What a confusing time and how disappointed can one be when one candidate running for President convinces a group of physicians to complain about Trump’s response to the Pandemic. I am embarrassed to say that they are in the same profession that I have been so proud to call my own. Can you blame the President for the pandemic as all the other countries that are experiencing the increased wave of COVID? Can you blame Trump for the lack of PPE’s when former President Obama and yes, Vice President Biden refused to restock the PPE’s used for the other SAR’s viruses? What a pathetic situation where the average American is so hateful and, yes, the word is stupid, and with no agreement in our Congress except to make us all hate them. Where is the additional financial support, the stimulus package promised, for the poor Americans without jobs and huge debts? This is a difficult situation when we have such poor choices for the most important political office and can’t see through the media bias.
I just had to get all that off my chest as I am like many very frustrated. How did we get here and who do we believe as we hear more about Biden’s connection with his son’s foreign dealings?
Thomas J. Bollyky and Stewart M. Patrick reported that the winner of the presidential election, whether that is Donald Trump or Joe Biden, will need to overcome the COVID-19 pandemic — the worst international health emergency since the 1918 influenza outbreak — and also begin preparing the United States and the world for the next pandemic.
Think it is too soon to worry about another pandemic? World leaders have called the coronavirus outbreak a “once-in-100-year” crisis, but there is no reason to expect that to be true. A new outbreak could easily evolve into the next epidemic or a pandemic that spreads worldwide. As lethal as this coronavirus has been, a novel influenza could be worse, transmitting even more easily and killing millions more people.
Better preparation must begin with an unvarnished assessment of what has gone wrong in the U.S. and in the global response to the current pandemic and what can be done to prepare for the next one when it strikes, as it inevitably will.
Preparedness needs to start with investment. Despite multiple recent threats, from SARS (2003) to H5N1 (2007) to H1N1 (2009) to Ebola (2013-2016); many blue ribbon reports and numerous national intelligence assessments; international assistance for pandemic preparedness has never amounted to more than 1% of overall international aid for health.
The United States devoted an even smaller share of its foreign aid budget in 2019 — $374 million out of $39.2 billion — to prepare for a pandemic that has now cost the country trillions of dollars. Meanwhile, funding for the Centers for Disease Control and Prevention’s support to states and territories has fallen by more than a quarter since 2002. Over the last decade, local public health departments have cut 56,360 staff positions because of lack of resources.
Preparation isn’t only about investing more money. It is also about embracing the public health fundamentals that allowed some nations to move rapidly and aggressively against the coronavirus. The United States has been hard hit by this pandemic, but all countries were dealt this hand.
But we can do better. Here are four measures, outlined in a new report from the Council on Foreign Relations, that would make Americans and the rest of the world safer.
First, the United States must remain a member of the World Health Organization, while working to reform it from within. The agency is hardly perfect, but it prompted China to notify the world of the coronavirus and it has coordinated the better-than-expected response to the pandemic in developing nations. Yet, the agency has no authority to make member states comply with their obligations and less than half of the annual budget of New York-Presbyterian Hospital. The WHO needs more dedicated funding for its Health Emergencies Program and should be required to report when governments fail to live up to their treaty commitments.
Second, we need a new global surveillance system to identify pandemic threats, one that is less reliant on self-reporting by early affected nations. An international sentinel surveillance network, founded on healthcare facilities rather than governments, could regularly share hospitalization data, using anonymized patient information. Public health agencies in nations participating in this network, including the CDC, can assess that data, identify unusual trends and more quickly respond to emerging health threats.
The U.S. should take the lead in forming a coalition to work alongside the WHO to develop this surveillance network. We should also work with like-minded G-20 partners, as well as private organizations, in this coalition to reduce unnecessary trade and border restrictions; increase the sharing of vaccines, therapeutics and diagnostics; and work with international financial institutions to provide foreign aid and debt relief packages to hard-hit nations.
Third, responding to a deadly contagion requires a coordinated national approach. Too often in this pandemic, in the absence of federal leadership, states and cities competed for test kits and scarce medical supplies and adopted divergent policies on reopening their economies. The next administration needs to clarify the responsibilities of the federal government, states and 2,634 local and tribal public health departments in pandemic preparedness and response. Elected leaders, starting with the president, must also put public health officials at the forefront of communicating science-based guidance and defend those officials from political attacks.
Finally, the U.S. must do better by its most exposed and vulnerable citizens. More than 35% of deaths in the U.S. from COVID-19 have been nursing home residents. Many others have been essential workers, who are disproportionately Black and Latinx and from low-income communities. Federal, state and local governments should direct public health investments to these groups as a matter of social justice and preparedness for future threats.
All of this will require leadership and marshaling support at home and abroad. The next president need not be doomed to replay this current catastrophe — provided he acts on the tragic lessons learned from the COVID-19 pandemic.
In search of President Trump’s mysterious health care plan
Hunter Walker responded to questions about President Trump’s healthcare plan noting that President Trump’s health care plan has become one of the most highly anticipated, hotly debated documents in Washington. And depending on whom you ask, it might not exist at all.
The contents — and the whereabouts — of the health plan have been a growing mystery since 2017, when efforts to pass a White House-backed replacement for Obamacare stalled in the Senate. Since then, Trump has repeatedly vowed to unveil a new health plan. In July, it was said to be two weeks away. On Aug. 3, Trump said the plan would be revealed at the end of that month. Last month, White House press secretary Kayleigh McEnany said it would be released within two weeks. At other points, Trump has suggested the plan is already complete. That shifting schedule has lent Trump’s health plan an almost mythical status.
Let me state here that if President Trump doesn’t win this election his lack of a healthcare plan as well as the blame for the pandemic will be the deciding reason that even previous GOP supporters will vote for Biden. Hard to believe, right? In fact, weeks to months ago I related the need for the President to release his healthcare plan to further prove to the voters that he is fulfilling his promises.
The mystery surrounding the president’s vision for health care has added urgency because the Supreme Court is currently scheduled to hear oral arguments in a case that could decide the future of former President Barack Obama’s signature health care law on Nov. 10, exactly one week after the election. That case was brought by Republican attorneys general and joined by the Trump administration. The argument that Obamacare is unconstitutional could lead to the current health care framework being struck down, but Trump has yet to present an alternative.
With both the election and the court date looming, questions about Trump’s health care plan have intensified on the campaign trail. And the White House’s answers have only added to the uncertainty.
During the first presidential debate last month, Trump was pressed by Fox News moderator Chris Wallace about the fact he has “never in these four years come up with a plan, a comprehensive plan, to replace Obamacare.”
“Yes, I have,” Trump replied. “Of course, I have.”
He was apparently referring to the Republican tax bill passed in 2017 that eliminated the tax penalty for individuals who did not purchase health insurance, or obtain it through their jobs or government assistance. That so-called individual mandate was a critical part of the Affordable Care Act, more commonly known as Obamacare, meant to ensure that even healthy people would buy health insurance and spread the costs out across the population. Other parts of the Affordable Care Act remain in place, but the Republican lawsuit argues that without the mandate the entire program should be overturned.
That could end the most popular feature of Obamacare: the requirement that insurance companies provide affordable coverage for preexisting conditions. While Trump has repeatedly insisted, he wants to maintain that protection, any details of his plan or evidence of how he would do it have remained elusive.
During the final debate last week, Democratic nominee Joe Biden argued that the administration “has no plan for health care.”
“He’s been promising a health care plan since he got elected. He has none,” Biden said of Trump. “Like almost everything else he talks about, he does not have a plan. He doesn’t have a plan. And the fact is, this man doesn’t know what he’s talking about.”
The issue also came up during the vice-presidential debate on Oct. 7, when Vice President Mike Pence said, “President Trump and I have a plan to improve health care and protect preexisting conditions for every American.”
“Obamacare was a disaster, and the American people remember it well,” Pence said.
But Trump seemed to admit during last week’s debate that his plan is more of a dream than a concrete proposal.
“What I would like to do is a much better health care, much better,” he said, adding, “I’d like to terminate Obamacare, come up with a brand-new, beautiful health care.”
However, by the end of last weekend, the idea of a written, completed Trump health plan was back on the table — literally.
During the president’s contentious “60 Minutes” interview that aired on Sunday, host Lesley Stahl asked Trump about his repeated promises of a health plan coming imminently.
“Why didn’t you develop a health plan?” Stahl asked.
“It is developed,” Trump responded. “It is fully developed. It’s going to be announced very soon.”
And after Trump ended the interview and walked out on Stahl, McEnany, the White House press secretary, came in and handed the “60 Minutes” correspondent a massive binder.
“Lesley, the president wanted me to deliver his health care plan,” McEnany said. “It’s a little heavy.”
Indeed, Stahl struggled with the huge book. The situation seemed reminiscent of other instances where Trump tried to dissuade debate by presenting massive piles of paper that didn’t stand up to scrutiny, and it sparked speculation that the contents of the massive binder were blank. However, the conservative Washington Examiner newspaper subsequently reported it contained more than 500 pages comprising “13 executive orders and 11 other pieces of healthcare legislation enacted under Trump.”
Stahl was unimpressed. After perusing the gigantic tome, she declared, “It was heavy, filled with executive orders, congressional initiatives, but no comprehensive health plan.”
McEnany took issue with that assessment and shot back with a tweet that declared, “@60Minutes is misleading you!!”
“Notice they don’t mention that I gave Leslie 2 documents: a book of all President @realDonaldTrump has done & a plan of all he is going to do on healthcare — the America First Healthcare Plan which will deliver lower costs, more choice, better care,” the press secretary wrote.
McEnany had implied one of Washington’s most wanted documents was printed, bound and ready for review. It even had a name! Were we really this close to seeing the Trump health plan?
After Yahoo News requested a copy of the “health care plan” that she presented to Stahl, McEnany provided a statement detailing the contents of the enormous binder.
“The book contains all of the executive orders and legislation President Trump has signed,” McEnany said.
She credited those actions with “lowering health care premiums and drug costs” compared with where they were under Obama and Vice President Biden. Trump has previously claimed premiums and costs have gone down during his administration, but these assertions aren’t entirely backed up by the data. And many of Trump’s executive orders on health care have been largely symbolic.
McEnany also provided us with a copy of the second document that she described on Twitter and Stahl had supposedly ignored. It was a 10-page report (including front and back covers) with a large-print, bullet-pointed list of highlights from Trump’s previous actions on health care and slogans making promises for the future.
“The America First Healthcare Plan lays out President Trump’s second term vision animated by the principles that have brought us lower cost, more choice and better care,” McEnany said.
The White House’s immense binder clearly didn’t contain Trump’s “health care plan” as McEnany declared during the dramatic on-camera delivery. But it did hold a fragment of the president’s policy vision.
Perhaps more pieces of the puzzle could be found on Capitol Hill. After all, in April 2019, Trump proclaimed on Twitter that “the Republicans … are developing a really great HealthCare Plan.” That comment followed reports that a group of Republican senators including Mitt Romney of Utah, John Barrasso of Wyoming, Rick Scott of Florida and Bill Cassidy of Louisiana were working on drafting a proposal. Trump said this plan would “be far less expensive & much more usable than ObamaCare.” The president further suggested it would be complete and ready to be voted on “right after the election.”
So, is there a finished plan floating around Capitol Hill ready to make its debut in a matter of weeks? No.
A Republican Senate source who has been privy to the talks told Yahoo News that a group of GOP senators including Romney, Barrasso, Lindsey Graham of South Carolina and Senate Health Committee Chairman Lamar Alexander of Tennessee have been “exploring” an alternative to Obamacare “over the course of the past year and a half.” However, with the coronavirus pandemic and a Supreme Court confirmation dominating the agenda, the source, who requested anonymity to discuss the deliberations, suggested the planning had stalled.
“I don’t think they’ve talked about this stuff for months now due to other pressing issues,” the source said of the health care planning.
The source predicted that activity on health care would not resume until the outcome of the election and the Supreme Court’s Obamacare case are clear.
“Depending on how things in November shake out and … what the Supreme Court does with the ACA, maybe those discussions will be revived,” the source said. “But there really has not been much going on of late.”
Nevertheless, the source contended that, even though there is no finished plan, Trump and his Republican allies on the Hill have made some real progress toward “a potential plan that would preserve private insurance but also seek to lower costs.” They suggested Senate efforts to lower drug prices and end surprise medical billing are part of the “frameworks,” as are some of the executive orders issued by Trump.
“There have been sort of piecemeal efforts in this area. … The executive branch has done what they can do within their authority to try to lower costs,” the source said. “There just hasn’t been … a wholesale piece of legislation or framework that everyone has coalesced around. That’s just something that has not come together.”
In the end, perhaps the truest answer to the ongoing mystery of Trump’s proposed Obamacare replacement came from the president himself during the “60 Minutes” interview. In the conversation, Trump suggested that his health plan exists in a realm beyond the bounds of space and time.
“A new plan will happen,” he said. “Will and is.”
As you can tell from the lead in to this post, that many of us who can really think and put enough words together to make a understandable sentence our choices are not good but it is really important for us all to go and turn out to vote, either in person, with masks in place and socially distancing or by mail in or drop off ballots.
So, first I wanted to relate an experience, which exemplifies the failure of telehealth, or maybe the failure of healthcare workers who are taking advantage of the “new” health care system of patient care.
Consider the case a two weeks ago. As I was about to operate on a cancer surgery patient, I was asked to evaluate a patient healthcare conundrum. One of our nurse teammate’s husband was sick and no one knew what was the problem. He had lost 23 pounds over 3 ½ weeks, was dehydrated, appetite, sore throat, weak and needed to go to the emergency room multiple times for intravenous fluids. Each time he was told that they were very sorry but they had no idea what the problem was.
His Primary care physician would not see him in person, and he had another telehealth visit, which he was charged for and was prescribed an antibiotic with no improvement.
I asked if he had a COVID test which he did and it was negative.
I then asked if I could examine him or if she had any pictures. She had pictures, with no skin rashes except I noticed something interesting on the intraoral pictures, which showed left sided ulcers on his cheeks, left lateral posterior tongue and palate, again-only on the left side.
I asked if this was true in that the ulcers were only on one side of his mouth? When his wife responded with a yes to the question I then responded that he had intraoral shingles involving the nerve to the tongue, cheek, palate ( glossophyngeal nerve ) and sometimes also affected additional nearby cranial nerve, which is probably why he was having some of his stomach problem. She thought that was interesting and wanted to know what to do since he was about to have some gallbladder studies.
I outlined a treatment plan and low and behold he is getting better. My question is why didn’t anyone in the doc’s office or ER never complete a thorough physical exam? Oh, wait- how does one do a complete physical exam through the telehealth system? What about heart or lung disease patients, how does a nurse or physician listen to their heart or lungs, etc?? Are we physicians forgetting our teachings and training regarding the proper approach to physical diagnosis?
And now what about Biden’s proposal for health care?
Leigh Page pointed out that physicians — like all Americans — are trying to size up Joe Biden’s healthcare agenda, which the Democratic presidential nominee has outlined in speeches and on his official website.
Many healthcare professionals, patients, and voters of all political stripes think our current healthcare system is broken and in need of change, but they don’t agree on how it should change. In Part I of this article, we take a look at Biden’s proposals for changing the US healthcare system. Then, we include comments and analysis from physicians on both sides of the fence regarding the pros and cons of these proposed healthcare measures.
Part 1: An Overview of Biden’s Proposed Healthcare Plan
Biden’s proposed healthcare plan has many features. The main thrust is to expand access to healthcare and increase federal subsidies for health coverage.
If elected, “I’ll put your family first,” he said in a speech in June. “That will begin the dramatic expansion of health coverage and bold steps to lower healthcare costs.” He said he favored a plan that “lowers healthcare costs, gets us universal coverage quickly, when Americans desperately need it now.”
Below are Biden’s major proposals. They are followed by Part 2, which assesses the proposals on the basis of comments by doctors from across the political spectrum.
Biden Says We Should Restore the ACA
At a debate of the Democrat presidential candidates in June 2019, Biden argued that the best way to expand coverage is “to build on what we did during the Obama administration,” rather than create a whole new healthcare system, as many other Democratic candidates for president were proposing.
“I’m proud of the Affordable Care Act,” he said a year later in his June 2020 speech. “In addition to helping people with preexisting conditions, this is the law that delivered vital coverage for 20 million Americans who did not have health insurance.”
At the heart of the ACA are the health insurance marketplaces, where people can buy individual insurance that is often federally subsidized. Buyers select coverage at different levels ― Gold, Silver, and Bronze. Those willing to pay higher premiums for a Gold plan don’t have high deductibles, as they would with the Silver and Bronze plans.
Currently, federal subsidies are based on premiums on the Silver level, where premiums are lower but deductibles are higher than with the Gold plan. Biden would shift the subsidies to the Gold plan, where they would be more generous, because subsidies are pegged to the premiums.
In addition, Biden would remove the current limit on subsidies, under which only people with incomes less than 400% of the federal poverty level qualify for them. “Many families making more than 400% of the federal poverty level (about $50,000 for a single person and $100,000 for a family of four), and thus not qualifying for financial assistance, still struggle to afford health insurance,” the Biden for President website states.
Under the Biden plan, there would still be a limit on insurance payments as a percentage of income, but that percentage would drop, meaning that more people would qualify. Currently, the level is 9.86% or more of a person’s income; Biden would lower that level to 8.5%.
“We’re going to lower premiums for people buying coverage on their own by guaranteeing that no American ever has to spend more than 8.5% of their income on health insurance, and that number would be lower for lower-income people,” Biden said in the June speech.
Add a Public Option, but Not Medicare for All
In the primary, Biden parted company from rivals who backed Medicare for All, a single-payer health system that would make the government pay for everyone’s healthcare. “I understand the appeal of Medicare for All,” he said in a video released by his campaign. “But folks supporting it should be clear that it means getting rid of Obamacare, and I’m not for that.” But he nor anyone else who supported Obamacare has come up with a way to finance this type of healthcare system.
However, Biden embraced a “public option” that would allow people to buy into or be subsidized into “a Medicare-like” plan. It is unclear how similar the public option would be to regular Medicare coverage, but the Biden campaign has made it clear that it would not take funds from the Medicare trust fund, which is expected to start losing funds by 2026.
The more than 150 million Americans who have employer-sponsored insurance could keep it, but they could still buy into the public option if they wanted to. In addition, the public option would automatically enroll ― at no cost to them ― some 4.8 million low-income Americans who were excluded from the ACA’s Medicaid expansion when many states chose to opt out of the Medicaid expansion.
In addition, the 37 states that participate in expanded Medicaid could switch coverage to the new public option, provided that they continue to pay their current share of the costs. (In June, Oklahoma became the 37th state to allow the expansion, following the results of a ballot measure.)
“We need a public option now more than ever, especially when more than 20 million people are unemployed,” Biden said in the June speech. “That public option will allow every American, regardless of their employment status, the choice to get a Medicare-like plan.”
Lower the Medicare Age
In spring 2020, Biden proposed lowering the age to qualify for Medicare from 65 to 60. This provision is not included among the official policies listed on the Biden for President website, but it has been cited by many, including the Biden-Sanders Unity Task Force.
This provision would bring almost 23 million people into Medicare, including 13.4 million from employer-sponsored coverage, according to one analysis. It’s not clear whether these people would buy into Medicare or simply be covered. Their care would not be paid for by the Medicare Trust Fund but would use tax dollars instead. Oh, finally, we find out that our taxes would go up. How much is the problem as we consider all the other programs that Biden and Harris have promoted.
Provide Relief in the Covid-19 Pandemic
Biden would cover the cost of COVID-19 testing and the cost of health coverage for people laid off during the pandemic.
“Testing unequivocally saves lives, and widespread testing is the key to opening our economy again,” Biden said in his June speech. “To fix the economy, we have to get control over the virus.”
Prescription Drug Reform
Biden would repeal a Bush-era exception that bars the Medicare program from negotiating prescription drug prices for the Part D prescription drug benefit. “There’s no justification for this except the power of prescription drug lobbying,” the Biden for President website states.
In addition, Biden’s prescription drug reform plan would do the following:
• Limit launch prices for drugs. The administration would establish an independent review board that would assess the value of new drugs and would have the power to set limits on their prices. Such drugs are “being abusively priced by manufacturers,” the Biden for President site says.
• Limit price increases to inflation. As a condition of participation in government programs, drug prices could not rise more than the general inflation rate. Biden would impose a tax penalty on drug makers whose prices surpassed inflation.
• Allow consumers to buy prescription drugs from other countries. Biden would allow consumers to import prescription drugs from other countries, provided the US Department of Health and Human Services certifies that those drugs are safe.
• Stop tax breaks for pharma ads: Biden would drop drug makers’ tax breaks for advertising, which amounted to $6 billion in 2016.
Stop Surprise Billing
Biden proposes to stop surprise billing, which occurs when patients receive care from a doctor or hospital that is not in their insurer’s network. In these situations, patients can be surprised with very high bills because no payment limit has been negotiated by the insurer.
Twenty-eight states have enacted consumer protections to address surprise medical billing, but Congress has not passed such a measure. One proposed solution is to require payers to pay for out-of-network services on the basis of a benchmark, such as the average Medicare rate for that service in a specific geographic area.
Closely Monitor Healthcare Mergers
Biden would take a more active stance in enforcing antitrust laws against mergers in the healthcare industry.
“The concentration of market power in the hands of a few corporations is occurring throughout our health care system, and this lack of competition is driving up prices for consumers,” the Biden for President website states.
Overhaul Long-term Care
Biden’s latest plan calls for a $775 billion overhaul of the nation’s caregiving infrastructure. Biden says he would help create new jobs, improve working conditions, and invest in new models of long-term care outside of traditional nursing homes.
Restore Funding for Planned Parenthood
Biden would reissue guidance barring states from refusing Medicaid funding for Planned Parenthood and other providers that refer for abortions or that provide related information, according to the Biden for President website. This action would reverse a Trump administration rule.
Boost Community Health Centers
Biden promises to double federal funding for community health centers, such as federally qualified health centers, that provide care to underserved populations.
Support Mental Health Parity
Biden says he supports mental health parity and would enforce the federal mental health parity law and expand funding for mental health services.
Part 2: Physicians’ Opinions on Biden’s Healthcare Plans: Pro and Con
Biden’s plans to expand coverage are at the heart of his healthcare platform, and many see these as the most controversial part of his legislative agenda.
Biden’s Medicare expansion is not Medicare for All, but it can be seen as “Medicare for all who want it.” Potentially, millions of people could enter Medicare or something like Medicare. If the Medicare eligibility age is dropped to 60, people could switch from their employer-sponsored plans, many of which have high deductibles. In addition, poor people who have no coverage because their states opted out of the Medicaid expansion would be included.
The possibility of such a mass movement to government-run healthcare alarms many people. “Biden’s proposals look moderate, but it is basically Medicare for All in sheep’s clothing,” said Cesar De Leon, DO, a family physician in Naples, Florida, and past president of the county’s medical society.
Reimbursements for Doctors Could Fall- No, Will Fall!
A shift of millions of people into Medicare would likely mean lower reimbursements for doctors. For example, the 13.4 million people aged 60 to 65 who would switch from employer-sponsored coverage to Medicare would be leaving some of the best-paying insurance plans, and their physicians would then be reimbursed at Medicare rates.
“Biden’s plan would lower payments to already cash-strapped doctors and hospitals, who have already seen a significant decrease in reimbursement over the past decade,” De Leon said. “He is trying to win the support of low-income voters by giving them lower healthcare prices, which doctors and hospitals would have to absorb.
“Yes, the US healthcare system is dysfunctional,” De Leon added, “but the basic system needs to be fixed before it is expanded to new groups of people.”
The American Association of Neurological Surgeons/Congress of Neurological Surgeons warns against Biden’s proposed government-run system. “We support expanding health insurance coverage, but the expansion should build on the existing employer-based system,” said Katie O. Orrico, director of the group’s Washington office. “We have consistently opposed a public option or Medicare for All.
“Shifting more Americans into government-sponsored healthcare will inevitably result in lower payments for physicians’ services,” Orrico added. “Reimbursement rates from Medicare, Medicaid, and many ACA exchange plans already do not adequately cover the costs of running a medical practice.”
Prospect of Higher Taxes- Absolutely, grab your wallets and your retirement funds!!
Paying for ambitious reforms means raising taxes. Biden’s plan would not make the Medicare trust fund pay for the expansions and would to some extent rely on payments from new beneficiaries. However, many new beneficiaries, such as people older than 60 and the poor, would be covered by tax dollars.
Altogether, Biden’s plan is expected to cost the federal government $800 billion over the next 10 years. To pay for it, Biden proposes reversing President Trump’s tax cuts, which disproportionately helped high earners, and eliminating capital gains tax loopholes for the wealthy.
“Rather than tax the average American, the Democrats will try to redistribute wealth,” De Leon said.
“The elephant in the room is that taxes would have to be raised to pay for all these programs,” said Gary Price, MD, president of the Physicians Foundation. Because no one likes higher taxes, he says, architects of the Biden plan would try to find ways to save money, such as tamping down reimbursements for physicians, to try to avoid a public backlash against the reforms.
“Physicians’ great fear is that efforts to keep taxes from getting too high will result in cutting physician reimbursement,” he said.
Impact of COVID-19
Perhaps an even larger barrier to Biden’s health reforms comes from the COVID-19 crisis, which didn’t exist last year, when health reform was the central issue in the presidential primary that pitted Biden against Vermont Senator Bernie Sanders, the chief proponent of Medicare for All.
“The top two issues on voters’ minds right now are the pandemic and the economy,” said Daniel Derksen, MD, a family physician who is professor of public health policy at the University of Arizona in Tucson. “Any other concerns are pushed down the list.”
The COVID-19 crisis is forcing the federal government to spend trillions of dollars to help businesses and individuals who have lost income because of the crisis. Will there be enough money left over to fund an ambitious set of health reforms?
“It’s not a good time to start reforms,” warned Kevin Campbell, MD, a cardiologist in Raleigh, North Carolina. “Given the current pressures that COVID-19 has placed on physicians, healthcare systems, and hospitals, I don’t believe that we can achieve meaningful change in the near term.”
However, supporters of Biden’s reforms think that now, during the COVID-19 crisis, is precisely the right time to enact healthcare reform. When millions of Americans lost their jobs because of the pandemic, they also lost their insurance coverage.
“COVID-19 has made Biden’s healthcare agenda all the more relevant and necessary,” said Don Berwick, MD, who led the Center for Medicare & Medicaid Services (CMS) under President Obama. “The COVID-19 recession has made people more aware of how vulnerable their coverage is.”
Orrico at the neurosurgeons group acknowledges this point. “The COVID-19 pandemic has exposed some cracks in the US healthcare system,” she said. “Whether this will lead to new reforms is hard to say, but policymakers will likely take a closer look at issues related to unemployment, health insurance coverage, and healthcare costs due to the COVID-19 emergency.”
Many Physicians Want Major Reform
Although many doctors are skeptical of reform, others are impatient for reform to come and support Biden’s agenda ― especially its goal to expand coverage.
“Joe Biden’s goal is to get everyone covered,” said Alice Chen, MD, an internist who is a leader of Doctors for Biden, an independent group that is not part of the Biden campaign. “What brings Democrats together is that they are united in the belief that healthcare is a right.”
In January, the American College of Physicians (ACP) endorsed both Medicare for All and the public option. The US healthcare system “is ill and needs a bold new prescription,” the ACP stated.
The medical profession, once mostly Republican, now has more Democrats. In 2016, 35% of physicians identified themselves as Democrats, 27% as Republicans, and 36% as independents.
Many of the doctors behind reform appear to be younger physicians who are employed by large organizations. They are passionate about reforming the healthcare system, and as employees of large organizations, they would not be directly affected if reimbursements fell to Medicare levels ― although their institutions might subsequently have to adjust their salaries downward.
Chen, for example, is a young physician who says she has taken leave from her work as adjunct assistant clinical professor of medicine at the University of California, Los Angeles, to raise her young children.
She is the former executive director of Doctors for America, a movement of thousands of physicians and medical students “to bring their patients’ experiences to policymakers.”
“Doctors feel that they are unseen and unheard, that they often feel frankly used by large health systems and by insurance companies,” Chen said. “Biden wants to hear from them.”
Many idealistic young physicians look to health system leaders like Berwick. “I believe this nation needs to get universal coverage as fast as we can, and Biden’s policies present a path to get there,” the former CMS director said. “This would be done chiefly through Biden’s public option and his plans to expand coverage in states that have not adopted the ACA Medicaid expansion.”
But what about the potential effect of lowering reimbursement rates for doctors? “The exact rates will have to be worked out,” Berwick said, “but it’s not just about who pays physicians, it’s about how physicians get paid.” He thinks the current fee-for-service system needs to be replaced by a value-based payment system such as capitation, shared savings, and bundled payments.
The Biden-Sanders Task Force
Berwick was a member of the Biden-Sanders Unity Task Force, which brings together supporters of Biden and Sanders to create a shared platform for the Biden campaign.
The task force issued a report in early July that recommended a variety of healthcare reforms in addition to expanding access to care. One of them was to find ways to address the social determinants of health, such as housing, hunger, transportation, and pollution, which can harm health outcomes.
Chen specifically cites this provision. “We need to focus on the social determinants of heath and try to encourage better health,” she said. “I remember as a doctor advising a patient who was a young mother with several small children that she needed to exercise more. She asked me, ‘When am I supposed to exercise, and who will watch my kids?’ I realized the predicament that she was in.”
Price is also glad to see the provision in Biden’s plan. “Social determinants of health has been a key focus of the Physicians Foundation,” he said. “To my knowledge, this is the first time that a political candidate’s healthcare policy has included this point.
“Physicians are not in control of the social determinants of health, even though they affect their reimbursements,” he said. Under Medicare’s Merit-based Incentive Payment System, for example, doctors are penalized when their patients don’t meet certain health standards, such as when diabetes patients can’t get their A1C levels under control, he says.
However, Price fears that Biden, in his efforts to make peace with Sanders supporters, may have to some degree abandoned his moderate stance on health reform.
Is the Nation Ready for Another Health Reform Battle?
Clearly, many Democrats are ready to reform the system, but is the nation ready? “Are American voters ready for another major, Democratic-led health reform initiative?” asked Patricia Salber, MD, an internist and healthcare consultant who runs a blog called The Doctor Weighs In.
“I’ve been around long enough to remember the fight over President Clinton’s health plan and then President Obama’s plan,” she said. Each time, she says, there seemed to be a great deal of momentum, and then there was a backlash. “If Biden is elected, I hope we don’t have to go through the same thing all over again,” Salber said.
Derksen believes Biden’s proposed healthcare reforms could come close to rivaling President Obama’s Affordable Care Act in ambition, cost, and controversy.
He shares Biden’s goal of extending coverage to all ― including paying the cost of covering low-income people. But the result is that “Biden’s agenda is going to be a ‘heavy lift,’ as they say in Washington,” he said. “He has some very ambitious plans to expand access to care.”
Derksen speaks from experience. He helped draft part of the ACA as a health policy fellow in Capitol Hill in 2009. Then in 2011, he was in charge of setting up the ACA’s insurance marketplace for the state of New Mexico.
Now Biden wants to begin a second wave of health reform. But Derksen thinks this second wave of reform could encounter opposition as formidable as those Obama faced.
“Assuming that Biden is elected, it would be tough to get this agenda passed ― even if he had solid Democratic majorities in both the House and Senate,” said Derksen,
According to polls by the Kaiser Family Foundation (KFF), 53% of Americans like the ACA, while 37% dislike it ― a split that has been relatively stable for the past 2 years, since the failed GOP effort to repeal the law.
In that KFF poll, the public option fared better ― 68% of Americans support the public option, including 42% of Republicans. These numbers help explain why the Biden campaign moved beyond its support of the ACA to embrace the public option as well.
Even when Democrats gain control of all the levers of power, as they did in 2009, they still have a very difficult time passing an ambitious healthcare reform bill. Derksen remembers how tough it was to get that massive bill through Congress.
The House bill’s public option might have prevailed in a reconciliation process between the two bills, but that process was cut short when Sen. Ted Kennedy died and Senate Democrats lost their filibuster-proof majority. The bill squeaked through as the Senate version, without the public option.
The ACA Has Survived-But at What Cost?
The ACA is much more complex piece of legislation than the public option.
“The ACA has survived for a decade, despite all efforts to dismantle it,” Salber said. “Biden wants to restore a law that the Republicans have been chipping away at. The Republicans eliminated the penalty for not having coverage. Think about it, a penalty of zero is not much of a deterrent.”
It was the loss of the ACA penalty in tax year 2019 that, paradoxically, formed the legal basis for the latest challenge of the ACA before the Supreme Court, in a suit brought by the Trump administration and 18 Republican state attorneys general.
The Supreme Court will make its ruling after the election, but Salber thinks the suit itself will boost both Biden and the ACA in the campaign. “I think most people are tired of all the attempts to repeal the ACA,” she said.
“The public now thinks of the US healthcare system as pathetically broken,” she added. “It used to be that Americans would say we have the best healthcare system in the world. I don’t hear that much anymore.”
Physicians who oppose the ACA hold exactly the opposite view. “Our healthcare system is in shambles after the Obamacare fiasco,” Campbell said. “Even if Biden has a Democrat-controlled House and Senate, I still don’t think that there would be enough votes to pass sweeping changes to healthcare.”
Biden Could Choose Issues Other Than Expanding Access
There are plenty of proposals in the Biden healthcare plan that don’t involve remaking the healthcare system.
These include making COVID-19 testing free, providing extra funding for community health centers, and stopping surprise billing. Proposals such as stepping up antitrust enforcement against mergers would involve administrative rather than Congressional action.
Some of these other proposals could be quite expensive, such as overhauling long-term care and paying for health insurance for laid-off workers. And another proposal ― limiting the prices of pharmaceuticals ― could be almost as contentious as expanding coverage.
“This proposal has been talked about for many years, but it has always met with strong resistance from drug makers,” said Robert Pearl, MD, former CEO of the Permanente Medical Group and now a faculty member at Stanford School of Medicine and Graduate School of Business.
Pearl thinks the first item in Biden’s drug plan ― to repeal a ban against Medicare negotiating drug prices with drug makers ― would meet with Congressional resistance, owing to heavy lobbying and campaign contributions by the drug companies.
In addition, Pearl thinks Biden’s plans to limit drug prices ― barring drug makers from raising their prices above the general inflation rate and limiting the launch prices for many drugs ― enter uncharted legal waters and could end up in the courts.
Even Without Reform, Expect Lower Reimbursements
Although many doctors are concerned that Biden’s healthcare reforms would reduce reimbursements, Pearl thinks reimbursements will decline even without reforms, owing in part to the COVID-19 pandemic.
Employer-based health insurance has been the bedrock of the US healthcare system, but Pearl says many employers have long wanted to get rid of this obligation. Increasingly, they are pushing costs onto the employee by raising deductibles and through premium sharing.
Now, with the pandemic, employers are struggling just to stay in business, and health insurance has truly become a financial burden, he says. In addition, states will be unable to balance their budgets and will try to reduce their Medicaid obligations.
“Before COVID-19 hit, healthcare spending was supposed to grow by 5% a year, but that won’t happen for some time into the future,” Pearl said. “The COVID economic crisis is likely to continue for quite some time, forcing physicians to either accept much lower payments or find better ways to provide care.”
Like Berwick, Pearl believes healthcare will have to move to value-based payments. “Instead of producing more services, doctors will have to preserve resources, which is value-based healthcare,” he said. The primary form of value-based reimbursement, Pearl thinks, will be capitation, in which physicians agree to quality and service guarantees.
Even steadfast opponents of many of Biden’s reforms foresee value-based payments taking off. “Certainly, there are ways to improve the current healthcare system, such as moving to value-based care,” said Orrico at the neurosurgeons’ group.
In short, a wide swath of observers agree that doctors are facing major changes in the payment and delivery of healthcare, regardless of whether Biden is elected and succeeds with his health agenda.
Notice that no one has mentioned tort reform in healthcare. Why Not???????
Trump health officials “not aware” of how he would replace Obamacare; and what about the Vaccines?
It is truly amazing how out of touch the GOP and, I believe President Trump is, on health care, especially “after” or during this COVID pandemic. Consider the amount of monies spent on caring for the millions of patients diagnosed with COVID-19. One must remember that due to the EMTALA Act, which ensures public access to emergency services regardless of ability to pay. Think of all the COVID testing and ICU care that has been provided for all that needed it. This experience, etc. should convince, even the clueless that we need a type of universal health care policy.
They, the GOP and the President, promised us all that they would create, provide a wonderful healthcare for all, better than Obamacare. But have they? No!
And now is the time to produce a well-designed alternative, or consider Obamacare as a well thought out program, except for the lack of financial sustainability. And guess what happened after I had a phone call with a member of the Trump administration. He asked me what I thought Trump’s chances of winning re-election. I responded that I thought he had about a 20% chance of getting re-elected. He pressed me as what I thought that would increase his chances. My response was to finally reveal their, the GOP/Trump’s
, plan and I suggested that they should adopt the Affordable Care Act but outline a plan to sustainably finance the healthcare plan.
My suggestion- embrace the Affordable Care Act as a good starting point and use a federal sales tax to finance it instead of putting the onus on the young healthy workers.
At a hearing on the coronavirus response, Senator Dick Durbin asked the Trump administration’s top health officials about the president’s comments touting a plan to replace the Affordable Care Act, also known as Obamacare. They said they did not know about such a plan.
And a Republican victory in Supreme Court battle could mean millions lose health insurance in the middle of a pandemic.
John T. Bennett noted that Ruth Bader Ginsburg, Barack Obama, Donald Trump and Mitch McConnell could soon be forever linked if the late Supreme Court justice’s death leads to the termination of the 44th president’s signature domestic policy achievement: the Affordable Care Act
All sides in the coming battle royal over how to proceed with filling the high court seat she left behind are posturing and pressuring, floating strategic possibilities and offering creative versions of history and precedent. Most Republicans in the Senate want to hold a simple-majority floor vote on a nominee Mr. Trump says he will announce as soon as this week before the end of the calendar year. Democrats say they are hypocrites because the blocked a Barack Obama high court pick during his final year.
It appears Democrats have only extreme options as viable tactics from preventing confirmation hearings and a floor vote before this unprecedented year is up. Speaker Nancy Pelosi on Sunday refused to rule bringing articles of impeachment against the president or even William Barr, his attorney general whom the Democrats say has improperly used his office to help Mr. Trump’s friends and use federal law enforcement unjustly against US citizens.
Unless Ms Pelosi pulls that politically dangerous lever, the maneuvering of the next few weeks most likely will end after Congress returns after the 3 November election with a high court with a 6-3 conservative bend. Analysts already are warning that conservatives appear months away from being able to partially criminalize abortion and also take down the 2011 Affordable Care Act, also known as Obama care.
Democrats have sounded off since Ms. Ginsburg’s death to warn that millions of Americans could soon lose their health insurance, especially those with pre-existing conditions. Last year, 8.5m people signed up for coverage using the Affordable Care Act, according to the Congressional Budget Office.
“Healthcare in this country hangs in the balance,” Joe Biden, who is the Democratic nominee for president and was vice president when Mr. Obama signed the health plan now linked to his name into law, said on Sunday.
Mr. Biden accused Republicans of playing a “game” by rushing the process to replace Ms. Ginsburg on the court because they are “trying to strip healthcare away from tens of millions of families.”
Doing so, he warned, would “strip away their peace of mind” because insurance providers would no longer be required to give some Americans policies. Should a 6-3 court decide to uphold a lower court’s ruling that the 2011 health law be taken down, those companies would “drop coverage completely for folks with pre-existing conditions,” Mr. Biden warned in remarks from Philadelphia.
“If Donald Trump has his way, the complications from Covid-19 … would become the next deniable pre-existing condition for millions of Americans.” That means they would lose their health insurance and be forced to either pay for care out of their pocket or use credit lines. Both could force millions into medical bankruptcy or otherwise create dire financial hardships.
Mr. Trump about a month ago promised to release a new healthcare plan that, if ever passed by both chambers of Congress and signed into law, would replace Obamacare.
So far, however, he has yet to unveil that alleged plan.
Trump Press Secretary Kayleigh McEnany told reporters last week that the White House’s Domestic Policy Council is leading the work on the plan. But when pressed for more details, she chose to pick a fight with a CNN reporter.
“I’m not going to give you a readout of what our healthcare plan looks like and who’s working on it,” Ms. McEnany said. “If you want to know, if you want to know, come work here at the White House.”
When pressed, Ms. McEnany said “stakeholders here in the White House” are working on a plan the president has promised for several years. “And, as I told you, our Domestic Policy Council and others in the White House are working on a healthcare plan,” she insisted, describing it as “the president’s vision for the next five years.”
The president frequently mentions healthcare during his rowdy campaign rallies, but only in general terms. He promises a sweeping plan that will bring costs down across the board and also protect those with pre-existing conditions. But he mostly brings it up to hammer Mr. Obama and Mr. Biden for pushing a flawed law that he has been forced to tinker with to make it function better for consumers.
His top spokeswoman echoed those broad strokes during a briefing on Wednesday. “In aggregate, it’s going to be a very comprehensive strategy, one where we’re saving healthcare while Democrats are trying to take healthcare away,” she told reporters. “We’re making healthcare better and cheaper, guaranteeing protections for people with preexisting conditions, stopping surprise medical billing, increasing transparency, defending the right to keep your doctor and your plan, fighting lobbyists and special interests, and making healthier and making, finding cures to diseases.”
If there is a substantive plan that would protect millions with pre-existing conditions and others affected by Covid-19, it would have made a fine backbone of Mr. Trump’s August Republican National Committee address in which he accepted his party’s presidential nomination for a second time. But healthcare was not the major focus, even though it ranks in the top two issues – along with the economy – in just about every poll that asks voters to rank their priorities in deciding between Mr. Trump and Mr. Biden.
If there is a coming White House healthcare plan that would protect those with pre-existing conditions and prevent millions from losing coverage as the coronavirus pandemic is ongoing, the president is not using his campaign rallies at regional airport hangars to describe or promote it.
“We will strongly protect Medicare and Social Security and we will always protect patients with pre-existing conditions,” said at a campaign stop Saturday evening in Fayetteville, North Carolina, before pivoting to a completely unrelated topic: “America will land the first woman on the moon, and the United States will be the first nation to land an astronaut on Mars.”
The push to install a conservative to replace the liberal Ms. Ginsburg and the lack of any expectation Mr. Trump has a tangible plan has given Democrats a new election-year talking point less than two months before all votes must be cast.
“Whoever President Trump nominates will strike down the Affordable Care Act,” Hawaii Democratic Senator Mazie Hirono told MSNBC on Sunday. “It will throw millions of people off of healthcare, won’t protect people with pre-existing conditions. It will be disastrous. That’s why they want to rush this.”
About 1 In 5 Households in U.S. Cities Miss Needed Medical Care During Pandemic
Patti Neighmond noted that when 28-year-old Katie Kinsey moved from Washington, D.C., to Los Angeles in early March, she didn’t expect the pandemic would affect her directly, at least not right away. But that’s exactly what happened.
She was still settling in and didn’t have a primary care doctor when she got sick with symptoms of what she feared was COVID-19.
“I had a sore throat and a debilitating cough,” she says, “and when I say debilitating, I mean I couldn’t talk without coughing.” She couldn’t lie down at night without coughing. She just wasn’t getting enough air into her lungs, she says.
Kinsey, who works as a federal consultant in nuclear defense technology, found herself coughing through phone meetings. And then things got worse. Her energy took a dive, and she felt achy all over, “so I was taking naps during the day.” She never got a fever but worried about the coronavirus and accelerated her effort to find a doctor.
She called nearly a dozen doctors listed on her insurance card, but all were booked. “Some said they were flooded with patients and couldn’t take new patients. Others gave no explanation, and just said they were sorry and could put me on a waiting list.” All the waiting lists were two to three months’ long.
Eventually Kinsey went to an urgent care clinic, got an X-ray and a diagnosis of severe bronchitis — not COVID-19. Antibiotics helped her get better. But she says she might have avoided “months of illness and lost days of work” had she been able to see a doctor sooner. She was sick for three months.
Kinsey’s experience is just one way the pandemic has delayed medical care for Americans in the last several months. A poll of households in the four largest U.S. cities by NPR, the Robert Wood Johnson Foundation and Harvard’s T.H. Chan School of Public Health finds roughly one in every five have had at least one member who was unable to get medical care or who has had to delay care for a serious medical problem during the pandemic (ranging from 19% of households in New York City to 27% in Houston).
We had people come in with heart attacks after having chest pain for three or four days, or stroke patients who had significant loss of function for several days, if not a week.
There were multiple reasons given. Many people reported, like Kinsey, that they could not find a doctor to see them as hospitals around the U.S. delayed or canceled certain medical procedures to focus resources on treating COVID-19.
Other patients avoided critically important medical care because of fears they would catch the coronavirus while in a hospital or medical office.
“One thing we didn’t expect from COVID was that we were going to drop 60% of our volume,” says Ryan Stanton, an emergency physician in Lexington, Ky., and member of the board of directors of the American College of Emergency Physicians.
“We had people come in with heart attacks after having chest pain for three or four days,” Stanton says, “or stroke patients who had significant loss of function for several days, if not a week. And I’d ask them why they hadn’t come in, and they would say almost universally they were afraid of COVID.”
Stanton found that to be particularly frustrating, because his hospital had made a big effort to communicate with the community to “absolutely come to the hospital for true emergencies.”
He describes one patient who had suffered at home for weeks with what ended up being appendicitis. When the patient finally came to the emergency room, Stanton says, a procedure that normally would have been done on an outpatient basis “ended up being a very much more involved surgery with increased risk of complications because of that delay.”
The poll finds a majority of households in leading U.S. cities who delayed medical care for serious problems say they had negative health consequences as a result (ranging from 55% in Chicago to 75% in Houston and 63% in Los Angeles).
Dr. Anish Mahajan, chief medical officer of the large public hospital Harbor-UCLA Medical Center in Los Angeles, says the number of emergencies showing up in his hospital have been down during the pandemic, too, because patients have been fearful of catching the coronavirus there. One case that sticks in his mind was a middle aged woman with diabetes who fainted at home.
“Her blood sugar was really high, and she didn’t feel well — she was sweating,” the doctor recalls. “The family called the ambulance, and the ambulance came, and she said, ‘No, no, I don’t want to go to the hospital. I’ll be fine.’ “
By the next day the woman was even sicker. Her family took her to the hospital, where she was rushed to the catheterization lab. There doctors discovered and dissolved a clot in her heart. This was ultimately a successful ending for the patient, Mahajan says, “but you can see how this is very dangerous — to avoid going to the hospital if you have significant symptoms.”
He says worrisome reports from the Los Angeles County coroner’s office show the number of people who have died at home in the last few months is much higher than the average number of people who died in their homes before the pandemic.
“That’s yet another signal that something is going on where patients are not coming in for care,” Mahajan says. “And those folks who died at home may have died from COVID, but they may also have died from other conditions that they did not come in to get cared for.”
Like most hospitals nationwide, Harbor-UCLA canceled elective surgeries to make room for coronavirus patients — at least during the earliest months of the pandemic, and when cases surged.
In NPR’s survey of cities, about one-third of households in Chicago and Los Angeles and more than half in Houston and New York with a household member who couldn’t get surgeries or elective procedures said it resulted in negative health consequences for that person.
“Back in March and April the estimates were 80[%] to 90% of normal [in terms of screenings for cancer]” at Memorial Sloan Kettering Cancer Center in New York, says Dr. Jeffrey Drebin, who heads surgical oncology there.
“Things like mammograms, colonoscopies, PSA tests were not being done,” he says. At the height of the pandemic’s spring surge in New York City, Drebin says, he was seeing many more patients than usual who had advanced disease.
“Patients weren’t being found at routine colonoscopy,” he says. “They were coming in because they had a bleeding tumor or an obstructing tumor and needed to have something done right away.”
In June, during patients’ information sessions with the hospital, Drebin says patients typically asked if they could wait a few months before getting a cancer screening test.
“In some cases, you can, but there are certainly types of cancer that cannot have surgery delayed for a number of months,” he explains. With pancreatic or bladder cancer, for example, delaying even a month can dramatically reduce the opportunity for the best treatment or even a cure.
Reductions in cancer screening, Drebin says, are likely to translate to more illness and death down the road. “The estimate,” he says, “is that simply the reduction this year in mammography and colonoscopy [procedures] will create 10,000 additional deaths over the next few years.”
And even delays in treatment that aren’t a matter of life and death can make a big difference in the quality of a life.
For 12-year-old Nicolas Noblitt, who lives in Northridge, Calif., with his parents and two siblings, delays in treatment this year have dramatically reduced his mobility.
Nicolas has cerebral palsy and has relied on a wheelchair most of his life. The muscles in his thighs, hips, calves and even his feet and toes get extremely tight, and that “makes it hard for him to walk even a short distance with a walker,” says his mother, Natalie Noblitt. “So, keeping the spasticity under control has been a major project his whole life to keep him comfortable and try to help him gain the most mobility he can have.”
Before the pandemic, Nicolas was helped by regular Botox injections, which relaxed his tight muscles and enabled him to wear shoes.
As Nicolas says, “I do have these really cool shoes that have a zipper … and they really help me — because, one, they’re really easy to get on, and two, they’re cool shoes.” Best of all, he says they stabilize him enough so he can walk with a walker.
“I love those shoes and I think they sort of love me, too, when you think about it,” he tells NPR.
Nicolas was due to get a round of Botox injections in early March. But the doctors deemed it an elective procedure and canceled the appointment. That left him to go months without a treatment.
His muscles got so tight that his feet would uncontrollably curl.
“And when it happens and I’m trying to walk … it just makes everything worse,” Nicolas says, “from trying to get on the shoes to trying to walk in the walker.”
Today he is finally back on his Botox regimen and feeling more comfortable — happy to walk with a walker. Even so, says his mom, the lapse in treatment caused setbacks. Nicolas has to work harder now, both in day-to-day activities and in physical therapy.
‘Warp Speed’ Officials Debut Plan for Distributing Free Vaccines
Despite the president’s statements about military involvement in the vaccine rollout, officials said that for most people, “there will be no federal official who touches any of this vaccine.”
Katie Thomas reported that Federal officials outlined details Wednesday of their preparations to administer a future coronavirus vaccine to Americans, saying they would begin distribution within 24 hours of any approval or emergency authorization, and that their goal was that no American “has to pay a single dime” out of their own pocket.
The officials, who are part of the federal government’s Operation Warp Speed — the multiagency effort to quickly make a coronavirus vaccine available to Americans — also said the timing of a vaccine was still unclear, despite repeated statements by President Trump that one could be ready before the election on Nov. 3.
“We’re dealing in a world of great uncertainty. We don’t know the timing of when we’ll have a vaccine, we don’t know the quantities, we don’t know the efficacy of those vaccines,” said Paul Mango, the deputy chief of staff for policy at the Department of Health and Human Services. “This is a really quite extraordinary, logistically complex undertaking, and a lot of uncertainties right now. I think the message we want you to leave with is, we are prepared for all of those uncertainties.”
The officials said they were planning for initial distribution of a vaccine — perhaps on an emergency basis, and to a limited group of high-priority people such as health care workers — in the final three months of this year and into next year. The Department of Defense is providing logistical support to plan how the vaccines will be shipped and stored, as well as how to keep track of who has gotten the vaccine and whether they have gotten one or two doses.
However, Mr. Mango said that there had been “a lot of confusion” about what the role of the Department of Defense would be, and that “for the overwhelming majority of Americans, there will be no federal official who touches any of this vaccine before it’s injected into Americans.”
Army Lt. Gen. Paul Ostrowski said Operation Warp Speed was working to link up existing databases so that, for example, a patient who received a vaccine at a public health center in January could go to a CVS pharmacy 28 days later in another state and be assured of getting the second dose of the right vaccine.
Three drug makers are testing vaccine candidates in late-stage trials in the United States. One of those companies, Pfizer, has said that it could apply for emergency authorization as early as October, while the other two, Moderna and AstraZeneca, have said they hope to have something before the end of the year.
Coronavirus vaccine study by Pfizer shows mild-to-moderate side effects
Pfizer Inc said on Tuesday participants were showing mostly mild-to-moderate side effects when given either the company’s experimental coronavirus vaccine or a placebo in an ongoing late-stage study.
The company said in a presentation to investors that side effects included fatigue, headache, chills and muscle pain. Some participants in the trial also developed fevers – including a few high fevers. The data is blinded, meaning Pfizer does not know which patients received the vaccine or a placebo. Kathrin Jansen, Pfizer’s head of vaccine research and development, stressed that the independent data monitoring committee “has access to unblinded data so they would notify us if they have any safety concerns and have not done so to date.”
The company has enrolled more than 29,000 people in its 44,000-volunteer trial to test the experimental COVID-19 vaccine it is developing with German partner BioNTech. Over 12,000 study participants had received a second dose of the vaccine, Pfizer executives said on an investor conference call.
The comments follow rival AstraZeneca’s COVID-19 vaccine trials being put on hold worldwide on Sept. 6 after a serious side effect was reported in a volunteer in Britain.
AstraZeneca’s trials resumed in Britain and Brazil on Monday following the green light from British regulators, but remain on hold in the United States.
Pfizer expects it will likely have results on whether the vaccine works in October. “We do believe – given the very robust immune profile and also the preclinical profile … that vaccine efficacy is likely to be 60% or more,” Pfizer’s Chief Scientific Officer Mikael Dolsten said.
Rushing the COVID-19 Vaccine Could Have Serious and Fatal Side Effects
Jason Silverstein noted that States have been told by the Centers for Disease Control and Prevention they should prepare for a coronavirus vaccine by “late October or early November,” according to reports last Wednesday. But an untested coronavirus vaccine may have serious and fatal side effects, could even make the disease worse, and may very well have an effect on the election.
What’s the worst that could happen if we give an untested vaccine to millions of people?
We received a reminder today, when one of the leading large coronavirus vaccine trials by AstraZeneca and Oxford University was paused due to a “suspected serious adverse reaction.” There are eight other potential coronavirus vaccines that have reached Phase 3, which is the phase that enrolls tens of thousands of people and compares how they do with the vaccine against people who only get a placebo. Those eight include China’s CanSino Biologics product that was approved for military use without proper testing back in July, and Russia’s coronavirus vaccine that has been tested in only 76 people.
If the CDC distributes an untested coronavirus vaccine this Fall, it would be the largest drug trial in history—with all of the risks and none of the safeguards.
“Approving a vaccine without testing would be like climbing into a plane that has never been tested,” said Tony Moody, MD, director of the Duke Collaborative Influenza Vaccine Innovation Centers. “It might work, but failure could be catastrophic.”
One concern about this vaccine is that it’s tracking to be an “October surprise.” From Henry Kissinger’s “peace is at hand” speech regarding a ceasefire in Vietnam less than two weeks before the 1972 election to former FBI Director James Comey’s letter that he would reopen the investigation into Hillary Clinton’s emails, October surprises have always had the potential to shift elections. But never before have they had the potential to catastrophically shift the health of an already fragile nation.
If there is an October surprise in the form of an untested coronavirus vaccine, it won’t be the first time that a vaccine was rushed out as a political stunt to increase an incumbent president’s election chances.
What happened with the last vaccine rush?
On March 24, 1976, in response to a swine flu outbreak, President Gerald Ford asked Congress for $135 million for “each and every American to receive an inoculation.”
How badly did the Swine Flu campaign of 1976 go? Well, one of the drug companies made two million doses of the wrong Swine Flu vaccine, vaccines weren’t exactly effective for people under 24, and insurance companies said, no way, they didn’t want to be liable for the science experiment of putting this vaccine into 120 million bodies.
By December, the Swine Flu vaccination program was suspended when people started to develop Guillain-Barré Syndrome, a rare neurological condition whose risk was seven times higher in people who got the vaccine and which paralyzed more than 500 people and killed at least 25.
What else can go wrong when vaccines are rushed
“Vaccines are some of the safest medical products in the world, but there can be serious side effects in some instances that are often only revealed by very large trials,” said Kate Langwig, Ph.D., an infectious disease ecologist at Virginia Tech.
One of the other possible side effects is known as vaccine enhancement, the very rare case when the body makes antibodies in response to a vaccine but the antibodies help a second infection get into cells, something that has been seen in dengue fever. “The vaccine, far from preventing Covid-19, might turn out to make a patient’s disease worse,” said Nir Eyal, D.Phil., a bioethics professor at Rutgers University.
We do not know whether a coronavirus vaccine might cause vaccine enhancement, but we need to. In 1966, a vaccine trial against respiratory syncytial virus, a disease that many infants get, caused more than 80 percent of infants and children who received the vaccine to be hospitalized and killed two.
All of these risks can be prevented, but safety takes patience, something that an American public which has had to bury more than 186,000 is understandably short on and Trump seems to be allergic to.
“To put this into perspective, the typical length of making a vaccine is fifteen to twenty years,” said Paul Offit, MD, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. Offit’s laboratory developed a vaccine for rotavirus, a disease that kills infants. That process began in the 1980s and wasn’t completed until 2006. The first scientific papers behind the HPV vaccine, for example, were published in the early 1990’s, but the vaccine wasn’t licensed until 2006.
An untested vaccine may also prove a deadly distraction. “An ineffective vaccine could create a false sense of security and perhaps reduce the emphasis on social distancing, mask wearing, hand hygiene,” said Atul Malhotra, MD, a pulmonologist at the UC San Diego School of Medicine.
Other issues with inadequately tested vaccines
Even worse, an untested vaccine may have consequences far beyond the present pandemic. Even today, one poll shows that only 57% of people would take a coronavirus vaccine. (Some experts argue that we need 55 to 82% to develop herd immunity.)
If we don’t get the vaccine right the first time, there may not be enough public trust for a next time. “Vaccines are a lot like social distancing. They are most effective if we work cooperatively and get a lot of people to take them,” said Langwig. “If we erode the public’s trust through the use of unsafe or ineffective vaccines, we may be less likely to convince people to be vaccinated in the future.”
“You don’t want to scare people off, because vaccines are our way out of this,” said Dr. Offit.
So, how will you be able to see through the fog of the vaccine war and know when a vaccine is safe to take? “Data,” said Dr. Moody, “to see if the vaccine did not cause serious side effects in those who got it, and that those who got the vaccine had a lower rate of disease, hospitalization, death, or any other metric that means it worked. And we really, really want to see that people who got the vaccine did not do worse than those who did not.
And finally, don’t forget to get your Flu vaccine, now!
Many were waiting whether lockdowns were the answer to this pandemic, especially when we learned that Sweden didn’t mandate lockdowns or self-quarantines. But low and behold we learn of the spike in infections and deaths at the end of last week. In the article by Meghan Roos, 6/12/2020, In Sweden, Where No Lockdown was Ever Implemented, there was an increase one day spike of 1,474 on Thursday, 6/11/2020. Swedish health officials reported 49,684 infections and 4,854 deaths by Friday 6/12/2020. This country now has one of the highest per capita fatality rates in the world with an estimate 10 per cent of all COVID-19 cases resulting in death, accounting to date from John Hopkins University.
Now, as Nick Visser reported that Texas, Arizona and Florida all reported their highest daily increases in new coronavirus cases on Tuesday, even after all three states implemented and later lifted stay-at-home orders meant to stop the spread of infections.
State officials in Florida reported 2,783 new cases, in Texas, 2,622, and in Arizona, 2,392. All three states have seen social distancing regulations relaxed for weeks, and most businesses have been allowed to reopen in some capacity.
The figures come amid ongoing efforts by President Donald Trump and other Republican leaders to downplay the ongoing spread of the virus. At least 21 states have seen rates of new cases increase over the last two weeks as a majority of the country reopens.
At the same time, Trump has been pushing misleading claims that infections are only increasing because there’s more testing, going so far as to claim Monday, without evidence, that “if we stop testing right now, we’d have very few cases, if any.”
The president is also preparing to hold a massive rally in Oklahoma this weekend with 20,000 attendees at an indoor arena, despite pleas from local officials and health professionals that the event could quickly lead to a renewed outbreak in the state. Infection rates in Oklahoma rose 68% in the second week of June.
“I’m extremely concerned,” Bruce Dart, the executive director of the Tulsa health department, told the Tulsa World. “I think we have the responsibility to stand up when things are happening that I think are going to be dangerous for our community, which it will be. It hurts my heart to think about the aftermath of what’s going to happen.”
Other state leaders have pushed back their own reopening efforts as cases have surged, including the governors of Utah and Oregon.
But in Florida, Gov. Ron DeSantis (R) said he was not considering another shutdown despite the surge in cases. He also rolled out the White House’s misleading talking point that cases were rising only because of increased testing.
“We’re not rolling back,” DeSantis said during a press briefing, according to the Miami Herald. “The reason we did the mitigation was to protect the hospital system.”
“You have to have society function,” he added. “To suppress a lot of working-age people at this point I don’t think would be very effective.”
In Arizona, some health officials were already reporting a strain on hospitals’ intensive care capacity due to a spike in coronavirus cases, even as Gov. Doug Ducey (R) said any concern was “misinformation” and said the facilities were prepared to handle an influx in patients.
And in Texas, Gov. Greg Abbott (R) said that, despite his own state’s figures, hospital capacity remained “abundant.”
“The more Texans protect their own health, the safer our state will be and the more we will be able to open up for business,” he said Tuesday.
Dr. Anthony Fauci, the country’s top infectious disease expert, said that, despite the attempts to alleviate any concern, some states jumped the gun on reopening before meeting White House criteria on case levels.
“There certainly were states that did not strictly follow the guidelines that we put out about opening America again,” Fauci said in an interview with NPR. “Clearly there were states that ― left to their own decision about that ― went ahead and opened to a varying degree … certainly before they got to the benchmarks that they needed to get.”
Recent news report is that multiple Florida hospitals have run out of ICU beds as the Coronavirus cases continue to spike.
In This State, the Virus Is ‘Spreading Like Wildfire’
Jenn Gidman noted that as states start to reopen, as well as the recent ongoing protests, amid the pandemic, there’s a red flag rising out of the Southwest. Business Insider reports the coronavirus outbreak “is going very badly” in Arizona, with more than 4,400 new cases over the weekend, bringing the total number of cases in the state to more than 37,500 as of Sunday, with nearly 1,200 deaths. Per Healthline, there’s been a 300% increase in reported cases since May 1. Tucson.com reports that in just one week (from May 31 to June 6), the state saw its biggest week-to-week increase yet: 7,121 new coronavirus patients, or about a 54% increase from the previous week. Meanwhile, the Arizona Republic reports that hospitalizations are on the rise as well, with two straight weeks of statewide hospitalizations surpassing 1,000 daily—the highest number since state reporting began in the beginning of April. Will Humble, a former director of the state’s Department of Health Services, says the spike is “definitely related” to the state’s stay-at-home order being dropped on May 15, per Newsweek. More on the Grand Canyon State:
Eyewitness to tragedy: CBS 5 talked to one doctor who works at two Phoenix hospitals, and he described what he’s been seeing in ERs and ICUs. “He asked if he could make a call in the hospital,” he says of one elderly patient. “It was very tragic to hear him say goodbye to his godkids and grandchildren, who you could really tell loved him.”
Texas Governor Says ‘No Reason Today to Be Alarmed’ As Coronavirus Cases Set Record
One question that I have is if states or cities declare a lockdown whether people will adhere to the lockdown? Laurel Wamsley reported that Texas has seen a recent uptick in the number of COVID-19 cases, with a record level of new cases and hospitalizations announced Tuesday. People are seen here Monday along the San Antonio River Walk.
Texas Gov. Greg Abbott announced on Tuesday the state’s highest-ever number of new COVID-19 cases: 2,622.
He also reported a second record high: 2,518 people hospitalized with the virus in Texas, up from 2,326 a day earlier.
Despite the concerning uptick in people sick with the virus, Abbott said that the reason for his news conference was to let Texans know about the “abundant” hospital capacity for treating people with COVID-19. He and other officials spent much of the briefing touting the state’s hospital bed availability.
Disclosing the new record high number of hospitalizations related to COVID-19, Abbott emphasized that figure is “really a very small percentage of all the beds that are available.” Texas has so far been spared the high case numbers in other populous states. While it’s the second-largest state by population, Texas currently ranks sixth in terms of cumulative case numbers.
Before releasing the number of new cases, Abbott delved into what he said accounted for the previous daily high on June 10, which had 2,504 new cases. The governor said that spike could be largely attributed to 520 positive tests of inmates in Texas prisons being reported at once as well as a data error in a rural county.
He said there are also reasons for why Tuesday’s new case count was so high: tests results coming from an assisted living facility near Plano; a county south of Austin where positive cases seemed to be reported in batches; and 104 cases in one East Texas county that appear to be primarily from tests at a prison.
But he also pointed to uncareful behavior as a possible driver in some of the new cases. Abbott said there were a number of counties where a majority of those who tested positive for the coronavirus were under the age of 30, which he attributed to people going to “bar-type” settings or Memorial Day celebrations and not taking health precautions.
Abbott said that measures such as wearing masks, hand sanitizing and social distancing are what make it possible to reopen the state’s economy and Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, struck the same note.
“The message is we are seeing some increase in the number of COVID patients in the state. We expected this,” he said. “But we are seeing it occurring at a manageable level. I really want to stress that the continued success is up to the people of the state of Texas.”
Despite Abbott’s emphasis on the importance of masks, he has barred Texas cities from implementing any rules that would require face coverings. Abbott signed an executive order on April 27 that says while individuals are encouraged to wear face masks, “no jurisdiction can impose a civil or criminal penalty for failure to wear a face covering.”
On Tuesday, the mayors of nine Texas cities — including Houston, Dallas, San Antonio, Austin, Fort Worth and El Paso — sent a letter to the governor asking for the authority to set the rules and regulations on the use of face coverings.
“A one-size-fits-all approach is not the best option. We should trust local officials to make informed choices about health policy. And if mayors are given the opportunity to require face coverings, we believe our cities will be ready to help reduce the spread of this disease,” they wrote. “If you do not have plans to mandate face coverings statewide, we ask that you restore the ability for local authorities to enforce the wearing of face coverings in public venues where physical distancing cannot be practiced.”
Abbott said Tuesday that judges and local officials have other tools available for enforcement such as issuing fines for gatherings that don’t follow state protocols.
Austin Mayor Steve Adler extended a stay-at-home warning on Monday amid the news of rising cases – but that warning could only be advice to residents and not an order due to the state’s preemption.
“People are confused,” Adler told NPR’s Steve Inskeep on Tuesday. “They just don’t know at this point if it’s really important to wear face coverings or not, because I think they’re feeling like they’re getting mixed messaging — not only from state leadership but from national leadership. So, we’re just not getting the vigilance that we need on these efforts.”
And the Surges In COVID-19 Cases Cause Friction Between Local Leaders, Governors
In Austin, Adler said, you’ll see most everyone wearing a mask in grocery stores but not in restaurants or music clubs: “When we started opening up the economy and when the governor took away from cities the ability to make it mandatory, more and more people stopped wearing them.”
Adler said he agreed with Abbott that face coverings are key to reopening parts of the economy, even if they’re unpleasant for wearers.
“I know it’s inconvenient. I know it’s hot. I know it’s a nuisance,” Adler said. “And it’s hard to do, and people don’t like it. But at the same time, our community has to decide just how much we value the lives of folks in our community that are over 65 and older. We have to decide how much we value the lives of the communities of color that are suffering disproportionately because of this virus.”
Florida Officials Spar Over Rising COVID-19 Cases
Greg Allen reported that in Florida, where there’s a surge of new COVID-19 cases, officials are divided over what to do about it. The state saw 2,783 new cases Tuesday. It was the third time in the past seven days that Florida set a new daily record.
Florida Gov. Ron DeSantis and other Republican officials, including President Trump, say the rising number of new cases was expected and is mostly the result of increased testing. Florida is now testing more than 200,000 people a week, more than double the number tested weekly in mid-May.
But local officials and public health experts are concerned about other statistics that show that the coronavirus is still spreading in Florida. The state’s Department of Health reports that the number of people showing up in hospital emergency rooms with symptoms of the flu and COVID-19 is rising. Also, worrisome — the percentage of people who are testing positive for the virus is going up, total positive residents are 63,374 with 11,008 hospitalizations and 2,712 deaths.
In Palm Beach County, health director Alina Alonso says the rising positivity rate is a clear sign that the new cases can’t just be attributed to increased testing. Since Palm Beach County began allowing businesses to reopen, Alonso says, the percentage of people testing positive has jumped from 4.9% to 8.9%. “The fact that these are going up means there’s more community spread,” she says. “The virus now has food out there. It has people that are out there without masks, without maintaining distancing. So, it’s infecting more people.”
Alonso say the number of people hospitalized for the coronavirus has also gone up in Palm Beach County. “The numbers are very concerning to the hospitals,” she says. So far, the number of deaths from COVID-19 has remained low. But Alonso says deaths lag behind new recorded cases by about six weeks. She thinks the number of deaths will also rise. “We need to be cautious at this time. Wait a little bit until we see whether or not that happens,” she says. “If we go forward without waiting to see what is going on … by the time we get those deaths, it will be too late.”
Palm Beach County currently isn’t requiring residents to wear face coverings when in public places. County commissioners are now considering following the lead of Broward and Miami-Dade counties and making face masks mandatory.
In Tallahassee, DeSantis held a news conference where he responded to concerns about the rising positivity rate. Much of it, he said, is related to outbreaks among farmworkers and people in prison. Among the incidents he highlighted — a watermelon farm near Gainesville where, out of 100 workers tested, 90 were positive. DeSantis said, “When you have 90 out of 100 that test positive, what that does to positivity — that’s huge numbers.” Some of the other localized outbreaks among farmworkers, he noted, were in Palm Beach County.
DeSantis said there’s no reason to consider rolling back the rules allowing businesses to reopen at the moment. He has encouraged the resumption of sports events and attended a NASCAR race in Homestead, Fla., on Sunday with a few hundred other spectators. And he successfully lobbied for Florida to host President Trump’s acceptance speech at a Republican National Convention event in Jacksonville. That gathering is expected to draw thousands.
Democrats have become increasingly critical, saying DeSantis is ignoring important data that favor a more cautious response. Florida’s top elected Democrat, Agriculture Commissioner Nikki Fried, said, “Refusing to acknowledge the alarming patterns in cases, hospitalizations and positivity is not only arrogant but will cost lives, public health and our economy.”
Asymptomatic coronavirus transmission appears worse than SARS or influenza — a runner can leave a ‘slipstream’ of 30 feet
Quentin Fottrell reported that the WHO currently estimates that 16% of people are asymptomatic and can transmit the novel coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness. One study says that asymptomatic transmission “is the Achilles” heel of COVID-19 pandemic control. How worried should you be about asymptomatic transmission of COVID-19?
hours earlier that transmission of the novel coronavirus in carriers who don’t show apparent symptoms happened in “very rare” cases.
Maria Van Kerkhove said it was a “misunderstanding to state that asymptomatic transmission globally is very rare,” and that her comments during a WHO news briefing had been based on “a very small subset of studies.” “I was just responding to a question; I wasn’t stating a policy of WHO,” she said.
The WHO currently estimates that 16% of people with COVID-19 are asymptomatic and can transmit the coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness.
Public-health officials have advised people to keep a distance of six feet from one another. Face masks are designed to prevent the wearer, who may be infected with COVID-19 but have very mild or no symptoms, from spreading invisible droplets to another person and thereby infecting them too. But “there’s nothing magic about six feet,” said Gregory Poland, who studies the immunogenetics of vaccine response in adults and children at the Mayo Clinic in Rochester, Minn., and is an expert with the Infectious Diseases Society of America.
“The virus can’t measure,” he told MarketWatch. “For example, the viral cloud while speaking will extend 27 feet and linger in the air for about 30 minutes. This is more like influenza in the sense that people transmit the virus prior to experiencing any symptoms and some people, of course, will not get sick.”
Asymptomatic transmission “is the Achilles’ heel of COVID-19 pandemic control through the public-health strategies we have currently deployed,” according to a study by researchers at the University of California, San Francisco published May 28 in the New England Journal of Medicine.
“Symptom-based screening has utility, but epidemiologic evaluations of COVID-19 outbreaks within skilled nursing facilities … strongly demonstrate that our current approaches are inadequate,” researchers Monica Gandhi, Deborah Yokoe and Diane Havlir wrote.
Brazil is on track to lead the world in coronavirus cases and deaths, and it still doesn’t have a plan for tackling the outbreak
Amanda Perobelli reported that Brazil could surpass the US in coronavirus cases and deaths by the end of July, according to estimates from the University of Washington.
The country recorded a daily record of 34,918 new coronavirus cases on Tuesday, according to Reuters. And despite the growing number of cases, the country has not created a plan to tackle the outbreak. Brazil could surpass the US in both coronavirus infections and deaths by the end of July, according to the main coronavirus tracking model from the University of Washington.
The country, which has yet to impose a national coronavirus lockdown, is on its way to registering more than 4,000 daily deaths, The Washington Post reported, citing the university. As of Tuesday, Brazil had more than 923,000 coronavirus infections and more than 45,000 deaths. Experts told Reuters the true number of cases was most likely higher.
As The Post noted, the country doesn’t have the same infrastructure to help it handle such a large outbreak as the US. But that hasn’t stopped President Jair Bolsonaro from largely dismissing the crisis the novel coronavirus is causing. In fact, he’s even attacked governors who chose to impose restrictions and threatened to host large barbecues in spite of public-health advice, The Post reported.
Brazil has not initiated a national testing campaign, has not implemented a national lockdown, and is dealing with insufficient healthcare expansion. Reuters reported that that country counted 34,918 new daily coronavirus cases on Tuesday.
In a report in early May, Carlos Machado, a senior scientist with Brazil’s Oswaldo Cruz Foundation, and his team warned that without a lockdown in Rio de Janeiro, the outcome would be “in a human catastrophe of unimaginable proportions.” He now says had his warnings been taken seriously, the outcome would not have been so bleak.
“From the point of view of public health, it’s incomprehensible that more-rigorous measures weren’t adopted,” Machado told The Post. “We could have avoided many of the deaths and cases and everything else that is happening in Rio de Janeiro. It was an opportunity lost.”
Scientists in the country told The Post that the country was veering into unknown territory. “We are doing something that no one else has done,” Pedro Hallal, an epidemiologist at the Federal University of Pelotas, told The Post. “We’re getting near the curve’s peak, and it’s like we are almost challenging the virus. ‘Let’s see how many people you can infect. We want to see how strong you are.’ Like this is a game of poker, and we’re all in.”
Bolsonaro’s approach has been to ignore the problem and sideline health experts
Reuters reported that senior officials leading Brazil’s coronavirus response had claimed the outbreak was under control.
“There is a crisis, we sympathize with bereaved families, but it is managed,” said Braga Netto, who spoke during a webinar held by the Commercial Association of Rio de Janeiro.
The World Health Organization’s regional director Carissa Etienne said Brazil was a major concern, Reuters reported. “We are not seeing transmission slowing down” in Brazil, Etienne said. Etienne said the country accounted for about 4 million coronavirus cases in the Americas and about 25% of the deaths.
The Post described Bolsonaro’s approach as being to ignore and sideline health experts. The Brazilian president fired Luiz Henrique Mandetta, his first health minister, after disagreements on social distancing, and then he fired his replacement, Nelson Teich, because he disagreed with the use of chloroquine as a treatment for coronavirus.
Similar to US President Donald Trump, Bolsonaro has boosted the use of hydroxychloroquine in the past. On Monday, the US Food and Drug Administration revoked the emergency-use authorization issued for the antimalarial drug.
One expert said even the public in Brazil did not heed public-health advice to limit the spread of the virus and continued to congregate without any safety measures implemented.
“It was a failure,” Ligia Bahia, a professor of public health at the Federal University of Rio de Janeiro, told The Post. “We didn’t have enough political force to impose another way. The scientists alone, we couldn’t do it. There’s a sense of profound sadness that this wasn’t realized.”
Presently there is only one country that has declared it COVID-19 cleared, that is Montenegro. New Zealand has declared their country COVID-19 free and then two cases turned up as two people from Europe who traveled to New Zealand tested positive and are now quarantined.
Look at the recent world numbers where the total cases are 8,174,327 with 443,500 deaths. Way too many!
Italy a country at the heart of the Corona virus outbreak in Europe — watched its number of cases and deaths due to the novel Corona virus astronomically leap once again, up 793 deaths with 6,557 newly confirmed cases recorded in just 24 hours.
Saturday’s jump marks the worst day for fatalities since the crisis began just four months ago. The country now counts 53,578 diagnosed infections, up 13.9 percent, with 4,825 deaths — the highest in the world.
More than 60 percent of the most recent deaths occurred in the northern region of Lombardy. Hospitals in the area have been reeling under a staggering caseload that has left intensive care beds scarce and respirators in extremely limited supply.
According to the Financial Times, 2,857 people were in intensive care in Lombardy on Saturday, up from 2,655 on Friday. The new increases come almost two weeks into a nationwide lock down in an attempt to stop the COVID-19 virus in its tracks there.
There were also 943 full recoveries tallied yesterday — another record for the country.
On Thursday, Italy was witness to yet another grim milestone in its fight against the deadly disease by overtaking China to become the country with the highest number of deaths.
On Friday the government banned the last types of outdoor exercise Italians were able to participate in under the lock down measures by deciding that running and bicycle rides were no longer permitted. In addition, the Italian military has also been dispatched to Milan to ensure that citizens follow the new lock down measures.
The Italian interior ministry reported that more than 223,633 people were inspected by the Italian police nationwide on Friday, with 9,888 people reported for breaking the lock down measures and 260 for false declarations about why they were outside.
Across the Atlantic, the number of cases in the United States has now exceeded 22,000 with more than 270 deaths. New York tops the list with at least 10,000 confirmed cases; Washington state follows with just over 1,500 cases, and California is in tow with more than 1,200.
Thus far, the global pandemic has infected more than 287,000 people and killed over 11,900. More than 90,000 people have recovered so far, mostly in China.
The Associated Press and The Financial Times contributed to this report.
I found this article in the Economist discussing what the economic influence would be from the COVID-19 pandemic. The titular conceit of “28 Days Later”, as with many contagion-style horror films, is of a man waking up after a month-long coma only to find society upended by a rampaging virus. Many Americans are experiencing something similar. On March 3rd there were just 122 confirmed cases of COVID-19—the disease currently sweeping the world—and only seven deaths. By March 17th there were 7,786 confirmed cases (even these were a sure underestimate given the dearth of testing) and 118 deaths. Twenty-eight days later, on March 31st, what might America look like?
“We don’t know whether we’re going to look like Italy or the provinces outside Hubei” in China where the spread of COVID-19 was fairly effectively contained, says David Blumenthal, president of the Commonwealth Fund, a health-policy think-tank. “But the likelihood is—given the slowness with which we responded to the epidemic—that we look more like Italy,” he adds. Jerome Adams, the surgeon-general, has warned of the same.
Can America’s health system cope? The structural problems that make pandemic response more difficult—lack of paid sick pay, a large uninsured population and a significant number of insured people nonetheless worried about out-of-pocket medical bills—cannot be mended overnight. Instead, public-health experts and doctors are increasingly worried about sheer capacity constraints. In China, 5% of those diagnosed needed intensive care. There are roughly 97,000 beds in intensive care units (ICUs), of which one-third are empty. Though America has relatively few total hospital beds per person compared with other countries, it ranks among the highest for ICU beds per person, with nearly three times as many as Italy.
“The real limiting factors are likely to be the ventilators or the staff,” says Greg Martin, a professor of medicine at Emory University and president-elect of the Society of Critical Care Medicine. There are roughly 50,000 physicians trained in critical care and 34,000 similarly specialized nurses and assistants. This could be insufficient in the face of hundreds of thousands of cases at peak rates of infection.
Then there is the problem of kit. In China, half of those in critical care required the use of ventilators, machines that help people breathe. There are thought to be 62,000 full-featured mechanical ventilators in the country, many of which are already in use. Older stocks of perhaps 100,000 devices—including CPAP machines used for those with sleep apnea—could be called upon if needed, but would provide only basic functions. Ramp-ups in ventilator production are being pondered, including through emergency powers given to the president under the Defense Production Act of 1950, but there has been little actual action yet. On a phone call with state governors, President Donald Trump urged “respirators, ventilators, all of the equipment—try getting it yourselves”, which could spark an unhelpful competition between states for scarce resources.
“Under almost any basic scenario, things look tough. Hospital beds will be completely full many times over if we don’t substantially spread the load,” warns Ashish Jha, director of the Global Health Institute at Harvard. To head that off, Mr Jha has called for an Italy-style national quarantine, lasting for at least two weeks, in which all non-essential businesses are closed and gatherings of more than five people are barred to give time for testing to become widespread. After a dismally slow start to testing, the numbers are finally heading up—although the best estimates come not from public-health agencies, but volunteer trackers using a Google sheet—to an estimated 12,535 tests conducted on March 17th. Given the expected scope of the disease, and the reported obstacles to people with symptoms actually getting tested, much more will be needed.
Most hospitals are making contingency plans. There are plans to add physical beds by cancelling elective surgeries that can be postponed, converting recovery rooms into added beds and building tents to house some patients. The Cleveland Clinic, a prominent hospital, says it has plans in place to add 1,000 beds of capacity within 72 hours if needed. Teams of doctors and nurses with other specialties could be conscripted into critical-care work, supervised by critical-care doctors who handle the trickiest cases—like respiratory distress coupled with organ failure in the kidneys or heart. If this is insufficient, recently retired doctors could be drafted into service. Some teaching hospitals are using simulation centers to prepare medical staff for the inevitable surge in cases.
Whether it will come to all this is still unclear. Testing capacity remains constrained, limiting the information epidemiologists have to feed both their models and their willingness to speculate. Their policy recommendations—social distancing, closure of schools and large gatherings—are nevertheless clear. One team of researchers has concluded that an epidemic resembling that of Wuhan, where the novel Corona virus first broke out, would overwhelm hospitals many times over, while one resembling Guangzhou, a city that locked down in the early days of the virus, could be dealt with.
On March 16th, however, a team of scientists based at Imperial College London, who have been advising the British government, also published forecasts of the epidemic’s trajectory in America. As with Britain, the figures look grim. Without any mitigation, America would experience 2.2m deaths, they predict. Even in the case of some mitigation—isolation of the sick, social distancing for the elderly, but an otherwise normal society—American hospital and ICU capacity would be exceeded eight times over, and the country would be on track for at least 1.1m deaths. Averting this through “suppression”—isolation of sick, closing of schools and universities, social distancing for everyone—would require months until therapeutics or vaccines can be developed.
America is therefore turning towards suppression of the virus. Millions of pupils and university students have been sent home and left to take classes online. Mr. Trump has advised that people not congregate in gatherings of more than ten people. San Francisco and surrounding counties have issued a “shelter-in-place” order that requires 7m to remain in their homes unless necessary. New York City is expected to do the same for its 8m residents. In 22 states, bars and restaurants have been ordered to close their seating and only serve takeaway. The state of New York is setting up drive-through testing centers, starting in New Rochelle, a commuter town in Westchester County that was one of the early sites of a COVID-19 cluster, and is urging federal troops to build emergency, temporary hospital facilities. New Rochelle’s mayor says he is surviving the lock down there on “adrenalin, coffee and M&Ms”.
The goal is to increase general hospital capacity by a factor of two and ICU capacity by a factor of ten within two months. Elections have been postponed in a few states for the Democratic primary, which now seems a dull, distant affair. America’s devolved system means that the shuttering will happen at different rates in different places, but the trajectory is clear. “You want a single national response. But when the federal government completely fails, as it has so far, then you can get states and cities to step up,” says Mr. Jha.
The question is how long this can go on for. Unmitigated, the epidemic would not peak for at least another three months. Suppression can reduce the spread of the disease, as China’s experiment with locking down most of its population showed, but relaxing these measures will inevitably bring another surge in cases. Mr. Trump, who a few weeks ago was suggesting the virus was the latest hoax invented to damage him, is now warning that this could be the start of a months-long reorientation in American life. And while these extraordinary actions should smother the disease, they will also smother the economy.
The dismal economic forecasts will require further action from Congress. It spent the last week haggling over a bill that would make testing for the disease free, increase the flow of safety-net benefits and grant paid sick leave to more workers (though this provision appears to be hollowing out with every iteration). Even before that bill was finalized, Washington’s attention had already turned to the even bigger economic stimulus package that must come next. Senators, both Democrats and Republicans, are tripping over themselves issuing plans to send cash directly to American families.
The total package, which could be worth $1trn or more, dwarfs the $100bn-or-so bill recently signed into law and every other stimulus package in history. The Trump administration has proposed sending $500bn in direct cash to taxpayers, $300bn to keep firms afloat, and $200bn to bail out critical industries like airlines. The typical partisan bickering from Congress and even from Mr. Trump has been muted. Every politician seems to now realize that the country faces an unprecedented crisis, first of public health and then of the economy, that will last for months. Whether this action will look sufficient 28 days later is, as with seemingly every aspect of the Covid-19 pandemic, deeply uncertain. ■
Ethicists agree on who gets treated first when hospitals are overwhelmed by Corona virus
As a member of our Ethics Committee I thought that the decisions that physicians and staff in other countries were facing regarding who gets the ventilators was an interesting conundrum. This article contributed by Oliva Goldhill in her article, The Aging Effect, is a great introduction into the decisions that we may have to make here in the US. Pandemics bring ethical dilemmas into sharp, terrible focus. Around the world, hospitals have been unable to cope with the millions who need treatment for Corona virus. China created makeshift hospitals and denied treatment to those who needed non-Corona virus care; Italians wait an hour on the phone to get through to emergency services. Few countries will fare better: The United States has fewer than 100,000 ICU beds, and is expected to need a minimum of 200,000 to cope with Corona virus; the UK has just 8,200 ventilators and is getting an extra 3,800.
As health care systems are overwhelmed with more patients than they can feasibly treat, medical personnel are forced to decide who should get the available ventilators and ICU beds. Quartz spoke with eight ethicists, all of whom agreed that in such dire situations, those who have the best chance of surviving get priority. Despite the unanimity, all agreed that this decision is far from easy and should not be taken lightly.
Different moral theories, same answer
The decision to prioritize those with good survival odds is reinforced by several moral theories. Utilitarianism, for example, argues that morality is determined by the consequences of actions, and so we should strive to create the maximum good for the maximum number of people. “If we give scarce treatments to those who don’t stand to benefit (and have a high chance of dying anyway), then not only will they die, but those with higher likelihood of survival (but require ventilator support) will also die,” says Lydia Dugdale, professor of medicine and director of the center for clinical medical ethics at Columbia University. “It’s not fair to distribute scarce resources in a way that minimizes lives saved.”
A contrarian theory, which bases ethics on the social contract we would agree to if we didn’t know our status in society, arrives at the same conclusion. Joshua Parker, a trainee general practitioner (primary care doctor) who co-wrote an article on the ethics of Corona virus care for the Journal of Medical Ethics, points to philosopher John Rawls’ concept of a “veil of ignorance” as a way to determine the just action: “Behind the veil of ignorance, I am stripped of any knowledge of my position. I don’t know if I’ll be old, young, rich, poor, well, unwell, male or female; and I don’t know if I will catch COVID-19 or if I do, what resources I will need,” he writes in an email to Quartz. This thought experiment makes it easier to judge what’s fair for society as a whole. Alex John London, director of the Center for Ethics and Policy at Carnegie Mellon University, agrees: “Such agents might agree that in a pandemic, when not everyone can be saved, health care systems should use their resources to save as many lives as possible—because that is the strategy that allows each person a fair chance of being able to pursue their life plan.”
Even typically diverging ethical theories are likely to point to this conclusion. Utilitarianism, which focuses on the consequences of an action, is typically opposed to deontology, which says morality is determined by the act itself. “The deontologist might well start with a justice argument: each person is individually valuable and should have an equal chance of health care,” says Anders Sandberg, a philosopher at the Future of Humanity Institute at the Oxford University. But if this is simply impossible, then the theory doesn’t hold. “As Kant said, “ought implies can,” and if one cannot do an action it cannot be obligatory.” A deontologist approach to treat everyone equally falls short when there simply isn’t enough medical equipment to treat everyone; if some will have access and some won’t, then we have to face the question of who gets preferential treatment. And so “even the most die-hard deontologist will usually agree” that it’s wrong to treat people who are unlikely to benefit while others are in need, agrees Brian D. Earp, associate director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center.
Doctors have reckoned with the need to allocate resources in the face of overwhelming demand long before Corona virus. Dugdale points out that the New York department of health’s ventilator allocation guidelines, published in November 2015 to address the issue amid a flu epidemic, states that first-come first-serve, lottery, physician clinical judgment, and prioritizing certain patients such as health care workers were explored but found to be either too subjective or failed to save the most lives. Age was rejected as a criterion as it discriminates against the elderly, and there are plenty of cases in which an older person has better odds of survival than someone younger.
So the decision was to “utilize clinical factors only to evaluate a patient’s likelihood of survival and to determine the patient’s access to ventilator therapy.” In tie-breaking circumstances, though, they did approve treating children 17 and younger over an adult where both have an equal odds of surviving. Dugdale adds that there’s talk of applying these guidelines to address Corona virus treatment in New York.
No good answer
The dire consequences of any decision made under such extreme circumstances means that, despite agreement, the best course of action is hardly favorable. “I would say that leaving some to die without treatment is NOT ethical, but it may be necessary as there are no good options,” David Chan, philosophy professor at the University of Alabama at Birmingham, writes. “Saying that it is ethical ignores the tragic element, and it is better that physicians feel bad about making the best of a bad situation rather than being convinced that they have done the right thing.”
Rather, it’s simply the least bad option. Alternatives, such as a lottery system or prioritizing the sickest, are likely to lead to more deaths. “There is a good chance that we invest resources into patients who don’t survive, and we have thus doomed not just the patient we tried to save, but also the patient who was passed over for care, because the resources have been used up,” says Vanessa Bentley, philosophy professor at the University of Alabama at Birmingham. “Lives that could have been saved were lost.”
Although there’s broad agreement on the best approach, the nuances of applying this decision will always be difficult. Not only must doctors accurately assess and prioritize those with the best chance of survival, but there could also be times when the hospital doesn’t have enough equipment to help even those with equal odds. Italy has prioritized treatment for those with “the best chance of success” but adds as a second criterion those “who have more potential years of life.” This secondary factor is not so easily agreed upon but, in the face of Corona virus, it’s an ethical question doctors will have to face.
Governments are spending big to keep the world economy from getting dangerously sick
The help is targeted at companies and individuals. More will be needed
In the recent edition of the Economist Today it was noted a character in a novel by Ernest Hemingway once described bankruptcy as an experience that occurs “two ways: gradually, then suddenly”. The economic response to the COVID-19 pandemic has followed this pattern. For weeks policymakers dithered, even as forecasts for the likely economic damage worsened. But in the space of just a few days the rich world has shifted decisively. Many governments are now on a war footing, promising massive state intervention and control over economic activity.
The new phrase on politicians’ lips is “whatever it takes”—a line borrowed from Mario Draghi, president of the European Central Bank (ECB) in 2011-19. He used it in 2012 to convince investors he was serious about solving the euro-zone crisis, and prompted an economic recovery. Mr Draghi’s promise was radical enough. Politicians are now proposing something of a different magnitude: sweeping, structural changes to how their economies work.
There are unprecedented promises. On March 16th President Emmanuel Macron of France declared that “no company, whatever its size, will face the risk of bankruptcy” because of the virus. Germany pledged unlimited cash to businesses hit by it. Japan passed a hastily compiled spending package in February, but on March 10th supplemented it with another one that included over ¥430bn ($4bn) in spending and almost four times as much in cheap lending. Britain has said it will lend over £300bn (15% of GDP) to firms. America may enact a fiscal package worth well over $1trn (5% of GDP). The most conservative estimates of the total extra fiscal stimulus announced thus far put it at 2% of global GDP, more than was shoveled out in response to the global financial crisis of 2007-09.
That sinking feeling
In part this radical action is motivated by the realization that the Corona virus, first and foremost a public-health emergency, is also an economic one. The jaw-dropping bad economic data coming out of China hint at what could be in store for the rest of the world. In the first two months of 2020 all major indicators were deeply negative: industrial production fell by 13.5% year-on-year, retail sales by 20.5% and fixed-asset investment by 24.5%. GDP may have declined by as much as 10% year-on-year in the first quarter of 2020. The last time China reported an economic contraction was more than four decades ago, at the end of the Cultural Revolution.
Grim numbers are starting to pile up elsewhere, not so much in the official statistics, which take time to be published, as in “real-time” economic data produced by the private sector. Across the world, attendance at restaurants has fallen by half, according to OpenTable, a booking platform. International-passenger arrivals at the five biggest American airports are down by at least 30%. Box-office receipts have crumpled (see chart 2).
The disruption to international travel will hurt trade, since over half of global air freight is carried in the bellies of passenger planes. The combination of disrupted supply chains and depressed demand from shoppers should hit trade far harder than overall GDP, if the experience of the last financial crisis is anything to go by. Already, the American Association of Port Authorities, an alliance of the ports of Canada, the Caribbean, Latin America and the United States, has warned that cargo volumes during the first quarter of 2020 could be down by 20% or more from a year earlier.
Official data are now starting to drip out. The Empire manufacturing index, a monthly survey covering New York state, in March saw its steepest drop on record, and the lowest level since 2009. In February Norway’s jobless rate was 2.3%; by March 17th it was 5.3%. State-level numbers from America suggest that unemployment there has been surging in recent days.
All this is fueling grim forecasts. In a report on March 17th Morgan Stanley, a bank, estimated that GDP in the euro area will fall by an astonishing 12% year-on-year in the second quarter of the year. The Japanese economy is forecast to contract by 2% this quarter and 2% next. Most analysts see global GDP shrinking in the first half of the year, with barely any growth over 2020 as a whole—the worst performance since the financial crisis of 2007-09.
Even that is likely to prove optimistic. On March 17th analysts at Goldman Sachs noted that they had “not yet built a full lock down scenario” into their forecasts for advanced economies outside Europe. Forecasts for America, which is at an earlier stage than Europe and Asia when it comes to the outbreak, remain Panglossian; very slow growth in China and a big recession in Europe could by itself be enough to send the world’s largest economy the same way. Steven Mnuchin, America’s treasury secretary, warned this week that the country’s unemployment rate could reach 20% unless Congress passes a stimulus package. A negotiating ploy? With shopping malls emptying, factories grinding to a halt and financial markets buckling, lawmakers may be loath to challenge the claim.
Despite stomach-churning declines in GDP in the first half of this year, and especially the second quarter, most forecasters assume that the situation will return to normal in the second half of the year, with growth accelerating in 2021 as people make up for lost time. That judgment is in part informed by China’s experience. More than 90% of its big industrial firms are officially back in business. Its stock market had been one of the world’s worst performers in early February but is now the best (or rather, least bad). There remains, however, a risk that global containment and suppression of the virus will need to continue for a year or longer. If so, global economic output could be dragged down for much longer than most people expect.
Perhaps the greatest lesson of the global financial crisis was that it paid to act decisively and to act big, convincing markets and households that policymakers were serious about countering the slump. If done right, central banks and governments can end up doing a lot less than they actually promised. A pledge to bail out banks makes it less likely savers will withdraw deposits and make a rescue necessary.
This time around, central banks sprang into action. Since February the Federal Reserve has cut interest rates by 1.5 percentage points. Other central banks have followed suit. Further deep rate cuts are not possible, though; interest rates were very low long before the virus began to spread.
Let’s get fiscal
Not all central banks are acting as boldly as they can. China has room to cut interest rates—its benchmark rate is 1.5%—but has held back in part because inflation is quite high (largely as a result of African swine fever, which hit pig stocks, raising prices). Central banks could try more creative policies. On March 19th the ECB’s governing council agreed to launch a €750bn bond-buying program, covering both sovereign and corporate debt. But the real action is now taking place on the fiscal front.
Governments are falling over each other to offer bigger and better stimulus packages. All countries are spending more on health care, both in an effort to find vaccines and cures and to increase hospital capacity. However, the bulk of the extra spending is on companies and people.
Take companies first. China, where the outbreak has slowed, is now trying to get people out and buying things. Foshan, a city in Guangdong province, has launched a subsidy program for people buying cars. Some cities have started giving out coupons that can be spent in local shops and restaurants. Nanjing this month gave out e-vouchers worth 318m yuan ($45m).
Most countries, however, are in or about to enter the worst part of the outbreak. As customers dry up, many firms will go bust without government help. Calculations by The Economist suggest that 40% of consumer spending in advanced economies is vulnerable to people shunning social situations. Firms in leisure and hospitality are especially rattled. The Moor of Rannoch hotel, in about as rural a part of Scotland as it is possible to find, says its insurer will not be paying out a penny for lost custom, since COVID-19 is a new disease and thus not covered under its policy.
One approach is to reduce firms’ fixed costs, largely rent and labor. China’s finance ministry will exempt companies from making social-security contributions for up to five months. The government has also temporarily cut the electricity price for most companies by 5% and enacted short-term value-added-tax cuts. The British government has extended a one-year business-rates holiday to all companies operating in the retail, hospitality and leisure sectors. Yet for many firms, no matter how much the government helps them reduce costs, revenues are likely to fall further.
So, measures may be needed to allow firms to maintain cash flow. Many banks are offering hefty overdrafts to tide corporate clients over. To encourage banks to keep lending, Britain has promised them cheap funding and state guarantees against losses. For very small firms, many of which do not borrow at all, it is offering non-repayable cash grants of up to £25,000.
Other countries are enacting similar plans. The Japanese government is helping small firms by mobilizing its state-owned lenders to provide up to ¥1.6trn of emergency loans, much of it free of interest and collateral requirements. Small firms qualify for help if their monthly sales fall at least 15% below a normal month’s takings. Bavaria, a rich state in Germany, announced on March 16th that small and medium-sized companies with up to 250 employees could receive an immediate cash injection of between €5,000 and €30,000. The European Commission has already relaxed state-aid rules so that governments can channel help to ailing companies.
The second part of the fiscal response is about helping people, and in particular protecting them from being made unemployed or suffering a drastic drop in income if that does happen. Ugo Gentilini of the World Bank counts more than 25 countries that are using cash transfers as part of their economic response to the virus. Brazil will give informal workers, who make up roughly 40% of the labor force, 200 Reais ($38) each. Small businesses will be allowed to delay tax payments and pensioners will get year-end benefits early. Australia is instituting a one-time cash payment of A$750 ($434) to pensioners, veterans and people on low incomes.
Northern Europe has led the way on implementing policies that make it less likely firms lay off workers. Germany has relaxed the criteria for Kurzarbeit (“short-time work”), under which the state pays 60-67% of the forgone wages of employees whose hours are reduced by struggling firms. Applications are going “through the roof”, according to the federal labor agency. The use of Kurzarbeit probably halved the rise in unemployment during the recession of 2008-09. More firms are now eligible to use it, temporary workers are covered, and the government will also reimburse the social-security contributions companies make on behalf of affected workers.
Bringing home, the Danish bacon
In Denmark firms that risk losing 30% or more of their workforce will see the government pay 75% of the wages of employees who would otherwise be laid off, until June. Norway’s government has beefed up unemployment benefits, guaranteeing laid-off workers the equivalent of their full salary for the first 20 days. Freelancers whose work vanishes for more than a fortnight will get payments equivalent to 80% of their previous average income. In Sweden the state will cover half of the income of workers who have been let go, with employers asked to cover most of the rest.
So far America has passed more modest legislation. Federal funding for Medicaid, which provides health care for the poor, is likely to boost spending by about $30bn, assuming it remains in place until the end of December, reckons Oxford Economics, a consultancy. America also has a new paid-sick-leave policy for some 30m workers, including 10m who are self-employed, worth just over $100bn. But in that regard America is merely catching up with other rich countries, which have far more generous sick-leave policies. America also has fewer automatic economic stabilizers, such as generous unemployment insurance, than most other rich countries. As a result, its discretionary fiscal boost needs to be especially large to make a difference.
It might be. The Trump administration’s plan to funnel money directly to households, if approved by Congress, is the most significant policy. It bears some resemblance to a scheme that was introduced in February in Hong Kong, in which the government offered HK$10,000 ($1,290) directly to every permanent resident. Mr. Mnuchin is thought to favor a check of $1,000 per American—roughly equal to one week’s average wages for a private-sector worker—with the possibility of a second check later. Some $500bn-worth of direct payments could soon be in the post.
Some economists are leery about such a policy. For one thing, it would do little to prevent employers from letting people go, unlike the plans in northern Europe. Another potential problem, judging by Hong Kong’s experience, is administration of the plan: the territory’s finance secretary hopes to make the first payments in “late summer”, far too far away for people who lost work last week. Mr. Mnuchin promises that payments will happen much sooner.
America has done something similar before, with results that were not entirely encouraging. The government sent out checks in both 2001 and 2008 to head off a slowdown. The evidence suggests that people saved a large chunk of it. The psychological reassurance of a bit of extra cash could be significant for many Americans, but the sums involved are not especially impressive. Bernie Sanders, a Democratic presidential contender, is not known for his smart economic policy making, but his suggestion of $2,000 per household per month until the crisis is over is probably closer to what is required.
Indeed, more fiscal stimulus will be needed across the world, especially if measures to contain the spread of the virus fall short. After the Japanese government passes the budget for next fiscal year at the end of this month, it can begin work on a supplementary budget that takes the virus into full account. Britain’s Parliament has given Rishi Sunak, the chancellor of the exchequer, carte blanche to offer whatever support he deems necessary, without limit.
How much further can fiscal policy realistically go? Last year the 35-odd rich countries tracked by the IMF ran combined fiscal deficits of $1.5trn (2.9% of GDP). On the not-unrealistic assumption that the average deficit rose by five percentage points of GDP, total rich-country borrowing would rise to over $4trn this year. Investors have to be willing to finance that splurge. The yield on ten-year Treasury bonds, which had fallen as low as 0.5% as fears of the virus took hold and traders sought havens, has recently risen above 1%. This is probably due to firms and investors selling even their safest assets to raise cash, but might reflect some anxiety over the scale of planned government borrowing.
Jesse Watters began “Waters’ World” on Saturday by delivering a message of positivity to his audience, saying he’s sure America can overcome the devastation from the coronovirus. “The United States of America is rolling into a recession or a depression. What we do now will determine which one it’ll be. First, we have to stop the spread. You know what to do. Wash your hands, stay clean and practice social distancing,” Watters said, reminding people of the guidelines given to keep people safe from exposure to the virus.
“If you can stay inside this week, work from home if you can. Don’t fly if you don’t have to. The virus is mostly in 10 large counties. A very high percentage in New York, California and Washington state,” he continued. “Some of these areas recognize the threat and are shutting down everything. All of them need to do that.”
Watters talked about where the country stands medically and scientifically, assuring people the “brightest” are on the case. “All the brightest scientists in America [are] working around the clock to find a vaccine. Our people are the most innovative in the world,” Watters said.
The host also addressed the president’s leadership, urging him and American industry leaders to do whatever they can. “The president should be invoking every possible law and power available to him. He should be mobilizing the military and declaring war on the coronavirus. Rally the country around the mantra ‘made in America,'” Watters said. “Every American industry should have all hands-on deck. This isn’t a time for weakness. This is a time for strength.”
“Our country’s fighting an invisible enemy within our borders,” Watters added. “We’ll dull the spike and kill it if we all work together.” Watters expressed his optimism toward an American rebound. “We’ve had to come together by staying apart. I know one thing for sure, we’ll stop it and we’ll kill it and we’ll be a better country for it. Tough times are ahead,” Watters said. “The American character shining bright, loving our families and our neighbors and working nonstop to save lives. It’s now in your hands. We have a great spirit and we shall overcome.”
Italy reported a second successive drop in daily deaths and infections from a coronavirus that has nevertheless claimed more than 6,000 lives in a month.The Mediterranean country has now seen its daily fatalities come down from a world record 793 on Saturday to 651 on Sunday and 601 on Monday.
The number of new declared infections fell from 6,557 on Saturday to 4,789 on Monday. The top medical officer for Milan’s devastated Lombardy region appeared on television smiling for the first time in many weeks. “We cannot declare victory just yet,” Giuglio Gallera said. “But there is light at the end of the tunnel.”
As we saw Wednesday the WHO declared the Corona Virus/COID-19 a pandemic. We also heard the President role out plans for travel restrictions, increased testings and economic assistance. But what really gets me angry is that the Democrats in Congress are still making this a political battleground. Shame on them all! This is not the time for partisan politics so that they can embarrass the President and get their wishes and show the evilness of the political hate out there. Grow up Congress and let’s all get in on this battle to keep us all healthy and limit the death toll!! Philip Verhoef of USA Today reported that Congress is grappling with the problem of surprise medical bills, but will its Band-Aid approaches make a difference? As a physician, I’m trained to look beyond superficial symptoms to diagnose the underlying ailment. When patients pay thousands of dollars each year for “good” private insurance, how does a health care system allow them to walk away from a single hospital visit with debilitating medical debt? These concerns have become even more pressing with the spread of the new coronavirus and the costs associated with prevention, testing and treatment.
Most Americans assume that a commercial insurance card in their wallet protects them from unexpected medical bills. They pay their premiums and deductibles, scour the pages of insurance fine print and keep up with the revolving door of “in-network” doctors and hospitals.
However, going to the “in-network” hospital is no guarantee that the emergency room doctor, radiologist or anesthesiologist will be “in-network.” Today, many hospitals no longer directly employ physicians but instead contract with physician staffing firms such as TeamHealth, which employs more than 16,000 clinicians at 3,300 medical facilities.
Caught unaware in a medical crisis
These agencies are extremely profitable, which is why private equity firms are so hungry to buy them. Contract physicians operate outside of insurance coverage agreements — they’re not part of any “network” — and can act like free agents, billing patients directly for services not covered by insurance, called “balance billing.”
What does this mean for patients? Imagine you’re having a heart attack and call 911. Paramedics transport you to the nearest emergency room, which may or may not be in your insurer’s network. And because that hospital — or the ER doctor on duty — does not have a contractual relationship with your insurer, they can essentially name their price and “balance bill” you for the amount the insurance company won’t cover.
Here in Hawaii, many critically ill patients must use air ambulances for transportation from their home island to one that can provide emergency specialty services. For one of my patients, an air ambulance was a life-or-death necessity but deemed “out of network” by their insurance. Weeks later, the family received a balance bill for more than $25,000. They were forced to file bankruptcy and then enroll in Medicaid to cover subsequent health care costs — all with an insurance card in their wallet.
If this hasn’t happened to you, it’s just a matter of time. Over 40% of privately insured patients face surprise medical bills after visiting emergency rooms or getting admitted to hospitals. These bills punch a major hole in most family budgets: The average surprise hospital bill is $628 for emergency care and $2,040 for inpatient admission. That’s on top of the more than $20,000 families pay in premiums and deductibles each year just for the insurance policy.
If faced with a surprise $500 medical bill, half of Americans would either have to borrow money, go into debt or wouldn’t be able to pay it at all. Medical bills are a key contributor in two-thirds of personal bankruptcies, and yet the vast majority of households filing for medical bankruptcy have insurance.
Medicare for All is the only solution-Really??
What is the value of commercial insurance if it can’t protect us from financial ruin?
Lawmakers are considering a number of policies that would prohibit balance billing, cap the amount patients pay at out-of-network facilities and implement baseball-style arbitration when providers and insurance companies can’t agree on a payment. But surprise bills are not the real problem — they are merely one symptom of a dysfunctional system based on private insurance. And insurance companies only turn a profit by restricting patient choice, denying claims and passing costs onto enrollees.
The only policy that can end this scourge for good is single-payer Medicare for All, which would cover everyone in the nation for all medically necessary care. Medicare for All would eliminate out-of-network bills, because every doctor and hospital would be covered. Patients would never see a medical bill again, because Medicare for All would pay doctors and hospitals directly, with no deductibles, co-pays or insurance paperwork to get in the way.
Right now the current Medicare system is covering the costs of coronavirus testing, protecting patients just as it was designed to do. This health emergency is another argument for expanding such protections to all Americans.
Working in various hospitals across the country, I have met so many patients who delay or avoid needed care for fear of surprise bills and financial catastrophe. That’s risky for them and, in the face of a threat like coronavirus, for all of us. It doesn’t have to be this way. As a doctor, I prescribe Medicare for All.
We are forgetting the huge cost of Medicare for All and the ineffectiveness and short comings of Medicare for All , which I have attempted to point out these last few weeks. Doesn’t any one read my posts?
America’s Health System Will Likely Make the Coronavirus Outbreak Worse
Abigail Abrams noted that as government officials race to limit the spread of the new coronavirus, fundamental elements of the U.S. health care system—deductibles, networks, and a complicated insurance bureaucracy—that already make it tough for many Americans to afford medical care under normal conditions will likely make the outbreak worse.
More than 140 cases of the coronavirus have been confirmed in the United States so far, according to a Johns Hopkins University tracker. But as the CDC makes the test for the virus more widely available, the structure of the U.S. health care system is complicating the response.
For one, people must actually choose to get tested—a potentially expensive prospect for millions of Americans. While the government will cover the cost of testing for Medicaid and Medicare patients, and for tests administered at federal, state and local public health labs, it’s unclear how much patients will be charged for testing at academic or commercial facilities, or whether those facilities must be in patients’ insurance networks. Just recently, a Miami man received a $3,270.75 bill after going to the hospital feeling sick following a work trip to China. (He tested positive for the seasonal flu, so did not have the new coronavirus, and was sent home to recover.)
Those who test positive for COVID-19 possibly face an even more financially harrowing path forward. Seeking out appropriate medical care or submitting to quarantines—critical in preventing the virus from spreading further—both come with potentially astronomical price tags in the U.S. Last month, a Pennsylvania man received $3,918 in bills after being released from a mandatory U.S. government quarantine after he and his daughter were evacuated from China. (Both the Miami and Pennsylvania patients saw their bills decrease after journalists reported on them, but they still owe thousands.)
More than 27 million Americans currently do not have health insurance of any kind, and even more are underinsured. But those who do have adequate health insurance are hardly out of the woods. Many current health plans feature massive deductibles—the amount you have to spend each year before your insurance kicks in. In 2019, 82% of workers with health insurance through their employer had an annual deductible, up from 63% a decade ago, according to a report from the Kaiser Family Foundation. The average deductible for a single person with employer insurance has increased 162% in that time, from $533 in 2009 to $1,396 last year.
More than one quarter of employees, and nearly half of those at small companies, have an annual deductible of at least $2,000. Those who are covered by Obamacare marketplace plans face an even bigger hurdle: the average deductible for an individual bronze plan last year was $5,861, according to Health Pocket, a site that helps consumers shop for health insurance.
For many Americans, paying down an unexpected bill of that size is almost unthinkable. Nearly 40% of U.S. adults say they wouldn’t be able to cover a $400 emergency with cash, savings or a credit card they could easily pay off, according to the Federal Reserve.
Research has shown that even in non-outbreak situations, high deductibles lead people to reduce their spending on health care and delay treatment or prescription drugs, which can pose particularly tough problems for patients with chronic illness or diseases that need early detection. The timing of the new coronavirus at the beginning of the year makes the outlook even worse: because most deductibles reset each January, millions of Americans will be paying thousands out of pocket before their insurance companies pay a cent.
“Most likely most people haven’t started paying down their deductible,” explains Adrianna McIntyre, a health policy researcher at Harvard. “For care they seek, unless it’s covered as zero dollar coverage before the deductible, they could be on the hook for the full cost of their visit, the diagnostic testing and other costs related to seeking care or diagnosis of coronavirus.”
Half of Americans report that they or a family member have put off care in the past because they couldn’t afford it. Others have gone without care because they couldn’t find an in-network provider, or couldn’t determine how much care would cost in advance, so decided not to risk seeking medical attention.
“When patients try to go to a doctor or hospital, they often don’t know how much it’s going to cost, so they get a bill that’s way more than expected,” says Christopher Whaley, a health economist at the RAND Corporation. “On a normal basis, that’s chaotic and challenging for patients. But when you add on top this situation where you have a potential pandemic, then that’s even worse.”
In the face of that kind of uncertainty, many patients may simply decide not to go to the doctor, he added, which is “exactly the opposite of what we want to happen in this type of situation.”
Public health experts and Democrats have also criticized the Trump administration’s decision to allow people to sidestep the Affordable Care Act’s rules and buy limited, short-term health insurance coverage. Such “junk plans,” said Senator Patty Murray, speaking at a Senate Health, Education, Labor and Pensions Committee hearing on Wednesday, are not required to cover diagnostic tests or vaccines.
The Trump administration’s embrace of such barebones plans “makes it much harder for people to get the care they need to keep this crisis under control,” she said. A large group of health, law and other experts also released a letter this week urging policymakers to “ensure comprehensive and affordable access to testing, including for the uninsured.”
Insurance industry trade group America’s Health Insurance Plans issued guidance on the coronavirus last week, but it did not recommend that insurance companies eliminate out-of-pocket costs related to the virus. It said insurers would be working with the CDC and “carefully monitoring the situation” to determine “whether policy changes are needed to ensure that people get essential care.”
New York Governor Andrew Cuomo issued a directive on Monday requiring New York health insurers to waive cost sharing for testing of the coronavirus, including emergency room, urgent care and office visits. This could help New Yorkers who receive coverage through Medicaid and other state-regulated plans, but it won’t apply to the majority of employer-based health insurance, which is regulated by the federal government. Other states have similar limitations on the insurance plans they can regulate, according to McIntyre.
The federal government, on the other hand, could step in. The Trump Administration is considering using a national disaster recovery program to reimburse hospitals and doctors for treating uninsured COVID-19 patients. And even Republicans, who have traditionally opposed health care paid for by the government, are warming to the idea. “You can look at it as socialized medicine,” Florida Rep. Ted Yoho, who has vocally opposed the Affordable Care Act, told HuffPost this week. “But in the face of an outbreak, a pandemic, what’s your options?”
But even if the federal government takes steps to eliminate deductibles or other cost-sharing related to the coronavirus, experts say that Americans should brace themselves for long wait times to see providers, or for having to see doctors who are out-of-network, due to the limited capacity of providers and hospitals.
Those who don’t need to be treated at a hospital may still be impacted. The CDC has recommended that people maintain a supply of necessary medications in case they are quarantined, for example. But many insurance companies do not allow patients to refill prescriptions until they are almost out. The CDC also recommends that people to stay home from work if they experience symptoms of respiratory illness, but a lack of federally mandated sick leave makes it impossible for many workers to afford to take time off.
These consequences of the country’s fragmented health care system become more visible in times of stress, says Whaley. “In a pandemic type situation, that’s harmful both for patients,” he says, “and also for the members of society.
”Coronavirus: US ‘past the point of containment’ in battle to stop outbreak spreading
Tim Wyatt reported that America is “past the point of containment” in its battle against the coronavirus, senior health officials have admitted.
There are now more than 550 confirmed cases of the virus in the United States and at least 22 deaths linked to the outbreak.
Now, the government’s strategy had to change from trying to hold the virus at bay to actively seeking to minimise its impact and slow its spread, experts said.
Speaking on US television, the former commissioner of the Food and Drug Administration Dr Scott Gottlieb, said everything had changed.
“We’re past the point of containment. We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country.
“We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty.”
A similar message came from the Surgeon General Jerome Adams who warned it was time to consider cancelling large gatherings, including sporting events, and closing schools.
Each community might take a different approach to mitigating Covid-19, but inaction was not longer an option he cautioned while speaking to CNN. “Communities need to have that conversation and prepare for more cases so we can prevent more deaths,” he said.
Those in the most at-risk groups, including the elderly or unwell, should refrain from spending time in confined spaces with large numbers of the public, Dr Adams added.“Average age of death for people from coronavirus is 80. Average age of people who need medical attention is age 60. “We want people who are older, people who have medical conditions, to take steps to protect themselves, including avoiding crowded spaces, including thinking very carefully about whether or not now is the time to get on that cruise ship, whether now is the time to take that long haul flight,” he said.
Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, echoed this advice. “If you are an elderly person with an underlying condition, if you get infected, the risk of getting into trouble is considerable,” he told NBC.“So it’s our responsibility to protect the vulnerable. When I say protect, I mean right now. Not wait until things get worse. Say no large crowds, no long trips. And above all, don’t get on a cruise ship.”
A swathe of conferences, including many tech-focused events in California, have already been cancelled over fears flying in thousands of delegates from across the country and world would exacerbate the spread of Covid-19. Some schools in the US are already closing, with major sporting events such as the Indian Wells tennis tournament being cancelled.
The comments from senior Trump administration health officials marks a shift from an earlier tone of calm. Several people, including the president, had sought to downplay fears about the coronavirus, insisting it probably would not turn into a full-blown epidemic in America.
Dr Fauci even suggested limited lockdowns could be imposed on regions or towns where a serious outbreak occurs, saying the government was ready to take “whatever action is appropriate” to try and mitigate the crisis.’We’re gearing up for something extremely significant’:
Top hospitals across the US told us how they’re preparing for the coronavirus outbreak
Lydia Ramsey and Zachary Tracer reviewed the U.S. hospitals preparation for this pandemic. Hospitals around the US are preparing for the novel coronavirus outbreak, which has sickened more than 200 people in the US and 100,000 worldwide.
They want to make sure workers and equipment are ready to go in the event of a worst-case scenario. “We’ve not yet seen an epidemic or pandemic in our lifetimes of this size and scope,” said Becca Bartles, the executive director of infectious disease prevention at Providence St. Joseph Health System. “We’re gearing up for something extremely significant.”
When the first case of novel coronavirus showed up in the US in January, Becca Bartles was ready for it.
As the executive director of infectious disease prevention at Providence St. Joseph Health System, she had been preparing for years. Bartles helps prepare Providence, which runs 51 hospitals across the West Coast, for potential outbreaks by keeping an eye out for new pathogens that could hit the communities the health system serves.
“We’ve not yet seen an epidemic or pandemic in our lifetimes of this size and scope,” Bartles said. “We’re gearing up for something extremely significant.”
Hospitals and healthcare workers are already starting to feel the effects of the coronavirus outbreak as it hits communities around the US. The US has reported more than 200 cases of the novel coronavirus, which causes the disease known as COVID-19. More than 100,000 people have come down the virus worldwide, mainly in China.
And they’re preparing for the outbreak to get worse. Some of the hospitals Bartles works with are in the Seattle area and are already treating coronavirus patients. She said the virus is positioned to be the biggest outbreaks we’ve seen in recent US history.
‘It will stretch our capacity to provide healthcare overall in the US’
“I don’t think we can appreciate, based on what we’ve seen in our lifetimes, how big that’s going to be,” Bartles said. “That does cause me significant concern.” “It will stretch our capacity to provide healthcare overall in the US,” she added.
According to the US Centers for Disease Control and Prevention, reported symptoms related to the novel coronavirus include fever, cough, and shortness of breath, appearing within 14 days of exposure to the virus.
In a presentation hosted by the American Hospital Association, which represents thousands of hospitals and health systems, one expert projected there could be as many as 96 million cases in the US, 4.8 million hospitalizations, and 480,000 deaths associated with the novel coronavirus. The American Hospital Association said the webinar reflects the views of the experts who spoke on it, not its own.
Preparing for the worst
Health systems like Providence perform drills and trainings in anticipation of outbreaks like the novel coronavirus. The goal is to make sure employees, especially those working in the emergency department or who might care for critically ill patients, are trained correctly and have the right protective equipment.
And they’re ramping those up now. In Philadelphia, Jefferson Health has been conducting extra protective-equipment trainings, focused on intensive care unit clinicians who might treat people with the coronavirus.
The 14-hospital system also started a coronavirus task force this week and is readying its outbreak plans. The idea is to prepare for a worst-case scenario.
“We’re saying, look, let’s plan as if there’s going to be a lot of cases, it’s going to be overwhelming to our hospital,” said Dr. Edward Jasper, an emergency medicine physician who leads the task force. “We don’t think that’s going to happen. And then whatever else comes, it’s going to be nothing compared to that. So we’re prepared.”
For now, Jasper said he’s not expecting the worst. “We watch it so closely and right now it’s not triggering keeping me awake at night,” he said.
At Providence, Bartles said leaders within the organization are now meeting multiple times a day to discuss issues like making sure the hospitals have enough supplies on hand, especially protective equipment for those working in emergency departments.
The goal of the meetings is also to inform other hospitals across Providence’s network of what’s going on in Washington, which has been hit hard with the virus.
How the largest health system in New York is preparing
The senior leadership at New York’s Northwell Health System, which operates 23 hospitals, has been meeting continuously for the last several weeks, chief quality officer Dr. Mark Jarrett told Business Insider. The discussions cover what happens if one individual comes in with symptoms all the way to a pandemic.
Northwell’s relying on some of the preparation it did in advance of the SARS epidemic in 2003, and its response to the H1N1, or Swine Flu pandemic in 2009. But, Jarrett said, the hospital has changed a lot since then. Northwell, New York’s largest health system by revenue and the state’s largest private employer, has been steadily moving more of its services outside the four walls of a hospital.
That means the health system will have to account for patients showing up for care in places other than the main hospital in a community — places like urgent care centers and primary care clinics.
Readying hospitals for a surge of patients
Should the outbreak intensify, hospitals are grappling with how to prepare for the surge in coronavirus patients while also keeping other patients safe. At first, hospitals will isolate patients with the coronavirus, but if lots of patients come down with the virus, hospitals will probably put them in rooms together, said Kelly Zabriskie, Jefferson’s director of infection prevention.
Dr. Kathleen Jordan, a vice president at CommonSpirit Health, a 142-hospital health system and chief medical officer at the system’s Saint Francis Memorial Hospital, told Business Insider that the health system is having conversations about what might happen if they’re confronted with an influx of patients.
That might include setting up tents, building out larger emergency rooms or adding more beds for patients who need to stay at the hospital. For now, the health system has a few cases of the novel coronavirus under investigation. Eventually, hospitals might have to consider reducing or pausing elective procedures to make room for the surge in patients, Northwell’s Jarrett said. Hospitals are also thinking about staff being out, either due to the virus itself, or in the event that they have to care for their family.
Northwell on Tuesday told its employees that it’s restricting travel for business both internationally and domestically through the end of March. That’s a move other hospitals are making as well. “These updated travel guidelines are designed to help us remain in good physical health so we can most effectively care for the patients and families we serve,” Northwell said in an email to employees.
But you shouldn’t rush to the emergency room if you start having flu symptoms. Bartles said the plan is to focus on following CDC recommendations. As the virus continues to spread in communities, it will be harder to distinguish what might be flu from coronavirus.
Jan Emerson-Shea, a spokeswoman for the California Hospital Association, said hospitals are encouraging patients to call ahead or use an online doctor visit, rather than show up to an emergency room with potential coronavirus. That can help prevent them from infecting others, and let hospitals focus their resources on the most serious cases.
And lastly, few have mentioned that in China they are already taking down some of the temporary housing for the quarantined patients as the infection rate decreases. Important to note as we prepare for the worst!
And next week we should discuss the economic issues resulting from the pandemic!
This is a lengthy post but with all the fear regarding COVID-19 I thought that it would be worth the time. I became more aware as we traveled to the West Coast for a half marathon at Napa Valley. There were many people on our planes wearing masks and my wife was so worried about our planned trip to Europe in April. The cruise companies now our offering to either give one hundred percent refund or hold the paid fees for 2 years to allow rescheduling of the cruises. Can you imagine what the Corona Virus scare is doing to economies around the world>
Sarah Midkiff reported that as the deadly coronavirus outbreak approaches pandemic status, the U.S. government remains in the midst of approving legislation for a $7.5 billion emergency spending bill. Meanwhile, coronavirus continues its spread in the U.S. — with 100 confirmed cases and six deaths across 15 states — so the need for these funds is more imperative than ever. The emergency bill will allocate money to the Department of Health and Human Services for vaccine development, protective and medical equipment, and aid for state and local governments affected by an outbreak, according to the Washington Post.
But, what legislators have yet to mention is whether subsidizing treatment or funding low-cost and free clinics will be part of the plan. The bill may address availability of vaccine development, but it does not directly address affordability of testing or treatment, which is of the utmost importance during a pandemic.
A report published by America’s Health Insurance Plans (AHIP) on Thursday stated that the Centers for Disease Control and Prevention (CDC) is currently the only facility equipped to test for COVID-19. The CDC is not billing for testing, but the test itself isn’t the only line item on a possible medical bill. There is the cost of the doctor’s visit; other tests they might run in conjunction with COVID-19, such as standard flu tests; treatment and medication, as well as getting the vaccine when it becomes available. And, medical bills can grow astronomically high if someone requires in-patient care, like an overnight stay in the hospital.
Stories have already begun to emerge of Americans seeking testing only to find that their insurance was insufficient to the tune of thousands of dollars in medical bills. One such example is a man in Florida who faces a $3,270 medical bill after he went through his insurance when he was concerned he might have been exposed to coronavirus. He was confirmed negative for COVID-19 after testing positive for the flu via a standard flu test rather than the more expensive CT scan which has been proven to be the most consistent test in diagnosing coronavirus.
Others have undergone government-mandated treatment and found that, despite the procedure being required, they were the ones left to foot bills that totaled thousands of dollars. Experiences like this make it easy to see why a 2018 national poll conducted by West Institute and NORC at the University of Chicago found that 44% of Americans declined to see a doctor due to cost.
Notably, the U.S. is alone among other developed countries as the only one that doesn’t offer federally mandated paid sick leave. This makes it particularly difficult to follow the CDC’s current advice that people experiencing even mild respiratory symptoms should stay home, other than when getting medical care. Between a lack of mandated paid sick leave and approximately 27 million Americans currently without health insurance, the coronavirus outbreak is at risk of exhausting our already failing public health system.
Even among people with health insurance, 29% are underinsured, according to results from a 2018 Commonwealth’s Fund survey, meaning that even though they technically have an insurance plan, the copays and deductibles make seeking care unaffordable in relation to their income. Cases of the virus could go undetected and untreated simply because Americans cannot afford to be saddled with medical debt or go without pay to take sick leave (or both), thus encouraging a rapid spread of the virus as people attempt to “power through” in spite of symptoms.
And then there are the approximately 11 million undocumented U.S. residents: Many of these people are un- or under-insured, and also have to grapple with the justified fear of coming into contact with federal authorities, therefore preventing them from seeking medical care.
If further evidence is needed that our health care system has been crippled by privatization, government officials are not debating whether or not pharmaceutical companies should be allowed to profit from a vaccine, but are just figuring out by how much. Last week, the Department of Health and Human Service secretary, Alex Azar, would not commit to price controls on a coronavirus vaccine. “We need the private sector to invest… price controls won’t get us there,” said Azar.
House Speaker Nancy Pelosi responded directly to Azar’s comments. “This would be a vaccine that is developed with taxpayer dollars…We think that should be available to everyone—not dependent on ‘Big Pharma,’” she said in a press release on February 27. She described the vaccine as needing to be “affordable,” but what does that even mean? What is affordable to some is not affordable to all.
Still, a vaccine – affordable or not – is a ways off. In a coronavirus task force briefing with Donald Trump on Monday, experts estimated that it would take a year to a year-and-a-half before a vaccine would be effective and safe for the public, reports CNN. Until then, the economic inequality that runs rampant in America is bound to be reflected in who can afford to survive this epidemic, and who can’t.
US may pay for uninsured coronavirus patients
Washington (AFP) – The US may invoke an emergency law to pay for uninsured patients who get infected with the new coronavirus, a senior health official said Tuesday.
Public health experts have warned that the country’s 27.5 million people who lack health coverage may be reluctant to seek treatment, placing themselves at greater risk and fueling the spread of the disease.
Robert Kadlec, a senior official with the Health and Human Services department told the Senate on Tuesday that talks were underway to declare a disaster under the Stafford Act, which would allow the patients’ costs to be met by the federal government.
Under this law, their health care providers would be reimbursed at 110 percent of the rate for Medicaid, a government insurance program for people with low income, he added.
“We’re in conversations, initial conversations with CMS (Centers for Medicare & Medicaid Services) to understand if that could be utilized in that way and be really impactful,” Kadlec told a Senate committee.
President Donald Trump also touched on the issue as he headed to a briefing on the coronavirus outbreak at the National Institutes of Health in Washington on Tuesday.
“We’re looking at that whole situation. There are many people without insurance,” Trump told reporters.
The number of Americans without health insurance began falling from a high of 46.5 million in 2010 following the passage of Obamacare (the Affordable Care Act).
It climbed again to 27.5 million in 2018, or 8.5 percent of the population, from 25.6 million the year before.
The reasons include policies by Trump’s administration that made it harder to enroll in Medicaid — such as adding requirements to work — or to sign up for insurance under the marketplaces created by Obamacare.
The Republican-held Congress also repealed a penalty on people who lack insurance, which may have led people to voluntarily drop out.
The Centers for Disease Control and Prevention (CDC) has said patients who are advised by their health care providers to stay at home should do so for at least two weeks, but a work culture that emphasizes powering through while sick could compound the problem further.
The US is alone among advanced countries in not offering any federally mandated paid sick leave. While some states have passed their own laws, 25 percent of American workers lacking any whatsoever, according to official data.
Maia Majumder, an epidemiologist at Harvard, told AFP she was particularly concerned by low-wage workers in the service and hospitality sector, who cannot afford to take time off but could act as vectors to transmit the spread of the disease.
The latest coronavirus death rate is 3.4% — higher than earlier figures. Older patients face the highest risk.
The global death rate for the novel coronavirus based on the latest figures is 3.4% — higher than earlier figures of about 2%.
In contrast, the seasonal flu kills 0.1% of those infected.
A patient’s risk of death from COVID-19 varies depending on age and preexisting health conditions.
Though the latest numbers mark an increase in mortality, experts have predicted that the fatality rate of COVID-19 could decrease as the number of confirmed cases rises.
The latest global death rate for the novel coronavirus is 3.4% — higher than earlier figures of about 2%.
The coronavirus outbreak that originated in Wuhan, China, has killed more than 3,100 people and infected nearly 93,000 as of Tuesday. The virus causes a disease known as COVID-19.
Speaking at a media briefing, the World Health Organization’s director-general, Tedros Adhanom Ghebreyesus, noted that the death rate was far higher than that of the seasonal flu, which kills about 0.1% of those infected.
The death rate is likely to change further as more cases are confirmed, though experts predict that the percentage of deaths will decrease in the longer term since milder cases of COVID-19 are probably going undiagnosed.
“There’s another whole cohort that is either asymptomatic or minimally symptomatic,” Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases, said at a briefing last month. “We’re going to see a diminution in the overall death rate.”
‘It is a unique virus with unique characteristics’
Tedros noted differences between the novel coronavirus and other infectious diseases like MERS, SARS, and influenza. He said the data suggested that COVID-19 did not transmit as efficiently as the flu, which can be transmitted widely by people who are infected but not yet showing symptoms.
He added, however, that COVID-19 caused a “more severe disease” than the seasonal flu and explained that while people around the world may have built up an immunity to the flu over time, the newness of the COVID-19 meant no one yet had immunity and more people were susceptible to infection.
“It is a unique virus with unique characteristics,” he said.
Tedros said last week that the mortality rate of the disease could differ too based on the place where a patient receives a diagnosis and is treated. He added that people with mild cases of the disease recovered in about two weeks but severe cases may take three to six weeks to recover.
Older patients face the highest risk
A patient’s risk of dying from COVID-19 varies based on several factors, including where they are treated, their age, and any preexisting health conditions.
COVID-19 cases have been reported in at least 76 countries, with a vast majority in China.
A study conducted last month from the Chinese Center for Disease Control and Prevention showed that the virus most seriously affected older people with preexisting health problems. The data suggests a person’s chances of dying from the disease increase with age.
Notably, the research showed that patients ages 10 to 19 had the same chance of dying from COVID-19 as patients in their 20s and 30s, but the disease appeared to be much more fatal in people ages 50 and over.
About 80% of COVID-19 cases are mild, the research showed, and experts think many mild cases haven’t been reported because some people aren’t going to the doctor or hospitals for treatment.
CDC reports 108 cases of coronavirus, including presumed infections; 4 more deaths
The Centers for Disease Control and Prevention (CDC) on Tuesday confirmed 17 new cases of the coronavirus and four more deaths due to the outbreak, bringing the total number of U.S. cases to 108, including among repatriated citizens.
Coronavirus is making some Republicans reconsider the merits of free health care
Tim O’Donnell reported that the Coronavirus has a lot of people re-thinking things. That apparently includes Republicans and government-funded health care.
With the possibility of an outbreak of the respiratory virus in the United States looming, the government is still trying to piece together its response. And it sounds like free testing could be on the table. Rep. Ted Yoho (R-Fla.), at least, thinks it’s really the only option. Yoho is normally known for opposing the Affordable Care Act, and certainly doesn’t seem likely to advocate for Medicare-for-All anytime soon. But he’s willing to blur the lines when an unforeseen circumstance like coronavirus comes to town and is even ok if you want call it “socialized medicine.”
Truly stunning to hear some Republicans advocate for free Coronavirus testing and treatment for the uninsured.
Rep. Ted Yoho (R-Fla.), one of the most anti-ACA members:
“You can look at it as socialized medicine, but in the face of an outbreak, a pandemic, what’s your options?”
The Trump administration, meanwhile, is contemplating funding doctors and hospitals so they can care for people who don’t have insurance should they become infected with the virus, a person familiar with the conversation told The Wall Street Journal. Read more at The Wall Street Journal.
The Coronavirus Outbreak Could Finally Make Telemedicine Mainstream in the U.S.
Time’s reporter, Jamie Ducharme noted that for years, telemedicine has been pitched as a way to democratize medicine by driving down costs, increasing access to care and making appointments more efficient. It sounds great—until you look at the data, and find that only about 10% of Americans have actually used telemedicine to make a virtual visit, according to one 2019 survey.
An outbreak of the novel coronavirus COVID-19 could change that. If extreme measures like mass quarantines come to pass, telehealth could finally have its bittersweet moment in the spotlight, potentially generating momentum that proponents hope will continue once life returns to normal.
“Something like having to stay home could springboard telehealth tremendously, because when we get over this—and we will—people will have had that experience, and they’ll be saying, ‘Well, why can’t I do other aspects of my health care that way?’” says Dr. Joe Kvedar, president-elect of the American Telemedicine Association (ATA).
As of March 3, more than 92,000 people worldwide have been sickened by the virus that causes COVID-19, including more than 100 in the U.S. As both numbers trend upward, the U.S. Centers for Disease Control and Prevention (CDC) has warned that increased person-to-person spread in U.S. communities is likely, and that containment measures may become increasingly disruptive to daily life. If the situation reaches the point where public health officials are encouraging or requiring people to stay home, the health care system may have to offer many medical appointments via telehealth services, the CDC’s Dr. Nancy Messonnier said during a Feb. 26 press briefing.
Kvedar says telehealth tools offered by health plans, private companies and pharmacies are ready and waiting for that possibility. There are some limitations to telehealth’s utility for COVID-19 testing—you can’t take a chest x-ray or collect a sample for lab testing remotely, after all—but Kvedar says it could be used for initial symptom assessment and questioning, as well as non-virus-related appointments that couldn’t happen in person due to precautions. If a patient turned up at an emergency room with possible COVID-19 symptoms, doctors could also do initial intake via virtual platforms, while keeping the patient in isolation to minimize spread within the vulnerable health care environment, he says.
Telehealth giants like Amwell and Teladoc are now advertising their availability for coronavirus-related appointments, and Teladoc’s stock prices spiked in late February. XRHealth, a company that makes health-focused virtual reality applications, is this week providing Israel’s Sheba Medical Center with VR headsets that will both allow doctors to monitor COVID-19 patients remotely, and enable quarantined patients to “travel” beyond their rooms using VR, says XRHealth CEO Eran Orr. The company will next week begin working with hospitals to deploy the technology in the U.S., Orr says.
All of these solutions seem logical. But in practice, there’s a “thicket of state laws and regulations that make telemedicine very complex…to implement broadly,” says Dr. Michael Barnett, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health. Insurers—especially Medicare—don’t always cover telehealth visits, and, since medical licenses are state-specific, there could be legal issues if a doctor is located in a different state than the patient they’re treating, Barnett says. Drug prescription and privacy laws can also complicate regulation, according to the American Hospital Association.
These regulatory issues, as well as a lack of patient awareness, have kept telehealth from being as widely adopted as it could be, Barnett says. COVID-19 could be “a good use case” for telemedicine, he says, but it will partially depend on lawmakers’ willingness to relax, or at least streamline, regulation.
The wheels are already in motion. On Feb. 28, telehealth groups including the ATA, the Personal Connected Health Alliance and the eHealth Initiative sent a letter to Congressional leaders, urging them to expand access to telehealth and to grant the Department of Health and Human Services the power to let Medicare cover telemedicine appointments during emergency situations. On March 3, Arizona Rep. Ruben Gallego announced he was introducing a bill that would allow Medicaid to cover all COVID-19-related charges, including virtual appointments.
That’s a good step, but Julia Adler-Milstein, director of the University of California, San Francisco’s Center for Clinical Informatics and Improvement Research, says there are still logistical challenges.
She says larger health systems that have invested heavily in telehealth, like Kaiser Permanente, have seen benefits from it, but providers with a less built-out infrastructure will have to grapple in real-time with questions like, “How do we know which patients are well-suited to telehealth?” and “How do we get their information into the doctor’s hands?” These issues are especially salient for patients with complex medical histories, who may have choose between seeing their regular doctor in person, potentially risking infection, or seeing a doctor virtually who does not have access to their medical records, she says.
Kvedar acknowledges that widespread adoption of telehealth during the COVID-19 outbreak may require some goodwill on the part of companies and doctors. Companies like CVS and Walgreens could waive fees for the use of their telemedicine services during the crisis, Kvedar suggests, or doctors could offer to see patients virtually for free for a few hours a week. “People pull together for all sorts of things,” he says.
Barnett is less optimistic that providers can seamlessly overcome regulations, but says patients and doctors will find a way through the outbreak with or without telemedicine, even if it means conducting many appointments over the old-fashioned telephone. “We have more pressing needs in this epidemic,” he says, “than telehealth availability.”
15 Italian tourists test positive for Covid-19, India springs into battle mode
Niharika Sharma reported that fifteen Italian tourists in India have been reportedly tested positive for the dreaded coronavirus, perhaps finally bringing home the full scale of the seriousness of the global health crisis to the country.
This is besides the six others who have been diagnosed with Covid-19 across the country, prompting India to take massive preventive measures.
The Italian tourists have been quarantined at a camp of the paramilitary, Indo-Tibetan Police Force, media reports said.
Fear and anxiety gripped India’s national capital region (NCR) after a 45-year-old man was diagnosed with the novel coronavirus infection in the city yesterday (March 3). This prompted authorities to step up the vigil.
Over 40 people in Delhi NCR, who came in contact with the patient, are under surveillance. Another 13 people have been screened in Uttar Pradesh’s Agra where he visited his family.
The man who self-reported at Delhi’s Ram Manohar Lohia Hospital had organised his son’s birthday party at Hyatt Regency on Feb. 28. The five-star hotel has asked staffers, who were on duty that day, to stay at home. “The hotel has also started to conduct daily temperature checks for all colleagues and contractors when they enter and exit the building,” the hotel said in a statement yesterday (March 3).
The school in Noida where the infected man’s son attended classes has been shut for the rest of the week, and five students are being screened.
Besides the Delhi man, an Italian tourist, and a person in Hyderabad, who travelled from Dubai to Bengaluru on Feb. 20 on an IndiGo flight, have also tested positive for the virus. ”We’re following all prescribed Airport Health Organisation guidelines,” IndiGo said in a statement yesterday. The airline has asked its four cabin crew who were on the aircraft to stay at home.
Authorities appear to be working overtime to track the footprints of all the patients and screen everyone who came in contact with them. “Our officers even visit the homes individually, taking necessary precautions, to check listed people for symptoms,” an official of the Integrated Disease Surveillance Programme (IDSP) under the health ministry told Hindustan Times on condition of anonymity. “For asymptomatic people, home quarantine for a stipulated period of time is good enough, but those who develop symptoms are moved to a hospital as per protocol.”
But the process could be tedious as the 69-year-old Italian tourist, who was tested positive in Jaipur on March 3,had travelled to six districts in India before arriving at Rajasthan. He and his wife, who has also tested positive, were part of a 21-member group, which landed in Delhi on Feb. 21. The rest of the group is in Agra, according to a Hindustan Times report.
The health ministry has now issued a travel advisory, suspending all regular visas/e-visas granted on or before March 3 to nationals of Italy, Iran, South Korea, and Japan, who have not yet entered India. The advisory also suspends visa on arrival issued until March 3 to Japanese and South Korean nationals who have not yet entered India.
The government has also made it mandatory for passengers entering India from other countries affected by coronavirus to fill forms with personal details and travel history to the health and immigration officials at 21 airports across the country and 12 major and 65 minor seaports.
Aviation watchdog Directorate General of Civil Aviation has also asked carriers to ensure that adequate protective gears like surgical masks and gloves are available in flight for passengers.
In Delhi, the Kejriwal government has reserved 230 beds in isolation wards at 25 hospitals and also sent advisories to schools mentioning precautions to tackle the situation.
On March 3, the information ministry asked all private radio and TV channels to give “adequate publicity” to the travel advisory issued by the health ministry in the wake of the coronavirus outbreak.
The health ministry has also launched a series of TV commercials as part of its awareness program against the outbreak.
Here’s what you must keep in mind:
In addition, the Narendra Modi government has asked the army, the navy and the air force to prepared quarantine facilities for over 2,500 in coming days, as per the sources quoted by various media reports.
Several events, where foreign delegates were expected to participate, have been cancelled or postponed.
The Indian Navy called off a multilateral naval exercise that was scheduled from March 18 in Visakhapatnam due to coronavirus. Around 30 countries were expected to take part in the event.
On March 3, Chinese smartphone maker Xiaomi said it is cancelling all upcoming on-ground launch events in India to reduce exposure risk in the wake of Covid-19.
Italy could have more than 100,000 coronavirus cases, expert warns
Reporter Will Taylor of the Yahoo News noted that Italy could have more than 100,000 cases of coronavirus, an expert has revealed.
Professor Neil Ferguson, of Imperial College London’s faculty of medicine, said he estimates there are “at least” 50,000 to 100,000 cases of the virus in the country, which is one of the worst affected by the virus.
Italy has 2,500 confirmed cases and has suffered 79 deaths.
Prof Ferguson told the BBC’s Today programme that he expects to see measures to tackle the virus rolled out in a matter of days.
“[Italy has] I think it’s over 50 deaths now,” he said, “so those people were probably infected three weeks ago, and for every person who dies we think there might be 100, maybe even 200 people infected.
“The lethality of this virus is not completely determined but it’s in that order… so the epidemic is probably doubling every week or so in Italy, so when you put those numbers together, we’d estimate somewhere between 50,000 and 100,000 cases at the moment in Italy.
“At least, it could even be higher, cases may still be being missed even in severe cases.”
He said the UK is “several weeks” behind Italy and is in an earlier stage of an epidemic.
Authorities will be looking to slow the spread of the virus to try to relieve pressure on health systems and the UK government yesterday announced measures to tackle the virus.
Prof Ferguson said screening air passengers is imperfect and pointed out that Spanish flu spread around the world in the days before commercial air travel.
His figures mean the total number of Italy’s cases could outstrip the total number confirmed worldwide. Just over 93,000 have been reported globally as of Wednesday morning.
After mainland China – where the virus originated – South Korea is the next worst hit with 5,328 confirmed cases and 28 deaths.
Iran reports 77 deaths from its 2,300 officially reported cases.
A Coronavirus Guide for Older Adults (And Their Family Advocates)
Jeffrey Kluger noted that it’s hard enough getting old, what with all of the creeping ailments—diabetes, COPD, dementia, heart disease—that come along with age. Now add a novel coronavirus to the mix. There are more than 91,000 COVID-19 cases and 3,100 deaths as of writing, but the virus doesn’t hit all demographics equally hard—and seniors are the most vulnerable.
A late February study in the Journal of the American Medical Association showed that children 10 and under accounted for just 1% of all COVID-19 cases, for example, while adults in the 30-79 age groups represented a whopping 87%. The World Health Organization (WHO) found something similar in China, with 78% of patients falling between the ages of 30 and 69.
The older you get, the likelier you are not only to contract a SARS-CoV-2 infection (the virus that causes COVID-19), but to suffer a severe or fatal case. One study out of China found that the average age of COVID-19 patients who developed acute respiratory distress syndrome—a severe shortness of breath often caused by fluid in the lungs and requiring a ventilator—is 61. As early as January, Chinese health authorities were already reporting that the median age range for people who died of the disease was 75.
“Older people are more likely to be infected, especially older people with underlying lung disease,” says Dr. Teena Chopra, medical director of infection prevention and hospital epidemiology at Wayne State University. “For this population, mortality rates for COVID-19 are about 15%.”
In this sense, COVID-19 behaves a lot like seasonal flu. From 70% to 85% of all flu deaths and 50% to 70% of flu-related hospitalizations occur among people in the 65-plus age group, according to the United States Centers for Disease Control and Prevention (CDC). The 2002-2003 SARS outbreak similarly proved lethal for more than 50% of people over 60 who contracted the disease..
None of this is a surprise of course. With their higher risk of underlying health conditions, older people are already under physical stress, and their immune systems, even if not significantly compromised, simply do not have the same “ability to fight viruses and bacteria,” says Dr. Steven Gambert, professor of medicine and director of geriatrics at the University of Maryland School of Medicine.
What’s more, seniors’ risk of exposure to any pathogen is often higher than that of other adults. There are 48 million seniors overall in the U.S., and while only about 3% of them reside in assisted living facilities, that still factors out to more than 1.4 million already at-risk people living in communal environments in which disease can spread quickly.
“People living in long care facilities have common meetings, they share common rooms,” says Chopra. Common meetings and common rooms can too often mean common pathogens.
In the event of coronavirus infection in a residential facility, Gambert says, those living there should avoid communal rooms and even meals, and, if possible, eat in their own rooms.
Even older people living at home face communal risks, since many of them regularly visit community senior centers, which are great places for socialization and provide a means to stay active and engaged, but can serve as pathogenic petri dishes. Gambert recommends being proactive in these situations, asking the staff of the senior center if they have had any cases of coronavirus, and if so, avoid those facilities.
The health system itself may be playing a significant role in putting seniors at risk. People with multiple medical conditions typically visit multiple specialists, and every such visit means entering a health care environment that can be teeming with viruses and bacteria. For now, Chopra advises older patients to postpone doctor visits that aren’t absolutely essential, like “their annual eye visit. Dental cleaning can be avoided too.” Telemedicine—conducting doctor visits that don’t require hands-on treatment online—can be helpful too, as can e-prescribing, with drugs being delivered straight to patients, sparing them exposure to pharmacies.
Staying current on vaccines—especially flu and pneumonia—can also be critical. Patients—or their family advocates—should ask doctors if they are up to date on their vaccines, or if they need a booster, especially since vaccine formulations change and improve over time. “If you haven’t had a pneumonia vaccine now is the time to get one,” says Gambert. “Even if you have had one in the past, ask your primary care provider if you need a newer one.”
Finally, it’s important to remember that the way COVID-19 presents itself in a younger person is not always the way it presents itself in someone who’s older. “Old people may not get a fever so just checking their temperature may not reveal the infection,” says Gambert.
Instead, he says, families and seniors should be alert for “atypical presentation” of COVID-19. A fall or forgetfulness, for example, might be a sign of infection, even if other, more common symptoms aren’t in evidence. “Any reason you don’t feel the same as you usually do should not be dismissed,” Gambert says.
The coronavirus epidemic is not going away any time soon. That means continued vigilance for our own health and special vigilance for that of seniors. The people who looked after us when we were younger need the favor returned now that they are older.
AOC says that ensuring access to free coronavirus testing and treatment is ‘absolutely’ an ‘argument for Medicare for All’
According to Joseph Zeballos-Roig AOC told the Huffington Post that the government is taking steps to guarantee free coronavirus testing and medical treatment.
“What this crisis has taught us is that, our health care system and our public health are only as strong as the sickest person in this country,” she told the outlet.
Concerns are increasing that the expensive nature of American healthcare could discourage people from seeking medical treatment if they are infected with the coronavirus.
Democratic Rep. Alexandria Ocasio-Cortez said in an interview published Tuesday that ensuring free coronavirus testing and medical treatment is “absolutely” an “argument for Medicare for All.”
The New York congresswoman told the Huffington Post that if the government took steps to guarantee public access to testing and treatments by paying for it, “then what makes coronavirus different from so many other diseases, particularly ones that are transmissible?”
“What this crisis has taught us is that, our health care system and our public health are only as strong as the sickest person in this country,” she told the outlet.
Medicare for All is the signature plan of Sen. Bernie Sanders, a leading Democratic presidential candidate that Ocasio-Cortez has thrown her support behind. It would provide comprehensive health coverage and do away with deductibles, premiums, and other out-of-pocket spending. Private insurance would be eliminated as well.
As of Wednesday, the coronavirus has infected more than 94,000 people in at least 80 countries beyond China, its point of origin. The death toll from the respiratory disease it causes, COVID-19, has killed more than 3,200 people, mostly in China. There are at least 128 confirmed cases in the US.
Over the last week, concerns have mounted that the skyrocketing costs of healthcare could form a barrier discouraging people from getting tested and receiving treatment for the virus.
Business Insider recently analyzed the medical bill of a Miami resident who tested negative for the coronavirus but still racked up a $1,400 in costs, though he was insured. The majority of it came from an emergency room visit.
The Trump administration announced on Monday it was reviewing what products and services it would cover for coronavirus under Medicare and Medicaid, the two biggest federal health insurance programs.
Vice President Mike Pence said a day later the programs would insure diagnostic testing, making it free for patients. But it was not immediately clear what additional medical care would be paid for by the government.
“People who are subject to cost sharing — they are less likely to use medical care, even if they need it,” John Cogan, a health-law expert at the University of Connecticut, previously told Business Insider.
The White House is also reportedly considering reimbursing hospitals and doctors for treating uninsured coronavirus patients. In 2018, 27.5 million Americans had no health insurance, an increase from 25.2 million the year before.
The Most Common Coronavirus Symptoms to Look Out for, According to Experts Coronavirus symptoms are similar to those associated with the flu.
Unless you get a lab test, you can’t really distinguish between coronavirus COVID-19 and a typical cold or the flu. Dr. Wesley Long, Houston Methodist Director of Diagnostic Microbiology The severity of coronavirus
symptoms varies from person to person, Dr. Long notes. In more serious cases, the infection may lead to pneumonia, severe acute
respiratory syndrome, kidney failure, and even death, says Dr. Neal Shipley. Those most at risk of severe illness from coronavirus include the very young, the very old, and people with generally weakened or impaired immune systems. It’s difficult to pinpoint how long it takes
for coronavirus symptoms to appear. “The generally accepted window from exposure to onset of symptoms is 2-14 days,” says Dr. Long. To be clear, there’s still a lot that experts don’t know about COVID-19. And, you can only contract it if you’ve come into contact with someone who already has it.
So, rather than cause continual promotion of more fear we should all be prepared using good hand washing, cleaning surfaces with appropriate products, if you are sick seek assistance with your medical physician or nurse practitioner offices regarding the need to be tested, etc. The question looms out there, not if you will become sick with this virus, but when and how you care for yourself!
First some good news, which in today’s boiling kettle we all need. Cancer death rates in the United States took their sharpest drop on record between 2016 and 2017, according to an analysis by the American Cancer Society.
Richard Harris reported that the cancer death rates in the U.S. have been falling gradually for about three decades, typically about 1.5% a year. But during the latest study period, the cancer mortality rate dropped 2.2%, “the biggest single-year drop ever,” says Rebecca Siegel, scientific director for surveillance research at the cancer society.
“It seems to be driven by accelerating declines in lung cancer mortality,” Siegel says. That’s “very encouraging, because lung cancer is the leading cause of cancer death in the U.S., causing more deaths than breast, colorectal and prostate cancers combined.”
“This is unambiguously good news,” says Dr. H. Gilbert Welch, senior investigator with the Center for Surgery and Public Health, at Brigham and Women’s Hospital in Boston. He was not involved in the analysis.
What’s behind the decline? In part, smoking rates have fallen steadily, which means the biggest risk factor for lung cancer has fallen appreciably. New cancer treatments are also playing a role, Siegel says.
Advanced lung cancer, however, remains deadly. People diagnosed with lung cancer that has spread elsewhere in the body have only a 5% chance of surviving for five years. And many smokers and former smokers are not following the advice to get screened with a low-dose CT scan to catch cancer early.
In fact, a recent study found that only 4.4% of people eligible for this screening test (which under the Affordable Care Act is available at no cost) actually got screened in 2015. Nearly twice as many people instead got a test that has been found to be unsuited as a screen for lung cancer: a chest X-ray.
And others who didn’t fit the U.S. Preventive Services Task Force recommendations took the CT screening test anyway. “The number of adults inappropriately screened for lung cancer greatly exceeds the number screened according to the USPSTF recommendations,” the study notes.
Screening for cancer has played a controversial role in cancer trends. Mammography and the PSA blood test for prostate cancer do identify some cancers early, when treatment is usually more effective. But the tests also identify many growths that would never turn deadly — a phenomenon called “overdiagnosis.”
A paper published in the New England Journal of Medicine in October delves into that issue to help distinguish between cancer trends that are true improvements and trends simply due to changes in screening practices.
That issue plays out in the latest statistics. The reported number of prostate cancers surged in the 1980s as doctors started detecting it with the PSA test. That led to treating many prostate cancers that would never have turned deadly. Even so, the test caught a lot of cancers, and the death rate from prostate cancer fell at about 4% per year.
No longer. “The rapid declines in death rates over the past couple of decades actually halted,” Siegel says.
Siegel says that’s partly because reduced PSA screening, while preventing many unnecessary treatments, is also finding fewer treatable cancers. “I think there is a big need for a better test,” she says.
That plateau doesn’t surprise Welch, at Brigham and Women’s, who agrees that it might be time to reevaluate screening for prostate cancer. “I think we’ve gotten about the decline we’re going to get from screening and treatment,” he says. Some types of prostate cancer are more treatable than others and with recent improvements, he says, “we’ve gotten the low-hanging fruit.”
Improvements in cancer treatment are apparent when it comes to melanoma, a skin cancer that’s far less common than prostate or lung cancer. The new statistics show that melanoma death rates have been dropping by 7% per year. The report attributes this largely to anti-cancer drugs called checkpoint inhibitors and other new drugs. Some 92% of people diagnosed with this cancer are still alive five years later (compared with 19% of those diagnosed with lung cancer).
While the report measures trends in cancer rates (which are measured as deaths per 100,000 people), that’s not the same as tracking the actual number of cancer cases and deaths. Cancer is mostly a disease of older people, and the U.S. population is aging rapidly. So, while rates are declining, the absolute number of cancer deaths is not.
“We have more than 600,000 deaths from cancer in this country every year, and that number continues to grow,” Siegel says.
And with treatments getting progressively more expensive, that’s a challenge not just for individuals but for the entire health care system.
A detailed analysis of the statistics is being published Wednesday in CA: A Cancer Journal for Clinicians.
Study Finds Talcum Powder Not Likely A Risk For Ovarian
And some more god news Patti Neighmond noted that in recent years, women have taken talcum powder manufacturers to court over concerns that the use of the product in the genital area could cause ovarian cancer. Now, a new study finds no meaningful association between using talc-based or other powders and ovarian cancer.
Researchers from NIH’s National Institute of Environmental Health Sciences and the National Cancer Institute conducted the largest study to date of genital powder use and ovarian cancer. The study, published Tuesday in JAMA, used data from 252,745 women who answered questions about whether they used powder on their genitals. This was a pooled analysis of four large studies gathering data about the frequency and length of time women used the powder.
According to epidemiologist Katie O’Brien who headed the study, women report applying the powder either directly on their genital area or on sanitary napkins, tampons, underwear or diaphragms. O’Brien doesn’t know exactly which type of powder women used. It could have been talcum powder alone, cornstarch alone or a combination of both.
The research finds that women who had ever used powder had an 8% increased risk of ovarian cancer compared to those who never used it. “That is not a statistically significant increase” says O’Brien. And she adds that this increase needs to be understood in context. Ovarian cancer is very rare and the lifetime risk of getting it is 1.3% so an increase of 8% to that is “small.” O’Brien says it represents an estimated 0.09% increase in risk by age 70.
But among the subset of women who had their uterus and fallopian tubes intact, their increased risk of ovarian cancer from using powder in their genital area was 13% — which is an estimated 0.15% increase in risk by age 70 and is still considered a very small increase.
Unlike most other studies of talc and ovarian cancer, which focused on women already diagnosed with cancer, this study was prospective, and asked about powder use before study subjects had developed ovarian cancer. This means the study is free from recall bias, says O’Brien. It removes the likelihood that study subjects “search for reasons why they have ovarian cancer, and may over-report certain things they have heard may be associated with it.”
Rates of powder use have declined over the last 50 years, yet it remains a routine practice for some women, says Dr. Dana Gossett, a professor of obstetrics and gynecology at the University of California, San Francisco. She wrote an editorial accompanying the study but was not involved in the study itself.
“Women have used powders for genital hygiene for decades to absorb odor and moisture,” she says.
Earlier investigations of an association between the use of talc-containing powders for genital hygiene and epithelial ovarian cancer risks have provided inconsistent results, says Gossett and have resulted in an “ongoing controversy.” Concerns have been raised about possible contamination of mineral talc with asbestos, a known cancer risk. Most powder products include some mineral talc.
Researchers say it’s been hypothesized that the powder could induce an inflammatory response by irritating epithelial ovarian tissue or fallopian tubes directly which, in turn, could set off a cascade of increased oxidative stress levels, DNA damage and cell division, all of which could contribute to carcinogenesis.
Gossett says the new study finding “doesn’t really support any association [of powder use with ovarian cancer].”
“No study can ever say definitively what the cause of cancer is, but this study at least shows there’s not a substantial increase in ovarian cancer risk,” she says.
The study has several limitations. Researchers were not able to document how frequently or how long women used powder nor were they able to identify exactly what ingredients were in the powder. It also included mostly white women. Anecdotally, black women are more likely to use baby powder.
Obstetrician Gossett says the study findings should be “reassuring to women that if they are choosing to use powders on their genitals that they’re not doing something horrendous.”
Gossett also notes that due to the very small number of cancer cases in the data, the study was “underpowered.” She suggests that future analyses would be strengthened by focusing on women with intact reproductive tracts, with particular attention to timing and duration of exposure to powder in the genital area.
In the meantime, since there’s no medical reason to use talcum powder, researcher O’Brien suggests women weigh perceived benefit with possible risk. Study participants will continue to be followed to track ovarian cancer development in the future, she says.
The Staggering Cost of US Health Care Bureaucracy
Yuval Posenberg, reporter for the Fiscal Times, wrote that seemingly everyone has a horror story to tell about dealing with the bureaucracy of the U.S. health care system, from mundane matters like medical records to financial fights over surprise medical bills or insurance claims.
Those individual experiences come at a high collective cost, according to a new study published in the Annals of Internal Medicine: U.S. health insurers and providers spent $812 billion on administration in 2017, representing more than a third of national health expenditures, or double the 17% percent that Canada spends under its single-payer system. The U.S. administrative costs translate to nearly $2,500 per person — or almost five times as high as in Canada.
“The gap in health administrative spending between the United States and Canada is large and widening, and it apparently reflects the inefficiencies of the U.S. private insurance–based, multipayer system,” the study’s authors conclude. “The prices that U.S. medical providers charge incorporate a hidden surcharge to cover their costly administrative burden.”
The study finds that U.S. could have saved more than $600 billion in 2017 if it were able to cut its administrative costs to match Canada’s. “The difference between Canada and the U.S. is enough to not only cover all the uninsured but also to eliminate all the copayments and deductibles, and to amp up home care for the elderly and disabled,” Dr. David Himmelstein, a professor at the CUNY School of Public Health at Hunter College and co-author of the study, told Time. “And frankly to have money left over.”
Why it matters: This isn’t the first study to show that the U.S. system has higher administrative costs than other countries, but it is the first major study calculating those system-wide costs in almost two decades. The spending disparity detailed in the study “could challenge some assumptions about the relative efficiency of public and private healthcare programs,” writes Melissa Healy of the Los Angeles Times. “It could also become a hot political talking point on the American campaign trail as presidential candidates debate the pros and cons of government-funded universal health insurance.”
A steep rise in U.S. costs: Administrative costs have grown in both the U.S. and Canada over the last 20 years, but the increase in the United States has been much higher, mostly as the result of insurance overhead. “The study showed that private insurers contributed to most of the increase in administrative costs between 1999 and 2017,” Modern Healthcare’s Rachel Cohrs reports. “Of the 3.2 percentage point increase in administrative costs as a share of overall health spending, 2.4 percentage points were due to the expanding role that private insurers have assumed in Medicare and Medicaid.”
The insurance industry response: America’s Health Insurance Plans, a group representing private health insurance companies, told the Los Angeles Times that government-run systems aren’t as efficient as private ones, citing a recent report by the Medicare Payment Advisory Commission, an independent body that advises Congress, that found that private Medicare Advantage plans deliver benefits at 88% of the cost of traditional Medicare. “Study after study continues to demonstrate the value of innovative solutions brought by the free market,” AHIP said in its statement. “In head-to-head comparisons, the free market continues to be more efficient than government-run systems.”
The researchers are single-payer advocates: Himmelstein and one of his co-authors, Dr. Steffie Woolhandler, also of the CUNY School of Public Health at Hunter College, have long advocated for a single-payer health-care system in the United States. They co-founded the group Physicians for a National Health Program and have been unpaid policy advisors to Sen. Bernie Sanders and have coauthored research manuscripts with Sen. Elizabeth Warren. Both senators are calling for a transition to a single-payer Medicare-for-All system. But the researchers say that their conclusions in the new study are based on the data — and that their estimates of U.S. administrative costs are likely conservative.
“It’s actually the data that guided us to the solution, the solution didn’t give rise to the data,” Himmelstein said, according to Modern Healthcare.
Himmelstein also says that, while it may be possible to reduce administrative costs without switching to a single-payer system, the benefits would be much smaller. “We could streamline the bureaucracy to some extent with other approaches, but you can’t get nearly the magnitude of savings that we could get with a single payer,” he told Time.
‘Obamacare’ mandate: hot for lawyers, ho-hum to consumers
Ricardo Alonso-Zaldivar of the Associated Press reported that the repeal of an unpopular fine for people without health insurance has had little impact on “Obamacare” sign-ups or premiums, a gap between the real world and legal arguments from conservatives again challenging the Affordable Care Act.
The 10-year-old law has proved more resilient than its creators or detractors imagined, even as the Supreme Court considers whether to take up the latest effort to roll it back.
Opponents argue that the constitutionality of the entire 900-page law hinges on the now-toothless penalty for not having health insurance. Collected as a tax by the IRS, the penalty was intended to enforce the law’s “individual mandate” that Americans be insured. A previous Republican-led Congress set the fines to $0, effective last year.
“We’ve gotten a lot of evidence by now about what the market looks like without a mandate penalty, and on the whole it looks pretty stable, which is surprising because that’s not what most people would have expected when the ACA was being written,” said Cynthia Cox, who directs research on the health law for the nonpartisan Kaiser Family Foundation.
A Kaiser study released this week found that removal of the penalty pushed premiums up about 5% going into 2019, but the bottom line was a wash because of other factors. Insurers appeared to be making healthy profits.
The penalty was thought to be critical when the law was being written in 2009-2010. The idea was to nudge healthy people to sign up, helping keep premiums in check. But Cox said there’s no indication that healthy people have dropped out in droves. In one telling statistic, the Kaiser study found that average hospital days per 1,000 people enrolled dipped slightly in 2019, even after the penalty was eliminated.
Partial sign-up numbers for 2020 released Wednesday by the government point to stability. Nearly 8.3 million people enrolled in the 38 states served by the federal HealthCare.gov website. That’s down only about 2% from last year, when one additional state was using HealthCare.gov. A final count including that state — Nevada — and others that run their own sign-up efforts is expected by the spring.
The insurance mandate was the central issue when the Supreme Court first upheld the health care law in 2012, over a year before HealthCare.gov opened for business.
Chief Justice John Roberts cast the key vote in that 5-4 decision. He found that Congress lacked constitutional authority to require that Americans have health insurance. But because Congress has broad powers to levy taxes, Roberts ruled that a tax on people who did not purchase coverage offered them was constitutional. That allowed the law to survive what’s still seen as its most serious legal challenge.
Kathleen Sebelius, health secretary for President Barack Obama, said in 2012 that it was generally accepted that the insurance mandate was part of a three-legged stool key to stable markets. The other two legs were taxpayer-provided subsidies for premiums and a guarantee that patients with preexisting medical conditions could no longer be turned down or charged more.
“It was thought that the trade-off for changing the rules on preexisting conditions would have to be … some penalty incentive so you would get healthy people in the pool, along with not-healthy people,” Sebelius said. “What became clear when the law went into effect (in 2014) is that the subsidies in many ways provided a greater incentive for people get health insurance.”
Those subsides are designed so that low- and moderate-income households only spend a fixed percentage of their incomes on premiums, shielding consumers from high sticker prices.
Cox agreed that the law’s “carrots” seem to have made more of a difference than its “stick.”
Fast-forward to 2018 and a coalition of conservative states led by Texas won a lower court decision that the insurance mandate was still critical, in a legal and constitutional sense.
U.S. District Court Judge Reed O’Connor in Texas ruled that by zeroing out the tax penalty, Congress rendered the insurance mandate unconstitutional, and without it the entire health law must fall. President Donald Trump agreed.
Recently, a federal appeals court in New Orleans agreed with O’Connor that an unenforceable insurance mandate is unconstitutional. But the appeals court sent the case back to him to see whether other parts of the law can stand.
Defending the law, a coalition of Democratic-led states, along with the U.S. House, appealed to the Supreme Court, seeking a fast-track decision amid this year’s presidential election. The court has asked lawyers for the conservative states to respond by Friday on the timing question.
University of Michigan law professor Nicholas Bagley said the stability of the health insurance markets exposes “the artificiality” of the conservatives’ argument.
“It really goes to show how ridiculous it is to claim that Congress understood the mandate to be so essential that if it were to be red-lined out, the rest of the law would have to fall,” said Bagley.
Not so fast, said Andrew Schlafly, a lawyer representing groups siding with Texas and the other GOP-led states opposing the law.
“The question is not whether in reality (the ACA) can work without the mandate,” said Schlafly. “The test is whether it was intended to work without the mandate.
“Theory does matter to these Supreme Court justices,” he added, “and they do take theory seriously.”
ObamaCare still working despite individual mandate’s repeal
Megan Henney noted that one year after Republicans repealed the Affordable Care Act’s individual mandate, President Barack Obama’s signature health care law remains surprisingly stable and profitable for insurers.
When Republicans gutted the ACA in the 2017 Tax Cuts and Jobs Act, eliminating the provision that required Americans to either buy health insurance or pay a fine, critics warned that decision would cause younger and healthier people to flee from the marketplace, leaving sicker, more expensive patients, remaining and causing the market to enter a “death spiral.”
But a report released by the Kaiser Family Foundation on Monday found that despite the removal of the mandate, those fears are largely unfounded.
Individual enrollment fell by 5 percent between the first quarter of 2018 and 2019, but the relatively modest growth in claims costs at the beginning of 2019 indicates that enrollment declines and policy changes did not cause healthy individuals to flee the market. In fact, the average number of days enrollees spent in a hospital in the first nine months of 2019 was slightly lower than inpatient days in the previous four years.
“Results from the first nine months of 2019 suggest that the individual market remains profitable and stable despite the effective repeal of the individual mandate,” the analysis said.
A key measure of insurers’ financial strength, margins — the average amount by which premium income exceeds claims costs per each enrollee in a given month — are the healthiest they’ve been in nearly eight years. (Insurer financial performance dipped slightly at the end of 2019, but the margins remained higher than all other previous years through 2017).
“These data suggest that insurers in this market remain on average financially healthy,” the report said.
The report comes amid attacks by Republicans and President Trump on arguably the biggest legislative accomplishment of the Obama administration.
Most recently, the U.S. Court of Appeals for the Fifth Circuit, in the case of Texas v. Azar, struck down the individual mandate as unconstitutional, though it did not invalidate the rest of the law, leaving its fate, once again, in limbo. The ruling was issued almost exactly one year after Judge Reed O’Connor in Fort Worth, Texas, struck down the entire law.
A coalition of Democratic states, led by California Attorney General Xavier Becerra, has made it clear that it intends to challenge the appeals court decision by petitioning the Supreme Court to take the case.
The ultimate outcome of the lawsuit will affect millions of Americans, and the repeal of the 9-year-old law could leave up to 32 million people without health insurance by 2026, according to a Congressional Budget Office report from 2017 about the effects of repealing the ACA.
I’m still confused as to why Bernie Sanders and Elizabeth Warren are pushing Medicare for All and not fixing the ACA/Obamacare. Let’s see with tomorrow’s debate whether we get and more suggestions. Moreover, why hasn’t the Republicans when they had the majority on the House and the Democrats now that they have control in the House, why no one party has tried hard to fix the healthcare problem. Politics and more political “strategies” continue to get in the way of the real solution.
The Holidays are finally over and Rudolf was just arrested for assaulting his teammate reindeers for calling him names and laughing at him. Was this a hate crime??? Oh, how sensitive these days!! Poor, poor Rudolf!
As I was picking up a prescription today I was reminded of this article, one copy sent to me by a friend, I then went to pay for the prescription with my GoodRx card though which I was given an 80% discount. This brings up the question how will we all be able to pay for the future drugs with their outrageous prices?
It also brings up the question, how do organizations like GoodRx and Singlecare give people the discount. And what is the true value of prescription drugs and what prices should be charged in order for the always-profitable pharmaceutical companies to make an acceptable profit and what is an acceptable profit?
Consider this report published in MarketWatch by Jared S. Hopkins.
Pharmaceutical companies started 2020 by raising the price of hundreds of drugs, according to a new analysis, though the increases are relatively modest this year as scrutiny grows from patients, lawmakers and health plans.
Pfizer Inc. led the way, including increasing prices by over 9% on more than 40 products. The drug industry traditionally sets prices for its therapies at the start of the year and again in the middle of the year.
More than 60 drugmakers raised prices in the U.S. on Wednesday, according to an analysis from Rx Savings Solutions, which sells software to help employers and health plans choose the least-expensive medicines. The average increase was 5.8%, according to the analysis, including increases on different doses for the same drug.
The average is just below that of a year ago, when more than 50 companies raised the prices on hundreds of drugs by an average of more than 6%, according to the analysis.
Pfizer said that 27% of the drugs Pfizer sells in the U.S. will increase in price by an average of 5.6%. More than 90 of the New York-based company’s products rose in price, according to the Rx Savings Solutions analysis. Among them are Ibrance, which sold nearly $3.7 billion globally through the first nine months last year, and rheumatoid arthritis therapy Xeljanz.
A Pfizer spokeswoman said that nearly half of its drugs whose prices went up are sterile injectables, which are typically administered in hospitals, and the majority of those increases amount to less than $1 per product dose.
Pfizer’s largest percent increases, 15%, are on its heparin products, which are generic blood thinners typically administered in hospitals.
Pfizer said the heparin increases are to help offset a 50% increase in the cost of raw materials and expand capacity to meet market demand. The company said it is monitoring the global heparin supply, which has been challenged by the impact of African swine flu in China, as the drug is derived from pig products and disruption could lead to a shortage. Pfizer said that its U.S. heparin supply is not sourced from China.
Overall, the increases by drugmakers Wednesday affect “list prices,” which are set by manufacturers, although most patients don’t pay these prices, which don’t take into account rebates, discounts and insurance payments. Drugmakers have said prices are increased in conjunction with rebates they give to pharmacy-benefit managers, or PBMs, in order to be placed on the lists of covered drugs known as formularies.
In fact, drugmakers have said that their net prices have declined because of large rebates to PBMs, which negotiate prices in secret with their clients, such as employers and labor unions.
Pfizer said its price increases will be offset by higher rebates paid to insurers and middlemen. The company said the net effect on revenue growth in 2020 will be 0%, which is the same percentage expected for 2019. The company said the average net price of its drugs declined by 1% in 2018.
In 2018, Pfizer was assailed by President Trump after the company raised the prices on some 40 drugs. Pfizer temporarily rolled back the increases, but raised prices again later.
In Washington, Republicans and Democrats in the U.S. Congress have drawn up proposals for lowering drug costs, while the Trump administration recently introduced a plan for importing drugs from Canada.
“Prices go up but demand remains the same,” said Michael Rea, CEO of Rx Savings Solutions. Clients of the Overland Park, Kan., company include Target Corp. and Quest Diagnostics Inc. “Without the appropriate checks and balances in place, this is a runaway train. Consumers, employers and health plans ultimately pay the very steep price.”
While some increases in his firm’s analysis were steep, most product prices rose by less than 9%.
AbbVie Inc. raised the price of rheumatoid arthritis treatment Humira, the world’s top-selling drug, by 7.4%, according to the analysis. Through the first nine months of 2019, Humira sales totaled nearly $11 billion.
AbbVie didn’t respond to a request for comment.
GlaxoSmithKline PLC raised the prices on more than two dozen different therapies, although none by more than by 5%. That includes its shingles vaccine, Shingrix, which sold about $1.7 billion globally in the first nine months of 2019.
A Glaxo spokeswoman confirmed the increases and said net prices for its U.S. products fell about 3.4% on average annually the past five years.
Other major companies that raised prices included generic drugmaker Teva Pharmaceutical Industries Ltd., which raised the price of more than two dozen products, but none by more than 6.4%, according to the analysis. Sanofi S.A. raised prices on some of their therapies, but none by more than 5%, while Biogen Inc. took increases that didn’t exceed 6%, including on multiple-sclerosis therapy Tecfidera.
Teva didn’t respond to requests for comment.
A Sanofi spokeswoman confirmed the increases and said that the changes are consistent with its pledge to ensure price increases don’t exceed medical inflation. A Biogen spokesman confirmed the price changes and said adjustments are made to products for which it continues to invest in research, and otherwise increases follow inflation.
In addition to Pfizer’s increases on heparin, companies increased prices for several therapies by more than 10%, according to the analysis.
Cotempla XR-ODT, which is approved in the U.S. to treat attention-deficit hyperactivity disorder in children between 6 and 17 years old, increased by more than 13% to $420 for a month supply. The therapy is sold by Neos Therapeutics Inc., based in Grand Prairie, Texas.
Representatives for Neos didn’t respond to requests for comment.
Democrats ask U.S. Supreme Court to save Obamacare
Lawrence Hurley of Reuters reported that the Democratic-controlled U.S. House of Representatives and 20 Democratic-led states asked the Supreme Court on Friday to declare that the landmark Obamacare healthcare law does not violate the U.S. Constitution as lower courts have found in a lawsuit brought by Republican-led states.
The House and the states, including New York and California, want the Supreme Court to hear their appeals of a Dec. 18 ruling by the New Orleans-based 5th U.S. Circuit Court of Appeals that deemed the 2010 law’s “individual mandate” that required people to obtain health insurance unconstitutional.
The petitions asked the Supreme Court, which has a 5-4 conservative majority, to hear the case quickly and issue a definitive ruling on the law, formally called the Affordable Care Act, by the end of June.
Texas and 17 other conservative states – backed by President Donald Trump’s administration – filed a lawsuit challenging the law, which was signed by Democratic former President Barack Obama in 2010 over strenuous Republican opposition. A district court judge in Texas in 2018 found the entire law unconstitutional.
“The Affordable Care Act has been the law of the land for a decade now and despite efforts by President Trump, his administration and congressional Republicans to take us backwards, we will not strip health coverage away from millions of Americans,” New York Attorney General Letitia James said.
Obamacare, considered Obama’s signature domestic policy achievement, has helped roughly 20 million Americans obtain medical insurance either through government programs or through policies from private insurers made available in Obamacare marketplaces. Republican opponents have called it an unwarranted government intervention in health insurance markets.
Congressional Republicans tried and failed numerous times to repeal Obamacare. Trump’s administration has taken several actions to undermine it.
In 2012, the Supreme Court narrowly upheld most Obamacare provisions including the individual mandate, which required people to obtain insurance or pay a financial penalty. The court defined this penalty as a tax and thus found the law permissible under the Constitution’s provision empowering Congress to levy taxes.
In 2017, Trump signed into law tax legislation passed by a Republican-led Congress that eliminated the individual mandate’s financial penalty. That law means the individual mandate can no longer be interpreted as a tax provision and therefore violates the Constitution, the 5th Circuit concluded.
In striking down the individual mandate, the 5th Circuit avoided answering the key question of whether the rest of the law can remain in place or must be struck down, instead sending the case back to a district court judge for further analysis.
That means the fate of Obamacare remains in limbo. The fact that the litigation is still ongoing may make the Supreme Court, which already has a series of major cases to decide in the coming months, less likely to intervene at this stage.
John Delaney: On health care, bold vision with pragmatism is what America needs
Pulitzer prize winning editor, Art Cullen noted that in living rooms and coffee shops across all of Iowa’s 99 counties, I am forever reminded that health care is the paramount issue facing Americans. Our current system is deeply broken, and our country needs a bold vision and a pragmatic approach for improving health care. In many ways, a candidate’s approach to health care defines their governing and leadership style. It answers important questions about their values, vision, pragmatism and management style.
The Democratic Party should have as its true north universal access — where every American has health care coverage as a right of citizenship. We should support plans that encourage innovation — curing diseases like cancer and Alzheimer’s — and that create a framework for getting costs under control. My Better Care Plan uniquely achieves all of these goals.
Universal access needs to be realistic
Currently, only three candidates have detailed plans for universal access — Sens. Elizabeth Warren and Bernie Sanders and I. Universal access is the right answer, both morally and economically. The plans advocated by Warren and Sanders, however, call for an extreme “single-payer” system, where the government is the only provider of coverage.
Aside from the extraordinary practical, fiscal and political issues associated with eliminating and replacing over 180 million private insurance plans, a single-payer system will massively underfund the health care system. Today, government reimbursement is dramatically less than reimbursements paid by insurance companies. Making the government the only payer in health care would underfund hospitals, particularly in rural America, resulting in hospital closures, practitioners closing up shop, and a reduction of investment in innovation.
On the other hand, most other candidates are advocating for a “public option” as our way forward. This is a modest proposal, insufficient for the challenges of our broken health care system. A public option is simply another insurer that is government-run. It will have co-payments, deductibles, and premiums. And it relies on people choosing to sign up. While it would provide more options than are currently available in the marketplace, undoubtedly helping many, it would not address the tragedy of the uninsured in our country.
Under BetterCare we achieve the ambition of universal coverage without the negatives of a single-payer system.
Under BetterCare, Medicare is left alone, because it works, and every American from birth to 65 (seniors are on Medicare) is auto-enrolled in a free federal health care plan that covers basic health care needs. This ensures every American has health care coverage. But unlike the single-payer Medicare for All, Americans could still choose private insurance. They could “opt out” of the BetterCare plan and buy private insurance or receive insurance from their employer. If they “opt out” they would receive a health care tax credit to offset the cost of health care they purchase or that their employer provides.
Alternatively, they could use the BetterCare plan and enhance it with supplemental plans, similar to how Medicare beneficiaries acquire supplemental plans. BetterCare is like Medicare. It provides guaranteed coverage but allows our seniors to have supplemental plans or “opt out” and accept a Medicare Advantage Plan.
BetterCare is similar to the plans of most developed nations that have universal coverage. As Art Cullen wrote, it provides “universal coverage while not eliminating private insurance.” By providing universal access, choice, protecting provider reimbursements, and encouraging innovation, BetterCare is bold, ambitious, practical and a political winner. Importantly, it can be fully paid for by applying the Obamacare subsidies and current federal and state Medicaid payments and by eliminating the corporate deductibility of health care.
It is bold, yet practical, and reflective of my approach to governing. As a former entrepreneur, CEO of two public companies and member of Congress, I bring a unique approach and real leadership experience, which is why I respectfully ask for your support.
Use Simple Economics to Contain Health Care Costs
Gary Shilling wrote for Bloomberg and makes so much sense when he looked at health care costs in terms of simple economics. (Bloomberg Opinion) — Spending on U.S. health care is out of control, expanding steadily from 5% of GDP in 1960 to 18% in 2018. There are, however, ways to curb the explosion in costs from both the demand and the supply side.
Health care costs per capita in the U.S. are almost double those of other developed countries, but life expectancy is lower than many, even South Korea, according to the CIA and Eurostat. Without restraint, costs will accelerate as more and more postwar babies age. The nonpartisan Congressional Budget Office projects Medicare spending alone will leap from 3% of GDP to 8% by 2090.
Medical costs are understandably high since the system is designed to be the most expensive possible for four distinct reasons. First, with the constantly improving but increasingly expensive modern technology, the best is none too good when your life or mine is at stake. Also, few patients have the knowledge to decide whether a recommended procedure will be medically much-less cost-effective. The medical delivery system encourages a gulf between the providers who supposedly know what’s needed and their patients who don’t.
Second, patients are quite insensitive to costs since their employers or governments pay most health care bills. And those who are privately insured want to get their money’s worth from their premiums, especially since Obamacare does not allow insurers to set premiums on a health risk basis.
Third, the pay-for-service system encourages medical providers to over-service. After my dermatologist burned off the pre-cancerous growths on my face, he wanted me back in two weeks to be sure, but also to bill another office visit.
Finally, domestic training programs and facilities for medical personnel are inadequate. As a result, many MD residents and nurses come from abroad, while medical schools of dubious quality in the Caribbean train U.S.-born physicians.
To control costs on the demand side, use the appeal of money. The importance of their health to most Americans means they will spend proportionally more on medical services than other goods and services, but they’ll think twice if it’s money they otherwise can keep. Increasing deductibles and co-payments are moving in that direction. In 1999, employees on average paid $1,500, or 22%, of $6,700 in family health coverage premiums, according to the Kaiser Family Foundation. The total rose to $26,600 in 2019, but employees’ share has climbed to $6,000, or 29%.
Medical savings accounts also make patients more aware of costs. Companies give employees a set amount of money and they can keep what they don’t spend on health care.
Accountable Care Organizations, now authorized by Medicare, attack the fee-for-service problem. The medical providers who participate are encouraged to be efficient since they can retain part of any savings due to cost controls as long as they provide excellent care.
To increase the supply of medical personnel, American medical and nursing schools can be expanded with government help. Also, shortening the whole training process would save time and get huge student debts under control. Does a physician need a four-year bachelor’s degree before beginning medical school?
Cartels among hospital medical specialties can be attacked. Now, physicians in, say, the general surgery department limit competition by controlling who has the privileges to use their institution’s facilities.
In another development, the entrepreneurial model of a small group of MDs operating a practice is fading in the face of high costs of medical record-keeping and other regulatory requirements. Over half of physicians now work for hospitals, either on their main campuses or in satellite facilities. This may shift the emphasis of many from money to medicine.
Limiting malpractice insurance premiums, a major outlay for medical providers, can also cut medical costs. Texas placed a $250,000 cap on non-economic damages, i.e., pain and suffering, in 2003. Texas Department of Insurance data reveals that medical malpractice claims, including lawsuits, fell by two-thirds between 2003 and 2011, and the average payout declined 22% to $199,000.
Also, average malpractice insurance premiums plunged 46%, according to the Texas Alliance for Patient Access, a coalition of health care providers and physician liability insurers. And physicians were then attracted to Texas. The Texas Medical Association reports that in the decade since malpractice awards were capped, 3,135 physicians came to the Lone Star State annually, 770 more than the average in the prior nine years.
At present, Americans basically pay the development costs of new drugs while other countries with centralized pharmaceutical-buying skip the expenses of R&D, field trials, etc., and only pay the much-lower marginal cost of production. Allowing Medicare to join Medicaid to negotiate drug prices could reduce costs if foreigners can be convinced to share development costs. Otherwise, new drug development would be curtailed. The Trump administration’s new rules that force health insurers and hospitals to publish their negotiated prices may force costs to the lowest level.
One approach that doesn’t work in easing the burden on consumers of medical costs is increasing overall government subsidies. They tend to be offset by higher costs, much as higher college tuition and fees often dissipate more scholarship aid. Ever notice that the most modern, prosperous institutions in town tend to be hospitals, hugely subsidized by governments?
Health care is critical, but that doesn’t mean its costs aren’t subjected to supply and demand. Then how do we assess the value as well as the costs and cost limitations? Are drug companies as well as insurance companies making way too much in profits by taking advantage of we the honest patients??
There many parts of the eventual answer to our need for a health care program which can service all at reasonable costs and each “part” needs thorough investigation and real solutions and that just addressing only one or two of these “parts” will never be sustainable!!
Last week Suneel Dhand reported that compared to a couple of years ago, very little has changed in the hospital medical community.
In fact, I’m sure the divergence of the curves has only grown bigger, as more and more administrators are added to the ranks of healthcare. Look at what happened in Chicago where one of the fairly large hospitals fired 15 of their physicians and replaced them with 15 nurse practitioners last year, and in Texas 27 pediatricians at a chain of clinics in the Dallas area lost their jobs and were replaced by nurse practitioners.
Quite often in life, the answers to some of the biggest questions we have, are staring us right in the face and incredibly simple. Healthcare can never be fixed unless we radically simplify everything and strip away the unnecessary complexities in our fragmented system. The divergence of the above lines, however, actually represents so much more than just an obnoxious visual. It actually symbolizes what happens when any organization, system, or even country, becomes top-heavy and loses sight of what is happening at the front lines. And in the end, it eventually collapses under its own weight.
When this happens in America, we cannot predict, but consider this: The amount we spend on healthcare would be the 4th largest economy in the world if it stood alone (at $3.5 trillion, only China and Japan have a higher total GDP). With an aging population, increasing chronic comorbidities, and expensive new treatments, if costs are not reined in, healthcare expenditure could account for a third of the entire GDP in about 25 years. A figure that will quite simply destroy the American economy.
It would be one thing if all the administration and bureaucracy was actually resulting in an improved and more efficient healthcare system. But look around you folks. Acute physician shortages now plague every state. Millions of people find it impossible to find a primary care doctor. Certain specialties are now booking out appointments months in advance. ERs and hospitals are overflowing. And in the end, patients are still facing soaring out of pocket expenses.
The last 20 years have witnessed the consolidation and corporatization of the entire U.S. healthcare system. Sold initially as a way to reign in costs, I am yet to see any evidence that it’s done anything other than dramatically increase costs (please feel free to forward me any financial analysis if I’m wrong). And why should that be a surprise to anyone?
I’ll leave you to stare once again at the above graph for a minute or two, and take in a comment that a distinguished physician colleague of mine recently made: “It’s like the physicians have been given weed killer and the administrators have been given Miracle-Gro.”
Affordable Care Act funding in question after health insurance taxes repealed
The Cadillac Tax, Health Insurance Tax and Medical Device Tax were recently repealed, raising questions over how the Affordable Care Act will be funded in the future. Yahoo Finance’s Anjalee Khemlani joins Adam Shapiro, Julie Hyman and Dan Howley during On the Move to break it all down.
Andrew Yang Has The Most Conservative Health Care Plan In The Democratic Primary
Daniel Marans of the Huff Post pointed out that Entrepreneur Andrew Yang has had unexpected staying power in the Democratic presidential primary thanks in part to the enthusiasm for his plan to provide every American with a basic income of $1,000 a month.
But the boldness of his signature idea only serves to underscore the unambitiousness of the health care plan he released earlier this month.
In fact, Yang’s health plan, which he bills as an iteration of the left’s preferred “Medicare for All” policy, is more conservative than proposals introduced by the candidates typically identified as moderate.
Former Vice President Joe Biden, South Bend, Indiana, Mayor Pete Buttigieg and Sen. Amy Klobuchar of Minnesota all at least call for the creation of a public health insurance option that would be available to every American. (Sen. Bernie Sanders of Vermont and Sen. Elizabeth Warren of Massachusetts favor Medicare for All, which would move all Americans on to one government-run insurance plan ― though the two senators disagree on the timeline for implementing the idea.)
In terms of expanding health insurance coverage, Yang says on his website merely that he would “explore” allowing the employees of companies that already provide health insurance the chance to buy into Medicare.
“We need to give more choice to employers and employees in a way that removes barriers for businesses to grow,” Yang writes.
Under Yang’s plan, people employed by businesses that do not provide insurance, or who are self-employed, would continue to purchase coverage on the exchanges created by former President Barack Obama’s Affordable Care Act.
The decision not to focus on expanding coverage distinguishes Yang dramatically from his competitors. And in the foreword to his plan, he explains that that is a deliberate choice, since enacting single-payer health care is “not a realistic strategy.”
“We are spending too much time fighting over the differences between Medicare for All, ‘Medicare for All Who Want It,’ and ACA expansion when we should be focusing on the biggest problems that are driving up costs and taking lives,” he writes. “We need to be laser focused on how to bring the costs of coverage down by solving the root problems plaguing the American healthcare system.”
When asked about how Yang plans to expand health insurance coverage ― 27 million Americans remain entirely uninsured and millions more have insurance that is so threadbare they do not use it ― Yang’s campaign referred HuffPost to his website.
Yang would increase health care access through reforms designed to reduce the health care system’s underlying costs, according to his campaign. On his website, he divides those reforms into six categories: bringing down the cost of prescription drugs through bulk negotiation; investing in waste-saving health care technologies; realigning medical providers’ “incentives” away from waste and abuse; increasing investment in preventive and end-of-life health care; making the provision of health care more “comprehensive”; and reducing the influence of lobbyists on the political system.
Yang implies that his rivals have sacrificed cost control in the name of expanding coverage. But when it comes to the specifics, Yang’s competitors have already gotten behind many of the ideas he is proposing ― and sometimes take them a step further.
For example, Buttigieg has a provision in his health care plan that would prohibit “surprise billing” ― the practice of providing unwitting patients with a large bill after a medical procedure when a doctor who performed it is not in the hospital’s insurance network. Yang does not mention the practice in his health care plan.
One provision of Yang’s plan that genuinely sets him apart is his plan to encourage the replacement of the fee-for-service billing model for doctors with salaries. The latter model is supposed to cut back on duplicative practices and foster more holistic care. Other elements of his plan, such as “incentivizing” gym memberships, healthy eating and bike commuting as a form of preventive health care, have drawn eye rolls from leftists who regard the ideas as paternalistic.
First and foremost, though, many progressives are likely to find fault with Yang’s plan, because they consider his use of the term “Medicare for All” misleading.
For months on the campaign trail, Yang claimed that he supported Medicare for All, though not the provision of Sanders’ bill ― and its companion in the House ― requiring people with private insurance to enroll in an expanded Medicare program.
He even aired a television ad casting his commitment to the policy as a reflection of his experience as the father of a special needs child.
Yang says on his campaign website that he is still firmly committed to the “spirit” of Medicare for All. But now that he has introduced a plan of his own, that claim is harder to defend.
Yet the Yang campaign is plowing full-steam ahead with its appropriation of the term in a new 30-second ad, “Caring.”
“If my husband, Andrew Yang, is president, he’ll fight for Medicare for All with mental health coverage,” Yang’s wife, Evelyn, says in the ad.
Fate of Obamacare uncertain amid tax repeals, lawsuits and Medicare-for-all push consider that Democrats seize on anti-Obamacare ruling to steamroll GOP in 2020
Alice Miranda Ollstein and James Arkin reported that a court ruling last week putting the Affordable Care Act further in jeopardy may provide the opening Democrats have been waiting for to regain the upper hand on health care against Republicans in 2020.
At the most recent Democratic presidential debate, candidates largely avoided discussing the lawsuit or Republicans’ years-long efforts to dismantle Obamacare, and instead continued their intra-party battle over Medicare for All.
But Senate Democrats, Democratic candidates and outside groups backing them immediately jumped on the news of the federal appeals court ruling — blasting out ads and statements reminding voters of Republicans’ votes to repeal the 2010 health care law, support the lawsuit and confirm the judges who may bring about Obamacare’s demise.
“I think it’s an opportunity to reset with the New Year to remind people that there’s a very real threat to tens of millions of Americans,” Sen. Brian Schatz (D-Hawaii) said in an interview. “We Democrats are always striving to improve the system, but, at a minimum, the American people expect us to protect what they already have.”
In 2018, Democrats won the House majority and several governorships largely on a message of protecting Obamacare and its popular protections for preexisting conditions. This year continued the trend, with Kentucky’s staunchly anti-Obamacare governor, Matt Bevin, losing to Democratic now-Gov. Andy Beshear.
The landscape in 2020 may be more challenging for Democrats than it was in 2018, when Republicans had more recently voted to repeal the Affordable Care Act. Republicans also say they now have more ammunition to push back on Democrats’ arguments with the party’s divisions over single-payer health care, which would replace Obamacare, shaping the presidential race.
Moreover, the appeals court’s ruling — which in all likelihood punted any final disposition on the case until after the 2020 elections — eliminates what some Republicans saw as a nightmare scenario: If the court had embraced a lower court ruling striking down the law in its entirety, it would have put the issue before the Supreme Court during the heat of the election, putting tens of millions of Americans’ health insurance at risk.
Still, Democrats believe they can win the political battle over health care, especially in Senate races. At least a half-dozen GOP senators are up for reelection, and Democrats need to net three seats to win back control of the chamber if they also win back the presidency. Democratic strategists and candidates are eager to run a health care playbook that mirrors that of the party’s House takeover in 2018, and say Republicans are uniquely vulnerable after admitting this year that they have no real plan for dealing with the potential fallout of courts striking down Obamacare.
Within a day of the ruling, the pro-Obamacare advocacy group Protect Our Care cut a national TV and digital ad featuring images of Sens. Susan Collins (R-Maine) and Cory Gardner (R-Colo.), warning that if the lawsuit succeeds, “135 million Americans with preexisting conditions will be stripped of protections, 20 million Americans will lose coverage and costs will go up for millions more.”
Other state-based progressive groups told POLITICO they’re readying their own ads going after individual Senate Republicans over the 5th Circuit’s ruling.
Protect Our Care director Brad Woodhouse predicts that it’s just a preview of the wave of attention the issue will get in the months ahead, as Democratic candidates and outside groups alike hammer the GOP on the threat their lawsuit poses to Obamacare.
“If there is one issue in American politics that is going to flip the Senate from Republican to Democratic in 2020, it’s this issue,” he said. “Our message is simple: President [Donald] Trump and Republicans are in court right now, suing to take away the ACA, take away your health care. And if Cory Gardner or Thom Tillis or any of them don’t think that’s an indefensible position, they should ask the 40-plus House Republicans who lost their seats in 2018.”
More than a dozen Republican state attorneys general, backed by the Trump administration, have been arguing in federal court for more than a year that Congress rendered the entire Affordable Care Act untenable when they voted as part of the 2017 tax bill to drop the penalty for not buying insurance down to zero. A district judge in Texas sided with them last year in a sweeping ruling declaring all of Obamacare unconstitutional.
Last week, an appeals court agreed that the elimination of the penalty made the individual mandate unconstitutional, but sent the case back down to the district court to decide whether any of the law could be separated out and preserved. The move all but guarantees the case won’t reach the Supreme Court until after the election, but it maintains the cloud of uncertainty hanging over the health law that experts say drives up the cost of insurance.
Though no one is in danger of losing their health coverage imminently, Democratic challengers in nearly every Senate battleground race, including Arizona, North Carolina, Maine and Iowa, jumped on the court ruling as an opportunity to attack Republicans on health care.
“Democrats have been in the fight to ensure that people across this country have access to affordable health care,” said Sen. Catherine Cortez Masto of Nevada, the chair of the DSCC. “This opinion does not help the Republicans.”
Sara Gideon, Democrats’ preferred candidate in Maine to take on Collins, called the lawsuit a “direct threat to the protections countless Mainers and Americans depend on. She has been reminding voters that Collins’ vote on the 2017 tax reform law triggered the ACA lawsuit in the first place, and she voted to confirm one of the 5th Circuit judges that recently sided with the Trump administration’s arguments against the law.
Unlike the vast majority of her GOP colleagues in the upper chamber, Collins has spoken up against the lawsuit. She has written multiple times to Attorney General Bill Bar, urging him to defend the ACA in court. Collins told POLITICO the day after the ruling that it was “significant” that the 5th Circuit judges were clearly “very uneasy with the thought of striking down the entire law” and instead sent the case back down to the lower court for reconsideration. Collins’ campaign spokesman both emphasized that she believes the government should defend the law and criticized Democrats for defending the unpopular individual mandate.
Tillis, the vulnerable North Carolina senator, said the lawsuit gave Republicans “breathing room” to find a viable replacement for Obamacare and attempted to flip the attack on Democrats by tying them to their presidential contenders.
“I think the fact that they all raised their hands and said we need Medicare for All is also raising their hands and saying the Affordable Care Act has failed,” Tillis said.
Though most of the 2020 presidential candidates have come out against Medicare for All, and more Democratic voters favor a choice between private insurance and a public option, the single-payer debate has given Republicans a potent line of attack that they’re turning to more than ever in the wake of the court’s ruling.
“Obamacare failed to lower health care costs for millions of Americans, and now Democrats want a complete government takeover of our health care system,” said Jesse Hunt, a spokesman for the National Republican Senatorial Committee. “They spent all of 2019 defending their socialist plan to eliminate employer-based health care coverage, and those problems will not subside anytime soon.”
The effectiveness of the GOP attacks will depend largely on the Democratic nominee for president — if it is someone who backs Medicare for All, it will be much more difficult for Senate candidates who don’t support the policy to separate themselves from it. But Democratic activists say they’re confident the GOP’s actions in court will sway voters more than their claims about Medicare for All.
“We can prepare for and counter those attacks by reminding voters that [Republicans are] fighting actively to take health care away,” said Kelly Dietrich, the founder and CEO of the National Democratic Training Committee, which coached more than 17,000 candidates for federal and state office in 2019. “Republicans’ ability to use fear as a tool to win elections should never be underestimated. But the antidote is to fight back just as hard.”
Year in Review: Lots of talk, not a lot of action in healthcare politics
Rachel Cohrs noted that lawmakers and regulators talked big on tackling high drug prices and surprise medical bills in 2019, but agreement on the bipartisan policies remained elusive. Some healthcare policy could be attached to a potential budget deal in December, but it is still unclear whether lawmakers will resolve funding disputes by the end of the year.
Despite major bipartisan legislative packages spearheaded by senior Senate Republican leaders, disputes over details and intense lobbying efforts have so far stalled progress in Congress. Drug makers are fighting a provision in the Senate Finance Committee’s drug pricing bill that would require them to pay back Medicare for drug price hikes faster than inflation, and providers and insurers are warring over how out-of-network medical bills should be handled.
Competing approaches to address surprise medical billing came to a head in December when a bipartisan, bicameral compromise proposal on addressing surprise medical bills emerged, but a key Senate Democrat involved in the negotiations had not signed on as of press time. Despite provider-friendly tweaks, providers still oppose the legislation and it is unclear whether House and Senate leadership have an appetite to include it in must-pass legislation.
Health reform 3.0: Early in the year, Senate health committee Chair Lamar Alexander and ranking Democrat Patty Murray released a wide-ranging plan to lower costs that addresses surprise medical bills; contract reform provisions; cost transparency; and boosting generic competition for Rx drugs. The year ended with a bipartisan, bicameral bill emerging, but at deadline it lacked Murray’s endorsement.
Reducing drug prices: Addressing drug prices was the other issue that dominated the policy landscape. Competing plans emerged, and the House passed a bill in mid-December on a party-line vote.
Grinding to a halt: House Speaker Nancy Pelosi announced a formal impeachment inquiry into President Donald Trump, which soured the prospects of a grand bargain between Trump and Pelosi on drug pricing and complicated the timeline for passing major healthcare policy.
Drug pricing was also a top priority for the Trump administration, but several marquee policy ideas have been stopped by the courts, abandoned, or are forthcoming. The White House decided to retract a prominent initiative that would have required insurers to pass manufacturer rebates directly to patients at the pharmacy counter, and a rule that would have compelled drug makers to include list prices in television advertisements is tied up in court. House Democrats passed a partisan government drug price negotiation bill, but it almost certainly will not become law.
The administration could at any time release a regulation outlining a process to allow states to import prescription drugs from Canada or move forward with a demonstration that would tie payments for physician-administered drugs in Medicare to international drug prices, but it has not yet acted on either proposal.
The 10 most-searched questions on health Reported by Sandee LaMotte of CNN
There were more questions that had people Googling in 2019.
The full list of the most-searched health questions in the United States this year also included questions about the flu, kidney stones and human papillomavirus or HPV:
How to lower blood pressure
What is keto?
How to get rid of hiccups
How long does the flu last?
What causes hiccups?
What causes kidney stones?
What is HPV?
How to lower cholesterol
How many calories should I eat a day?
How long does alcohol stay in your system?
NYU started to answer one of the big questions in the design of a fair healthcare system when they decided to declare their medical school tuition free. If all medical schools were tuition free the graduating doctors wouldn’t have the huge debt and they could have the opportunities to chose primary care and provide care to underserved rural and poorer communities.
One step at a time and maybe next year Congress can really improve the health care system of our U.S.A.
And to all you interested readers out there Happy New Year! Maybe those in control will start the process of improving the delivery of affordable health care to all and not worry about their future political aspirations. What a change that would be!