACA,” he said.

A Kaiser Family Foundation poll in August found that more than 72 percent of Americans think the protections — prohibiting insurers from denying coverage to people with pre-existing conditions or charging them more for coverage — should remain law.

Democrats in June seized on the Trump administration’s announcement in court that it would not defend ObamaCare’s protections for people with pre-existing conditions. The Department of Justice sided in large part with the 20 Republican state attorneys general who filed a lawsuit seeking to overturn ObamaCare.

Now Democrats, who are looking to flip both the House and Senate, are tying Republicans to that decision while highlighting the GOP’s ObamaCare repeal-and-replace efforts, which they say would have diminished pre-existing conditions protections for people in the individual market.

Tyler Law, the national press secretary for the Democratic Congressional Campaign Committee (DCCC), said the “overwhelming majority” of campaign ads from the DCCC and Democrats have focused on health care, with pre-existing conditions as the central theme.

“Republicans are stuck on defense, forced to respond to devastatingly effective ads on their record on pre-existing conditions, and touting nonbinding resolutions as they panic because they see the political fallout,” Law said.

“Republicans clearly recognize how politically disastrous their policies are in regards to pre-existing conditions,” he added. “They are now just making up an alternative record on which all of a sudden they seem to care about pre-existing conditions.”

Reps. David Young (Iowa) and Pete Sessions (Texas) — two Republicans running in competitive races this year — introduced separate resolutions in September supporting pre-existing conditions protections. Later that month, Rep. Steve Knight (R-Calif.), who is locked in a toss-up race, introduced a similar bill.

Another measure — the Pre-existing Conditions Protection Act of 2017 — was introduced by Rep. Greg Walden (R-Ore.) in February of last year but has attracted 16 Republican co-sponsors in the past month and a half — all but four of whom are running in competitive races. Twenty Republicans in competitive races co-sponsored the legislation last year.

Of the 23 Republican incumbents who are considered to be most in danger of losing their seat, according to Cook Political Report, 18 co-sponsored at least one of the resolutions or bills since September.

The measures, however, are more of a political statement. They aren’t expected to pass or even get a markup at the committee level.

“It’s a political gesture,” Miller said. “You don’t introduce bills in September of 2018 with the intent of marking it up.”

Democrats say it’s part of a transparent attempt by the GOP to deflect from their failed efforts to repeal ObamaCare.

“They’re trying to claim they support protections for people with pre-existing conditions. It’s really disingenuous,” said Maura Calsyn, managing director of health policy at the Center for American Progress, a liberal think tank. “They’re hoping the public is going to ignore their past votes and their past statements that they don’t support the ACA.”

While some Republicans have pointed to their vote in favor of the GOP-backed American Health Care Act as proof they support protections for pre-existing conditions, Democrats argue that the legislation didn’t match the protections guaranteed by the ACA.

The nonpartisan Congressional Budget Office concluded last year that under the GOP bill, people with pre-existing conditions “would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law if they could purchase it at all.”

Vulnerable Republicans have also been running ads about pre-existing conditions, sometimes with a focus on their family members.

Rep. Dana Rohrabacher (R-Calif.), who is a toss-up race against Democrat Harley Rouda, recently released an ad focusing on his daughter’s pre-existing condition — leukemia.

“So for her and all our families, we must protect America’s health-care system,” Rohrabacher says in the ad. “That’s why I’m taking on both parties, and fighting for those with pre-existing conditions.”

Rohrabacher, who voted multiple times to repeal the ACA, signed on to legislation Tuesday supporting pre-existing conditions protections.

“The Republicans who are pushing now to clean things up three weeks up before the election aren’t able to do it,” said Amanda Harrington, director of communications for Protect Our Care, a pro-ObamaCare advocacy group that is involved in the midterms. “The deficit they have created themselves on the issue of health care is far too steep for them to climb.”

There are many fights going forward as we get closer to the Mid-terms and if the majorities change in the House and Senate there are going to be many more. My hope is that the children in both the House and the Senate grow up and realize that they had better learn how to work together.

On my visit to California to spend some time with my daughter, I realized how bad things still were when we discussed the last few weeks and even though Judge Kavanaugh was investigated 7 times she still believed that he was a horrible person. There was no pursuing further discussion with her or anyone else in her group of graduate students.

I was amused last week when a favorite patient of mine and a long time strategist for the Democrat party was seen in my office. As I entered the exam room she raised her right hand and flashed me a peace sign. She then apologized for the behavior of her party during the Kavanaugh hearings and that she and her husband warned them of the possible blowback.

Remember, this lady agreed with me that no matter what good pieces of legislation put to a vote before the Mid-Term elections that the Democrats would vote against, even if the legislation was what the Democrats would “normally” be in agreement at any other time. What a farce and now how do we correct this type of behavior? I’m not sure unless we vote all of those in the House and the Senate out and find some candidates who really want to improve our country despite the media who fight each day to upset our free country for a sound bite to capture the next media attention spot despite the facts.

Newt Gingrich predicted that Ignoring health care could spell disaster for Republicans in 2018 elections. Maybe, But What About the “ME-To” Wave And All Men Are Bad?

43066034_1731880880274897_8358288627561660416_nAs Newt Gingrich wrote, the U.S. economy has been growing and breaking records ever since President Trump first took office and Republicans took control of Congress.

Many in the GOP are hoping this success will help them get re-elected in November. Some consultants I’ve spoken with seem to think it will inoculate Republican candidates against most all Democratic attacks.

They are mostly right, except for one area – health care.

Here I have to modify his thoughts. I think that after this Judge Kavanaugh circus we are, no the Democrats are not finished with the “Me To”/sexual assault and “All Men Are Bad” push. They are going to mobilize the women and some of the crazy men who will listen to their leaders.

But let us continue with the health care issue.

No doubt, Republicans should be proud of the enormous success of the economy. But the economy won’t reach its full potential and the GOP will not win big in the 2018 elections unless Republicans deal with the cost of health care in America.

The reason is simple:

Health care represents nearly one-fifth of our country’s economy and is the largest driver of government spending. It is also such a huge slice of household budgets that many Americans don’t end up feeling the benefits of the 4.1 percent growth in the gross domestic product (GDP). In 2016, individual health care costs amounted to $10,328 per person (in 1960, that figure was $146).

As Dave Winston and Myra Miller at The Winston Group have noted, with nearly half of Americans saying they are living paycheck-to-paycheck (with no reserves for emergencies) it is hard for people to “feel the prosperity” implicit in a remarkably strong macroeconomy. Their individual micro-economies are too deeply impacted by the cost of health care.

Additionally, health care costs are outpacing income growth because businesses have had to eschew raises and promotions to afford more and more health care costs. According to a 2017 report by the Kaiser Family Foundation and the Health Research & Education Trust and federal income data, “premiums for an employer-provided family insurance plan have climbed 19 percent, while worker pay increased 12 percent.” The additional money Americans are receiving in their paycheck from the Tax Cut and Jobs Act helps, but lowering health care costs still needs to be a priority.

A Republican party that hides from the challenge of modernizing the health system is a party, which has conceded a huge part of the political playing field to the left.

Fortunately for Republicans – and for the country – we now have leadership capable of developing a serious strategy for a dramatically improved health care system. Secretary of Health and Human Services Alex Azar has the knowledge and the experience to help shape a new, profoundly better health system for all Americans.

Secretary Azar’s move this week to widen access to less expensive, short-duration health insurance plans was a step in the right direction. These plans will give Americans more options to buy the level of insurance they need for themselves – rather than being forced to buy more expensive coverage they don’t necessarily need.

President Trump’s earlier announced plan for reducing prescription drug prices will also be a huge help for families, and the administration’s support for the expansion of association health plans will provide more options for small businesses and self-employed individuals.

So, while there is still more work to be done, Republicans can point to positive steps that have been taken and progress that has been made — but they can’t shy away from talking about health care.

This reality of half the nation operating on the margin is what drives support for government-run health care, which is now sweeping large parts of the Democratic Party.  If Republicans refuse to articulate a better solution, a large portion of the American people will decide that government bureaucracy is better than constant economic anxiety about unknowable, increasing health costs.

As I have written before, if the left wins on health care and puts in place a single-payer system, it would be a disaster.

So, to truly win the economic argument, Republicans must think through and win the health care argument. The dynamics of the fall campaign give them no choice. The Democrats’ government-run health care system will fill the gap left by the absence of a serious Republican alternative.

There is a long tradition of Republicans trying to avoid health issues. Consultants assert “it isn’t our topic.” Incumbents find it hard to communicate a clear policy or plan for improving the health system. “Repeal and Replace” was largely about repeal because Republicans lacked a coherent plan to replace ObamaCare. This is why it failed.

A Republican party that hides from the challenge of modernizing the health system is a party which has conceded a huge part of the political playing field to the left.

Conversely, a Republican party that can explain common sense improvements that will empower Americans to have longer lives, better health, greater convenience, more choices, and lower costs in healthcare is a party that can easily demolish the left’s arguments.

Healthcare Is The No. 1 Issue For Voters; A New Poll Reveals Which Healthcare Issue Matters Most

And as Robert Pearl, M.D. stated, depending on which news outlet, politician or pundit you ask, American voters will soon participate in the most important midterm election “in many years,” “in our lifetime” or even “in our country’s history.”The stakes of the November 2018 elections are high for many reasons, but no issue is more important to voters than health care. In fact, NBC News and The Wall Street Journal found that healthcare was the No. 1 issue in a poll of potential voters.

What’s curious about that survey, however, is that the pollsters didn’t ask the next, most-logical question.

What Healthcare Issue, Specifically, Matters Most To Voters?                                          To answer this question, I surveyed readers of my monthly newsletter. Will the opioid crisis sway voters at the polls? What about abortion rights? The price of drugs? The cost of insurance?

See for yourself:

Untitled. mid-term.elections

To understand the significance of these results, look closely at the top four:

  1. Prescription drug pricing (58%)
  2. Universal/single-payer coverage (57%)
  3. Medicare funding (50%)
  4. Medicaid funding (40%)

Notice a pattern here? All of these healthcare issues come down to one thing: money.

Healthcare Affordability: The New American Anxiety                                               Because the majority of my newsletter readers operate in the field of healthcare, they’re well informed about the industry’s macroeconomics. They understand healthcare consumes 18% of the gross domestic product (GDP) and that national health care spending now exceeds $3.4 trillion annually. The readers also know that Americans aren’t getting what they pay for. The United States has the lowest life expectancy and highest childhood mortality rate among the 11 wealthiest nations, according to the Commonwealth Fund Report. But these macroeconomic issues and global metrics are not what keeps healthcare professionals or their patients up at night. Eight in 10 Americans live paycheck to paycheck. Most don’t have the savings to cover out-of-pocket expenses should they experience a serious or prolonged illness. In fact, half of U.S. adults say that one large medical bill would force them to borrow money. The reality is that a cancer diagnosis or an expensive, lifelong prescription could spell financial disaster for the majority of Americans. Today, 62% of bankruptcy filings are due to medical bills.

To understand how we’ve arrived at this healthcare affordability crisis, we need to examine the evolution of health care financing and accountability over the past decade.

The Recent History Of Healthcare’s Money Problems

Until the 21st century, the only Americans who worried about whether they could afford medical care were classified as poor or uninsured. Today, the middle class and insured are worried, too. How we got here is a story of evolving policies, poor financial planning and, ultimately, buck-passing.

A big part of the problem was the rate of health care cost inflation, which has averaged nearly twice the annual rate of GDP growth. But there are other contributing factors, as well.

Take the evolution of Medicare, for example, the federal insurance program for seniors. For most of the program’s history, the government reimbursed doctors and hospitals at (approximately) the same rate as commercial insurers. That started to change after a series of federal budget cuts and sequestration reduced provider payments. Today, Medicare reimburses only 90% of the costs its enrollees incur and commercial insurers are forced to make up the difference. As a result, businesses see their premiums rise each year, not only to offset the growth in their employee’s medical expenses but also to compensate hospitals and physicians for the unreimbursed portion of the cost of caring for Medicare patients.

Combine two high-cost factors: general health care inflation and price constraints imposed by Medicare and what you get are insurance premiums rising much faster than business revenues.

To compensate, companies are shifting much of the added expense to their employees. The most effective way to do so: Raise deductibles. By increasing the maximum deductible annually, the company reduces the magnitude of its expenses the following year, at least until that limit is reached. A decade ago, only 5% of workers were enrolled in a high-deductible health plan. That number soared to 39.4% by 2016 and jumped again to 43.2% the following year.

High-deductible coverage holds individual patients and their families responsible for a major portion of annual healthcare costs, anywhere from $1,350 to $6,650 per person or $2,700 to $13,3000 per family. This exceeds what the average available savings for most American families and helps to explain the growing financial angst in this country.

And it’s not just employees under the age of 65 who are anxious. Medicare enrollees also fear that the cost of care will drain their savings. As drug prices continue to soar, Medicare enrollees are hitting what has been labeled “the donut hole,” which means that once the cost of their “Part D” prescriptions reaches a certain threshold, patients are on the hook for a significant part of the cost. Now, more and more seniors find themselves having to pay thousands of dollars a year for essential medications.

When it comes to paying for health care, the United States is an anxious nation in search of relief. The fear of not being able to afford out-of-pocket requirements is the reason so many voters have made health care their No. 1 priority as they head to the polls this November. And it’s why both parties are scrambling to deliver the right campaign message.

On Healthcare, Each Party Is A House Divided

In the last presidential election, the Democratic Party chose a traditional candidate, Hilary Clinton, whose views on healthcare were closer to the center than her leading challenger, Bernie Sanders. Two years later, the party is divided by those who believe that (a) the only way to regain control of Congress is by fronting centrist candidates who support and want to strengthen the Affordable Care Act as the best way to attract undecided and independent voters, and (b) those who will accept nothing less than a government-run single payer system: Medicare for all. The primary election of New York congressional candidate Alexandria Ocasio-Cortez, a Sanders supporter, over long-time incumbent Joseph Crowley, represents this growing rift within the party.

The Republicans also face two competing ideologies on healthcare. Since his election in 2016, President Donald Trump has sought to dismantle the ACA. In addition, he and his political allies want to shift control of Medicaid (the insurance program for low-income Americans) from the federal government to the states—a move that would lower health care spending while eroding coverage protection. There are others in the Republican Party who worry that shrinking Medicaid or undermining the health exchanges will come back to bite them. Most of them live and campaign in states where voters support the ACA.

Do The Parties Agree On Anything?

Regardless of party, everyone, from the president to the most fervent single-payer advocate, understands that voters are angry about the cost of their medications and the associated out-of-pocket expenses. And, not surprisingly, each party blames the other for our current situation. Last week, the president gave the Medicare program greater ability to reign in costs for medications administered in a physician’s office. In addition, Trump has promised a major announcement this week to achieve other reductions in drug costs. Of course, generous campaign contributions may dim the enthusiasm either party has for change once the voting is over.

Playing “What If” With Healthcare’s Future

If both chambers remain Republican controlled, we can expect further erosion of the ACA with more exceptions to coverage mandates and progressively less enforcement of its provisions. For Republicans, a loss of either the Senate (a long-shot) or the House (more likely), would slow this process.

But regardless of what happens in the midterms, no one should expect Congress to solve healthcare’s cost challenge soon. Instead, patient anxiety will continue to escalate for three reasons.

First, none of the espoused legislative options will do much to address the inefficiencies in the current delivery system. Therefore, prices will continue to rise and businesses will have little choice but to shift more of the cost on to their workers. Second, the Fed will persist in limiting Medicare reimbursement to doctors and hospitals, further aggravating the economic problems of American businesses. whose premium rates will rise faster than overall health care inflation. Finally, compromise will prove even more elusive since so many leading candidates represent the extremes of the political spectrum.

Politics, the economy, and health care will all be deeply entangled this November and for years to come. I believe the safest path, relative to improving the nation’s health, is toward the center. Amending the more problematic parts of the ACA is better than either of the two extreme positions. If our nation progressively undermines the current coverage provisions, millions of Americans will see their access to care erode. And on the other end, a Medicare-for-all health care system will produce large increases in utilization and cost.

It’s anyone’s guess what will happen in three months. But, whatever the outcome, I can guarantee that two years from now healthcare will remain top-of-mind for voters.

The Memo: GOP to win Kavanaugh fight but Dems vow midterm revenge

Niall Stanage noted that Brett Kavanaugh is set to be confirmed to the Supreme Court on Saturday, notching a big victory for President Trump and the Republican Party — but one that carries sizable complications.

Democrats believe their voters are now more fired up than ever to deliver a rebuke to the GOP in the November midterm elections.

They vow that women’s anger at the judge’s near-certain confirmation, despite allegations of sexual assault and misconduct against him, will be a potent electoral force.

“What I have seen is anger and outrage from women in a way that I’ve never seen before,” said Karine Jean-Pierre, senior adviser and national spokeswoman for MoveOn, a progressive group. “I don’t think Republicans realize what they have unleashed.”

One national women’s group, UltraViolet Action, issued a stark two-sentence statement Friday from co-founder Shaunna Thomas.

“This doesn’t end tomorrow. It ends in November,” Thomas said.

Sen. Kamala Harris(D-Calif.), widely predicted to become a 2020 presidential candidate, made a broader argument that the GOP had disrespected women by backing Kavanaugh.

“To all survivors of sexual assault: We hear you. We see you. We will give you dignity. Don’t let this process bully you into silence,” Harris tweeted as the Kavanaugh drama neared its peak on Friday afternoon in the Senate.

Some Republicans had expressed concern earlier this week when Trump mocked Kavanaugh’s most prominent accuser, Christine Blasey Ford, during a rally in Mississippi. They worried that the president’s rhetoric seemed likely to cause deeper erosion of support for the GOP among suburban women in particular — a demographic that is already skeptical of the president.

An NPR/PBS/Marist poll conducted in late September showed Trump’s job approval rating to be very negative among college-educated white women. Fifty-seven percent within that group disapproved of Trump’s job performance, whereas only 38 percent approved.

At that time, GOP strategist Liz Mair told The Hill: “The party is already in trouble with suburban women. I just have a sneaking suspicion that the Republicans will find a way to mess this up. We are already in trouble with a group of voters we need to not totally hate us.”

But by Friday such concerns seemed to have been supplanted by satisfaction about getting Kavanaugh to the finish line.

Republicans believe they will be rewarded by conservative voters who might not have gone to the polls had GOP senators proved unable to confirm Kavanaugh, who’s spent the past 12 years as a judge on the U.S. Court of Appeals for the District of Columbia Circuit. Many social conservatives voted for Trump with a degree of ambivalence in 2016, given his colorful personal life, but did so in the hope that he would tilt the Supreme Court in their favor.

Kavanaugh’s confirmation would give the nine-member high court a solid 5-4 conservative majority.

“At the moment it appears that Republican voters, Trump voters, have re-engaged and are heading to the polls,” said GOP pollster John McLaughlin on Friday.

Had Kavanaugh plunged to defeat, McLaughlin asserted, “you would have a lot of angry Trump voters who would blame the Republicans and not show up” for the Nov. 6 midterms.

The Kavanaugh drama came to a head on Friday afternoon when Sen. Susan Collins(R-Maine), who had not previously declared her position, announced she would support him.

Moments after her announcement, Sen. Joe Manchin (D-W.Va.) became the only Democrat to cross party lines to back the judge. Manchin is seeking re-election this year in a state that Trump carried by 42 points in 2016 over Hillary Clinton.

The liberal dismay about those decisions was immediately evident on social media and elsewhere.

Susan Rice, who served as U.S. ambassador to the United Nations during former President Obama’s administration, suggested she would be willing to challenge Collins when she comes up for reelection in 2020. It was not clear if Rice was being serious.

Democracy for America, a progressive group, announced that it would work with “anyone we can to finish the job” of defeating Collins.

In a parallel development, former Alaska Gov. Sarah Palin (R) suggested she would consider challenging Sen. Lisa Murkowski(R-Alaska), who voted against Kavanaugh in a procedural vote Friday morning.

“Hey, @LisaMurkowski – I can see 2022 from my house…” Palin tweeted, referring to the year when Murkowski is up for reelection.

Beyond that, the sheer bitterness of the battle over Kavanaugh is striking to all sides.

“The starting gun for the 2020 election was fired with this confirmation fight,” said Ron Bonjean, a Republican who served as a communications strategist in the battle to confirm Trump’s first Supreme Court nominee, Neil Gorsuch, in 2017.

“This rollercoaster nomination has bonded both parties together in a way,” Bonjean added, “because of the intensity of it, how close this vote was and the unfair tactics both sides claimed the other party utilized.”

The president seemed to begin a victory lap on Friday. “Very proud of the U.S. Senate for voting ‘YES’ to advance the nomination of Judge Brett Kavanaugh!” he tweeted.

Democrats are hoping that air of celebration will be short-lived.

Who is correct? We will soon see!

 

HHS chief dismisses ‘Medicare for all’ as ‘too good to be true’ and the Black Hole that Our Politicians are Creating!

42703967_1726301250832860_5436017798763511808_n

Apologies to all those that read my posts for not posting Sunday evening. My home computer finally crashed. So, here is the weekly post for your review.

These last two weeks have convinced me that both the Republicans and Democrats are flawed and no longer deserve our support. More on that later!

But back to Medicare for All and the confirmation that it may not be the best offer for our health care system.  Nathaniel Weixel wrote that the Trump administration’s top health official on Thursday dismissed “Medicare for all” as a promise that’s too good to be true.

“When you drill down into the details, it’s clear that Medicare for all is a misnomer. What’s really being proposed is a single government system for every American that won’t resemble Medicare at all,” Health and Human Services Secretary Alex Azar said during a wide-ranging speech in Nashville, Tenn.

Azar said embracing Medicare for all would mean ignoring the mistakes of ObamaCare, which he called a failure.

“The main thrust of Medicare for all is giving you a new government plan and taking away your other choices,” Azar said.

This was not the first time a top official at the Department of Health and Human Services has tried to discredit the idea of Medicare for all. Centers for Medicare and Medicaid Services Administrator Seema Verma in July called it socialized medicine that would put seniors at risk.

Medicare for all has become increasingly popular among Democrats and is now favored by many of the party’s potential 2020 presidential candidates.

However, many congressional Democrats have yet to completely embrace the idea, and while Sen. Bernie Sanders (I-Vt.) has sponsored a “Medicare for all” bill, there’s no real push for it in Congress.

Republicans have been pointing to Democratic calls for single-payer as a key rebuttal in this year’s midterm campaign, part of an effort to push back against Democratic attacks on GOP bills to repeal ObamaCare.

Aside from attacking Medicare for all, Azar in his speech praised President Trump as a better steward of ObamaCare than former President Obama ever was.

“The president who was supposedly trying to sabotage the Affordable Care Act has proven better at managing it than the president who wrote the law,” Azar said.

He said premiums have been decreasing and there are more plans available for consumers to choose from on state exchanges.

According to Azar, premiums for the typical ObamaCare plan will decrease in 2019 by an average of 2 percent nationwide.

But insurance experts say the main reason premiums are either stable or decreasing this year is because they were so high in 2018. Insurers overpriced their plans this year, driven by the uncertainty over how the Trump administration would handle ObamaCare.

In addition, studies have shown premiums would also be decreasing much more if not for Trump administration policies like the elimination of the individual mandate penalty and expansion of short-term plan.

And now some good, positive news on the healthcare front!

Congress Passes Healthcare Appropriations Bill

Includes funding increase for NIH, $$ for opioid disorder treatment and research

  • Our friend Joyce Frieden of MedPage wrote that Congress has passed a major appropriations bill that increases funding for medical research and opioid disorder treatment and research.

The bill, which includes a $2-billion increase in the National Institutes of Health budget, passed the House Wednesday evening; the Senate passed it last Tuesday. The $674 billion measure, which also includes funding for the departments of Labor and Defense, now heads to the White House, where President Trump is expected to sign it before Oct. 1, in time to avoid a government shutdown.

Medical groups praised the bill’s passage. “We applaud congressional approval of the FY19 Labor-HHS/Defense spending bill which ensures increased funding for innovative research and public health initiatives to address deadly and disabling diseases,” Mary Woolley, CEO of Research!America, a trade group for medical research organizations, said in a statement. “Passage of the measure before the end of the current fiscal year is also noteworthy and congressional leaders should be commended for their commitment to advancing the bill in a timely fashion. The $2-billion increase for the National Institutes of Health builds on the momentum to accelerate research into precision medicine, Alzheimer’s disease, cancer, and other health threats.”

In addition, she noted, “The measure will also enable the Centers for Disease Control and Prevention to step up efforts to combat antibiotic resistance, and the opioid epidemic through research, treatment, and prevention.”

The appropriations bill also includes $317 million for various rural health initiatives, including $20 million for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption of health information technology, and up to $1 million for telehealth services, “including pilots and demonstrations on the use of electronic health records to coordinate rural veterans’ care between rural providers and the Department of Veterans Affairs electronic health record system,” according to the conference report on the bill that was worked out between the House and Senate.

Other health-related provisions of the bill include:

  • $1.5 billion for State Opioid Response Grants
  • $765 million to the Centers for Medicare & Medicaid Services for fighting fraud
  • $338 million for the Agency for Healthcare Research and Quality, which had been targeted for closure by the Trump administration
  • $120 million for the Rural Communities Opioids Response Program

The Association of American Medical Colleges (AAMC) also applauded the bill’s passage. In addition to the NIH funding bump, “funding for the Health Resources and Services Administration’s workforce and pipeline programs will help create a strong and culturally competent health care workforce to provide those cures and treatments to vulnerable patients and those living in underserved communities,” AAMC president and CEO Darrell Kirch, MD, said in a statement.

In her statement about the bill’s passage, Rep. Lucille Roybal-Allard (D-Calif.) singled out the healthcare provisions in particular. “I am particularly pleased that [Health and Human Services] programs received such robust funding in this Conference agreement,” she said. “The bill increases funding for three of my top legislative priorities: fighting underage drinking, supporting newborn screening, and reducing maternal mortality.”

In addition, “at a time when this country is experiencing the highest rates of sexually transmitted diseases in history, this bill restores both the Teen Pregnancy Prevention Program and all Title X Family Planning dollars that help our teens gain critical access to reproductive health care and education.”

But not everyone was happy with the bill. “We’re pleased policymakers have likely avoided a shutdown and actually appropriated most of this year’s discretionary budget on time,” said Maya MacGuineas, president of the Committee for a Responsible Federal Budget, in a statement. “But let’s not forgot that Congress did so without a budget and had to grease the wheels with $153 billion to pass these bills. That isn’t function; it’s a fiscal free-for-all.

“Policymakers should not be budgeting by borrowing more; they should put in place a full budget with a plan to bring our borrowing down, not up,” she continued. “Let’s stop patting ourselves on the back for adding hundreds of billions of dollars to the deficit in an orderly manner. Let’s instead work together to stabilize the nation’s finances.”

 ‘Indelible in the Hippocampus’: Christine Blasey Ford Explains Science Behind Her Trauma

The teaching psychologist Dr. Ford explained the uneven memories of sexual assault survivors to the Senate Judiciary Committee.

Anna Almendria wrote that while recounting her allegations against Supreme Court nominee Brett Kavanaugh in front of the Senate Judiciary Committee Thursday, Christine Blasey Ford said the judge had covered her mouth to prevent her from screaming during an assault while the two were teenagers in high school. In follow-up questions, Sen. Dianne Feinstein (D-Calif.) asked Blasey how she could be so sure that it was Kavanaugh who did it.

Blasey, who is a psychology professor at Palo Alto University, offered a lesson in neuroscience in reply.  “The same way that I’m sure that I’m talking to you right now, just basic memory functions,” Blasey told Feinstein in response. “And also just the level of norepinephrine and epinephrine in the brain that sort of, as you know, encodes ― that neurotransmitter encodes memories into the hippocampus, and so the trauma-related experience then is kind of locked there whereas other details kind of drift.”

Norepinephrine and epinephrine are two hormones released when the body experiences stress. When a person is experiencing a threat like a sexual assault, these stress neurotransmitters flood the brain and help encode details like the environment and the people who you’re with on the hippocampus, which is a part of the brain that’s responsible for creating and retrieving memories.

Later on in the hearing, she again referred to the hippocampus when responding to Sen. Patrick Leahy’s (D-Vt.) question about her most vivid memory of the alleged assault, which Blasey said took place in the early 1980s.

“Indelible in the hippocampus is the laughter, the uproarious laughter between the two,” she said, referring to Kavanaugh and Mark Judge, the other person Blasey alleges was in the room when the assault took place. “And their having fun at my expense.”

In pairing the retelling of her traumatic experience with explanations of the way assault affects the brain, Blasey is educating the public about how survivors process and store violent memories and can recall them years later.

Sabrina Segal, a psychology professor at Cal State University, Channel Islands, says that Blasey was making a distinction between everyday memories that the brain records during calm, relaxed moments and traumatic memories that the brain encodes during periods of high stress and fear for one’s life.

“The hippocampus is a structure in the brain that we know basically converts short-term memory traces into long-term memory traces,” Segal said, a term that psychologists use to describe the physical change that takes place in the brain when it stores a memory. “We know this because of studies where this part of the brain was removed, and it altered a person’s ability to do that.”

This bit of biology explains why Blasey would be certain of some details like Kavanaugh’s face, or the environment of the room and less so of other details that occurred before the alleged assault, such as the owner of the home where the incident took place. In moments where she feared for her life and was in “fight or flight” mode, she would have details “seared” into her memory, Segal said.

The full mechanics of this response also involve the amygdala, an almond-shaped structure in the brain, which perceives and responds to danger.

“What a lot of people don’t know is that your body releases adrenaline, which is a stress hormone, and almost simultaneously your brain will release [norepinephrine] in the amygdala,” Segal said. “It’s a potency maker in terms of being able to strengthen the memory.”

Research shows that it is common for survivors of sexual trauma to strongly remember the details of the event itself but not have many memories of other details around the event.

“When something is incredibly traumatic and emotional, that [norepinephrine] is going to make specific details etched in, and you will never forget them,” Segal said. “The fact that she’s had these memories for 20 years is not shocking to me in any way.”

Negar Fani, an assistant professor at Emory University who specializes in the neurobiology of post-traumatic stress disorder, says that this traumatic memory-storing process has a strong evolutionary purpose.

“It’s so that you can avoid things that could potentially harm you in the future,” Fani said. “When you encounter and encode these contextual aspects of the memory, you’ll avoid things that even remotely relate to that trauma memory.”

Fani said this could explain why Blasey requested that Kavanaugh not be present in the room during her testimony. “This person who assaulted her produces that same fight or flight reaction,” Fani said. “Because he’s a critical part of the threat context, it’s going to arouse her fight or flight system, and it’s hard to think clearly when that fight or flight system is engaged.”

But there is a lesson for Dr. Ford, and these experts, who has accused the supreme court nominee, Judge Kavanaugh, of sexual harassment saying that the norepinephrine and epinephrine levels in her hipocampus basically cements that memory 100% in her hippocampus. Interesting!! If that were true how come that she doesn’t remember where it took place, when it took place and how she got home.

Well, the last article the “professionals” tries to explain these differences. Alas, this “expert”, along with those others, who are not medical doctors with no training in neurology or medicine don’t understand the effect of alcohol has on the levels of norepinephrine in the hippocampus or chose not to mention these facts. Study up Doc/PhD, before you try to sound so sure of yourself.

Now also remember the Prosecutor that the Republicans brought in to question Ford and Kavanaugh. Rachel Mitchell, the prosecutor who questioned Christine Blasey Ford on behalf of Republican senators last week during an emotional hearing before the Senate Judiciary Committee, released a memo late Sunday detailing why no “reasonable prosecutor” would bring a case against Brett Kavanaugh given the “evidence” that exists against him.

“A ‘he said, she said’ case is incredibly difficult to prove. But this case is even weaker than that,” Mitchell said, explaining the case’s “bottom line.”

Ironically, Mitchell’s language mirrors the vernacular of former FBI Director James Comey, who similarly argued in July 2016 that “no reasonable prosecutor” would bring charges against Hillary Clinton for her use of a private email server.

The career Arizona prosecutor, who specializes in sex-related crimes, goes on to outline eight reasons why no “reasonable prosecutor would bring this case,” explaining the evidence fails to “satisfy the preponderance-of-the-evidence standard.”

  1. Ford has not offered a consistent account of when the alleged assault happened

Mitchell explained that initially Ford said the assault occurred in the “mid-1980s,” but later changed the date to the “early 80s.” But when she met with the polygraph administrator, Ford crossed out the word “early” for unknown reasons.

Ford has also described the incident occurring in the “summer of 1982” and her “late teens” — despite claiming it happened when she was 15.

“While it is common for victims to be uncertain about dates, Dr. Ford failed to explain how she was suddenly able to narrow the time frame to a particular season and particular year,” Mitchell said.

  1. Ford has struggled to identify Judge Kavanaugh as the assailant by name

Mitchell explained Ford neither identified Kavanaugh by name during marriage counseling in 2012 or individual counseling in 2013. Ford’s husband claims she identified Kavanaugh in 2012, but Mitchell noted that Kavanaugh’s name was widely circulated as a potential Supreme Court pick should then-Republican presidential nominee Mitt Romney have won the presidency.

“In any event, it took Dr. Ford over thirty years to name her assailant,” Mitchell wrote. “Delayed disclosure of abuse is common so this is not dispositive.”

  1. When speaking with her husband, Ford changed her description of the incident to become less specific

According to Mitchell, Ford told her husband before they married that she had been the victim of a “sexual assault,” but told the Washington Post that she told her husband she was a victim of “physical abuse.”

“She testified that, both times, she was referring to the same incident,” Mitchell said.

  1. Ford has no memory of key details of the night in question — details that could help corroborate her account

Mitchell explained:

  • Ford does not remember who invited her to the “party, how she heard about it, or how she got there”
  • Ford does not remember whose house the assault occurred or where the house is located with any specificity
  • Ford remembers very specific details about that night that are unrelated to the assault, such as how many beers she consumed and whether or not she was on medication

Perhaps the most significant hole in Ford’s memory, Mitchell said, is the fact that Ford does not remember how she returned home from the party.

Factually speaking, the location of the party that Ford identified to the Washington Post is a 20-minute drive from her childhood home. And it was only during her testimony last week that she agreed for the first time that someone had driven her somewhere that night. Ford remembers locking herself in a bathroom after the alleged assault, but cannot identify who drove her home.

Significantly, no one has come forward to identify themselves as the driver.

“Given that this all took place before cellphones, arranging a ride home would not have been easy. Indeed, she stated that she ran out of the house after coming downstairs and did not state that she made a phone call from the house before she did, or that she called anyone else thereafter,” Mitchell said.

  1. Ford’s account of the alleged assault has not been corroborated by anyone she identified as having attended — including her lifelong friend

As widely reported, Mitchell explained that each individual Ford identified as having been at the party has submitted sworn statements — under penalty of felony — that they do not remember the party and cannot recall or corroborate any detail that Ford alleges.

  1. Ford has not offered a consistent account of the alleged assault

Ford claimed in her letter to Sen. Dianne Feinstein (D-Calif.) that she heard Kavanaugh and Mark Judge talking downstairs while hiding in a bathroom after the assault. But she testified that she could not hear anyone, and only “assumed” people were talking.

Meanwhile, Ford’s therapist’s notes show that she said there were four boys in the bedroom when she was assaulted. However, she told the Washington Post it was only two, and blamed the error on her therapist. Also, in Ford’s letter to Feinstein she said there were “me and 4 others” at the party. However, in her testimony, she said there were “four boys” at the party in addition to herself and Leland Keyser, her female friend.

Additionally, “Dr. Ford listed Patrick ‘PJ’ Smyth as a ‘bystander’ in her statement to the polygrapher and in her July 6 text to the Washington Post, although she testified that it was inaccurate to call him a bystander. She did not list Leland Keyser even though they are good friends. Leland Keyser’s presence should have been more memorable than PJ Smyth’s,” Mitchell said.

     7. Ford has struggled to recall important recent events relating to her allegations, and her testimony regarding recent events raises further questions about her memory

Mitchell explained that Ford is unable to accurately remember her interactions with the Washington Post, such as what she told reporters or whether or not she provided them with a copy of her therapist’s notes.

Also of significance is Ford’s claim that she wished to remain confidential since she submitted her assault allegations to a person operating the Washington Post’s tip line. She testified that she did this due to a “sense of urgency,” claiming she did not know how to contact the Senate Judiciary Committee. However, she was unable to explain how she knew to contact the offices of Feinstein and Rep. Anna Eshoo (D-Calif.).

Also, Ford cannot recall if she was recorded, via audio or video, during the administration of her polygraph, nor can she remember if the polygraph was administered on the same day as her grandmother’s funeral or the day after.

“It would also have been inappropriate to administer a polygraph to someone who was grieving,” Mitchell said.

  1. Ford’s description of the psychological impact of the event raises questions

Ford testified that she suffers from anxiety, PTSD, and claustrophobia, which explains her fear of flying. However, she testified that she has flown many times in the last year, and flies on a regular basis for her hobbies and work.

Meanwhile, Ford testified that the assault affected her academically in college. However, she never claimed it affected her in high school after the assault allegedly occurred.

“It is significant that she used the word ‘contributed’ when she described the psychological impact of the incident to the Washington Post. Use of the word ‘contributed’ rather than ’caused’ suggests that other life events may have contributed to her symptoms. And when questioned on that point, said that she could think of ‘nothing as striking as’ the alleged assault,” Mitchell explained.

Finally, Mitchell said the “activities of congressional Democrats and Dr. Ford’s attorneys likely affected Dr. Ford’s account.”

And now we are going to have the FBI do an additional investigation after they have already vetted this candidate 6 times. That’s right, 6 times for his other judicial positions!

Besides this expert and witness to the horrible things that the judge has done, the behavior of most of the Democrats especially, but also some of the Republicans really sickens me. It represents childish, uncivil and I think truly unethical behavior, which has no place in this confirmation hearing. Do you all remember all that you did in high school and or college? I doubt it and some of these allegations can be interpreted in various ways. But trust me I am no fan of sexual aggressive behavior on anyone’s part but some of these allegations have to be taken in context and timing and in lieu of the behaviors of the time and grouping behaviors. Really??

I remember college gals exposing themselves when drunk or even after only one or two drinks as well as “men and women” away from home in college who were so drunk that they fell on each other, etc.

But that being what it is I am still angrier with our Senators and Representatives who by their behavior and lack of respect for Judge Kavanaugh and their anger for President Trump have created a circus. All this horrible behavior, the anger, hatred and the vitriol has convinced me to vote for independents and not anyone from each of our popular parties, unless it only leaves me the Republican as my only choice.

I was even going to vote for a Democrat in our Senate race because of the lack of any positive input or suggestions for health care decisions from the two term physician who has filled that spot. But now it will be the independent gentleman who gets my vote. I hope that many of you out there when you get to vote in November carefully make your choices. We the voters are the only people that can turn this black era in our society’s history around. The Democrats are pitting Democrats against Republicans, whites against Afro-Americans, “straights against gays/LGTBXXX and finally men against women. For what?  They want control of our government and to get on with their agenda. Horrifying!!

And now here is another insult by our politicians. I had an interesting experience on Friday afternoon while waiting for our train to New York City. Our Acela train was delayed by 1 ½ hours so that Senator Coons could give interviews in D.C. regarding the Kavanaugh hearing. Yes, they held up the train in D.C. Union Station, so that the senator could complete his interviews and claim the Business Car for him and his troop. Unbelievable!!

Next, more discussion on single payer health care choices and if there are other alternatives to consider.

 

A Journalist’s Family escaped Socialism and now the Democrats think that they should move the party in its direction; So Let’s Look Closer at the British Experience.

 

 

40790419_1699020056894313_3889611529598795776_nAfter reviewing last week’s craziness I am convinced that our politicians along with the media are truly dysfunctional and really lack civility. Look at the demonstrators who were interviewed during the next potential Supreme Court Judge’s “interrogation”. Most didn’t even know what they were demonstrating against or even what their signs meant. What a crazy world we live in!!

As the “New Democrats” declare their need to change us all and make our system based on socialism I found this interesting article.

Giancarlo Sopo wrote an Opinion contributor who stated that Cuba’s socialist revolution was supposed to work for workers — like his grandparents who lived in Miami during Fulgencio Batista’s dictatorship this interesting article. In January 1959, just two weeks after Fidel Castro seized power, they returned to the island to care for his grandmother’s ailing mother. For the next 20 years, they remained prisoners in their own country. Democratic socialism is a lot like the system his family fled, except its proponents promise to be nicer when seizing your business.

As Cuba’s political and economic situation worsened, his grandfather told a friend he wanted to return to the United States. Someone overheard the conversation and reported him to the authorities. For this, the Castro regime threw him in jail. He was later stripped of his job and salary as an accountant and assigned to feed zoo animals. In addition to the emotional distress it caused, this made my family’s financial circumstances even more precarious.

To understand his grandparents’ desperation to flee socialism, imagine leaving everything behind and starting anew at almost 60 years old.

He, the writer was born in Miami a little after his family was able to return to America — when President Jimmy Carter allowed travel restrictions to lapse. Growing up, a framed photo of his parents with President Ronald Reagan was a mainstay in the living room of his modest duplex. Yet, during the first election, he was able to vote, he served as a precinct captain for Democratic presidential candidate John Kerry. Four years later, he knocked on doors in New Hampshire for then-Sen. Barack Obama. In 2016, his wife and he drove 14 hours to volunteer for Hillary Clinton and this June, they marched in support of immigrant families.

The popularity of ‘democratic socialism’

Despite his working-class immigrant roots, he is concerned by the popularity of socialism within my party. On the night of Alexandria Ocasio-Cortez’s victory in New York, he thought that she used the term as a misnomer. He then began studying the views of the Democratic Socialists of America (DSA), remember that we discussed the various forms of socialism and the system here would be democratic socialism and now the rapidly growing national organization she belongs to and was disturbed by what he learned.

Like those of yesteryear, today’s socialists believe the government should nationalize major industries, propose eliminating private ownership of companies, and reject profits. In other words, democratic socialism is a lot like the system my family fled, except its proponents promise to be nicer when seizing your business.

When he confronted some progressive friends about this, they initially dismissed his concerns. After sharing some articles with them, the conversation shifted to “they just want us to be more like the Nordic countries” and “they’re not like real socialists!” Both are reductionist, self-delusions to avoid confronting difficult truths.

The latter is a particularly absurd fallacy because it requires one to believe that adults who willfully join socialist organizations, sound like socialists and call themselves socialists are not what they claim to be.

Claims of “Nordic socialism” are also largely exaggerated. As Jostein Skaar, of Oslo Economics, told him, “I would stress that the Norwegian economic system is capitalistic, heavily influenced by the U.S. and U.K.”

This is probably why DSA argues that the Nordic model is not good enough.

The ideological counterparts of America’s democratic socialists are likelier to be found to our south than in northern Europe. For instance, Cuba — where the state controls three-fourths of the economy, limits private-sector activity, and employs the majority of workers — is clearly more representative of DSA’s economic vision than Denmark, where 89 percent of the wealth is privately owned and seven out of 10 Danes work in the private sector.

Moreover, as an investigation by Transparency International revealed, the Venezuelan government owns at least 511 companies — resulting in a state-owned enterprise’s per-capita ratio that is more than three times greater than all of Scandinavia’s combined.

As someone who spent years defending Democrats from “socialista” charges, he understood why people roll their eyes when Cuba and Venezuela are mentioned alongside democratic socialism, but to reject the comparison simply because we don’t like those countries’ outcomes misses the point of why they turned out the way they did. He is under no illusion that increased access to health care and education will turn us into the Venezuelan capital Caracas, but it’s foolish to believe that democratic socialists — who promise to end capitalism — would be satisfied with Medicare for all if given the reins of power.

This must never happen. The descendants of Karl Marx and Friedrich Engels should have no place in the party of Harry Truman and John F. Kennedy. Given its horrific record of human suffering, it would be a moral disgrace for Democrats to embrace socialism just to win elections, as some suggest. Those who use the blitheful ignorance of many for the political gain of a few deserve to lose. Indeed, if socialism represents the future of the Democratic Party, that’s a dystopia, no American should want to be a part of.

Britain’s Health Care System Demonstrates Perils of Socialized Medicine

Dr. Kevin Pham and Robert Moffit reviewed the British experience with socialized medicine and why those who want to convert our system to socialized medicine had better do some serious research first. Younger doctors who are flirting with the support of government-run health care should consider some hard facts—including the unfortunate results such control would likely have for patients and doctors themselves. They should also look at the recent raw experience of Britain with a government-controlled health care system.

But first, let’s look at the most serious plan for government-run health care: Sen. Bernie Sanders’ Medicare for All Act of 2017, which has the support of one-third of Senate Democrats.

Recently, Sanders, I-Vt., claimed that his bill would save more than $2 trillion over a 10-year period. According to the Associated Press, however, the senator “mischaracterized” the analysis upon which that estimate was based, a major study of the cost of the Sanders bill by Charles Blahous, a former Medicare trustee, now at the Mercatus Center.

As the Associated Press’ fact check notes, the $2.1 trillion “savings” estimate rests on the implausible assumption—studiously ignored by Sanders and others—that hospitals and staffing levels would remain the same—despite an estimated 40 percent reduction in compensation for medical services.

Such a massive pay cut would guarantee, says Blahous, that doctors and hospitals would get paid for services “substantially below” their costs of providing the services. Thus, he warns, “ … whether providers could sustain such losses and remain in operation, and how those who continue operations would adapt to such dramatic payment reductions, are critically important questions.”

Yes, they are. Blahous’ findings are particularly relevant for young men and women entering medical school. As Kaiser Health News recently reported, a growing contingent of young physicians and medical students favor expanding the power of government officials to control medicine, and thus their professional lives.

After all, most students become doctors more out of a desire to care for patients than to make a lot of money. Sanders’ proposed pay cut, however, would likely price many doctors out of independent practice, as well as decimate larger medical systems—neither of which would benefit patients.

Medicare would ostensibly be the model for Sanders’ national health insurance program. Beyond lower payment levels, Medicare is governed by tens of thousands of pages of rules, regulations, and guidelines.

The transactional or administrative costs that doctors and other medical professionals already incurred in compliance with these reams of red tape are real, though they do not show up on Medicare or Medicaid budget documents. That is one reason why Medicare’s official administrative costs are deceptively low; the government shifts a large share of administrative costs for medical professionals.

By 2030, America faces a physician shortage ranging from roughly 43,000 to 121,000, depending upon the assumptions. The crush of nonclinical administrative duties is today a leading cause of American physician burnout and accelerated retirements.

Ultimately, the Sanders bill, by reducing physician compensation while enlarging the power of Washington’s health care bureaucracy, would only make matters worse.

Young doctors—and anyone else considering government-run health care—should look at the performance of the British National Health Service.

In a candid Oct. 12, 1975 interview with the London Sunday Times, then-Labor Minister David Owen, conceded:

“The health service was launched on a fallacy. First, we were going to finance everything, cure the nation and then spending would drop. That fallacy has been exposed. Then there was a period when everybody thought the public could have whatever they needed on the health service- it was just a question of governmental will. Now we recognize that no country, even if they are prepared to pay the taxes, can supply everything.”

Today, the British National Health Service is plagued with long wait times, delayed procedures, and an overstressed medical workforce.

A cursory survey of recent British news sources reveals a worrying trend in the delayed delivery and deteriorating quality of National Health Service health care. While British tabloids can be sensational, with bleeding ledes on hospital problems, sober British analysts are concerned.

Last winter, a particularly virulent strain of influenza hit Britain. British hospital wards are often overcrowded, but the crush of flu patients exacerbated the system’s persistent and underlying problems—inadequate staffing and insufficient resources. The British Medical Association’s quarterly survey of physicians found that 82 percent of respondents felt their workplaces were understaffed.

One doctor described the situation this way to the British Medical Association: “I came on to shift yesterday afternoon and there were patients literally everywhere. The corridor into the hospital was so busy we couldn’t have got a cardiac arrest patient through it into the resuscitation room.” He added, “To say the staff was at the end of their tethers would be a complete understatement.”

National Health Service morale has been suffering, and British Medical Association surveys show that complaints about resources, understaffing, and perpetual physician vacancies have been constant.

Aggravated by the flu season, and budget constraints, the National Health Service canceled some 50,000 “non-urgent” surgeries. The problem is that the urgency for a particular patient’s surgery is, or should be a doctor’s clinical judgment. For example, surgery for a person to repair an abdominal aortic aneurysm (AAA), for instance, may be delayed. But delaying an AAA repair is risking a rupture, and patients with a ruptured AAA have a 90 percent mortality rate.

By March 2018, British emergency departments reached new lows, leaving 15.4 percent of patients waiting over four hours before being seen. This was far short of the goal of less than 5 percent of patients forced to wait over four hours.

When considering only major emergency departments, classified as Type 1 in the National Health Service, the rate increased to 23.6 percent of patients waiting longer than four hours to be seen. The British Medical Journal reports that this is the worst performance since 2004 when these metrics were first tracked.

Outside of emergency departments, the number of British patients waiting 18 weeks or more for treatment increased by 35 percent, which was an increase of 128,575 patients from about 362,000 patients in 2017, to over 490,000 patients in 2018.

Additionally, by March 2018, 2,755 patients had waited over a year to be treated, compared to 1,528 patients in 2017. In England, the National Health Service also broke records by canceling over 25,000 surgeries at the last minute in the first quarter of 2018—this was the highest number of last-minute cancellations in 24 years. Remarkably, this was after the British authorities initiated a series of reforms that started in 2016.

The British, of course, are responsible for their system and its results. They will, or will not, undertake reforms to reduce long queues, delayed care, and the consequent harm to British patients.

It is naïve, however, to believe that Americans can avoid similar consequences—annual budget dramas, long waiting times, and scandalous care denials—by giving members of Congress and officials of the federal bureaucracy control over American health care.

And if you want to see how crazy “our” politicians are, one only has to look at New York State and the governor’s race. We have discussed weeks ago the estimation of how much Medicare for All will cost.

Cynthia Nixon on getting single-payer health care in New York: ‘Pass it and then figure out how to fund it’

Kaitlyn Schallhorn wrote about Ms. Cynthia Nixon’s pursuit in her quest to become New York’s next governor.  Cynthia Nixon has advocated for a single-payer health care system in the state – something studies have shown would be a costly endeavor.

The proposed New York Health Act(NYHA), which would establish universal health care for everyone in the state, including undocumented immigrants, would require the state’s tax revenue to increase by about 156 percent by 2022, according to a study by the RAND Corp. But it also found state spending on total health care under NYHA would be slightly lower – about 3 percent – by 2031 than under the current system.

Nixon recently told the New York Daily News editorial board she did not yet have a plan to pay for single-payer.

“Pass it and then figure out how to fund it,” Nixon said. What an ignoramus and I’m not sure who or what she is as she tells the media not to call her a lesbian, but instead label her a queer!!

Gov. Andrew Cuomo, who Nixon is challenging in the Democratic primary next week, has said it should be up to the federal government to pass a universal health care system. During a debate between the two candidates last month, Cuomo said the NYHA was good “in theory,” but would cost more than New York’s annual budget to implement it “in the long-term,” according to the Albany Times Union.

‘SEX AND THE CITY’ STAR CYNTHIA NIXON COULD BE NEW YORK’S NEXT GOVERNOR: A LOOK AT HER POLITICAL ACTIVISM

Nixon, on the other hand, has said a single-payer system will save the state and New Yorkers money overall.

There is widespread disagreement over how much it would cost to implement a single-payer health care system. Supporters of the single-payer system say it would cut excessive administrative costs compared to those incurred by private insurers. But critics, including most Republicans, warn the savings would be less dramatic than expected – and the system would cost too much.

Joe White, president of the Council for Affordable Health Coverage, has estimated that with single-payer “costs and taxes will rise, or patient access will be severely diminished – turning America’s medical system into a third-world product.”

The Medicare-for-all bill proposed earlier this year by Sen. Bernie Sanders, I-Vt., was estimated to cost$32.6 trillion over 10 years by a Mercatus Center at George Mason University study and it is estimated that a single-payer health care system in New York will cost $155 billion dollars over 10 years or less.

ANDREW CUOMO, CYNTHIA NIXON ACCUSE EACH OTHER OF LYING, CORRUPTION IN HEATED PRIMARY DEBATE

The term “single-payer health care” denotes only one entity bears the financial responsibility of health care – the government. Under this system, the government would be solely responsible for covering health care costs.

“The basic idea of single-payer is to cover everybody with a single government program, and that program would basically cover all the doctors and hospitals,” Dr. Adam Gaffney, an instructor of medicine at Harvard Medical School, told Fox News.

As the Times Union reported, the NYHA has continuously been introduced by Democrats in the state Assembly every year since 1992 but has been unsuccessful in the Senate.

I believe that the dysfunction in our Congress will continue and may get worse as the Mid-Term elections get closer and they will get nothing done. What happens after the elections will be determined depending on whether the Democrats grab the majority in one or both the House and the Senate.

On forward to look closer at Medicare for All and other ideas for a single-payer health care system as we get closer to what a real future health care system will or could look like in the U.S.A.

The Effects of Socialism on Healthcare and Healthcare Reform

39975971_1685066984956287_3032019853234929664_nIn the current discussions, a single word — “socialism” — seems to have triggered the most emotional responses, needlessly so.

As more and more of the Democrats campaigning for the Mid-Term elections tout Socialism I wonder if they have any idea of what socialism means and more importantly how it would impact health care. David Nash and Richard Jacoby, both physicians wrote in MedPage Today back in 2009 that the health care reform debate is, all too often, confusing. The subject is multifaceted and is generally not presented in a logical, orderly fashion.

One reason is that, when we approach an issue as large as health care reform, we tend to focus on the segments about which we have strong personal feelings. Emotions come into play, often vigorously, making objective discussion difficult or impossible.

Often, the basis for these strongly held beliefs is rooted in the misunderstanding of a principle, a definition, or how things work in the real world. Such understanding is fundamental to a logical debate.

In the current health care reform discussions, a single word — “socialism” — seems to have triggered the most emotional responses. It is used almost pejoratively as if it is the worst thing that could possibly happen in America.

Socialism is most commonly invoked when the healthcare reform discussion turns to whether or not we should have a government-funded public insurance option.

Simple definitions can help here. In capitalism, individuals own the means of production of goods and services. In socialism, the government owns them. Let’s look a bit more at what socialism really is. Look at Venezuela and their currency, the Bolivar, which has been devalued to 0.0000040 of the U.S, dollar! Wow!

Kimberly Amadeo stated at the beginning of the month that Socialism is an economic system where everyone in the society equally owns the factors of production. The ownership is acquired through a democratically elected government. It could also be a cooperative or a public corporation where everyone owns shares. The four factors of production are labor, entrepreneurship, capital goods, and natural resources.

Socialism’s mantra is, “From each according to his ability, to each according to his contribution.” Everyone in society receives a share of the production based on how much each has contributed.

That motivates them to work long hours if they want to receive more.

Workers receive their share after a percentage has been deducted for the common good. Examples are transportation, defense, and education. Some also define the common good as caring for those who can’t directly contribute to production. Examples include the elderly, children, and their caretakers.

Socialism assumes that the basic nature of people is cooperative. That nature hasn’t yet emerged in full because capitalism or feudalism has forced people to be competitive. Therefore, a basic tenet of socialism is that the economic system must support this basic human nature for these qualities to emerge.

These factors are valued for their usefulness to people. This includes individual needs and greater social needs. That might include preservation of natural resources, education, or health care. That requires most economic decisions to be made by central planning, as in a command economy.

Advantages:

Workers are no longer exploited since they own the means of production. All profits are spread equitably among all workers, according to his or her contribution. The cooperative system realizes that even those who can’t work must have their basic needs met, for the good of the whole.

The system eliminates poverty. Everyone has equal access to health care and education. No one is discriminated against.  Everyone works at what one is best at and what one enjoys. If society needs jobs to be done that no one wants, it offers higher compensation to make it worthwhile.

Natural resources are preserved for the good of the whole.

Disadvantages:

The biggest disadvantage of socialism is that it relies on the cooperative nature of humans to work. It negates those within society who are competitive, not cooperative. Competitive people tend to seek ways to overthrow and disrupt society for their own gain.

A secondly related criticism is that it doesn’t reward people for being entrepreneurial and competitive. As such, it won’t be as innovative as a capitalistic society.

A third possibility is that the government set up to represent the masses may abuse its position and claim power for itself.

Difference Between Socialism, Capitalism, Communism, and Fascism

Untitled.Differences between Socialism,Some say socialism’s advantages mean it is the next obvious step for any capitalistic society. They see income inequality as a sign of late-stage capitalism. They argue that capitalism’s flaws mean it has evolved past its usefulness to society. They don’t realize that capitalism’s flaws are endemic to the system, regardless of the phase it is in.

America’s Founding Fathers included promotion of the general welfare in the Constitution to balance these flaws. It instructed the government to protect the rights of all to pursue their idea of happiness as outlined in the American Dream. It’s the government’s role to create a level playing field to allow that to happen. That can happen without throwing out capitalism in favor of another system.

Examples of Socialist Countries:

There are no countries that are 100 percent socialist, according to the Socialist Party of the United Kingdom. Most have mixed economies that incorporate socialism with capitalism, communism, or both.

The following countries have a strong socialist system.

Norway, Sweden, and Denmark: The state provides health care, education, and pensions. But these countries also have successful capitalists. The top 10 percent of each nation’s people hold more than 65 percent of the wealth. That’s because most people don’t feel the need to accumulate wealth since the government provides a great quality of life.

Cuba, China, Vietnam, Russia, and North Korea: These countries incorporate characteristics of both socialism and communism.

Algeria, Angola, Bangladesh, Guyana, India, Mozambique, Portugal, Sri Lanka, and Tanzania: These countries all expressly state they are socialist in their constitutions. Their governments run their economies. All have democratically elected governments.

Belarus, Laos, Syria, Turkmenistan, Venezuela, and Zambia: These countries all have very strong aspects of governance, ranging from healthcare, the media, or social programs run by the government.

Many other countries, such as Ireland, France, Great Britain, Netherlands, New Zealand, and Belgium, have strong socialist parties and a high level of social support provided by the government. But most businesses are privately owned. This makes them essentially capitalist.

Many traditional economies use socialism, although many still use private ownership. There are eight types of socialism. They differ on how capitalism can best be turned into socialism. They also emphasize different aspects of socialism. Here are a few of the major branches, according to “Socialism by Branch,” in The Basics of Philosophy.

Democratic Socialism: a democratically elected government manages the factors of production. Central planning distributes common goods, such as mass transit, housing, and energy, while the free market is allowed to distribute consumer goods.

Curiously, socialism is rarely used to describe Medicare, Medicaid, and the various other government-sponsored plans that account for roughly half of the healthcare dollars spent in this country and that are bona fide examples of socialist services.

It should be clear to any objective observer that the U.S. is not a purely capitalist country. We have many government-run services — the military, highways, public education, the Postal Service, Social Security, and Medicare to name a few.

Thus, the U.S. exhibits elements of both capitalism and socialism — a so-called mixed economy.

As has become abundantly clear through the recent financial crisis and subsequent government-sponsored rescue of the financial system, government spending shortened what otherwise would have been an extended economic downturn — when the private sector could not or would not do so.

So, a little government (read “socialism”) mixed in with our capitalism can be a good thing. Students of economics embrace “capitalism” because it has proven unparalleled in raising living standards for vast numbers of people and for fostering innovation. But, the conventional wisdom about capitalism is rooted in flawed logic that assumes free markets are inherently self-correcting. They are not. A capitalist system does not guarantee a good outcome.

What are the prospects for “market forces” to reshape our current health care system in a fashion that decreases cost and increases quality? For a market to work its magic, transparency about costs (which allows comparison shopping by patients) and information about quality (public reporting of quality measures in a standardized format) need to be widely available so that value can be assessed and delivered.

Clearly, these elements are not present in our current system and are not likely to be present for some time. Further, our current payment structures give patients little incentive to engage in “comparison shopping” or for providers to be efficient in delivering services. Indeed, providers are rewarded on the basis of quantity rather than quality or value of the services they provide.

The U.S. occupies the 37th place in the World Health Organization’s ranking of health care quality in industrialized nations. This, coupled with the fact that we pay almost twice as much as other countries for that level of care, suggests that our “capitalistic” healthcare system could use some “socialistic” guidance.

Who will provide guidance toward better outcomes in healthcare?

Historically, the government (in the form of the Centers for Medicare and Medicaid Services) has led the way to cost and quality reform through various demonstration projects and programs involving “Value-Based Purchasing.” Private insurers have followed the government’s lead.

The premise of health insurance is that a risk pool with a large number of people reduces the cost of protecting any one individual from the consequences of a serious health problem. The larger the pool, the broader the risk is spread, and the lower the cost.

A federally provided public insurance option covering all Americans would spread the risk as broadly as possible. In fact, many Medicare services are administered currently by Blue Shield and other private insurance companies.

Combining a single large insurance pool with the private administration is a nice mixed economic insurance solution. Certainly, this is not as crazy a scheme as the status quo.

Why is Socialized Health Care Is Unjust?

Hadley Heath Manning looked more critically and healthcare in a socialized system. As she states, when the government runs hospitals, clinics, and other healthcare institutions, people get worse care for more money. Sen. Bernie Sanders’s presidential campaign is exceeding expectations and drawing large support from young and blue-collar voters. At the center of his policy platform is a plan to completely socialize the U.S. healthcare system, turning it into a “single-payer” program, or a single government fund that pays for all citizens’ health costs.

The argument for this kind of system is simple. Supporters say it will enable everyone to access health care and cost less than our current mix of private and public health expenditures. Most of all, they argue this system would be morally superior to others.

All of those claims are dubious, but the last is the biggest whopper. In fact, socialized medicine is immoral. It relies on coercion and results in shortages and long wait times, which means worse care. It is rife with inequality and inefficiency, leading to serious harms.

This Would Ratchet Up the Doctor Squeeze!                                                                 Consider how a socialized system would cut costs. Single-payer advocates brag that having one, the national fund for health costs would allow the government to “negotiate” health-care prices down because it would essentially have prevented everyone else from bidding to pay for them. In other words, the government would have control of an entire industry and be able to dictate the terms of work and trade for everyone within it. How is this morally superior to allowing free people to negotiate arrangements on their own?

We already see the bullying of providers in the single-payer systems that exist in the United States.

Unfortunately, America hasn’t had a truly free, market-based health system for decades. Many people feel the outsized power of insurance companies has allowed them to dominate and unfairly control doctors and hospitals. This is true: Insurance companies, thanks in large part to regulations from the Affordable Care Act, are consolidating and using their growing market shares to bargain, and perhaps bully, health-care providers and dictate the terms for everyone.

We already see the bullying of providers in the single-payer systems that exist in the United States, including Medicare. Doctors consistently complain about the ways Medicare makes practicing medicine hard, from bureaucratic paperwork and compliance burdens to low pay.

Socialism Means Force and Force Are Wrong!

In fact, each year more and more physicians opt out of the Medicare program altogether. It’s become so bad in Hawaii that legislators have proposed a bill that would force providers to accept Medicare or else lose their medical licenses! This is always the end of government-controlled health care: coercion.

As Dr. Jim Geddes, a trauma surgeon near Denver, CO, recently told Medscape.com, “The only way physicians can afford to participate in Medicare is that they get higher payment from commercial insurers. Single-payer advocates talk about ‘Medicare for all,’ but if Medicare were standing alone, it would fall flat.”

But at least some choice remains: Doctors today can still choose not to participate in certain plans or programs.

But at least some choice remains: Doctors today can still choose not to participate in certain plans or programs. If single-payer were the law of the land, no health-care provider could engage in his profession without having to bill the government, as the government would be the only payer for these services in most cases.

Health-care providers would be forced to accept a government-set price for their services. This would inevitably harm the quality of care we receive by locking in current ways of doing things instead of allowing people to try new ones and discourage people from pursuing grueling expensively learned work in the medical field because of low pay and bad working conditions.

We’ve seen how a similar standardized compensation system has worked for public-school teachers. It effectively punishes excellent teachers and rewards mediocre ones. It’s helped create a bifurcated education system, with private schools delivering higher quality to families that can afford to pay tuition on top of taxes, while too many families are left to attend low-quality public schools.

The same phenomena would take place in medicine. Under a government-dominated system, excellent health-care providers wouldn’t be rewarded and would suffer new burdens, while mediocre and even poor providers would receive the same payments as those that provide high-quality care.

Socialized Style Health Care Means Rationing and Shortages.

Patients too would suffer at the hands of a single payer, due to the rationing and shortages that always result when a government sets prices. That is, of course, unless you are wealthy and can find a concierge medical practice to sell you some special service. Single-payer systems always unravel, giving the rich a chance to buy superior care, and thus creating tremendous economic inequities in the system.

Single-payer results in implicit rationing, which manifests in long waiting lists for the desired service or treatment.

In fact, it may shock some single-payer advocates to hear, but the National Bureau of Economic Research has found that health outcomes are more strongly tied to income in Canada (already a single-payer system) than in the United States.

Single-payer would also lead to waste and great inefficiency, which can have serious health consequences. If the government sets a price for a certain service that is too high, providers may over-prescribe it and patients may over-consume it. If the government sets a price for a certain service that is too low, then too few providers will offer it, and there will be a shortage.

In a market system, higher prices signal shortages and give providers an incentive to adapt to meet people’s actual needs. In a government-based system like single-payer, patients always face the same price—zero—so the government has to limit what services are available to whom based on data. This is straight-up rationing.

But single-payer also results in implicit rationing, which manifests in long waiting lists for the desired service or treatment. Long waits, common in other countries with government-controlled health-care systems, can lead to inferior health outcomes. To be blunt, this means more pain and suffering. In some cases, this even means more death.

That was the case for Laura Hiller, an 18-year-old Canadian with leukemia who died in January for lack of a hospital bed. Numerous bone marrow donors were ready and willing to assist her, but because her hospital could only perform about five transplants per month, Laura died while waiting for her turn. Stories like this are not uncommon in countries with single-payer health-care systems.

So, a Better Idea: A Medical Free Market!

Surely there is nothing moral about this. Americans shouldn’t accept that either insurers or government must dominate the health-care market or set the prices and payments for everyone. Rather, we should reform our health-care system to give individuals more power and choice. Market competition would drive prices down without the need for coercion.

Patients should pay providers directly for any services that are routine and not catastrophic, and patients could carry low-cost insurance policies to protect them in the event of catastrophic health-care costs. This is how it works for house and auto insurance, which almost everyone can afford even though cars and houses are frequently as expensive as many medical services.

A direct-pay model would create an incentive for providers to offer more pricing information, and to compete with one another on price. Market competition would drive prices down without the need for coercion. Quality would go up, prices would go down, and, just as importantly, this would be a morally superior system free of the coercion and domination implicit in a government-run socialized system.                                                The level of freedom in research and medical commercialization matters greatly. It is a very large determinant of the speed with which future medicine arrives – and especially medical technologies capable of reversing the age-related cellular damage that lies at the root of frailty, degeneration, and death. At the moment, right this instant, the system is broken. The very fact that we have “a system” is a breakage; that entrepreneurs are held back from investment by rules and political whims that are now held to be of greater importance than any number of lives. Those decisions about your health and ability to obtain medicine are made in a centralized manner, by people with neither the incentives nor the ability to do well.

As is always the case, the greatest cost of socialism in medicine lies in what we do not see. It lies in the many billions of dollars presently not invested in medical research and development, or invested wastefully, because regulations – and the people behind them, supporting and manipulating a political system for their own short-term gain – make it unprofitable to invest well. Investment is the fuel of progress, and it is driven away by self-interested political cartels.

The situation is grim; the greatest engines of progress in medicine – the research communities of the US and other Western-style countries – are moving forward very much despite the ball and chain of regulation that drags them down. In the fight against the age-related disease, and aging itself, how much further ahead would we be if we cut those chains and restored freedom to research, manufacture, review and quality assurance of medicine?

Sadly, I do not see this happening in the near future; a long, but a hard battle lies ahead for advocates of freedom and faster progress in any field. We live in an era of creeping socialism, economic ignorance, and blind acceptance thereof. It’s almost as though no lesson was learned from the megadeaths, poverty, and suffering of the Soviet experience, and now as I pointed out what is happening in other countries like Greece and now Venezuela as we step a little at a time in that direction once more.