Category Archives: Socialized medicine

Five Worrisome Trends in Healthcare and the VA Seeks to Redirect Billions of Dollars into Private Care and the VA Access to Healthcare

50065252_1872612819535035_7021591760191094784_nAs the idiots in Congress still fight over the wall and continue to act like spoiled children we, the intelligent voters should be looking at healthcare delivery reality. What can we expect from these liberals and their cultural revolution? Joyce Frieden, the News Editor of MedPage Today pointed out last year that a reckoning is coming to American healthcare, said Chester Burrell, outgoing CEO of the CareFirst BlueCross BlueShield health plan, here at the annual meeting of the National Hispanic Medical Association.

Burrell, speaking on Friday, told the audience there are five things physicians should worry about, “because they worry me”:

  1. The effects of the recently passed tax bill.“If the full effect of this tax cut is experienced, then the federal debt will go above 100% of GDP [gross domestic product] and will become the highest it’s been since World War II,” said Burrell. That may be OK while the economy is strong, “but we’ve got a huge problem if it ever turns and goes back into recession mode,” he said. “This will stimulate higher interest rates, and higher interest rates will crowd out funding in the federal government for initiatives that are needed,” including those in healthcare.

Burrell noted that Medicaid, 60 million by Medicare, currently covers 74 million people and 10 million by the Children’s Health Insurance Program (CHIP), while another 10 million people are getting federally subsidized health insurance through the Affordable Care Act’s (ACA’s) insurance exchanges. “What happens when interest’s demand on federal revenue starts to crowd out future investment in these government programs that provide healthcare for tens of millions of Americans?”

  1. The increasing obesity problem.”Thirty percent of the U.S. population is obese; 70% of the total population is either obese or overweight,” said Burrell. “There is an epidemic of diabetes, heart disease, and coronary artery disease coming from those demographics, and Baby Boomers will see these things in full flower in the next 10 years as they move fully into Medicare.”
  2. The “congealing” of the U.S. healthcare system. This is occurring in two ways, Burrell said. First, “you’ll see large integrated delivery systems [being] built around academic medical centers — very good quality care [but] 50%-100% more expensive than the community average.”

To see how this affects patients, take a family of four — a 40-year-old dad, 33-year-old mom, and two teenage kids — who are buying a health insurance policy from CareFirst via the ACA exchange, with no subsidy. “The cost for their premium and deductibles, copays, and coinsurance [would be] $33,000,” he said. But if all of the care were provided by academic medical centers? “$60,000,” he said. “What these big systems are doing is consolidating community hospitals and independent physician groups, and creating oligopolies.”

Another way the system is “congealing” is the emergence of specialty practices that are backed by private equity companies, said Burrell. “The largest urology group in our area was bought by a private equity firm. How do they make money? They increase fees. There is not an issue of quality but there is a profound issue on costs.”

  1. The undermining of the private healthcare market. “Just recently, we have gotten rid of the individual mandate, and the [cost-sharing reduction] subsidies that were [expected to be] in the omnibus bill … were taken out of the bill,” he said. And state governments are now developing alternatives to the ACA such as short-term duration insurance policies — originally designed to last only 3 months but now being pushed up to a year, with the possibility of renewal — that don’t have to adhere to ACA coverage requirements, said Burrell.
  2. The lackluster performance of new payment models.”Despite the innovation fostering under [Center for Medicare & Medicaid Innovation] programs — the whole idea was to create a series of initiatives that might show the wave of the future — ACOs [accountable care organizations] and the like don’t show the promise intended for them, and there is no new model one could say is demonstrably more successful,” he said.

“So beware — there’s a reckoning coming,” Burrell said. “Maybe change occurs only when there is a rip-roaring crisis; we’re coming to it.” Part of the issue is cost: “As carbon dioxide is to global warming, the cost is to healthcare. We deal with it every day … We face a future where cutbacks in funding could dramatically affect the accessibility of care.”

“Does that mean we move to move single-payer, some major repositioning?” he said. “I don’t know, but in 35 years in this field, I’ve never experienced a time quite like this … Be vigilant, be involved, be committed to serving these populations.”

VA Seeks to Redirect Billions of Dollars into Private Care

Jennifer Steinhauer and Dave Phillipps reported that The Department of Veterans Affairs is preparing to shift billions of dollars from government-run veterans’ hospitals to private health care providers, setting the stage for the biggest transformation of the veterans’ medical system in a generation.

Under proposed guidelines, it would be easier for veterans to receive care in privately run hospitals and have the government pay for it. Veterans would also be allowed access to a system of proposed walk-in clinics, which would serve as a bridge between V.A. emergency rooms and private providers, and would require co-pays for treatment.

Veterans’ hospitals, which treat seven million patients annually, have struggled to see patients on time in recent years, hit by a double crush of returning Iraq and Afghanistan veterans and aging Vietnam veterans. A scandal over hidden waiting lists in 2014 sent Congress searching for fixes, and in the years since, Republicans have pushed to send veterans to the private sector, while Democrats have favored increasing the number of doctors in the V.A.

If put into effect, the proposed rules — many of whose details remain unclear as they are negotiated within the Trump administration — would be a win for the once-obscure Concerned Veterans for America, an advocacy group funded by the network founded by the billionaire industrialists Charles G. and David H. Koch, which has long championed increasing the use of private sector health care for veterans.

For individual veterans, private care could mean shorter waits, more choices and fewer requirements for co-pays — and could prove popular. But some health care experts and veterans’ groups say the change, which has no separate source of funding, would redirect money that the current veterans’ health care system — the largest in the nation — uses to provide specialty care.

Critics have also warned that switching vast numbers of veterans to private hospitals would strain care in the private sector and that costs for taxpayers could skyrocket. In addition, they say it could threaten the future of traditional veterans’ hospitals, some of which are already under review for consolidation or closing.

 President Trump, who made reforming veterans’ health care a major point of his campaign, may reveal details of the plan in his State of the Union address later this month, according to several people in the administration and others outside it who have been briefed on the plan.

The proposed changes have grown out of health care legislation, known as the Mission Act, passed by the last Congress. Supporters, who have been influential in administration policy, argue that the new rules would streamline care available to veterans, whose health problems are many but whose numbers are shrinking, and also prod the veterans’ hospital system to compete for patients, making it more efficient.

“Most veterans chose to serve their country, so they should have the choice to access care in the community with their V.A. benefits — especially if the V.A. can’t serve them in a timely and convenient manner,” said Dan Caldwell, executive director of Concerned Veterans for America.

In remarks at a joint hearing with members of the House and Senate veterans’ committees in December, Mr. Wilkie said veterans largely liked using the department’s hospitals.

“My experience is veterans are happy with the service they get at the Department of Veterans Affairs,” he said. Veterans are not “chomping at the bit” to get services elsewhere, he said, adding, “They want to go to places where people speak the language and understand the culture.”

Health care experts say that whatever the larger effects, allowing more access to private care will prove costly. A 2016 report ordered by Congress, from a panel called the Commission on Care, analyzed the cost of sending more veterans into the community for treatment and warned that unfettered access could cost well over $100 billion each year.

A fight over the future of the veterans’ health care system played a role in the ousting of the department’s previous secretary, David J. Shulkin, center.

Tricare costs have climbed steadily, and the Tricare population is younger and healthier than the general population, while Veterans Affairs patients are generally older and sicker.

Though the rules would place some restrictions on veterans, early estimates by the Office of Management and Budget found that a Tricare-style system would cost about $60 billion each year, according to a former Veterans Affairs official who worked on the project. Congress is unlikely to approve more funding, so the costs are likely to be carved out of existing funds for veterans’ hospitals.

At the same time, Tricare has been popular among recipients — so popular that the percentage of military families using it has nearly doubled since 2001, as private insurance became more expensive, according to the Harvard lecturer Linda Bilmes.

“People will naturally gravitate toward the better deal, that’s economics,” she said. “It has meant a tremendous increase in costs for the government.”

A spokesman for the Department of Veterans Affairs, Curt Cashour, declined to comment on the specifics of the new rules.

“The Mission Act, which sailed through Congress with overwhelming bipartisan support and the strong backing of veterans service organizations, gives the V.A. secretary the authority to set access standards that provide veterans the best and most timely care possible, whether at V.A. or with community providers, and the department is committed to doing just that,” he said in an email.

Veterans’ services organizations have largely opposed large-scale changes to the health program, concerned that the growing costs of outside doctors’ bills would cannibalize the veterans’ hospital system.

Dr. Shulkin, the former secretary, shared that concern. Though he said he supported increasing the use of private health care, he favored a system that would let department doctors decide when patients were sent outside for private care.

The cost of the new rules, he said, could be higher than expected, because most veterans use a mix of private insurance, Medicare and veterans’ benefits, choosing to use the benefits that offer the best deal. Many may choose to forgo Medicare, which requires a substantial co-pay if Veterans Affairs offers private care at no charge. And if enough veterans leave the veterans’ system, he said, it could collapse.

Robert L. Wilkie, the secretary of veterans’ affairs, has repeatedly said his goal is not to privatize veterans’ health care.

One of the group’s former senior advisers, Darin Selnick, played a key role in drafting the Mission Act as a veterans’ affairs adviser at the White House’s Domestic Policy Council and is now a senior adviser to the secretary of Veterans Affairs in charge of drafting the new rules. Mr. Selnick clashed with David J. Shulkin, who was the head of the V.A. for a year under Mr. Trump and is widely viewed as being instrumental in ending Mr. Shulkin’s tenure.

Mr. Selnick declined to comment.

Critics, which include nearly all of the major veterans’ organizations, say that paying for care in the private sector would starve the 153-year-old veterans’ health care system, causing many hospitals to close.

“We don’t like it,” said Rick Weidman, executive director of Vietnam Veterans of America. “This thing was initially sold as to supplement the V.A., and some people want to try and use it to supplant.”

Members of Congress from both parties have been critical of the administration’s inconsistency and lack of details in briefings. At a hearing last month, Senator John Boozman, Republican of Arkansas, told Robert L. Wilkie, the current secretary of Veterans Affairs, that his staff had sometimes come to Capitol Hill “without their act together.”

Although the Trump administration has kept details quiet, officials inside and outside the department say the plan closely resembles the military’s insurance plan, Tricare Prime, which sets a lower bar than the Department of Veterans Affairs when it comes to getting private care.

Tricare automatically allows patients to see a private doctor if they have to travel more than 30 minutes for an appointment with a military doctor, or if they have to wait more than seven days for a routine visit or 24 hours for urgent care. Under current law, veterans qualify for private care only if they have waited 30 days, and sometimes they have to travel hundreds of miles. The administration may propose for veterans a time frame somewhere between the seven- and 30-day periods.

Mr. Wilkie has repeatedly said his goal is not to privatize veterans’ health care, but would not provide details of his proposal when asked at a hearing before Congress in December.

Access to VA Health Services Now Better Than Private Hospitals?

So, the question is with the shift of funding to the privatization of VA care is access better? Nicole Lou, contributing writer for the MedPage noted that efforts to stir up access to Veterans Affairs (VA) hospitals have cut down on wait times for new patient appointments, according to a report.

In 2014, the average wait for a new VA appointment in primary care, dermatology, cardiology, or orthopedics was 22.5 days, compared with 18.7 days in private sector facilities (P=0.20). Although these wait times were statistically no different in general, there was a longer wait for an orthopedics appointment in the VA that year (23.9 days vs 9.9 days for private sector, P<0.001), noted David Shulkin, MD, former VA secretary under President Trump, and now at the University of Pennsylvania’s Leonard Davis Institute of Health Economics, and colleagues.

The study, published in JAMA Network Open, found that wait times in 2017 favored VA medical centers (17.7 days vs 29.8 days for private sector facilities, P<0.001). This was observed for primary care, dermatology, and cardiology appointments — but not orthopedics, which continued to produce appointment lags in the VA system (20.9 days vs 12.4 days, P=0.01), the authors stated.

“Although the results reflect positively on the VA, we intend to continue improving wait times, the accuracy of the data captured, and the transparency of reporting information to veterans and the public,” the researchers wrote.

Their study included VA medical centers in 15 major metropolitan areas and compared them with private sector facilities. Wait times were calculated differently based on VA records and secret shopper surveys, respectively, which was a limitation of the study, the team said.

Shulkin and colleagues found that VA wait times trended toward improvement in 11 of 15 regions, whereas private medical centers had significant increases in wait times in 12 of the 15.

Prompting the scrutiny over VA hospital wait times was a 2014 report showing that at least 40 veterans died waiting for appointments at the Phoenix VA Health Care System in Arizona. Even worse, the wait times had apparently been deliberately manipulated to look better than they were.

“This incident damaged the VA’s credibility and created a public perception regarding the VA health care system’s inability to see patients in a timely manner,” Shulkin and co-authors said. “In response, the VA has worked to improve access, including primary care, mental health, and other specialty care services.”

Meanwhile, VA medical centers continue to suffer from staffing issues such as high turnover and employee vacancies in the tens of thousands.

The study authors noted a modest increase in the number of patients going to VA hospitals for the four services studied, although that number still stayed around five million per year.

From 2014 to 2017, patient satisfaction scores also increased by 1.4%, 3.0%, and 4.0% for specialty care, routine primary care, and urgent primary care, respectively (P<0.05 for all).

Another problem with the methodology of the study was that it failed to address how easily established patients could obtain return appointments, noted an accompanying editorial by Peter Kaboli, MD, MS, of Iowa City Veterans Affairs Healthcare System, and Stephan Fihn, MD, MPH, of the University of Washington in Seattle and JAMA Network Open’s deputy editor.

Furthermore, they pointed out, a patient returning for a 6-month follow-up visit may show up in the scheduling system as having a long delay.

“As this study highlights, measuring access to healthcare remains dodgy. Even so, the seven million veterans who receive care from the VA seem able to obtain routine and urgent care in a time frame that is on par for other Americans despite increasing demand, although there are and always will be exceptions,” Kaboli and Fihn noted.

“As resources in the VA are increasingly diverted to purchase care in the community, it remains to be seen if access to healthcare services can be maintained while access in the private sector continues to deteriorate,” they continued, adding that virtual care may be one way to improve access given the non-infinite supply of face-to-face appointments.

The VA experience seems to say that privatization of healthcare delivery is the way to go with improved access to care. So, onward to discuss universal healthcare and single payer systems of health care delivery. What would they all look like and what are the strategies to develop any of these systems.

 

 

‘Medicare for all’ proposal headed for House hearings and More States Expanding Medicaid

 

 

49025855_1851541661642151_2035183627737759744_nFirst, as we all are frustrated because of the government shutdown, most Federal Health Agencies are OK despite the shutdown. The FDA is feeling the pinch; IHS, ATSDR are affected also. However, it does point out the problems that Congress will face in the next 2 or more years because of political differences and the lack of civility.

News Editor Joyce Frieden pointed out that the partial shutdown of the federal government doesn’t appear to have had an immediate effect on most healthcare-related agencies, but observers expressed concern over what the shutdown might mean for the long term.

The Department of Health and Human Services (HHS), obviously the largest healthcare-related agency, has been largely unaffected by the shutdown, which began at 12:01 a.m. December 22, since most of the department is already funded through fiscal year 2019. However, the FDA is affected because its appropriations fall under a different authorization bill than the rest of HHS, so the agency had to furlough 7,053 staff members; the remaining 10,344 staff members were retained, either because they were performing functions critical to public health and safety, such as protecting ongoing experiments, or because their programs — such as tobacco regulation or new drug development — are funded by user fees.

The Alliance for a Stronger FDA — a group of patient organizations, trade associations, and pharmaceutical and biomedical companies that support adequate funding for the agency — expressed some concerns about the shutdown. “The FDA regulates products that make up 20% of consumer spending,” the organization said in a statement. “The agency’s responsibilities cannot be fully met when 7,000 employees are furloughed. Further, when the FDA is not fulfilling its critical public health responsibilities, there is no backstop to the agency’s work.”

However, “having said that, we have confidence that [FDA Commissioner] Dr. [Scott] Gottlieb and FDA leadership have ensured the emergency and critical public health and safety functions will be covered during a shutdown,” the statement continued. “Consumers should not panic — the FDA is still on the job. The immediate problem, quite a serious one, is the slowing of work on longer-term priorities and items that aren’t absolutely essential. Managing only those items that could turn into an immediate crisis is no way to run an agency that is critical to public health.”

The shutdown also hits the Indian Health Service (IHS), although direct patient care is not affected, HHS explained in its FY 2019 Contingency Staffing Plan, which was issued before the shutdown actually began. In the event of a shutdown, “IHS would continue to provide direct clinical health care services as well as referrals for contracted services that cannot be provided through IHS clinics,” the document noted. As for other IHS services, “many administrative activities are impacted due to the lapse in funding for the IHS,” a spokeswoman said in an email to MedPage Today.

Asked for examples of administrative services that IHS would continue to perform, the spokeswoman said, “The IHS can only perform administrative, oversight, and other functions that are necessary to meet the immediate needs of its patients, medical staff, and medical facilities.” Other media are reporting that some tribes will need to furlough staff and cut back services at their tribally run health clinics if the shutdown continues.

The National Institutes of Health (NIH) is largely unaffected by the shutdown except for the National Institute of Environmental Health Sciences, based in Research Triangle Park, North Carolina. There, Superfund Research Program staff are furloughed and oversight work dealing with about 50 grants is suspended, according to the staffing plan. An NIH spokeswoman confirmed in an email that no other NIH divisions have been affected.

The Agency for Toxic Substances and Disease Registry in Atlanta is another HHS division affected by the shutdown. Although the agency, which deals with environmental health threats and emergencies, will continue carrying out emergency-related functions, it cannot “support most environmental health professional training programs, continuous updating of health exposure assessments and recommendations, and technical assistance, analysis, and [provide] other support to state and local partners,” the staffing plan noted.

Susannah Luthi noted that a new single-payer health system concept will have a set of congressional hearings in the new Democratic House, and a new draft of a so-called “Medicare for all” proposal could be released as soon as next week.

Washington state progressive Democratic Rep. Pramila Jayapal, who over the summer launched the Medicare for All Caucus, said the hearings, with the support of House Speaker Nancy Pelosi (D-Calif.), will start in the House Rules and Budget committees before moving on to the House Energy and Commerce Committee.

“My goal is that these are opportunities to make the case not to the American people—the American people already had the case made to them—but to members of Congress, to really put forward what the legislation looks like,” Jayapal said Thursday after the new Congress elected Pelosi to the speakership.

Pelosi spokesperson Henry Connelly confirmed the speaker supports holding the hearings, although Jayapal acknowledged House Energy and Commerce Chair Frank Pallone (D-N.J.) hasn’t yet committed his panel.

“But I have the speaker’s commitment that she will help me do this, and I’ve spoken to Frank Pallone and he is not opposed,” Jayapal said. “He just hasn’t said ‘yes’ yet.”

A Pallone spokesperson did not respond to a request for comment by deadline.

Jayapal has not yet discussed possible hearings with the head of the other key health panel, Chair Richard Neal (D-Mass.) of the House Ways and Means Committee, but Neal said he is open to discussing the policy as one of the “many options that are out there” as part of holding his committee to regular order.

“That’s what committees are supposed to do, to flesh out alternatives,” Neal said.

This will be the first House hearing since the Affordable Care Act debate when the health panel of the House Committee on Education and Workforce looked at the option.

Details of the bill, a draft of which Jayapal said should be available in the next couple of weeks, are under wraps but she said it does vary from the legislation introduced by Sen. Bernie Sanders (I-Vt.) in 2017. Sanders catapulted talk of “Medicare for all” to the fore during his 2016 presidential bid and key Democratic senators has signed on to his policy since.

This is a different bill, Jayapal said. It’s largely the work of her staff and the staff of Rep. Debbie Dingell (D-Mich.), who sits on the Energy and Commerce Committee.

This new momentum for single payer—an issue that sharply divides the party—comes as Democrats are focused on defending Obamacare and as insurers hold out hope for more funding to shore up the law and draw more people into the individual market.

House Democrats will formally intervene in the lawsuit to overturn the Affordable Care Act following a Texas federal judge’s invalidation of the law—largely a political move around litigation that proved to help the Democrats in November’s elections.

In his first hearing announcement of the new Congress on Thursday, Pallone said his panel will focus on the lawsuit and its impacts. “This decision, if it is upheld, will endanger the lives of millions of Americans who could lose their health coverage,” the release from the Energy and Commerce Committee said. “It would also allow insurance companies to once again discriminate against more than 133 million Americans with pre-existing conditions.”

Judge Reed O’Connor, the Texas judge presiding over the case, ordered that the law is to remain in place as the lawsuit winds its way through the courts on appeal. It is headed next to the Fifth U.S. Circuit Court of Appeals in Louisiana.

The lawsuit was a political winner for Democrats in their campaign to reclaim the House in November, denouncing the GOP state attorneys general who filed the lawsuit and the Trump administration, which sided with the plaintiffs and refused to defend the ACA.

New Maine governor orders Medicaid expansion

Harris Meyer pointed out that the new Democratic Gov. Janet Mills signed an executive order Thursday implementing Maine’s Medicaid expansion, which was overwhelmingly approved by the state’s voters in 2017.The previous governor, Republican Paul LePage, had strongly resisted the expansion, resulting in a court battle that dragged through most of last year and ended with a judge ordering him to move forward with the Medicaid changes. In previous years, he vetoed five bills passed by the legislature to expand the program. An estimated 70,000 low-income adults will be eligible for Medicaid coverage under the expansion. Maine will become the 33rd state to extend the program under the Affordable Care Act to people with incomes up to 138% of the federal poverty level. Voters in Idaho, Nebraska and Utah approved similar Medicaid expansions.

‘Medicare for all’ advocates emboldened by ObamaCare lawsuit

Nathaniel Weixel looked at the ObamaCare lawsuit and its relationship to Medicare for All. Progressive groups and lawmakers plan to use a Texas judge’s ruling against ObamaCare to jump-start their push for “Medicare for all” in the next Congress.

Supporters of a single-payer health system are arguing that now is the time to start moving in a new direction from the Affordable Care Act, in part because they feel the 2010 health law will never be safe from Republican attempts to destroy or sabotage it.

“In light of the Republican Party’s assault, a version of Medicare for all is necessary for the future,” said Topher Spiro, vice president for health policy at the Center for American Progress. “There are just too many points of vulnerability in the current system.”

The court decision in Texas that invalidates ObamaCare in its entirety came on the heels of sweeping Democratic victories in the midterm elections, a combination that has energized advocates of Medicare for all.

“We need to do everything we can to ensure every single American has access to affordable, quality healthcare. Medicare for all has the potential to do just that as it can reduce the complexity and cost with a single payer health care system,” Rep. Debbie Dingell (D-Mich.), co-chair of the Medicare for All Caucus, said in a statement to The Hill.

Yet the effort could very well create divisions within the Democratic Party, as leaders who want to protect and strengthen the health law are reluctant to completely embrace government-run universal health insurance.

In the House and Senate, leading Democrats have said their priorities should be strengthening ObamaCare, rather than fighting over single-payer.

The lawsuit in Texas is almost certain to be overturned, they argue, and their time is better spent making sure people with pre-existing conditions remain free from discrimination by insurers.

“I think the ruling gets overturned within a couple months, so I’m not sure it matters in the long-term fight over the next generation of health-care reform,” said Sen. Chris Murphy(D-Conn.).

Sen. Ron Wyden (D-Ore.) said Democrats should focus on making sure the insurance landscape doesn’t revert to what it was before ObamaCare.

“The first thing we have to do is make sure people don’t lose what they have today — the pre-existing conditions protections — and going back to the days when there was health care for the healthy and the wealthy,” he said.

U.S. District Court Judge Reed O’Connor this month struck down the Affordable Care Act, throwing a new round of uncertainty into the fate of the law.

O’Connor ruled that the law’s individual mandate is unconstitutional, and that because the mandate cannot be separated from the rest of the law, the rest of the law is also invalid.

The court case, brought by 20 GOP-led states, was at the center of this year’s midterm campaign after Democrats attacked Republicans for supporting the lawsuit and seeking to overturn ObamaCare’s protections for pre-existing conditions.

The Trump administration, in a rare move, declined to defend the law in court, arguing instead that the pre-existing condition protections should be overturned.

“This is an outrageous, disastrous decision that threatens the health care and lives of millions of people. It must be overturned,” Sen. Bernie Sanders (I-Vt.) tweeted shortly after the decision was published. “We must move forward to make health care a right for every American.”

Rep. Ro Khanna (D-Calif.), who will be vice chairman of the House Progressive Caucus next year, said the decision “absolutely” makes a case for Medicare for all.

“There’s no doubt that would be constitutional. Medicare is already constitutional and what we’re saying is extend it to everyone, so there can be no constitutional argument,” Khanna told The Hill.

Eagan Kemp, a health-care expert with the advocacy group Public Citizen, also noted how uncontroversial Medicare is compared to ObamaCare.

“This is one more example of how tenuous the law really is,” Kemp said. “You don’t see the same type of sabotage to Medicare. So to me it highlights that the Medicare program remains the third rail of politics, so if we’re going to build a new health-care system, it’s something that can be safe.”

Some lawmakers said they understand the need to be pragmatic since centrist Democrats might not take the same message from the Texas ruling as progressives.

Khanna said he doesn’t think protecting ObamaCare from Republican attacks has to be a separate endeavor from Medicare for all.

Rep. Jan Schakowsky (D-Ill.), a member of the Medicare for All Caucus, told The Hill the fallout from the lawsuit “may help us move in an even more bold and aggressive agenda” on health care.

“We’ll see, though. I think this is the kind of issue that needs a broad consensus, may need some more outreach to the public,” Schakowsky said. “But I am interested in pursuing that agenda.”

Judge grants stay after ruling Affordable Care Act unconstitutional, Obamacare stays in effect

William Cummings of USA Today, reviewed the latest wrinkle in the Obamacare sage,  a federal judge on Sunday said his decision declaring the Affordable Care Act unconstitutional will not take effect while the appeals of his ruling move through the courts.

U.S. District Judge Reed O’Connor wrote in a 30-page court filing that while he believes the Fifth Circuit Court of Appeals “is unlikely to disagree” with his ruling, he agreed to stay his decision because “many everyday Americans would otherwise face great uncertainty” while the appeals play out.

On Dec. 14, O’Connor sided with a coalition of conservative states in a lawsuit challenging the constitutionality of former President Barack Obama’s signature health care law. He found that the individual mandate requiring people to buy health insurance was unconstitutional and said that meant the rest of the law was invalid as well.

In 2012, the Supreme Court upheld the law on the grounds that mandate fell within Congress’ taxation powers. When Congress removed the tax penalty for not buying insurance, that constitutional foundation was knocked out, O’Connor reasoned.

The Trump administration announced in June that it would not defend the individual mandate and other provisions of the law – such as protections for people with pre-existing conditions. But the Justice Department argued those provisions of the law could be thrown out without striking down the entire. O’Connor disagreed.

A group of Democratic states and congressional Democrats have said they plan to appeal O’Connor’s decision, which will next head to the Fifth Circuit. Although O’Connor did not grant an injunction blocking Obamacare in his initial ruling, the coalition led by California asked the judge on Dec. 17 to issue a stay and make it clear that the law will stay in place pending the appeal.

Many experts expect that appellate court to disagree with O’Connor’s ruling that the individual mandate can’t be separated from the rest of the law. If O’Connor’s ruling is upheld it is expected that the case would head to the Supreme Court.

Calif. Medical Assn. President Shares Medical Horror Story

Cheryl Clark, a contributing writer for MedPage Today wrote that the new president of the California Medical Association was expecting to spend New Year’s at a wedding in Las Vegas.

Instead, David Aizuss, MD, posted on Facebook about his “eye opening” first-hand view of “American medicine at its worst.” (The post is visible only to his Facebook friends and he declined MedPage Today‘s request to elaborate, citing ongoing “medical issues.”)

In his post, Aizuss said he was rushed by ambulance to a hospital Monday morning. “I spent hours in the emergency room where I received inadequate treatment of mind boggling pain, was never touched or examined by a physician, was mixed up with another patient and almost inadvertently transferred to another hospital, (and) was scheduled for emergency surgery based on a third patient’s lab work that was confused with mine,” he wrote.

He “finally signed out of the hospital against medical advice so I could obtain care from physicians that I know and trust.” He did not name the hospital.

Aizuss, an ophthalmologist who practices in Calabasas, northwest of Los Angeles, posted his complaint New Year’s Eve, apparently while at the LAX International airport in Los Angeles, where he said he was “just returning from Las Vegas where we were supposed to attend a wedding.”

Dozens of Facebook friends, several apparently also physicians, expressed their shock that the CMA president could receive such poor emergency room response, and some said they were happy he was speaking out about poor quality of hospital care.

“If you get terrible care like this (at least you know the difference) think about the care that Joe Sixpack gets; he doesn’t have the resources to get better care. This system is broken and we need to fix it,” posted one.

Wrote another, “As president of the CMA, your voice can be loud! Don’t be timid and do not be afraid of making enemies. Remember our patients know and respect us when we stand against poor medicine.”

Aizuss ended the post by saying, “Truly an eye-opening experience for the President of the California Medical Association. Happy New Year to all!”

He began his one-year term as CMA president in mid-October, saying he wanted to focus on physician burnout, practice sustainability, and payment. He is also past chairman of the CMA Board of Trustees.

He is a medical staff member at Tarzana Hospital and West Hills Hospital, in Los Angeles County, and serves as an assistant clinical professor of ophthalmology at the UCLA Geffen School of Medicine.

The CMA represents about 43,000 physicians in the state and is the second largest organized medicine group of any state, next to the Texas Medical Association, which represents about 52,000 physicians.

Why did I end with this article? It points out the fact that whatever the politics, we all have to continue to forge a better health care system. We need to get rid of the biases and the politics and strive, no demand a better healthcare delivery system. But we also have to realize that it will take some radicle changes, but it will be worth it in the end.

Let us continue the research and discussion  into what the healthcare system will look like in our future!

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

 

 

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

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

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

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

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

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

The popularity of ‘democratic socialism’

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

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

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

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

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

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

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

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

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

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

Britain’s Health Care System Demonstrates Perils of Socialized Medicine

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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