Editor's Note -
The following link will take you to a 21 minute long video about the US response to the Covid-19 pandemic. Well worth the time to watch it.
https://www.nytimes.com/2020/09/29/opinion/covid-pandemic-us-response.html
--SPC
In a First, New England Journal of Medicine Joins Never-Trumpers
Editors at the world’s leading medical journal said the Trump administration “took a crisis and turned it into a tragedy.”
by Gina Kolata - NYT - October 7, 2020
Throughout its 208-year history, The New England Journal of Medicine has remained staunchly nonpartisan. The world’s most prestigious medical journal has never supported or condemned a political candidate.
Until now.
In an editorial signed by 34 editors who are United States citizens (one editor is not) and published on Wednesday, the journal said the Trump administration had responded so poorly to the coronavirus pandemic that they “have taken a crisis and turned it into a tragedy.”
The journal did not explicitly endorse Joseph R. Biden Jr., the Democratic nominee, but that was the only possible inference, other scientists noted.
The editor in chief, Dr. Eric Rubin, said the scathing editorial was one of only four in the journal’s history that were signed by all of the editors. The N.E.J.M.’s editors join those of another influential journal, Scientific American, who last month endorsed Mr. Biden, the former vice president.
The political leadership has failed Americans in many ways that contrast vividly with responses from leaders in other countries, the N.E.J.M. said.
In the United States, the journal said, there was too little testing for the virus, especially early on. There was too little protective equipment, and a lack of national leadership on important measures like mask wearing, social distancing, quarantine and isolation.
There were attempts to politicize and undermine the Food and Drug Administration, the National Institutes of Health and the Centers for Disease Control and Prevention, the journal noted.
As a result, the United States has had tens of thousands of “excess” deaths — those caused both directly and indirectly by the pandemic — as well as immense economic pain and an increase in social inequality as the virus hit disadvantaged communities hardest.
The editorial castigated the Trump administration’s rejection of science, writing, “Instead of relying on expertise, the administration has turned to uninformed ‘opinion leaders’ and charlatans who obscure the truth and facilitate the promulgation of outright lies.”
The uncharacteristically pungent editorial called for change: “When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”
Scientific American, too, had never before endorsed a political candidate. “The pandemic would strain any nation and system, but Trump’s rejection of evidence and public health measures have been catastrophic,” the journal’s editors said.
The N.E.J.M., like all medical journals these days, is deluged with papers on the coronavirus and the illness it causes, Covid-19. Editors have struggled to reconcile efforts to insist on quality with a constant barrage of misinformation and misleading statements from the administration, said Dr. Clifford Rosen, associate editor of the journal and an endocrinologist at Tufts University in Medford, Mass.
“Our mission is to promote the best science and also to educate,” Dr. Rosen said. “We were seeing anti-science and poor leadership.”
Mounting public health failures and misinformation had eventually taken a toll, said Dr. Rubin, the editor in chief of The New England Journal of Medicine.
“It should be clear that we are not a political organization,” he said. “But pretty much every week in our editorial meeting there would be some new outrage.”
“How can you not speak out at a time like this?” he added.
Dr. Thomas H. Lee, a professor of medicine at Harvard Medical School and a member of the journal’s editorial board, did not participate in writing or voting on the editorial.
But “to say nothing definitive at this point in history would be a cause for shame,” he said.
Medical specialists not associated with the N.E.J.M. applauded the decision.
“Wow,” said Dr. Matthew K. Wynia, an infectious disease specialist and director of the Center for Bioethics and Humanities at the University of Colorado. He noted that the editorial did not explicitly mention Mr. Biden, but said it was clearly “an obvious call to replace the president.”
There is a risk that such a departure could taint the N.E.J.M.’s reputation for impartiality. While other medical journals, including JAMA, the Lancet and The British Medical Journal, have taken political positions, the N.E.J.M. has dealt with political issues in a measured way, as it did in a forum published in October 2000 in which Al Gore and George W. Bush answered questions on health care.
But it is hard to imagine such a deliberative debate in today’s acrimonious atmosphere, said Dr. Jeremy Greene, a professor of medicine and historian of medicine at Johns Hopkins University.
The Trump administration, he said, had demonstrated “a continuous, reckless disregard of truth.”
“If we want a forum based on matters of fact, it strikes me that no form of engagement could work,” Dr. Greene added.
https://www.nytimes.com/2020/10/07/health/new-england-journal-trump.html?
How Much Would Trump’s Coronavirus Treatment Cost Most Americans?
Even for those with insurance, surprise bills for things not covered can add up fast.
by Sarah Kliff - NYT - October 7, 2020
President Trump spent three days in the hospital. He arrived and left by helicopter. And he received multiple coronavirus tests, oxygen, steroids and an experimental antibody treatment.
For someone who isn’t president, that would cost more than $100,000 in the American health system. Patients could face significant surprise bills and medical debt even after health insurance paid its share.
The biggest financial risks would come not from the hospital stay but from the services provided elsewhere, including helicopter transit and repeated coronavirus testing.
Mr. Trump has praised the high quality of care he received at Walter Reed National Military Medical Center, and has played down the risk of the virus. “Don’t be afraid of Covid,” Mr. Trump tweeted on Monday, before returning to the White House. “Don’t let it dominate your life.”
Across the country, patients have struggled with both the long-term health and financial effects of contracting coronavirus. Nearly half a million have been hospitalized. Routine tests can result in thousands of dollars in uncovered charges; hospitalized patients have received bills upward of $400,000.
Mr. Trump did not have to worry about the costs of his care, which are covered by the federal government. Most Americans, including many who carry health coverage, do worry about receiving medical care they cannot afford.
For some Americans, the bills could start mounting with frequent tests. Insurers are generally required to pay for those tests when physicians order them, but not when employers do.
The Trump administration made that clear in June, when it issued guidance stating that insurers do not have to pay for “testing conducted to screen for general workplace health and safety.” Instead, patients need to pay for that type of testing themselves. Some might be able to get free tests at public sites, and some employers may voluntarily cover the costs. Others could face significant medical debt from tests delivered at hospitals or urgent care centers.
Covid tests can be expensive. Although they typically cost $100, one emergency room in Texas has charged as much as $6,408 for a drive-through test. About 2.4 percent of coronavirus tests billed to insurers leave the patient responsible for some portion of payment, according to the health data firm Castlight. With 108 million tests performed in the United States, that could amount to millions of tests that leave patients responsible for some share of the cost.
Marta Bartan, who works as a hair colorist in Brooklyn, needed a coronavirus test to return to her job this summer. She received a $1,394 bill from the hospital running the drive-through site where she was tested.
“I was so confused,” said Ms. Bartan, who is contesting the bill. “You go in to get a Covid test expecting it to be free. What could they have possibly charged me $1,400 for?”
The bills for the typical American would continue at the hospital, with the routine monitoring that any patient would receive and the drugs provided in the course of care.
Remdesivir, a new coronavirus treatment created by Gilead, costs $3,120 when purchased by private insurers and $2,340 with public programs like Medicare and Medicaid.
Mr. Trump also received an experimental antibody treatment from Regeneron. It’s currently available to clinical trial participants or to those granted a “compassionate use” exemption. In either situation, the drug would typically be provided to the patient at no charge. This will most likely change, however, when the treatment finishes trials and hits the commercial market. These types of drugs are hard to manufacture, and other monoclonal antibodies cost thousands of dollars.
Health economists are only starting to understand the full costs of coronavirus treatment, just as scientists are mapping out how the disease works and spreads. They do have some early estimates: The median charge for a coronavirus hospitalization for a patient over 60 is $61,912, according to a claims database, FAIR Health
That figure includes any medical care during the hospital stay, such as an emergency room visit that led to admission or drugs provided by the hospital.
For insured patients, that price would typically be negotiated lower by their health plan. FAIR Health estimates that the median amount paid is $31,575. That amount, like most things in American health care, varies significantly from one patient to another.
In the FAIR Health data on coronavirus patients over 60, a quarter face charges less than $26,821 for their hospital stay. Another quarter face charges higher than $193,149, in part because of longer stays.
Many, but not all, health insurers have said they will not apply co-payments or deductibles to patients’ coronavirus hospital stays, which could help shield patients from large bills.
Uninsured patients, however, could be stuck with the entire hospital charges and not receive any discounts. While the Trump administration did set up a fund to cover coronavirus testing and treatment costs for the uninsured, The Times has reported that some Americans without health insurance have received large bills for their hospital stays.
The biggest billing risk for a patient receiving treatment similar to Mr. Trump’s would probably come from helicopter rides to the hospital.
Air ambulances are expensive and often not in major health insurance plans’ networks. The median charge for an air ambulance is $38,770, according to a study in the journal Health Affairs published this year. When the helicopter trip is out of network — as about three-quarters of them are — patients are left with a median charge of $21,698 after the insurance payout.
Taking two helicopter rides, as Mr. Trump did, could plausibly result in more than $40,000 in medical debt for patients without access to their own aircraft (though of course most people do not leave the hospital by helicopter).
The financial consequences of a coronavirus hospitalization could be long-lasting, if a new Supreme Court challenge to the Affordable Care Act is successful. That case argues that all of Obamacare is unconstitutional, including the health law’s protections for pre-existing conditions. The administration filed a brief in June supporting the challenge.
The Supreme Court hears that case on Nov. 10. If the challenge succeeds, Covid-19 could join a long list of pre-existing conditions that would leave patients facing higher premiums or denials of coverage. In that case, coronavirus survivors could face a future in which their hospital stays increase their health costs for years to come.
https://www.nytimes.com/2020/10/07/upshot/trump-hospital-costs-coronavirus.html?
Covid nurse who shared patient’s tragic last words shocked by US inaction
Derrick Smith shared last words of patient who asked ‘Who’s going to pay for it?’ and says some have discharged themselves because of fears over costs
by Amanda Holpuch - The Guardian - October 7, 2020
In a country where access to affordable healthcare is not guaranteed, New York City nurse Derrick Smith struck a nerve across the US after sharing the last words of a Covid-19 patient who minutes before being intubated asked: “Who’s going to pay for it?”
His Facebook post went viral six months ago, when cases in the city were surging and the streets echoed with the constant sound of ambulance sirens.
Today, Smith is shocked about how little the US has done to address healthcare costs during a global pandemic. In part because he has seen Covid-19 patients fearful of the eventual price tag for care leave his hospital against doctors’ advice.
Smith told the Guardian the inaction was “probably the most upsetting part about it. I don’t know another critical healthcare event that could take place that would necessitate instituting some sort of measure to universalize access to healthcare.”
Congress ordered insurers to cover testing costs in March, but there is no such order in place for treatment. A program created to cover testing and treatment of uninsured people has been riddled with problems leaving people with tens of thousands of dollars in medical bills. At the same time, health insurer profits are double what they were last year.
A certified registered nurse anesthetist (CRNA), Smith has worked in healthcare for more than a decade, always in intensive care settings. But because the patients he usually treats have pre-scheduled procedures for which they know the cost, he had not been faced with such a horrific example of what it means to not guarantee healthcare to every citizen.
It didn’t help that the patient’s question wasn’t the only alarming collision of money and healthcare at his hospital during the pandemic.
Smith said Covid patients concerned about the cost of healthcare have left the hospital “against medical advice”, a situation known as an AMA. “Not only is that a problem for them in terms of their healthcare outcomes, but they are also going back into the community and possibly increasing spread,” he said.
Smith’s job normally involves preparing people for scheduled surgeries but when Covid-19 cases spiked in New York City in March and April, his job was moved to the intensive care unit and to a team which responded to emergencies in the hospital. They would quickly assess patients, then prepare them for intubation to be placed on a ventilator.
His first night on the quick response team involved at least 10 intubations and left no moment for pause. “During the peak it was back to back, sometimes almost simultaneously, so you’re running around,” Smith said.
Patients were out of breath, exhausted, with vital signs off and desaturating oxygen.
This included the patient who asked about the treatment costs. Smith said the patient showed signs of needing intubation sooner, rather than later, and Smith and his colleague focused on getting them on the phone with their spouse because it was their last moment to speak before being put on a ventilator. “The priority was to have them speak to someone briefly and then perform the clinical duties to help save their life at that moment,” he said.
Smith tucked the question in the back of his mind, unable to answer it or absorb its implications. “I work in a relatively underserved area, so I have some inclination of knowing about the socioeconomic status of my patients, but it was the most real I’ve experienced during this pandemic,” he said.
Smith stabilized the patient but does not know what happened next.
He posted on Facebook about it a few days later, in part to process a shocking moment he had compartmentalized while performing the duties of his job. “It was kind of traumatic and I’d been thinking about it a lot,” Smith said.
His page was fairly private and he only made the post public at the request of friends who wanted to share it with their network. It exploded shortly after.
Ever since, Smith has become more active on social media, sharing articles about the unequal healthcare system in the US.
“I’m not really one to frequently take a public platform, but I felt what it was highlighting was important to have a dialogue about and hopefully compel our legislatures to make some meaningful change going forward,” Smith said.
“Because in my opinion, it shouldn’t be happening in this country, which as we know is one of the richest countries in the world, but we are not allocating funds to where I think they should be.”
Workers With Health Insurance Face Rising Out-of-Pocket Costs
A new survey from the Kaiser Family Foundation shows annual premiums for a family now top $21,000, and deductibles have more than doubled since 2010.
by Reed Abelson - NYT - October 8, 2010
The high cost of health care is persisting during the pandemic, even for people lucky enough to still have job-based insurance.
The average annual cost of a health plan covering a family rose to $21,342 in 2020, according to the latest survey by the Kaiser Family Foundation, a nonprofit group that tracks employer-based coverage. Workers paid about a quarter of the total premiums, or $5,588, on average, with their employers picking up the rest of the cost.
An analysis of the results was published Thursday online in Heath Affairs, an academic journal. While premiums rose only slightly from the 2019 survey, the increase in premiums and deductibles together over the last decade has far outpaced both inflation and the growth in workers’ earnings. Since 2010, premiums have climbed 55 percent, more than double the rise in wages or inflation, according to the foundation’s analysis.
About 157 million Americans had coverage from their employer before the pandemic, but millions have lost their insurance along with their jobs over the past several months. Many experts expect more people to lose coverage in the coming months as companies lay off workers or drop their health benefits.
“Nothing changed much, but then everything changed,” said Gary Claxton, a senior vice president at the foundation. The survey was conducted from January through July of this year, making it hard for the researchers to see how the changed circumstances will affect costs and employers’ willingness to pay for coverage.
“Things may look different moving forward as employers grapple with the economic and health upheaval sparked by the pandemic,” Drew Altman, the foundation’s chief executive, said a statement.
The survey also underscored how much workers with health insurance still have to spend out of pocket for their care. In addition to paying for their share of premiums, most employees face a hefty deductible — an average of $1,644 for an individual. That is more than twice as high as it was in 2010, when the average for a single person was $646, according to the foundation.
Some employers and insurance companies waived cost-sharing during the early months of the pandemic, but some of them have started to reinstate deductibles and co-payments for care unrelated to the coronavirus. The potential costs are particularly worrisome during the economic downturn as even people with coverage hesitate to spend money on a doctor’s visit.
The Kaiser research also highlights a concern that has most likely intensified during the pandemic: the limited availability of mental health providers within the typical insurance network. The pandemic has increased the need for access to mental and behavioral health services, Mr. Claxton said, but the networks offered by insurers often have very limited choices.
Only 67 percent of employers surveyed indicated they were satisfied with the choices of mental health providers available under their plan, compared with 83 percent who were satisfied with their overall selection of doctors and hospitals.
While employers and insurers have made use of telemedicine during the crisis to provide workers better access to therapists and medicine, Mr. Claxton said, it is unclear whether these options will become permanent.
https://www.nytimes.com/2020/10/08/health/health-insurance-premiums-deductibles.html?
Pandemic Highlights Deep-Rooted Problems in Indian Health Service
Few hospital beds, lack of equipment, a shipment of body bags in response to a request for coronavirus tests: The agency providing health care to tribal communities struggled to meet the challenge.
by Mark Walker - NYT - September 29, 2020
WINDOW ROCK, Ariz. — Matalynn Lee Tsosie showed up at the Indian Health Service hospital in Gallup, N.M., one day in April feeling poorly and having trouble breathing. When her coronavirus test came back positive, the hospital gave her a prescription for an inhaler, an oxygen tank and orders to go home and rest.
Three days later Ms. Tsosie, a 40-year-old secretary for the local school system, was back at the hospital, this time in dire condition. But the hospital was ill-equipped to handle severe coronavirus cases. She was transferred to a hospital two hours away in Albuquerque, where she died alone after doctors tried to take her off a ventilator.
“My thought from the beginning was that it was a slow response,” said her sister, Kirsten Tsosie, fighting back tears. “I think a lot of lives could have been saved if we had a quick response to it.”
Long before the coronavirus, the Indian Health Service, the government program that provides health care to the 2.2 million members of the nation’s tribal communities, was plagued by shortages of funding and supplies, a lack of doctors and nurses, too few hospital beds and aging facilities.
Now the pandemic has exposed those weaknesses as never before, contributing to the disproportionally high infection and death rates among Native Americans and fueling new anger about what critics say has been decades of neglect from Congress and successive administrations in Washington.
Hospitals waited months for protective equipment, some of which ended up being expired, and had far too few beds and ventilators to handle the flood of Covid-19 patients. The agency failed to tailor health guidance to the reality of life on poverty-wracked reservations and did little to collect comprehensive data on hospitalizations, death rates and testing to help tribes spot outbreaks and respond.
The virus has killed more than 500 people in the Navajo Nation in the southwest United States, giving it a death rate higher than New York, Florida and Texas. It has infected more than 10 percent of the small tribe of Choctaw Indians in Mississippi.
A New York Times analysis found that the coronavirus positivity rate for Indian Health Service patients in Navajo Nation and the Phoenix area was nearly 20 percent from the start of the pandemic through July, compared with 7 percent nationally during the same period. It is now down to about 14 percent in both areas, nearly three times higher than the current nationwide rate.
In Arizona, Native Americans account for 11 percent of all coronavirus deaths in the state despite making up only 5 percent of the population. In New Mexico, nearly 30 percent of infections are Native Americans even though they are only 11 percent of the population.
The systematic weaknesses in the health system forced tribal officials to take matters into their own hands, spending millions of dollars of tribal money to bolster the response and enacting curfews and other steps to enforce social distancing. The Oglala Sioux and Cheyenne River Sioux tribes in South Dakota, among others, tried to head off the spread by limiting entry into their reservations.
“If we would have waited for the federal government’s help, our deaths could have been in the thousands,” said Mike Sixkiller, a city coronavirus coordinator in Tuba City, Ariz., where the virus first entered the Navajo Nation.
The doctors and nurses at the federally run hospital in Tuba City pleaded on social media for protective medical equipment, hand sanitizer and other supplies while waiting for assistance from Washington. City officials took the same approach and began receiving donations from across the country.
In states with Indian Health Service hospitals, the death rates for preventable diseases — like alcohol-related illnesses, diabetes and liver disease — are three to five times higher for Native Americans, who largely rely on those hospitals, than for other races combined.
So the virus hit the Indian Health Service and the people it is supposed to serve like a freight train.
“It started as a complete nightmare here,” said Frank Armao, the chief medical officer at the Winslow Indian Health Care Center in Arizona.
He said the hospital struggled to obtain protective equipment for its medical workers during the initial surge. The hospital relied heavily on donations from outside groups and nurses stitching together masks as patients began to flood in.
“It was absolute panic at first; everyone assumed N95s were going to be forthcoming, and pretty quickly we realized that, holy cow, the tribe doesn’t have the stockpiles they were supposed to have,” Mr. Armao said.
He said 32 patients died at the hospital. Most were the tribe’s older members, who were in their 70s and had underlying conditions like diabetes and heart disease. Many critically ill patients had to be transferred to hospitals in Arizona and New Mexico because the health care system was not equipped to treat them.
Many of the service’s hospitals lack the medical expertise and equipment to treat patients with severe illness. The vacancy rate in the health system for doctors in Navajo Nation is more than 25 percent; for nurses, it is 40 percent.
Based in Rockville, Md., the Indian Health Service, often referred to as I.H.S., was created to carry out the government’s treaty obligation to provide health care services to eligible American Indians and Alaskan Natives. The tribes agreed to exchange land and natural resources for health care and other services from the U.S. government as part of the Fort Laramie Treaty of 1868.
The agency, which has 15,170 employees, most of whom work in the hospitals and clinics, was without permanent leadership until a few months into the pandemic. Rear Adm. Michael D. Weahkee, a member of the Zuni Tribe, was confirmed by the Senate in April after leading the agency on an interim basis since 2015. Mr. Weahkee declined to comment for this article.
Coronavirus Schools Briefing: It’s back to school — or is it?
The system consists of 26 hospitals, 56 health centers and 32 health stations. The hospitals range in size from four beds to 133. The Indian Health Service is broken into a dozen service regions across the country, each one serving tribes living in that area.
The pandemic forced the agency to scramble.
“We can get you N95s (they’re expired, but the C.D.C. and I.H.S. say that they’re still OK to use),” an I.H.S. official wrote in an email to tribal officials looking for protective medical equipment.
“I feel like it is common practice that we are always getting the bottom of the barrel, the leftover,” said Esther Lucero, the chief executive officer of the Seattle Indian Health Board. At one point, she requested more coronavirus tests and instead received body bags.
Even before the pandemic, health problems were rampant in communities served by the agency, meaning many people had underlying conditions that would complicate treatment of the virus. And the poverty on many reservations created an additional problem.
At the Navajo Nation, which includes parts of Arizona, New Mexico and Utah, many people live in homes without electricity, and a third of the population does not have running water. Many units house more than one family, and it is not uncommon for grandparents, parents and grandchildren to live under one roof.
These settings made it difficult to follow the main guidance from the Centers for Disease Control and Prevention to stop the spread of the virus: frequent hand-washing, social distancing and isolation in case of infection.
Many residents have spent the past months rationing a limited supply of water, prioritizing drinking water for themselves and livestock over hand washing. That also means more than a third of residents travel to the reservation’s most populous cities and nearby border towns to buy water in bulk, potentially exposing themselves and others to the virus.
“We’re a sparsely populated area, so people have to travel miles to get their health care,” said Jonathan Nez, the president of the Navajo Nation. “It’s especially difficult if you don’t have electricity or even water.”
But those needs were not reflected in the health service’s initial response.
The small town of Kayenta, Ariz., was among the first on the reservation to be hit by the pandemic. Ruth White, a registered nurse with the Navajo Public Health Nursing Program, said patients looking to be tested or seeking treatment were being turned away if they did not have severe symptoms. The public health nurses would try to track down these patients and track their symptoms by phone. And at times, nurses pooled together money to provide the patients with masks, food and medication while they quarantined.
But sometimes, it wasn’t enough, and patients died waiting for medical treatment that never came.
“They developed relationships, and as the patients got sicker and sicker our staff would feel it, too,” Ms. White said, wiping tears from her face. “Our staff felt like it was our fault.”
Philana Brown, a public health nurse at the hospital in Kayenta, dealt with the virus personally. Ms. Brown said that her brother’s condition worsened after initially experiencing headaches, and that he collapsed and died just as the ambulance arrived at his home.
Ms. Brown later tested positive for the virus but refused to be airlifted out, fearing she might not make it back. Instead, she spent weeks in an isolation room, sometimes with other patients.
The Navajo Nation is one of I.H.S.’s 12 service regions. The federal agency runs 14 health care facilities on the reservation. There are 222 hospital beds available to the reservation’s more than 170,000 residents. (The agency says the region also serves another 74,000 Native Americans who live off the reservation.) That ratio of hospital beds to population is about a third of the figure for the general population in the United States.
“We only have a handful of health facilities, and some of them don’t even have beds anymore,” Mr. Nez said. “For a nation that is the size of West Virginia to have only a handful of hospitals is unacceptable.”
The agency’s defenders say it has always been woefully underfunded. They say Congress and previous presidential administrations should shoulder just as much blame as President Trump and the agency’s management for its current shortcomings.
“I see members of Congress eager to point the finger at Indian Health Service, and they should be pointing the finger at themselves,” said Dr. Donald Warne, the director of the Indians Into Medicine program at the University of North Dakota School of Medicine and Health Sciences.
In 2017, the Indian Health Service spent $3,332 per patient, according to a report by the National Congress of American Indians. By comparison, Medicare spent $12,829 per patient that year, and Medicaid spent $7,789 per patient, the report said.
After a scandal in 2014 uncovered appalling patient care issues at the hospitals of the Department of Veterans Affairs, Congress and the Obama administration spent billions of dollars to shorten wait times, fill provider gaps and upgrade the medical facilities.
Native Americans can only wish that sense of urgency be afforded to the government-run hospitals that are supposed to serve them.
Dr. Jill Jim, the executive director of the Navajo Department of Health, said officials in the Navajo Nation area of the Indian Health Service responded to the best of their abilities despite a lack of resources and expertise at the headquarters level.
“I don’t think Indian Health Service was generally positioned to respond to a pandemic nationally,” she said. “They don’t have a public emergency office, they don’t have dedicated staff that are hired for public health emergencies.”
https://www.nytimes.com/2020/09/29/us/politics/coronavirus-indian-health-service.html?
Super-PAC ad takes aim at Gideon’s health-care policies
The ad by American Crossroads relies heavily on studies funded by the insurance industry to critique Gideon's support for a public option for Medicare.
by Kevin Miller - Portland Press Herald - October 3, 2020
A new attack ad by a deep-pocketed, conservative organization ignores a key part of Senate candidate Sara Gideon’s health care platform in describing a Medicare buy-in as a “gamble.”
The ad also neglects growing popular support for a “public option.”
The ad by American Crossroads – a political action committee that has spent nearly $200 million since 2010 – is part of Republicans’ national strategy to cast Democratic proposals as a dangerous “government takeover” of health care.
The ad against Gideon warns of massive tax hikes and shuttered hospitals across rural Maine, but bases those dire predictions on worst-case scenarios from studies produced for the insurance industry.
The ad also fails to actually state what the candidate supports – in this case, a public option allowing some Americans to buy into Medicare coverage as an alternative to private insurance.
Polls suggest a majority of Americans support the general idea of a public option, including a January poll by Kaiser Family Foundation that 68 percent of respondents supported the concept.
The gambling-themed ad also relies heavily on worst-case scenarios from studies produced for an industry trade group whose members from the insurance and hospital industries oppose a public option of “Medicare for all.”
Gideon, a Freeport resident currently serving as Maine’s House speaker, is in a high-profile race against incumbent Republican Sen. Susan Collins as well as two independents, Max Linn and Lisa Savage.
American Crossroads is one of more than 40 PACs and other outside groups that have collectively spent more than $50 million, to date, on Maine’s Senate race, according to the campaign finance watchdog group the Center for Responsive Politics.
Gideon lands in the middle of the Democratic spectrum on health care reforms.
On the far left are progressives like Savage and former presidential candidate Bernie Sanders pushing Medicare for all. Under such a scenario, every American would obtain health coverage through the federal program now offered largely to people age 65 or older, likely eventually leading to the elimination of private insurance.
But Gideon, presidential nominee Joe Biden and other moderates support a public option. Details vary among the proposals but, generally speaking, a public option would expand the Affordable Care Act to enable some people under age 65 – but probably not everyone – to buy into Medicare coverage.
But consumers would have a choice – hence the “option” in public option – and could stay on private insurance plans typically offered through their employers.
The American Crossroads ad claims that Gideon’s public option plan “could put employer-provided health insurance at risk.” To back that up, the ad points to a December 2019 New York Times analysis that says an inexpensive, efficient public option would likely lure some people away from private plans or force commercial insurers to change their offerings.
On the other hand, few people would likely drop their private coverage if the public option provided expensive, less-robust coverage. So it all depends on how the program is structured.
“A public-option plan wouldn’t directly affect private insurers,” the New York Times analysis states. “But by changing the rules of the market, it could influence a company’s business decisions. And that could affect consumers who want to buy private coverage.”
Other claims in the American Crossroads ad deal with how a public option could affect Maine’s ever-fragile rural hospitals and consumers’ wallets.
The ad states that a public option could “raise taxes on Maine workers more than $2,300 a year.” The $2,300 figure appears to come from payroll tax increases that academics at the conservative Hoover Institution said would be necessary to pay the government’s portion of a public option.
The January 2020 study was financed “with support from the Partnership for America’s Health Care Future,” which is an industry trade group comprised of insurance companies, hospitals, chambers of commerce and other business groups. The partnership was created to oppose Medicare for All and a public option.
The ad then asserts that Gideon’s “health care scheme” could lead to the closure of 15 rural hospitals in Maine, or 75 percent of the state’s 21 rural hospitals in the state. That scenario is based on an August 2019 study also paid for by the Partnership for America’s Health Care Future.
Digging deeper, the 15 shuttered hospitals prediction is based on revenue losses if 25 percent to 50 percent of people with private insurance opted to buy into Medicare – which would be a substantial buy-in to the program.
It also assumes no change in current Medicare reimbursement rates, which are typically lower than the rates paid by private insurers.
But Gideon has said that she believes any public option plan should also increase Medicare reimbursement rates.
“In the Senate, Sara supports expanding the number of ‘critical access hospitals’ in Maine and raising Medicare reimbursement rates to ensure rural hospitals are able to continue to meet their communities’ needs,” the Gideon campaign said in response to the American Crossroads ad.
To be clear, Maine’s rural hospitals were struggling years before the COVID-19 pandemic made things even more financially tenuous. Two of Maine’s 21 rural hospitals, Penobscot Valley Hospital in Lincoln and Calais Regional Hospital, are in bankruptcy.
And all hospitals in Maine, rural or urban, would be affected by a public option.
A 2017 financial report from the Maine Hospital Association stated that Medicare and Medicaid accounted for, on average, 62 percent of hospitals’ business but only 55 percent of their revenues “due to significant levels of underpayment” by the federal programs. Privately insured individuals accounted for 35 percent of business but 45 percent of hospital revenues.
“This forces Maine hospitals to shift the costs of caring for Medicare and Medicaid (MaineCare) patients to commercial health insurance carriers,” reads the report.
Those dynamics can also vary significantly. People with private insurance make up as little as 25 percent of clients at some hospitals and as much as 50 percent at others. Regional trends in age, demographics and employment also directly affect that breakdown.
Profit margins are also thin across the board but even more so in rural areas. According to Maine Hospital Association figures, urban hospitals averaged an operating/profit margin of 1.7 percent last year versus 0.4 percent for rural hospitals.
https://www.pressherald.com/2020/10/03/super-pac-ad-takes-aim-at-gideons-health-care-policies/
Bidencare Would Be a Big Deal
Don’t dismiss it because it isn’t Medicare for All.
by Paul Krugman - NYT - October 5, 2020
On Monday morning America’s most prominent beneficiary of socialized medicine, in the process of receiving expensive, taxpayer-financed care at a government-run hospital, was tweeting furiously. One of President Trump’s manic missives particularly caught the eyes of health care experts: his exhortation to “PROTECT PREEXISTING CONDITIONS. VOTE!”
As always, it’s not clear whether Trump is merely being cynical or whether he is also genuinely ignorant.
He’s definitely lying when he claims to have a plan that’s better and cheaper than Obamacare. No such plan exists, and he has to know that.
But does he know that Americans with pre-existing medical conditions are already protected by the Affordable Care Act, which his administration is asking the Supreme Court to overturn? Does he realize that the reason his party has never offered an acceptable alternative to the A.C.A., in particular an alternative that would protect pre-existing conditions, is that no such alternative is possible? That’s less clear.
In any case, how the nation votes will indeed make a huge difference to the future of health care — and not just because Trump, if he holds on to power, will almost surely find a way to destroy Obamacare, causing tens of millions of Americans to lose health insurance. Joe Biden, if he wins (and gets a Democratic Senate), will make a big difference in the other direction, substantially expanding coverage and reducing premiums for middle-class families.
Paul Krugman’s Newsletter: Get a better understanding of the economy — and an even deeper look at what’s on Paul’s mind.
The second part of this statement may come as news to many readers, because Biden’s health proposals haven’t drawn much attention so far.
Why not? One reason is that the election is — rightly — being seen mainly as a referendum on Trump rather than on likely Democratic policy. Another is that since the Democratic primary fight pitted Biden against rivals calling for radical changes in health policy, many people assume that the winner of that fight, who rejected those radical proposals, wouldn’t change much.
But while Biden is indeed proposing incremental change rather than Medicare for All, we’re talking about some big increments. Independent estimates suggest that under Biden’s plan, 15 million to 20 million Americans would gain health insurance. And premiums would fall sharply, especially for middle-class families.
What policy changes are we talking about? To the extent that the Biden plan has received any attention at all, this attention has largely been focused on his proposed introduction of a “public option” — a Medicare-like plan that individuals could buy instead of purchasing private insurance. This option might be a first step toward a single-payer system, but it would be a small step, and in the near term would be much less important than other aspects of the plan.
First and foremost, the Biden plan — Bidencare? ObamaBidencare? — would substantially increase the subsidies that currently help many but not all Americans who don’t get insurance from their employers.
The Affordable Care Act, as passed in 2010, was underfunded, because Democrats wanted to hold down the headline cost. This meant that premiums and co-payments were and are too high for many families. Since then, however, the politics have shifted: Public opinion has shifted in favor of the A.C.A., the Democratic Party has moved somewhat to the left and Republican willingness to ram through expensive, unfunded tax cuts has encouraged Democrats to be more aggressive.
So the Biden plan would increase subsidies and also remove the upper-income limit that prevents many middle-class families from receiving aid. This would cost a fair amount of money: The Committee for a Responsible Federal Budget puts the price tag at $850 billion over a decade. But it would cost far less than the 2017 tax cut, much of which went to corporations, which were supposed to respond by increasing investment, but didn’t.
The Biden plan would also automatically enroll low-income Americans in the public option, which is more important than it might sound. One of the defects of our system is that it’s complex and confusing, and those who need help the most are often the least able to navigate their way to getting it. Ideally we’d just move to a simpler system, but for now auto-enrollment would be an important palliative measure.
Oh, and the plan would also provide significant aid for long-term care, rural health, and mental health.
None of this amounts to revolutionary change — in contrast to Trump’s efforts to kill Obamacare, which would drastically change American health care, for the worse. But Bidencare would still be, as Biden didn’t quite say when President Barack Obama signed the A.C.A. into law, a pretty big deal.
True, America would still fall somewhat short of achieving what every other advanced country has — universal health care. But we’d get a lot closer, and many who currently have insurance coverage would see their costs fall and the quality of coverage improve.
So health care, including to PROTECT PRE-EXISTING CONDITIONS, really does need your VOTE! If Trump wins, Americans will lose that protection and many will lose their health insurance or see their premiums soar; if Biden wins, Americans will keep that protection and many will gain insurance or see their premiums fall.
https://www.nytimes.com/2020/10/05/opinion/joe-biden-health-care.html?
'It is a slaughter': Infectious disease icon asks CDC director to expose White House, orchestrate his own firing
A former director of the Centers for Disease Control and Prevention and public health titan who led the eradication of smallpox asked the embattled, current CDC leader to expose the failed U.S. response to the new coronavirus, calling on him to orchestrate his own firing to protest White House interference.
Dr. William Foege, a renowned epidemiologist who served under Democratic and Republican presidents, detailed in a private letter he sent last month to CDC director Dr. Robert Redfield his alarm over how the agency has fallen in stature while the pandemic raged across America.
Foege, who has not previously been a vocal critic of the agency's handling of the novel coronavirus, called on Redfield to openly address the White House’s meddling in the agency’s efforts to manage the COVID-19 crisis and then accept the political sacrifice that would follow. He recommended that Redfield commit to writing the administration's failures — and his own — so there was a record that could not be dismissed.
“You could upfront, acknowledge the tragedy of responding poorly, apologize for what has happened and your role in acquiescing,” Foege wrote to Redfield. He added that simply resigning without coming clean would be insufficient. “Don’t shy away from the fact this has been an unacceptable toll on our country. It is a slaughter and not just a political dispute.”
The CDC did not immediately respond to a request for Redfield's response. Redfield, an HIV/AIDS expert and former military physician, lacked experience running a public health agency when Trump selected him to head the CDC in 2018.
White House spokesman Judd Deere did not respond to the contents of the letter but said in a statement that the CDC has not been compromised. "This dishonest narrative that the media and Democrats have created that politics is influencing decisions is not only false but is a danger to the American public," Deere said.
Foege's Sept. 23 letter, which was obtained by USA TODAY and has not been previously reported, is a striking condemnation from a legendary public health figure who has spent decades helping prevent the spread of diseases while earning the respect of peers.
In an interview, Foege said he felt compelled to write to Redfield after the White House appointed Dr. Scott Atlas to the coronavirus task force, even though he is not an infectious disease expert.
The Washington Post and other outlets have reported that Atlas has endorsed the controversial strategy of herd immunity, although Atlas has denied doing so. Nevertheless, such reports prompted Foege, who helped successfully steer India away from such a strategy during the smallpox epidemic, to reach out to Redfield.
Now Foege sees an opportunity for Redfield to help the U.S. to turn around its response to COVID-19 if he helps implement the lessons learned from decades of fighting pandemics.
“So much of this is the deaths. It's the deaths,” Foege told USA TODAY, noting that he did not want the letter to become public for fears that it may create a political sideshow and add to Redfield’s burden.
“Going public can only embarrass him and it doesn't allow him to redeem himself,” Foege said, explaining his motivations. “By doing this privately, he has a chance to do the right thing.”
MORE: Help USA TODAY with its contact tracing of Washington D.C.’s recent COVID outbreak
Foege’s opinion carries extraordinary weight within a public health community that credits him with decades of accomplishments even beyond the eradication of smallpox. His public health credentials include helping to improve millions of lives with his work to eliminate guinea worm disease and river blindness as executive director of the Carter Center. He also helped to shape the public health efforts of the Bill and Melinda Gates Foundation.
In 2012, President Barack Obama awarded him the Presidential Medal of Freedom for his contributions.
Nancy Cox, former director of the CDC’s influenza division, who worked at the agency for 37 years, told USA TODAY that Foege crystallized how many scientists and experts are feeling.
“The fact that Bill Foege went to the trouble to write this is a testament to how much he values the reputation of the CDC,” Cox said after reviewing the letter, “and how concerned he is that the reputation is being besmirched by what is happening.”
Dr. Tom Frieden, also a former CDC director, said Foege is not known for being especially partisan, having served in both the Carter and Reagan administrations. Frieden called him the “best CDC director in history.”
“Bill Foege is the Babe Ruth of public health,” said Frieden, now the president and CEO of Resolve to Save Lives, an initiative aimed at preventing deaths from cardiovascular disease and epidemics. “Bill Foege really is in a league of his own in terms of accomplishment and is revered with reason by essentially everyone in the public health field.”
Foege's letter to Redfield lamented how the CDC’s scientific experts have been rendered impotent during the most significant health crisis in a century while decades of experience have been ignored.
“This will go down as a colossal failure of the public health system of this country,” Foege wrote. “The biggest challenge in a century and we let the country down. The public health texts of the future will use this as a lesson on how not to handle an infectious disease pandemic.”
Foege added that the CDC's scientific reputation was tainted under White House pressure, citing examples such as publishing official guidance not rooted in science.
“The White House has had no hesitation to blame and disgrace CDC, you and state governors,” he wrote. “They will blame you for the disaster. In six months, they have caused CDC to go from gold to tarnished brass.”
Foege also described how morale among the agency’s staff had broken down. “At the moment, they feel you accepted the White House orders without sufficient resistance,” he wrote. “You have a short window to change things.”
In his letter, Foege called on Redfield to take a strong, public stance against the White House and accept that he would lose his job as a result.
“When they fire you, this will be a multi-week story and you can hold your head high. That will take exceptional courage on your part,” Foege wrote in closing. “I can't tell you what to do except to revisit your religious beliefs and ask yourself what is right.”
Foege, in his interview with USA TODAY, said he’d like to see the CDC reclaim its leadership role from the White House.
“Dr. Redfield could still be a savior in all of this,” he said.
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