Category Archives: Trump

American life has been transformed in a few short weeks and the Cost to Economies and the Ethics in Decision Making in a Pandemic

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?

cap.gifp-a8GHW19EK4IzY.gif“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.

Testing? Testing?

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.

Checkered past

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.”

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

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

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

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

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

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

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

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

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

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

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

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

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

US may pay for uninsured coronavirus patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘It is a unique virus with unique characteristics’

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

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

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

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

Older patients face the highest risk 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

On guard

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

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

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

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

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

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

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

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

Here’s what you must keep in mind:

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

Preventive measures

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stay well!!

What the Trump budget says about the administration’s health priorities; The Dems and Bloomberg and More on the Corona Virus

As Michael Bloomberg continues to attempt to buy the Primaries and the Elections let us look at Trump’s new budget and its effect on health care. University of Pennsylvania Assistant Professor of Public Policy, Simon F. Haeder reported that the Trump administration recently released its budget blueprint for the 2021 fiscal year, the first steps in the complex budgetary process.

The final budget will reflect the input of Congress, including the Democratic House of Representatives, and will look significantly different.

However, budget drafts by presidential administrations are not meaningless pages of paper. They are important policy documents highlighting goals, priorities and visions for the future of the country.

As a health care expert, I find the vision brought forward by the Trump administration deeply concerning. Cuts to virtually all important health-related programs bode ill for nations future. To make things worse, ancillary programs that are crucial for good health are also on the chopping block. To be sure, most of the proposed damage will find it hard to pass muster with Congress. Yet given the nation’s ever-growing debt Congress may soon be amenable to rolling back the nation’s health safety net.

Rolling back the ACA and the safety net

To no one’s surprise, some of the biggest cuts in the proposed budget focus on health care programs. The budget document uses a number of terms to disguise its true intentions. Yet a closer look indicates that terms like “rightsizing government,” “advancing the President’s health reform vision,” “modernizing Medicaid and the Children’s Health Insurance Program,” and “reforming welfare programs” all come down to the same end result: cuts to the safety net.

One of the main targets remains the Affordable Care Act, or ACA. In 2017, after several failed attempts to repeal and replace the ACA, the Trump administration has scaled back its open hostility. Instead of asking directly to repeal the ACA, this year’s budget proposal calls for initiatives to “advance the president’s health reform vision,” by cutting more than half a trillion dollars from the budget.

These initiatives come on top of actions the Trump administration has already taken to roll back the Affordable Care Act, including the repeal of the individual mandate penalty, severely limiting outreach and enrollment efforts, and creating a parallel insurance market by expanding the roles of short-term, limited duration and association health plans.

The Trump administration has also targeted Medicaid, the nation’s largest safety net program serving mostly low-income Americans, pregnant women, children, the disabled and those in need of long-term care, as well as its cousin, the Children’s Health Insurance Program. Overall “modernization” for these two programs alone would entail cuts of almost US$200 billion.

Medicare, the program serving America’s seniors, technically would not undergo significant restructuring. However, “streamlining” and “eliminating waste” would reduce the program by more than half a trillion dollars or 6%. All put together, cuts to the ACA, Medicaid and Medicare will exceed a trillion dollars over a decade. Coverage losses, mostly affecting lower-income Americans, would range in the millions of dollars.

Health is more than just medical care

In the U.S, we often equate health with access to medical care. However, researchers have long recognized that medical care contributes only about 10% to 20% to the health of individuals.

One crucial component of good health is access to education. However, the Trump budget includes cuts of more than $300 billion across the entire education spectrum from Head Start to grants that support college education. This just doesn’t make any sense!

Access to food and nutrition also plays a major role in maintaining good health. However, two programs providing important food security to millions of Americans would face significant cuts. For one, the Supplemental Nutrition Assistance Program (SNAP), which supplements food budgets for 34 million Americans with an annual budget of $58 billion, is slated for $22 billion in cuts over a decade. There are also cuts exceeding $2 billion over a decade to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which reaches more than 6 million Americans with an annual budget of $6.4 billion.

Cuts to nutritional benefits would be further compounded by a 15.2% reduction to the Department of Housing and Urban Development. The department provides a range of housing assistance programs to needy individuals. Moreover, the Temporary Assistance for Needy Families (TANF) program which provides cash benefits to needy families, faces 10% in cuts. Again, this doesn’t make any sense!

A healthy environment and access to clean air and water unquestionably are crucial to living a healthy life. However, the proposed budget would trim spending on the agency tasked with protecting the nation’s environment, the Environmental Protection Agency, by more than 40%, or $36 billion.

A myriad of public health crises has been slowly but steadily harming communities all across the country. Much of the attention has been garnered by the devastating opioid crisis. More recently, the coronavirus and the seasonal flu epidemic have caught the headlines. Yet, there are countless other epidemics harming communities around the country including syphilis, hepatitis C and gonorrhea. Yet the nation’s major public health agency, the Centers for Disease Control, would see its budget decline by 9%.

The Trump administration is also proposing to significantly reduce funding for health-related research programs. One target is the National Science Foundation, which would see a reduction by 6.5%. Moreover, the National Institutes of Health, the nation’s premier medical research agency, is set for 7.2% in cuts. Both agencies play crucial roles in positioning the nation to tackle current and future health challenges. Do any of these budget cuts make any sense?

A blueprint for the future?

Since the Kennedy administration, taxes have generally been cut and only rarely increased. Particularly large tax cuts under the George W. Bush administration, without commensurate budget cuts, have created a systemic imbalance in the federal budget. This imbalance was further exacerbated by the recent tax cuts under the Trump administration.

So far, we have been able to stall the eventual reckoning because of strong economic growth and our ability to borrow heavily. Eventually, it seems inevitable that this massive imbalance will catch up with us.

Faced with the choice to either raise taxes or cut programs, Congress may choose the latter. With defense spending largely untouchable, health programs and other social support systems will likely bear the brunt.

Democrats Get Personal on Healthcare 

Shannon Firth reported that the Democratic presidential candidates engaged in one of the most brutal and bruising fights to date, attacking each other’s integrity and physical fitness while still reserving time to tear into each other’s healthcare plans.

The debate took place in Las Vegas, with caucuses in Nevada only a few days away, and was broadcast by NBC/MSNBC.

Ahead of the debate, Sen. Bernie Sanders of Vermont, was leading nearly every poll according to RealClearPolitics.

In addition to Sanders, participants included former New York City Mayor Mike Bloomberg, Sen. Elizabeth Warren of Massachusetts, former Vice President Joe Biden, former South Bend, Indiana, Mayor Pete Buttigieg, and Sen. Amy Klobuchar of Minnesota.

Sanders’ health came under scrutiny in the wake of his October 2019 heart attack and stent placements.

When asked whether he would offer voters “full transparency” around his medical records, he was quick to point out that Bloomberg also has two stents. Sanders then said he had released the “full report” of his heart attack and decades of records from the attending physicians on Capitol Hill. (Last month, though, cardiologist Anthony Pearson, MD, noted that the recent report didn’t include Sanders’ left ventricular ejection fraction, a key indicator of cardiac function.)

In addition, two “leading Vermont cardiologists” had also released reports stating that he is “more than able to deal with the stress and the vigor of being president of the United States,” Sanders said, challenging anyone who doubts his stamina to “follow me around the campaign trail.”

Buttigieg quipped that Sanders was in “fighting shape,” but continued to stress the need for transparency.

When President Obama was in office the standard, he was to release “the read out” after a physical. While President Trump lowered that bar, Buttigieg said it should be raised.

“I am certainly prepared to get a physical, put out the results,” he said, “and I think everybody here should be willing to do the same.”

‘A PowerPoint,’ a ‘Post-It,’ and a ‘Good Start’

When it came to healthcare reform plans, Warren took aim at each of the other candidates.

Buttigieg has a “slogan” dreamed up by consultants, she said. “It’s not a plan, it’s a PowerPoint,” referring to Buttigieg’s “Medicare for All Who Want It.”

Buttigieg’s plan, which includes a public option, would initially preserve the role of private insurers, but later serve as a “glide path to Medicare for All.”

She likened Klobuchar’s plan, which also involves a public option, to a “a Post-It Note, ‘Insert plan here,'” then she took aim at Sanders’ more comprehensive plan. Although she had endorsed it in the first debate, this time she called it merely “a good start” that leaves gaping holes in how it would be implemented.

As candidate’s hands shot, with each rebuke, signaling a request to defend themselves, Warren shared her own vision for healthcare reform.

“[W]e need as much help for as many people as quickly as possible and bring in as many supporters as we can. And if we don’t get it all the first time,” presumably here she’s referring to a complete transition to a single-payer system, “… take the win and come back into the fight and ask for more,” Warren said.

Medicare for All has been a particular point of contention in Nevada, where the powerful Culinary Workers Union has been vocal in opposing any plan that takes away its members’ negotiated healthcare coverage. (The union declined to endorse any candidates in the state’s caucuses.) Asked about it in Wednesday’s debate, Sanders said, “I will never sign a bill that will reduce the healthcare benefits that they have, we will only expand it for them, for every union in America and for the working class of this country.”

Buttigieg, however, suggested that Sanders hadn’t been listening. “This idea that the union members don’t know what’s good for them is the exact kind of condescension and arrogance that makes people skeptical of the policies we’ve been putting forward.”

At another point, Biden took a shot at Bloomberg for having attacked the Affordable Care Act during a 2010 speech.

Bloomberg countered that he was in fact “a fan” of the landmark law. “I was in favor of it, I thought it didn’t… go as far as we should,” he said.

Now, his position is that Obamacare should be preserved and strengthened. “We shouldn’t just walk away and start something that is totally new, untried. People depend on this,” he said. One of his first moves as president would be to “bring back those things” that President Trump eliminated.

Other features of Bloomberg’s plan include a public option, caps on healthcare prices, and elimination of “surprise medical bills.” The overall goal is to achieve universal coverage while preserving private insurance.

Bloomberg To Grieving Family: Elderly Cancer Patients Are Too Expensive

Peter Hasson of the National Interest reported that Billionaire and Democratic presidential candidate Michael Bloomberg said in a 2011 video that elderly cancer patients should be denied treatment in order to cut health care costs.

“All of these costs keep going up, nobody wants to pay any more money, and at the rate we’re going, health care is going to bankrupt us,” said Bloomberg, who was then New York City’s mayor.

“We’ve got to sit here and say which things we’re going to do, and which things we’re not, nobody wants to do that. Y’know, if you show up with prostate cancer, you’re 95 years old, we should say, ‘Go and enjoy. Have a nice [inaudible]. Live a long life. There’s no cure, and we can’t do anything.’ If you’re a young person, we should do something about it,” Bloomberg said in the video.

“Society’s not ready to do that yet,” he added.

Bloomberg made the comments while visiting a grieving family whose brother had died after reportedly waiting 73 hours in an emergency room.

His presidential campaign didn’t return a request for comment.

The New York billionaire has faced increased scrutiny over past statements as he has continued to rise in Democratic primary polls.

Fake Facts Are Flying About Coronavirus. Now There’s A Plan to Debunk Them

We have been hearing all sorts of information regarding the Corona Virus and I thought that I would share some of the Fake Facts and some of the truths. Malaka Gharib reported that the coronavirus outbreak has sparked what the World Health Organization is calling an “infodemic” — an overwhelming amount of information on social media and websites. Some of it’s accurate. And some is downright untrue.

The false statements range from a conspiracy theory that the virus is a man-made bioweapon to the claim that more than 100,000 have died from the disease (as of this week, the number of reported fatalities is reported at 2,200-plus).

WHO is fighting back? In early January, a few weeks after China reported the first cases, the U.N. agency launched a pilot program to make sure the facts about the newly identified virus are communicated to the public. The project is called EPI-WIN — short for WHO Information Network for Epidemics.

“We need a vaccine against misinformation,” said Dr. Mike Ryan, head of WHO’s health emergencies program, at a WHO briefing on the virus earlier this month.

The Coronavirus Outbreak
What you should know

  • Where the virus has spread
  • Coronavirus 101
  • Coronavirus FAQs

While this is not the first health crisis that has been characterized by online misinformation — it happened with Ebola, for example — researchers are especially concerned because this outbreak is centered in China. The world’s most populous country has the largest market of Internet users globally: 21% of the world’s 3.8 billion Internet users are in China.

And fake news can spread quickly online. A 2018 study from Massachusetts Institute of Technology found that “false news spreads more rapidly on the social network Twitter than real news does.” The reason, say the researchers, may be that the untrue statements inspire strong feelings such as fear, disgust and surprise.

This dynamic could cause fake coronavirus cures and treatments to fan out widely on social media — and as a result, worsen the impact of the outbreak, says Bhaskar Chakravorti, dean of global business at the Fletcher School at Tufts University. Over the past decade, he has been tracking the effect of digital technology on issues such as global health and economic development.

The rumors offer remedies that have no basis in science. One untrue statement suggests that rubbing sesame oil on the skin will block the coronavirus.

If segments of the public turn to false treatments rather than follow the advice of trusted sources for avoiding illness (like frequent hand-washing with soap and water), it could cause “the disease to travel further and faster than it ordinarily would have,” says Chakravorti.

There could be a political agenda behind the fake coronavirus news as well. Countries that are antagonistic toward China could try to hijack the conversation in hopes of creating chaos and eroding trust in the authorities, says Dr. Margaret Bourdeaux, research director for Harvard Belfer Center’s Security and Global Health Project.

“Disinformation that specifically targets your health system or your leaders who are trying to manage an emergency is a way of destroying, undermining, disrupting your health system,” she says.

In the instance of vaccines, Russian bots have been identified as fueling skepticism about the effectiveness of vaccination for childhood diseases in the U.S.

The World Health Organization’s EPI-WIN team believes that the countermeasure for misinformation and disinformation is simply to tell the truth.

It works rapidly to debunk unjustified medical claims on social media. In a series of bright blue graphics posted on Instagram, EPI-WIN states categorically that neither sesame oil nor breathing in the smoke of fire or fireworks will kill the new coronavirus.

Part of this truth-telling strategy involves enlisting large-scale employers.

The approach, says Melinda Frost, an officer on the EPI-WIN team, is based on the idea that employers are the most trusted institution in society, a finding reflected in a 2020 study on global trust from the public relations firm Edelman: “People tend to trust their employers more than they trust several other sources of information.”

Over the past few weeks, Frost and her team have been organizing rounds of conference calls with representatives from Fortune 500 companies and other multinational corporations in sectors such as health, travel and tourism, food and agriculture, and business.

The company representatives share questions that their employees might have about the coronavirus outbreak — for example, is it safe to go to conferences? The EPI-WIN team gathers the frequently asked questions, has their experts answer them within a few days, and then sends the responses back to the companies to distribute in internal newsletters and other communication.

Because the information is coming from their employer, says Frost, the hope is that people will be more likely to believe what they hear and pass the information on to their family and community.

Bourdeaux at Harvard calls this approach a “smart move.”

It borrows from “advertising techniques from the 1950s,” she adds. “They’re establishing the narrative before anybody else can. They are going on offense, saying, ‘Here are the facts.’ “

WHO is also collaborating with tech giants like Google, Twitter, Facebook, Pinterest and TikTok to limit the spread of harmful rumors? It’s pursuing a similar tactic with Chinese digital companies such as Baidu, Tencent and Weibo.

“We are asking them to filter out false information and promote accurate information from credible sources like WHO, CDC [the U.S. Centers for Disease Control and Prevention] and others. And we thank them for their efforts so far,” said Dr. Tedros Adhanom Ghebreyesus, director-general of WHO, in a briefing earlier this month.

Google and Twitter, for example, now actively bump up credible sources such as WHO and the CDC in search results for the term “coronavirus.” And Facebook has deployed fact-checkers to remove content with false claims or conspiracy theories about the outbreak. Kang-Xing Jin, head of health at Facebook, wrote in a statement about one such rumor that it has eliminated from its platform: that drinking bleach cures coronavirus.

Chakravorti applauds WHO’s coordination with the digital companies — but says he’s particularly impressed with Facebook’s efforts. “This is a radical departure from Facebook’s past record, including its controversial insistence on permitting false political ads,” he wrote in an op-ed in Bloomberg News.

[Facebook and Twitter did not respond to requests from NPR for comments. Facebook is one of NPR’s financial sponsors.]

Still, there is no silver bullet to fighting health misinformation. It has become “very, very difficult to fight effectively,” says Chakravorti of Tufts University.

A post making a false claim about coronavirus can just “jump platforms,” he says. “So you might have Facebook taking down a post, but then the post finds its way on Twitter, then it jumps from Twitter to YouTube.”

In addition to efforts by WHO and other organizations, individuals are doing their part.

On Wednesday, The Lancet published a statement from 27 public health scientists addressing rumors that the coronavirus had been engineered in a Wuhan lab: “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin …. Conspiracy theories do nothing but create fear, rumors and prejudice that jeopardize our global collaboration in the fight against this virus.”

Dr. Deliang Tang, a molecular epidemiologist at Columbia University’s Mailman School of Public Health, says his friends from medical school and his research colleagues in China find it difficult to trust Chinese health authorities, especially after police reprimanded the eight Chinese doctors who warned others about a pneumonialike disease in December.

As a result, Tang’s network in China has been looking to him and others in the scientific community to share information.

Since the outbreak began, Tang says he has been answering “30 to 50 questions a night.” Many want to fact-check rumors or learn about clinical trials for a potential cure.

“My real work starts at 7 p.m.,” he says — morning in China.

And the latest news on the Corona virus: Coronavirus update: 80,238 cases, 2,700 deaths; CDC warns Americans to prepare for disruption

And: Harvard scientist predicts coronavirus will infect up to 70 percent of humanity

More on the Corona Virus next week!

Health care spending hit $3.6 trillion in 2018 due to ACA tax, The GDP and Again My Worry Concerning Rural Hospitals

bus559National spending on health care is rising, fueled in part by the reinstatement of an Affordable Care Act tax on insurers, according to a new federal report.

Total national health expenditures last year increased by 4.6 percent to $3.6 trillion last year, the Centers for Medicare and Medicaid Services said. The U.S. spent about $11.172 per person, and national health care spending accounted for about 17.7 percent of the total U.S. economy last year, compared with 17.9 percent in 2017. It was roughly the same as in 2016.

By household, health care spending, which includes out-of-pocket spending, contributions to private health insurance premiums and contributions to Medicare through payroll taxes and premiums, also grew by 4.4 percent.

Private businesses, meanwhile, shelled out $726.8 billion on health care, a 6.2 percent increase from the year-ago period. Most of that goes toward employers’ contributions for insurance premiums. At 20 percent, it absorbed the second-largest shares of health care spending, preceded only by the federal government and households.

Overall, spending by Medicare, Medicaid, and private health insurance grew faster because of the health insurance tax; an annual fee on all health insurers intended to help fund the estimated $1 trillion cost of the ACA. Congress suspended the tax in 2017 and 2019. It was expected to raise $14.3 billion in 2018, according to the Internal Revenue Service.

“It was responsible for a significant portion of the rise we saw,” Micah Hartman, the report’s lead author, told The Wall Street Journal.

As baby boomers age, the pace of health care spending is only expected to grow. Health care’s share of the economy is projected to climb to 19.4 percent by 2027 from 17.9 percent in 2017, according to a previous CMS study cited by the Journal.

The number of uninsured Americans rose by 1 million for the second year in a row to 30.7 million in 2018. The rate of people without health insurance held steady under 10 percent.

The report could draw the ire of Democrats, who have criticized the Trump administration for its attacks on the ACA. The future of the Obama-era health law is in limbo as a panel of three federal appeals court judges weighs whether it’s unconstitutional after Republicans stripped it of the individual mandate in 2017.

Rare Dip in Healthcare’s Share of GDP in 2018

CMS report shows growth in spending on physician services fell slightly

Joyce Frieden, the News Editor of the MedPage points out that overall U.S.healthcare spending increased by 4.6% in 2018 — higher than the 4.2% growth in 2017, but still representing a slight drop in healthcare’s percentage of the nation’s gross domestic product (GDP), the Centers for Medicare & Medicaid Services (CMS) said Thursday.

The increase left the U.S. with health spending of $3.6 trillion in 2018, or $11,172 per person. Some of the spending increase was attributed to growth in private health insurance and Medicare spending due to collection of the Affordable Care Act’s health insurance tax — postponed from 2017 — which raised $14.3 billion in 2018, said Micah Hartman, a statistician in CMS’s Office of the Actuary, during a press briefing hosted by Health Affairs. (The figure for the tax revenue came from the Internal Revenue Service, not CMS.) Other growth drivers included faster growth in healthcare prices. Because the overall economy’s 5.4% growth in 2018 outpaced healthcare spending, the percentage of GDP spent on healthcare dropped slightly, from 17.9% in 2017 to 17.7% in 2018, Hartman said.

Paul Hughes-Cromwick, MA, co-director of Sustainable Health Spending Strategies at Altarum, a healthcare consulting firm here, said in an email that he found the decrease in percentage of GDP “encouraging,” but added that “we can safely predict that this will return to near 18% in 2019 with mildly accelerating health spending and weakening GDP growth.” And “despite all the talk and support for social determinants of health (SDOH) across the political spectrum, government public health activities only grew at 2.4%, the second slowest in the past 7 years (though it is expected that much SDOH activity lies outside formal public health spending).”

Jamie Hall, a research fellow in quantitative analysis at the Heritage Foundation here, said in a phone interview that the decrease in the percentage of GDP “is the first time that’s happened since before Obamacare. So it’s a good sign that some of the Trump administration policies that are oriented toward containing costs are having an effect” — things like short-term, limited-duration insurance policies and efforts to lower the cost of prescription drugs. “We’re sort of more at equilibrium and it’s somewhat more of a stable system at this point,” he said.

Growth in Spending on Physicians Declines

Spending on physician care and other clinical services increased by 4.1% in 2018, down from 4.7% the year before. This was due in part to slower growth in private health insurance, Medicaid, and “residual use and intensity” — the number and intensity of clinician visits — and was not offset by faster growth in healthcare prices, said Aaron Catlin, deputy director in the Office of the Actuary.

Healthcare prices are accelerating from an all-time low measured in 2015, Hughes-Cromwick noted. “If health care price growth returns to a historical pattern, i.e., significantly higher than economy-wide inflation, healthcare spending will definitely accelerate,” consistent with CMS’s long-run projections, he said.

The percentage of uninsured Americans grew by one million people, from 29.7 million to 30.7 million, according to CMS; that was on top of a previous one-million-person increase from 28.7 million in 2016. “We can’t track individuals, so we can’t say where those people came from and the status of their coverage before and after becoming uninsured … but we do show decreases in private health insurance and reductions in other directly purchased insurance,” said Catlin.

This increase in the uninsured “is a huge issue,” said Dan Mendelson, founder and former CEO of Avalere, a healthcare consulting firm here, in a phone interview. “The numbers are on an upward march and it will be a major electoral issue going into 2020.”

But Hall said the uninsured numbers were “quite misleading.” “Of the folks officially considered uninsured, the overwhelming majority of these folks have access to some type of coverage but have chosen not to enroll,” he said. “It’s important that folks not equate a lack of insurance with lack of access to coverage or lack of access to care.”

Private Insurance Enrollment Down

Private health insurance enrollment declined by 1.6 million people, with the drop coming primarily from those enrolled in private plans outside the ACA’s health insurance marketplaces, said Anne Martin, an economist in the Office of the Actuary. The number of enrollees who purchased employer-sponsored health insurance also fell slightly, from 175.6 million to 175.2 million. Medicare enrollment, on the other hand, grew from 57.2 million in 2017 to 58.7 million in 2018, while Medicaid enrollment also rose slightly during the same time period, from 72.1 million to 72.8 million.

Despite the enrollment drop, spending on private health insurance grew by 5.8%, to $1.2 trillion, up from 4.9% the prior year, Martin continued. “The most significant factor in insurance spending was the increase in the net cost of health insurance, which was influenced by the health insurance tax.”

Retail prescription drug spending rose by 2.5% in 2018, to $335 billion, up from a 1.4% increase in 2017. “This faster rate of growth was driven by non-price factors, such as the use and mix of drugs consumed, which more than offset a decline of 1% in prices for retail prescription drugs,” the agency said in a press release. This spending category does not take into account spending on physician-administered drugs or drugs administered in the hospital.

Home Healthcare Spending Up

“The fact that drug spending at the pharmacy is attenuating is a big deal, and it appears to be a combination of the mix of drugs being used,” Mendelson said. “It shows that consumers are using drugs more efficiently, which is good news. I think that change of behavior has been happening for quite some time; it’s durable and it’s a positive effect.”

However, he added, “The other thing is that healthcare costs are still rising much more rapidly than wages, and what it shows is that while costs have attenuated, the fact that they’re still rising faster than wages is squeezing consumers significantly … The fact we’re seeing macro[-level] progress doesn’t help the patient who is facing a $5,000 deductible and trying to figure out how to pay for their healthcare.”

In terms of personal healthcare spending, some of the largest increases were in-home healthcare (up 5.2%), durable medical equipment (up 4.7%), and dental services (up 4.6%). Spending on hospital care in 2018 rose 4.5% to $1.2 trillion, down slightly from a 4.7% increase the year before. The slower growth was attributed to a decrease in out-of-pocket hospital spending growth, decreased residual use and intensity, a slowing in inpatient days in hospitals, and a drop in the growth of hospital spending by the Defense Department.

Overall, 33% of healthcare expenditures in 2018 went for hospital care, 20% went for physician care and other clinician services, 13% to other services, 9% to retail prescription drugs, 8% to government administration and net cost of health insurance, and 5% to nursing care and continuing care retirement communities, according to the agency.

Sally Pipes: Sanders, Warren wants ‘Medicare-for-all’ like Canada – But Canadian health care is awful

Sally Pipes of the Fox News reported that the Democratic presidential candidates Sens. Bernie Sanders and Elizabeth Warren want you to believe Canada’s health care system is a dream come true. And they want to make the dream even better with their “Medicare-for-all” plans. Don’t believe them.

In truth, Canada’s system of socialized medicine is actually a nightmare. It has left hospitals overcrowded, understaffed and unable to treat some patients. Americans would face the same dismal reality if Canadian-style “Medicare-for-all” takes root here.

Canada’s health care system is the model for the “Medicare-for-all” plan that both Sanders, I-Vt., and Warren, D-Mass., embrace.

North of the border, all residents have taxpayer-funded, comprehensive health coverage. In theory, they can walk into any hospital or doctor’s office and get the care they need, without a co-pay or deductible.

Sanders and Warren would one-up Canada by providing all Americans with free prescription drugs, free long-term care, free dental care, free vision care, and free care for people with hearing problems.

Who could possibly object to all that free care?

Well, politicians in Canada object. They say even their country can’t do what Sanders and Warren want because all this free care would cost too much and cause other problems.

But for Sanders and Warren, money is no object. They can just raise taxes as higher and higher and higher. And the huge tax increases needed to fund “Medicare-for-all” would hit us all – there aren’t enough millionaires and billionaires to foot the bill.

It’s true that everyone in Canada has health coverage. But that coverage doesn’t always secure care. According to the Fraser Institute, a Canadian think tank, patients waited a median of nearly 20 weeks to receive specialist treatment after referral by a general practitioner in 2018. That’s more than double the wait patients faced 25 years ago.

In Nova Scotia, patients faced a median total wait time of 34 weeks. More than 6 percent of the province’s population was waiting for treatment in 2018.

Waiting for care is perhaps better than not being able to seek it at all. The hospital emergency department in Annapolis Royal in Nova Scotia recently announced that it would simply close on Tuesdays and Thursdays. There aren’t enough doctors available to staff the facility.

Canadians can’t escape waits like these unless they leave the country and payout of pocket for health care abroad. Private health insurance is illegal in Canada.

Private clinics in Canada are not allowed to charge patients for “medically necessary” services that the country’s single-payer plan covers. And the government has deemed just about every conceivable service “medically necessary.”

For the past decade, Dr. Brian Day, an orthopedic surgeon who runs the private Cambie Surgery Centre in British Columbia, has tried to offer Canadians a way out of the waits by expanding patient access to private clinics. He’s been battling his home province in court for a decade to essentially grant patients the ability to pay providers directly for speedier care.

During closing arguments in Day’s trial before the British Columbia Supreme Court at the end of November, Dr. Roland Orfaly of the British Columbia Anesthesiologists’ Society testified that over 300 patients in the province died waiting for surgery from 2015 to 2016 because of a shortage of anesthesiologists. And that was in just one of the province’s five regional health authorities!

Shortages of crucial medical personnel and equipment are common throughout Canada. The country has fewer than three doctors for every 1,000 residents. That puts it 26th among 28 countries with universal health coverage schemes. If current trends continue, the country will be short 60,000 full-time nurses in just three years.

In 2018, Canada had less than 16 CT scanners for every million people. The United States, by comparison, had nearly 45 per million.

These shortages, combined with long waits, can lead to incredible suffering.

In 2017, one British Columbia woman who was struggling to breathe sought treatment in an overcrowded emergency room. She was given a shot of morphine and sent home. She died two days later.

That same year, a Halifax, Nova Scotia, man dying of pancreatic cancer was left in a cold hallway for six hours when doctors couldn’t find him a bed. Yes, people must sometimes be treated on hallway floors because of severe overcrowding.

In fact, some Canadian hospital emergency rooms look like they belong in poverty-stricken Third World countries.
WBUR Radio, Boston’s NPR station, documented these terrible conditions in a story about a hospital in Nova Scotia earlier this month.

Americans who find the promise of free health care difficult to resist would do well to take a hard look north.

Sure, “Medicare-for-all” as pitched by Sanders and Warren sounds good. But the reality is far from what these two far-left candidates are promising. Like a drug that helps you in one way but causes even more serious problems, “Medicare-for-all” has dangerous side effects that can be hazardous to your health.

Rural hospital acquisitions may reduce patient services

I have already discussed the outcome of Medicare for All on physicians and especially rural hospitals. Beware, especially when we hear of what is happening already! Last week it was reported that one of the hospital systems in Chicago fired 15 physicians and hired NP’s/nurse practitioners to take over their patient care responsibilities.

Also, Carolyn Crist of Reuters noted that although hospitals can improve financially when they join larger health systems, the merger might also reduce access to services for patients in rural areas, according to a new study.

After an affiliation, rural hospitals are more likely to lose onsite imaging and obstetric and primary care services, researchers report in a special issue of the journal Health Affairs devoted to rural health issues in the United States.

“The major concern when you think about health and healthcare in rural America is access,” said lead study author Claire O’Hanlon of the RAND Corporation in Santa Monica, California.

More than 100 rural hospitals in the U.S. have closed since 2010, the study authors write.

“Hospitals in rural areas are struggling to stay open for a lot of different reasons, but many are looking to health-system affiliation as a way to keep the doors open,” she told Reuters Health by email. “But when you give up local control of your hospital to a health system, a lot of things can change that may or may not be good for the hospital or its patients.”

Using annual surveys by the American Hospital Association, O’Hanlon and colleagues compared 306 rural hospitals that affiliated during 2008-2017 with 994 nonaffiliated rural hospitals on 12 measures, including quality, service utilization, and financial performance. The study team also looked at the emergency department and nonemergency visits, long-term debt, operating margins, patient experience scores, and hospital readmissions.

They found that rural hospitals that affiliated had a significant reduction in outpatient non-emergency visits, onsite diagnostic imaging technologies such as MRI machines, and availability of obstetric and primary care services. For instance, obstetric services dropped by 7-14% annually in the five years following affiliation.

“Does this mean that patients are getting prenatal care in their community at a different location, traveling to receive prenatal care at another location of the same health system, or forgoing this care entirely?” O’Hanlon said. “Trying to figure out the extent to which the observed changes in the services available onsite at rural hospitals reflect real changes in patient access is an important next step.”

At the same time, the affiliated hospitals also experienced an increase in operating margins, from an average baseline of -1.6%, typical increases were 1.6 to 3.6 percentage points, the authors note. The better financial performance appeared to be driven largely by decreased operating costs.

Overall, patient experience scores, long-term debt ratios, hospital readmissions, and emergency department visits were similar for affiliating and non-affiliating hospitals.

“Research on these mergers has been mixed, with some suggestions they are beneficial for the community (access to capital, more specialty services, keep the hospital open) and other evidence that there are costs (employment reductions, loss of local control, increase in prices),” said Mark Holmes of the University of North Carolina at Chapel Hill, who wasn’t involved in the study.

“Mergers can have a large impact on a community, so understanding the effect on the resultant access, cost and quality of locally available services is important,” he told Reuters Health by email.

A limitation of the study is that the surveys capture affiliation broadly and don’t specifically describe the arrangements, the study authors’ note. Future studies should investigate the different types of affiliations, such as a full acquisition versus a clinically integrated hospital network, which may show different outcomes, said Rachel Mosher Henke of IBM Watson Health in Cambridge, Massachusetts, who also wasn’t involved in the study.

For instance, certain types of rural hospital affiliations may be better for the community than a full hospital closure, she said.

“However, it’s important to evaluate the potential for negative consequences for the community in terms of reduced service offerings,” she told Reuters Health by email. “New payment models such as all-payer global payments that allow rural hospitals to continue to operate independently with consistent cash flow may be an alternative to affiliation to consider.” But it may not fix the impossible especially if the system pays all at Medicare or Medicaid rates?

Next is to discuss the basis of single-payer healthcare systems and look who is back trying to hold his lead in the Democratic-run for President a guy who can’t even remember where he is, dates, or where he is going, Joe Biden!!!

 

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

 

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

The Big Push for Medicare Advantage, Trump’s Counter Health Care Proposal and Dumb Bernie!

rights328Michael Rainey reported that Medicare is shaping up as one of the most important issues in the 2020 election, with several leading Democrats offering proposals that would significantly expand the program. President Trump jumped into the fray with an executive order last week that he claimed would protect and improve the Medicare system, in part by promoting broader use of private Medicare Advantage plans. Those plans are quite lucrative for the private insurers that sell them, Bloomberg’s John Tozzi said Wednesday, and they’ll be pushing hard to sell more of them when Medicare enrollment begins next week.

Enrollment in Medicare Advantage has more than tripled in the last 20 years, and now about a third of all Medicare beneficiaries get coverage through private plans. If current trends continue, more than half of all beneficiaries will be in Medicare Advantage by 2025, according to Tozzi.

How it works: Those who sign up for Medicare Advantage pay the same monthly premiums as regular plans but agree to certain limits imposed by the insurers, such as a restricted network of doctors, and also receive a wider range of benefits, which can include drugs plans and dental care. Insurers get a fee from the government for each person who signs up and is responsible for managing their plans to ensure a profit. In 2019, the average fee for each of the roughly 22 million participants was $11,545 – which comes to a total of about $254 billion.

Big numbers for insurers: Insurers see Medicare Advantage as “as a lucrative market they can’t afford to pass by,” Tozzi said, especially as sales of traditional, employer-based insurance plans slow. Medicare is now the biggest part of UnitedHealthcare’s business and the insurance giant is expanding to reach 90% coverage of the market next year. Other major players including Humana and Aetna are also expanding their coverage, and competition in the space is growing.

More generous benefits: Recent rule changes have allowed private insurers to offer new benefits within Medicare Advantage, such as meal delivery, air-conditioners, and in-home help. Regular fee-for-service Medicare doesn’t offer such options due to concerns about fraud.

A potential political battle ahead: Insurers increasingly rely on the revenues and profits from Medicare Advantage and can be expected to fight any effort to restrict – or, as some Democrats are calling for, eliminate – the existing private system. And as the plans become more generous – and, as critics have pointed out, more expensive for the government – seniors are likely to resist changes as well, complicating any Democratic effort to enact sweeping changes in the Medicare system.

Targeting ‘Medicare For All’ Proposals, Trump Lays Out His Vision For Medicare

Selena Simmons reported that President Trump gave a speech and signed an executive order on health care Thursday, casting the “Medicare for All” proposals from his Democratic rivals as harmful to seniors.

His speech, which had been billed as a policy discussion, had the tone of a campaign rally. Trump spoke from The Villages, a huge retirement community in Florida outside Orlando, a deep-red part of a key swing state.

His speech was marked by cheers, standing ovations and intermittent chants of “four more years” by an audience of mostly seniors.

Trump spoke extensively about his administration’s health care achievements and goals, as well as the health policy proposals of Democratic presidential candidates, which he characterized as socialism.

The executive order he signed had previously been titled “Protecting Medicare From Socialist Destruction” on the White House schedule but has since been renamed “Protecting and Improving Medicare for Our Nation’s Seniors.”

“In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens,” Trump told the audience. “Today I’ll sign a very historic executive order that does exactly what — we are making your Medicare even better, and … it will never be taken away from you. We’re not letting anyone get close.”

The order is intended, in part, to shore up Medicare Advantage, an alternative to traditional Medicare that’s administered by private insurers. That program has been growing in popularity, and this year, premiums are down and plan choices are up.

The executive order directs the Department of Health and Human Services to develop proposals to improve several aspects of Medicare, including expanding plan options for seniors, encouraging innovative plan designs and payment models and improving the enrollment process to make it easier for seniors to choose plans.

The order includes a grab bag of proposals, including removing regulations “that create inefficiencies or otherwise undermine patient outcomes”; combating waste, fraud, and abuse in the program; and streamlining access to “innovative products” such as new treatments and medical devices.

The president outlined very little specific policy in his speech in Florida. Instead, he attacked Democratic rivals and portrayed their proposals as threatening to seniors.

“Leading Democrats have pledged to give free health care to illegal immigrants,” Trump said, referring to a moment from the first Democratic presidential debate in which all the candidates onstage raised their hands in support of health care for undocumented migrants. “I will never allow these politicians to steal your health care and give it away to illegal aliens.”

Health care is a major issue for voters and is one that has dominated the presidential campaign on the Democratic side. In the most recent debate, candidates spent the first-hour hashing out and defending various health care proposals and visions. Only two candidates, Sen. Bernie Sanders, and Sen. Elizabeth Warren — between a Medicare for All system — support the major divide and a public option supported by the rest of the field.

Trump brushed those distinctions aside. “Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare,” he said. “These Democratic policy proposals … may go by different names, whether it’s single-payer or the so-called public option, but they’re all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism.”

Toward the end of the speech, he highlighted efforts that his administration has made to lower drug prices and then suggested that drugmakers were helping with the impeachment inquiry in the House of Representatives. “They’re very powerful,” Trump said. “I wouldn’t be surprised if … it was from some of these industries, like pharmaceuticals, that we take on.”

Drawing battle lines through Medicare may be a savvy campaign move on Trump’s part.

Medicare is extremely popular. People who have it like it, and people who don’t have it think it’s a good thing too. A recent poll by the Kaiser Family Foundation found that more than 8 in 10 Democrats, independents and Republicans think of Medicare favorably.

Trump came into office promising to dismantle the Affordable Care Act and replace it with something better. Those efforts failed, and the administration has struggled to get substantive policy changes on health care.

On Thursday, administration officials emphasized a number of its recent health care policy moves.

“[Trump’s] vision for a healthier America is much wider than a narrow focus on the Affordable Care Act,” said Joe Grogan, director of the White House’s Domestic Policy Council, at a press briefing earlier.

The secretary of health and human services, Alex Azar, said at that briefing that this was “the most comprehensive vision for health care that I can recall any president putting forth.”

He highlighted a range of actions that the administration has taken, from a push on price transparency in health care to a plan to end the HIV epidemic, to more generic-drug approvals. Azar described these things as part of a framework to make health care more affordable, deliver better value and tackle “impassable health challenges.”

Without a big health care reform bill, the administration is positioning itself as a protector of what exists now — particularly Medicare.

“Today’s executive order particularly reflects the importance the president places on protecting what worked in our system and fixing what’s broken,” Azar said. “Sixty million Americans are on traditional Medicare or Medicare Advantage. They like what they have, so the president is going to protect it.”

Trump’s New Order For Medicare Packs Potential Rise In Patients’ Costs

Julie Appleby reported that vowing to protect Medicare with “every ounce of strength,” President Donald Trump last week spoke to a cheering crowd in Florida. But his executive order released shortly afterward includes provisions that could significantly alter key pillars of the program by making it easier for beneficiaries and doctors to opt-out.

The bottom line: The proposed changes might make it a bit simpler to find a doctor who takes new Medicare patients, but it could lead to higher costs for seniors and potentially expose some to surprise medical bills, a problem from which Medicare has traditionally protected consumers.

“Unless these policies are thought through very carefully, the potential for really bad unintended consequences is front and center,” said economist Stephen Zuckerman, vice president for health policy at the Urban Institute.

While the executive order spells out few details, it calls for the removal of “unnecessary barriers” to private contracting, which allows patients and doctors to negotiate their own deals outside of Medicare. It’s an approach long supported by some conservatives, but critics fear it would lead to higher costs for patients. The order also seeks to ease rules that affect beneficiaries who want to opt-out of the hospital portion of Medicare, known as Part A.

Both ideas have a long history, with proponents and opponents duking it out since at least 1997, even spawning a tongue-in-cheek legislative proposal that year titled, in part, the “Buck Naked Act.” More on that later.

“For a long time, people who don’t want or don’t like the idea of social insurance have been trying to find ways to opt-out of Medicare and doctors have been trying to find a way to opt-out of Medicare payment,” said Timothy Jost, emeritus professor at Washington and Lee University School of Law in Virginia.

The specifics will not emerge until the Department of Health and Human Services writes the rules to implement the executive order, which could take six months or longer. In the meantime, here are a few things you should know about the possible Medicare changes.

What are the current rules about what doctors can charge in Medicare?

Right now, the vast majority of physicians agree to accept what Medicare pays them and not charge patients for the rest of the bill, a practice known as balance billing. Physicians (and hospitals) have complained that Medicare doesn’t pay enough, but most participate anyway. Still, there is wiggle room.

Medicare limits balance billing. Physicians can charge patients the difference between their bill and what Medicare allows, but those charges are limited to 9.25% above Medicare’s regular rates. But partly because of the paperwork hassles for all involved, only a small percentage of doctors choose this option.

Alternatively, physicians can “opt-out” of Medicare and charge whatever they want. But they can’t change their mind and try to get Medicare payments again for at least two years. Fewer than 1%of the nation’s physicians have currently opted out.

What would the executive order change?

That’s hard to know.

“It could mean a lot of things,” said Joseph Antos at the American Enterprise Institute, including possibly letting seniors make a contract with an individual doctor or buy into something that isn’t traditional Medicare or the current private Medicare Advantage program. “Exactly what that looks like is not so obvious.”

Others said eventual rules might result in lifting the 9.25% cap on the amount doctors can balance-bill some patients. Or the rules around fully “opting out” of Medicare might ease so physicians would not have to divorce themselves from the program or could stay in for some patients, but not others. That could leave some patients liable for the entire bill, which might lead to confusion among Medicare beneficiaries, critics of such a plan suggest.

The result may be that “it opens the door to surprise medical billing if people sign a contract with a doctor without realizing what they’re doing,” said Jost.

Would patients get a bigger choice in physicians?

Proponents say allowing for more private contracts between patients and doctors would encourage doctors to accept more Medicare patients, partly because they could get higher payments. That was one argument made by supporters of several House and Senate bills in 2015 that included direct-contracting provisions. All failed, as did an earlier effort in the late 1990s backed by then-Sen. Jon Kyl (R-Ariz.), who argued such contracting would give seniors more freedom to select doctors.

Then-Rep. Pete Stark (D-Calif.) opposed such direct contracting, arguing that patients had less power in negotiations than doctors. To make that point, he introduced the “No Private Contracts To Be Negotiated When the Patient Is Buck Naked Act of 1997.”

The bill was designed to illustrate how uneven the playing field is by prohibiting the discussion of or signing of private contracts at any time when “the patient is buck naked and the doctor is fully clothed (and conversely, to protect the rights of doctors, when the patient is fully clothed and the doctor is naked).” It, too, failed to pass.

Still, the current executive order might help counter a trend that “more physicians today are not taking new Medicare patients,” said Robert Moffit, a senior fellow at the Heritage Foundation, a conservative think tank based in Washington, D.C.

It also might encourage boutique practices that operate outside of Medicare and are accessible primarily to the wealthy, said David Lipschutz, associate director of the Center for Medicare Advocacy.

“It is both a gift to the industry and to those beneficiaries who are well off,” he said. “It has questionable utility to the rest of us.”

Elizabeth Warren Has Many Plans, But on Health Care, She’s ‘With Bernie’

Sahil Kaput noted that Elizabeth Warren has a plan for everything — but on the crucial 2020 issue of health care, she’s borrowing from a rival and fellow progressive — Bernie Sanders.

The presidential candidate who made a mark with her signature “I have a plan for that!” is the only one of the five top-polling Democrats without a sweeping proposal of her own to remake the health care system. She has instead championed Sanders’ legislation to replace private insurance by putting every American in an expanded Medicare program.

“I’m with Bernie on Medicare for All,” Warren said recently in New Hampshire when asked if she’d devise a blueprint of her own. “Health care is a basic human right. We need to make sure that everybody is covered at the lowest possible cost, and draining money out for health insurance companies to make a lot of profits, by saying no.”

Warren’s deference to a rival is unusual for a candidate who has styled herself as the policy wonk with a program for everything from cradle to grave. It has allowed her to attract many liberal voters who supported Sanders in 2016, leading her to a dead heat with former vice president Joe Biden for the top spot in the Democratic field. And if Sanders were to eventually drop out of the race before Warren, her embrace of his most popular plan could keep his supporters in her camp.

Sean McElwee, a left-wing activist, and researcher with Data For Progress said that Warren cannot afford to go soft on Medicare for All.

“It’s the best option for the campaign to stay in alignment with Sanders on health care through the general election,” he said. “These Sanders voters have the highest risk of voting third party or staying home, and you have to keep them mobilized.”

Weeks before Warren, a Massachusetts senator, announced that she was exploring a presidential run last December, she sounded less wedded to the Sanders proposal, describing a three-step approach to health care.

“Our first job is to defend the Affordable Care Act. Our second is to improve it and make changes, for example to families’ vulnerability to the impact of high-priced drugs,” she told Bloomberg News. “And the third is to find a system of Medicare available to all that will increase the quality of care while it decreases the cost of all of us.”

As Warren was rising in the polls, her allies began to pick up signals that Sanders supporters were questioning her commitment to progressive ideas. Since June, Warren has given them little ammunition to claim she’s going soft on Medicare for All, a defining issue for many left-wing voters.

“The biggest concern Warren has from the left is this idea that, at the end of the day, Sanders is the one true progressive,” McElwee said. “If your main issue is Medicare for All, and that’s a central tenet of your politics, Warren probably can’t win you. But she doesn’t want you to hate her. She wants to be your fallback option.”

At the same time, Warren faces attacks from Biden for supporting a plan that would replace Obamacare, which Democrats bitterly fought for in 2009 and 2010. “The senator says she’s for Bernie. Well, I’m for Barack,” the former vice president said in the third Democratic debate in September. “I think Obamacare worked.”

Biden’s plan would build out Obamacare and have a public option for those who want it.

Health care consistently ranks as the top issue for Democratic voters. Government-run health care is popular among Democrats and Americans overall, but that support dips once voters are given the arguments against it, including that it would require higher middle-class taxes and abolish employer-sponsored coverage.

Medicare for All, which lay at the heart of Sanders’ stronger-than-expected 2016 campaign, has become a litmus test for some progressive activists and voters. To them, it indicates a candidate’s belief in universal health care and willingness to take on private insurers who they say are gouging consumers for profit.

In Los Angeles on Friday, Warren was asked if her health care vision would raise middle-class taxes. She evaded the question and said working families would see their overall medical costs reduced, referring to the end of premiums and out-of-pocket expenses. “The very wealthy and big corporations will see their costs go up, but middle-class families will see their costs go down,” she said.

Surveys show that Sanders voters clearly prefer Warren as their second choice. But it doesn’t cut both ways — Warren’s supporters are more split among Sanders, Biden and Kamala Harris as their second choice.

Mary Anne Marsh, a Democratic consultant based in Boston, said that if Warren believes Sanders has the best plan, she has to “be all in on it — and if she’s got elements of her own to put in it, she needs to do that.”

The Sanders health care plan tracks with the “big structural change” Warren has called for, a message that also appeals to mainstream Democrats who backed Hillary Clinton in 2016. Maintaining that cross-section of support is critical to Warren’s path to the nomination. Biden is dominating with moderate and conservative Democrats, some of whom worry that running on Medicare for All will cost Democrats the general election.

“By supporting Bernie Sanders’ health care plan, Elizabeth Warren improves the chances of Bernie Sanders voters supporting her if she’s the nominee, thereby avoiding some for the heartburn Bernie gave Clinton and her supporters all the way through Election Day,” Marsh said.

A voter at her event in Keene, New Hampshire, asked Warren how she would handle the transition from private insurance to a government-run system.

“What we’ve got on Medicare for All is a framework,” she said. “And it doesn’t have the details, and you’re right to be antsy.”

To contact the reporter on this story: Sahil Kapur in Washington at skapur39@bloomberg.net

To contact the editors responsible for this story: Wendy Benjaminson at wbenjaminson@bloomberg.net, John Harney

Pete Buttigieg explains why he’s against Medicare for All

As reported by Adriana Belmont, Mayor Pete Buttigieg stands apart from other Democratic presidential candidates when it comes to health care policy. Unlike frontrunners Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-Mass.), he does not support for Medicare for All, but rather an alternative.

“I am a candidate who believes Medicare for All is not as attractive as Medicare for All Who Want It,” Buttigieg said at The New Yorker Festival. “Because it gives people a choice.”

Through Buttigieg’s plan, everyone would automatically be involved in universal health care coverage for those who are eligible. It would also expand premium subsidies for low-income individuals, cap out-of-pocket costs for seniors on Medicare, and limit what health care providers charge for out-of-network care at double what Medicare pays for the same service. However, those who still want to stay on private insurance can do so.

When asked whether or not this is a matter of “having your cake and eating it too,” Buttigieg responded: “Why not?”

“This is how public alternatives work,” Buttigieg said. “They create a public alternative that the private sector is then forced to compete with.”

This differs from other candidates like Sanders and Warren, both vocal supporters of a single-payer health system. Sanders has even gone so far as to call for the elimination of private insurance companies. Buttigieg, however, sees his plan as an opportunity for private insurance companies to step up.

“The way I come at it is with a certain humility about what’s going to happen,” Buttigieg said. “Because one of two things will happen. Either, there’s really no private option that’s as good as the public one we’re going to create … which means pretty soon everyone migrates to it and pretty soon it’s Medicare for all.”

“Or, some private plans are still better, in which case we’re going to be really glad we didn’t command the American people to abandon them whether they want to or not,” Buttigieg said. “I’m neutral on which one of those outcomes happen.”

According to Politico, although there is no official cost for what Medicare for All Who Want It would cost, a campaign adviser said the federal spending would “be in the ballpark” of $790 billion.

“The core principle is not whether or not the government is your health insurance provider,” Buttigieg said. “The core principle for me is you get covered one way or the other. That’s what Medicare for All Who Want It entails.”

Bernie Sanders admits he was ‘dumb’ for ignoring symptoms ahead of heart attack

Sen. Bernie Sanders (I-Vt.) is turning his heart attack into a PSA.

The 2020 candidate was hospitalized last week with what his doctors later said was a heart attack, leading Sanders to suspend his campaign events and a forthcoming Iowa ad buy. Sanders hasn’t said if he’ll resume campaigning before the Oct. 15 primary debate, but he does have a universally agreeable message in the meantime.

Sanders gave a health update at his home on Tuesday, telling reporters he was on his way to meet with a new cardiologist. “I must confess, I was dumb,” he said. Despite being “born” with “a lot of energy” and usually handling multiple rallies a day without a problem, “in the last month or two,” Sanders said he’d been “more fatigued than I usually have been.” “I should’ve listened to those symptoms,” Sanders continued, and then advised listeners to do the same “when you’re hurting when you’re fatigued when you have pain in your chest.”

Bernie Sanders is meeting a cardiologist this morning. A new doctor he has not met with before. Before he left he told reporters that he was “dumb” and should’ve listened to the warning signs his body was sending him prior to his heart attack.

Sanders first tied his hospitalization to his campaign in a tweet last week expressing his thanks for “well wishes,” “great doctors,” and “good health care.” “No one should fear going bankrupt” if they experience a medical emergency, he continued, and added in a call for “Medicare for All!”

What a dumb comment but it seems to follow how dumb Bernie is to neglect his heart disease however, he is telling us all about health care. And remember that Bernie has Congressional Blue Cross Blue Shield health care insurance, the best in the world!

 

Death toll from vaping-linked illness now at 19 in the ​US. Trump’s answer for Medicare and Bernie’s health issue!

bernie465Why aren’t more people interested in the severity of the vaping complications in our youth? We are now up to 19 deaths, and this is just the reported deaths. We haven’t figured the long-term severity of chronic vaping inhalation, a form of COPD-chronic obstructive pulmonary disease!

The death toll in the United States from illnesses linked to e-cigarette use has risen to at least 19, health authorities say, as more than 1,000 others have suffered lung injuries probably linked to vaping.

Officials have yet to identify the cause for the outbreak, which dates back to March and is pursuing multiple lines of investigation.

A report by clinicians in North Carolina last month pointed to the inhalation of fatty substances from aerosolized oils, but a new study by the Mayo Clinic published this week found patients’ lungs had been exposed to noxious fumes.

The Centers for Disease Control and Prevention said Thursday that 18 deaths in 15 states had now been positively linked to vaping, from a total of 1,080 cases of people sickened —a jump of 275 since last week.

Connecticut officials also announced the first death in the state, bringing the total to at least 19.

The CDC attributed the sharp increase to a combination of new patients becoming ill in the past two weeks and recent reporting of previously identified patients.

“I think we really have the feeling right now that there may be a lot of different nasty things in e-cigarette or vaping products, and they may cause different harms in the lung,” Anne Schuchat, a senior official with the Centers for Disease Control and Prevention (CDC), said in a call with reporters.

Among a group of 578 patients interviewed on substances they had used, 78 percent reported using tetrahydrocannabinol (THC), the primary psychoactive substance of marijuana, with or without nicotine products.

Another 37 percent reported exclusive use of THC products, and 17 percent said they had only used nicotine-containing products.

About 70 percent of patients are male, and 80 percent are under 35 years old.

Skyrocketing use

E-cigarettes have been available in the US since 2006.

It is not clear whether the outbreak is only happening now—or if there were cases earlier that were wrongly diagnosed.

Initially conceived as a smoking cessation device, e-cigarette use has skyrocketed among teens, with preliminary official data for 2019 showing more than a quarter of high school students using e-cigarettes in the past 30 days.

They were until recently perceived as a less harmful alternative to smoking because they do not contain the 7,000 chemicals in cigarettes, dozens of which are known to cause cancer.

Only one case of lung injury has been reported abroad, making the outbreak more mysterious still.

Canadian authorities said in September a youth had been hospitalized, but so far no other countries have reported anything similar.

Public and political opinion appears to be hardening, however, with the administration of US President Donald Trump announcing in September that it would ban in the coming month’s flavored e-cigarette products, which are particularly attractive to young people.

India has issued an outright ban on all e-cigarette products, as has the US state of Massachusetts.

E-cigarettes: five things to know about vaping linked deaths and illnesses in the U.S.

E-cigarettes have become hugely popular in the past decade but a rash of vaping-linked deaths and illnesses in the United States is feeding caution about a product, already banned in some places.

Here are five things to know about electronic cigarettes.

Around for two decades

Early designs for an electronic cigarette were drawn up in the United States in the 1960s but Chinese pharmacist Hon Lik is acknowledged as the inventor of a viable commercial version in the early 2000s.

Hon, who was trying to quit his own pack-a-day habit, took out patents between 2003 and 2005. But his devices would soon be overtaken as the international market exploded.

How do they work?

A battery powers a coil that heats a liquid containing various amounts of nicotine as well as propylene glycol and vegetable glycerin, which mimic tobacco smoke when heated.

This “e-juice” can also contain flavorings and other substances, such as THC, or tetrahydrocannabinol, the psychoactive ingredient in marijuana.

E-cigarettes are mostly draw-activated, with the puffing releasing vapor.

They do not produce tar or carbon monoxide—two of tobacco’s most noxious elements and associated with cancer and cardiovascular disease.

Harmful to health?

E-cigarettes were initially touted as less damaging than tobacco, which causes around eight million deaths a year.

In 2015 public health authorities in England said best estimates showed they were 95 percent less harmful than tobacco.

“Even if it is difficult to quantify precisely the long-term toxicity of electronic cigarettes, there is evidence that it is significantly lower than traditional cigarettes,” the French Academy of Medicine said the same year.

However, concern has been growing.

On October 3, 2019, US health authorities reported 18 vaping-related deaths and more than 1,000 cases of damage since March, the cause of which had not been identified.

The US Centers for Disease Control and Prevention said on September 2019 that many of the cases involved the use of black-market marijuana products.

In July 2019 the World Health Organization (WHO) warned that electronic smoking devices were “undoubtedly harmful and should, therefore, be subject to regulation”.

Another worry is that the vaping flavors are particularly attractive to teenagers and an enticement to pick up the habit.

Exponential growth

The number of vapers worldwide has leaped from seven million in 2011 to 41 million in 2018, according to leading market researcher Euromonitor International.

By comparison, there were 1.1 billion tobacco smokers on the planet in 2016, according to the latest WHO figures on its website.

The largest markets for e-cigarettes are the United States followed by Britain, France, Germany, and China.

The increase in vaping has been particularly dramatic among teenagers.

Moving towards regulation

In September 2019 India became the latest country to ban the import, sale, production, and advertising of e-cigarettes, citing in particular concerns about its youth.

The devices are already banned in several places, such as Brazil, Singapore, Thailand and the US state of Massachusetts, but elsewhere legislations are inconsistent.

In June 2019 San Francisco became the first major US city to effectively ban the sale and manufacture of electronic cigarettes.

In September New York followed Michigan in banning flavored e-cigarettes.

Trump woos seniors with an order to boost Medicare health program

Reporter Jeff Mason pointed out that U.S. President Donald Trump sought to woo seniors on Thursday with an executive order aimed at strengthening the Medicare health program by reducing regulations, curbing fraud, and providing faster access to new medical devices and therapies.

The order, which Trump discussed during a visit to a retirement community in Florida known as The Villages, is the Republican president’s answer to some Democrats who are pushing for a broad and expensive expansion of Medicare to cover all Americans.

Trump referred to such proposals as socialist and pledged to prevent them from coming to fruition, a political promise with an eye toward his 2020 re-election campaign in which healthcare is likely to be a major issue.

“They want to raid Medicare to fund a thing called socialism,” Trump told an enthusiastic crowd in Florida, a political swing state that is critical to his goal of keeping the White House.

The executive order follows measures his administration rolled out in recent months designed to curtail drug prices and correct other perceived problems with the U.S. healthcare system. Policy experts say the efforts are unlikely to slow the tide of rising drug prices in a meaningful way.

Trump suggested that drug companies were backing impeachment efforts in Washington, which he considers a “hoax,” as a way to sabotage his efforts to make prescriptions affordable.

“We’re lowering the cost of prescription drugs, taking on the pharmaceutical companies. And you think that’s easy? It’s not easy… I wouldn’t be surprised if the hoax didn’t come from some of the people that we’re taking on,” he said.

Medicare covers Americans who are 65 and older and includes traditional fee-for-service coverage in which the government pays healthcare providers directly and Medicare Advantage plans, in which private insurers manage patient benefits on its behalf.

Seniors are a key political constituency in America because of a high percentage of the vote.

The order pushes for Medicare to use more medical telehealth services, which is care delivered by phone or digital means, leading to cost reductions by reducing expensive emergency room visits, an administration official told Reuters ahead of the announcement.

The order directs the government to work to allow private insurers that operate Medicare Advantage plans to use new plan pricing methods, such as allowing beneficiaries to share in the savings when they choose lower-cost health services.

It also aims to bring payments for the traditional Medicare fee-for-service program in line with payments for Medicare Advantage.

Trump’s plans contrast with the Medicare for All program promoted by Bernie Sanders, a Democratic socialist who is running to become the Democratic Party’s nominee against Trump in the 2020 presidential election.

Sanders’ proposal, backed by left-leaning Democrats but opposed by moderates such as former Vice President Joe Biden, would create a single-payer system, effectively eliminating private insurance by providing government coverage to everyone, using the Medicare model.

“Medicare for All is Medicare for none,” said Seema Verma, the administrator of the U.S. Centers for Medicare and Medicaid Services, on a conference call with reporters, calling the proposal a “pipe dream” that would lead to higher taxes.

Sanders has argued that Americans would pay less for healthcare under his plan.

The White House is eager to show Trump making progress on healthcare, an issue Democrats successfully used to garner support and take control of the House of Representatives in the 2018 midterm elections. Trump campaigned in 2016 on a promise to repeal and replace the Affordable Care Act, his predecessor President Barack Obama’s signature healthcare law also known as “Obamacare.” So far he has not repealed or replaced it.

In July, the U.S. Department of Health and Human Services (HHS) said it would propose a rule for imports of cheaper drugs from Canada into the United States. A formal rule has not yet been unveiled.

The administration also issued an executive order in June demanding hospitals and insurers make prices they charge patients more transparent. Another in July encouraged novel treatments for kidney disease.

Trump considered other proposals that did not reach fruition.

A federal judge in July shot down an executive order that would have forced drugmakers to display list prices in advertisements, and Trump scrapped another planned order that would have banned some rebate payments drugmakers make to payers.

The administration is mulling a plan to tie some Medicare reimbursement rates for drugs to the price paid for those drugs by foreign governments, Reuters reported.

Targeting ‘Medicare For All’ Proposals, Trump Lays Out His Vision For Medicare

Faced with the pressure from the Democrats and their proposal for health care, Medicare for All President Trump gave a speech and signed an executive order on health care Thursday, casting the “Medicare for All” proposals from his Democratic rivals as harmful to seniors.

His speech, which had been billed as a policy discussion, had the tone of a campaign rally. Trump spoke from The Villages, a huge retirement community in Florida outside Orlando, a deep-red part of a key swing state.

His speech was marked by cheers, standing ovations and intermittent chants of “four more years” by an audience of mostly seniors.

Trump spoke extensively about his administration’s health care achievements and goals, as well as the health policy proposals of Democratic presidential candidates, which he characterized as socialism.

The executive order he signed had previously been titled “Protecting Medicare From Socialist Destruction” on the White House schedule but has since been renamed “Protecting and Improving Medicare for Our Nation’s Seniors.”

“In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens,” Trump told the audience. “Today I’ll sign a very historic executive order that does exactly what — we are making your Medicare even better, and … it will never be taken away from you. We’re not letting anyone get close.”

The order is intended, in part, to shore up Medicare Advantage, an alternative to traditional Medicare that’s administered by private insurers. That program has been growing in popularity, and this year, premiums are down and plan choices are up.

The executive order directs the Department of Health and Human Services to develop proposals to improve several aspects of Medicare, including expanding plan options for seniors, encouraging innovative plan designs and payment models and improving the enrollment process to make it easier for seniors to choose plans.

The order includes a grab bag of proposals, including removing regulations “that create inefficiencies or otherwise undermine patient outcomes”; combating waste, fraud, and abuse in the program; and streamlining access to “innovative products” such as new treatments and medical devices.

The president outlined very little specific policy in his speech in Florida. Instead, he attacked Democratic rivals and portrayed their proposals as threatening to seniors.

“Leading Democrats have pledged to give free health care to illegal immigrants,” Trump said, referring to a moment from the first Democratic presidential debate in which all the candidates onstage raised their hands in support of health care for undocumented migrants. “I will never allow these politicians to steal your health care and give it away to illegal aliens.”

Health care is a major issue for voters and is one that has dominated the presidential campaign on the Democratic side. In the most recent debate, candidates spent the first-hour hashing out and defending various health care proposals and visions. The major divide is between a Medicare for All system — supported by only two candidates, Sen. Bernie Sanders and Sen. Elizabeth Warren — and a public option supported by the rest of the field.

Trump brushed those distinctions aside. “Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare,” he said. “These Democratic policy proposals … may go by different names, whether it’s single-payer or the so-called public option, but they’re all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism.”

Toward the end of the speech, he highlighted efforts that his administration has made to lower drug prices and then suggested that drugmakers were helping with the impeachment inquiry in the House of Representatives. “They’re very powerful,” Trump said. “I wouldn’t be surprised if … it was from some of these industries, like pharmaceuticals, that we take on.”

Drawing battle lines through Medicare may be a savvy campaign move on Trump’s part.

Medicare is extremely popular. People who have it like it, and people who don’t have it think it’s a good thing too. A recent poll by the Kaiser Family Foundation found that more than 8 in 10 Democrats, independents and Republicans think of Medicare favorably.

Trump came into office promising to dismantle the Affordable Care Act and replace it with something better. Those efforts failed, and the administration has struggled to get substantive policy changes on health care.

On Thursday, administration officials emphasized a number of its recent health care policy moves.

“[Trump’s] vision for a healthier America is much wider than a narrow focus on the Affordable Care Act,” said Joe Grogan, director of the White House’s Domestic Policy Council, at a press briefing earlier.

The secretary of health and human services, Alex Azar, said at that briefing that this was “the most comprehensive vision for health care that I can recall any president putting forth.”

He highlighted a range of actions that the administration has taken, from a push on price transparency in health care to a plan to end the HIV epidemic, to more generic-drug approvals. Azar described these things as part of a framework to make health care more affordable, deliver better value and tackle “impassable health challenges.”

Without a big health care reform bill, the administration is positioning itself as a protector of what exists now — particularly Medicare.

“Today’s executive order particularly reflects the importance the president places on protecting what worked in our system and fixing what’s broken,” Azar said. “Sixty million Americans are on traditional Medicare or Medicare Advantage. They like what they have, so the president is going to protect it.”

Sanders presidential campaign pivots health scare to Medicare for All message

And now Bernie Sander’s health becomes an issue! Simon Lewis reported that Bernie Sanders’ 2020 presidential election campaign on Wednesday sought to use news the candidate had a heart procedure to highlight the benefits of his trademark Medicare for All healthcare plan.

Sanders’ campaign canceled campaign events and pulled TV ads after the 78-year-old U.S. senator had two stents inserted into an artery after he experienced discomfort during a campaign visit to Nevada on Tuesday.

The candidate would rest for a few days after the relatively common procedure, his campaign for the November 2020 presidential election said.

Sanders’ speechwriter, David Sirota, said in a daily newsletter that the unexpected medical procedure was “a perfect example of why the United States needs to join the rest of the world and pass Bernie’s Medicare for All legislation.”

Sirota cited a 2018 paper by researchers at the London School of Economics that found cardiac implant devices cost up to six times more in the United States than in some European countries with government-run healthcare systems.

Sanders advocates an approach that would extend the existing Medicare program for Americans aged over 65 to all Americans and largely eliminate the private insurance industry.

Sirota argued the gulf in price was in part due to the U.S. healthcare system’s “complex web of payers – rather than a single-payer Medicare for All system that can negotiate better prices.”

As many as 1 million Americans a year get stents, a procedure that involves inserting a balloon-tipped catheter to open the blockage and deploy tiny wire-mesh tubes to prop open the artery.

“I’m feeling good. I’m fortunate to have good health care and great doctors and nurses helping me to recover,” Sanders tweeted on Wednesday afternoon, his first public statement since the procedure.

“None of us know when a medical emergency might affect us. And no one should fear going bankrupt if it occurs. Medicare for All!”

News of Sanders’ health scare sparked mean-spirited jokes pointing out the U.S. senator was treated by the healthcare system he wants to overhaul.

“Any bets on whether he’ll be going to Cuba for their great communist medical care? Get well soon Bern. #SocialismSucks!” tweeted Ben Bergquam, a right-wing California radio host.

Sanders’ supporters also took to social media to post #GetWellBernie messages.

The senator from Vermont’s campaign manager, Faiz Shakir, retweeted one message from a supporter that read, “take my heart, Bernie!!”

Another issue, which his campaign manager refuses to point out is did Bernie used his Medicare insurance to cover his diagnostic studies, his stenting procedure or his post-op care? As they are touting Medicare for All after Bernie had a quick diagnosis and stenting of his coronary artery disease we should all remember that Bernie, as well as all of the candidates for the presidency, don’t have Medicare for their health care insurance. No, they all have Congressional Blue Cross and Blue Care. So, don’t fall for their politicization of healthcare. Again, I point out, how can you promote Medicare for all when you all have no idea of the impact on patients of being insured under Medicare and the multiple restrictions and the true expense of Medicare insurance!