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Sunday, September 27, 2015

Health Care Reform Articles - October 1, 2015

New Kennedy tape shows frustration with Clintons, health bid

By  GLOBE STAFF  

WASHINGTON — Some 15 years had passed since Bill and Hillary Clinton’s health care legislation failed when Senator Edward M. Kennedy sat for a 2008 oral history interview, but his frustration over the couple’s handling of the measure seemed to anger him as much as ever.
“I think everybody understands now that that was a catastrophic mistake,” Kennedy told a historian from the University of Virginia’s Miller Center, according to transcripts released this week.

“Was there any consultation about this strategy with people in the Congress?” interviewer James Sterling Young asked.
“No,” Kennedy replied.
It will be no surprise to Kennedy watchers that the Massachusetts Democrat was upset with the way the Clintons launched their failed effort to pass health care legislation in the early 1990s or that Kennedy was perturbed that he — the longtime champion of such a bill — was kept out of the loop. But his words are bound to revive a memory that presidential candidate Hillary Clinton, who was given authority over the health care proposal by her husband, might prefer be long forgotten.
Kennedy’s lament about the Clintons is among thousands of pages of transcripts of oral history given by Kennedy and 170 people who interacted with him at crucial periods. The transcripts are to be released Wednesdayjointly by the University of Virginia’s Miller Center and the Edward M. Kennedy Institute in Boston. The institute provided Kennedy’s interview about health care issues to the Globe as a preview of the release.
A more complete set of Kennedy’s 19 interviews and those given by others is slated to be posted online Wednesday, giving the public a fresh chance to review the senator’s career.

Clinton expected to break with Obama on healthcare ‘Cadillac’ tax

By Sarah Ferris - 09/21/15

Hillary Clinton will seek to align herself with ObamaCare’s successes and use it to attack the GOP on Tuesday as she begins to map out her long-awaited healthcare agenda.

The effort could also lead to a public break with the Obama administration on healthcare for the first time.
After months of delivering nothing but praise for ObamaCare, presidential candidate Clinton is expected to weigh in — and oppose — one of the law's most controversial taxes: The “Cadillac tax."
If she joins her 2016 Democratic rivals in calling for the repeal of the tax on generous healthcare plans, she will distance herself from most ObamaCare supporters but also unlock important endorsements from unions that staunchly oppose it.

Clinton will drop the first details of her healthcare plan during a campaign event in Iowa on Tuesday, part of a two-day, three-state tour. Her speech will come weeks after hinting earlier this summer that she has concerns with the tax.

“Hillary Clinton believes protecting, defending and improving the Affordable Care Act is a top issue for this campaign, so she plans to highlight its benefits and go on offense against Republicans for their never-ending push to repeal,” a campaign official told The Hill on Monday.

Looking beyond the law’s current scope, she will also target the rising costs of prescription drugs and out-of-pocket healthcare costs — two policy areas that were largely left out of the Affordable Care Act. Rising costs have become a rallying cry of Clinton’s Democratic rival, Sen. Bernie Sanders (I-Vt.), who recently introduced legislation targeting the “skyrocketing” costs of drugs.
Sanders, as well as presidential hopeful, former Maryland Gov. Martin O’Malley, have both come out in opposition of the Cadillac tax, putting pressure on Clinton to do the same or risk losing big-dollar union support.


The Democratic threat to Obamacare

by Charles Lane

Who says there’s no bipartisan consensus in the United States? Based on their campaign promises so far, if any of the leading contenders for the Republican and Democratic presidential nominations actually wins in November 2016, Obamacare as we know it is doomed.
The Republicans, of course, pledge to repeal the whole thing. The Democrats, by contrast, merely want to hollow it out, by removing a crucial systemic reform, the absence of which will make the Affordable Care Act less able to meet its twin goals of curbing costs and expanding coverage.
Specifically, Democratic front-runner Hillary Clinton has just joined her main rivals, Sen. Bernie Sanders (I-Vt.) and former Maryland governor Martin O’Malley, in calling for the repeal of Obamacare’s excise tax of 40 percent of the value of employer-paid health insurance plans that exceeds $10,200 for individuals and $27,500 for families; the tax takes effect in 2018.
Health-care economists universally praised this feature of Obamacare because it attacked the wasteful and regressive tax exclusion for employer-paid health plans, a $250 billion-plus annual item, 35 percent of which accrues to the top 20 percent of the income distribution scale.
Reducing the value of that tax break would help slow health-care cost growth, because it encourages many employers to pay employees not higher wages but generous “Cadillac benefits,” prompting the recipients, in turn, to overutilize medical care. 
As it happens, the mere anticipation of the tax has already caused employers to right-size their benefits packages, just as Obamacare’s authors intended. This is one reason, among many, that health-care cost growth has remained moderate even as health reform has brought millions of new consumers onto the insurance rolls.


Prescription Drug Costs Are Rising as a Campaign Issue

Both Bernie Sanders and Hillary Rodham Clinton are trying to make the rising cost of prescription drugs an issue in the presidential campaign.
Mr. Sanders introduced a bill in Congress this month, spelling out a host of policy changes to drive down drug costs. Mrs. Clinton tweeted on Monday that her plan would be released Tuesday, and her campaign has released some details.
Here’s why prescription drugs are bubbling up to the top of the Democratic health care agenda: Drug prices are bubbling up. Per capita drug spending increased by more than $100 last year, a big jump. At the same time, a growing share of Americans are being asked to foot the bill for their medicines, even if they’re insured. The Affordable Care Act, which has expanded insurance coverage, didn’t do much to counteract those trends.
Voters have clearly noticed the higher drug costs. This year, a survey from the Kaiser Family Foundation asked people to identify health issues that they thought should be top priorities for the president and Congress. The No. 1 issue was making drugs for serious diseases affordable. The No. 2 issue: lowering the cost of prescription drugs. A follow-up survey in August found that 24 percent of people said that they or a family member had declined to fill a prescription because of the cost.

Drug Price Gouging Enters Spotlight as Candidates Take on Big Pharma

Bernie Sanders and Hillary Clinton among those calling for reforms to pharmaceutical marketplace
by
Nadia Prupis, staff writer
Amid a growing scandal over two pharmaceutical companies' price hikes on two vital medications, voices from the political sphere are promising renewed action to tackle price gouging in the medical marketplace.
On Sunday, Turing Pharmaceuticals increased overnight the price of Daraprim, a malaria medication, from $12.50 to $750 a pill. Around the same time, a separate drug company, Rodelis Therapeutics, sent the cost of tuberculosis drug Cycloserine from $15 to $360 a pill.
After ensuing outrage, Rodelis rescinded the increase and handed Cycloserine back to the nonprofit organization from which it had purchased ownership of the drug brand. But Turing refused to back down.
Turing CEO Martin Shkreli defended his company's actions from widespread criticism, telling Bloomberg TV about the Daraprim decision, "This drug saves your life for $50,000. At this price, it's a no-brainer."
Shkreli's actions and cavalier defense did little to soothe public furor. But among the continued outcry, some politicians stepped up with their own solutions to the issue of unregulated medication costs.
Hillary Clinton on Monday tweeted, "Price gouging like this in the specialty drug market is outrageous. Tomorrow I'll lay out a plan to take it on."
While the official plan will not be unveiled until the Democratic presidential candidate's speech in Iowa later Tuesday, early reports indicate that it would force pharmaceutical companies to reinvest profits into disease and treatment research and allow Medicare to lower and cap out-of-pocket expenses for consumers.
Bernie Sanders, Clinton's current chief rival for the nomination, has also sponsored legislation that would allow Medicare to negotiate drug prices with pharmaceutical companies. Many of the provisions in his bill are echoed in Clinton's new plan.
Sanders also sent Turing a letter on Monday demanding information on the company's price hike.
"The enormous, overnight price increase for Daraprim is just the latest in a long list of skyrocketing price increases for certain critical medications," Sanders said in a joint statement with Rep. Elijah E. Cummings (D-Md.), ranking member of the House Committee on Oversight and Government Reform.
"Without fast access to this drug, used to treat a very serious parasitic infection, patients may experience organ failure, blindness or death," Sanders and Cummings said.
Indeed, Daraprim is widely considered one of the best medications for toxoplasmosis or people whose immune systems are weakened by HIV/AIDS or cancer. The Infectious Diseases Society of America slammed Turing's action, saying it burdens patients and creates unsustainable costs for the country's healthcare system.
http://www.commondreams.org/news/2015/09/22/drug-price-gouging-enters-spotlight-candidates-take-big-pharma


Clinton proposing $250 monthly cap on prescription drug costs for patients

Democratic presidential candidate Hillary Rodham Clinton is proposing a $250 monthly cap on the amount patients with chronic and serious medical problems would have to pay out of pocket for prescription drugs as a way to reduce the effect of skyrocketing drug prices on consumers.
The cap is part of Clinton’s program to alter and expand the Affordable Care Act, the signature domestic policy achievement of President Obama, if she is elected to succeed him. Clinton will discuss the prescription drug plan Tuesday in Des Moines, Iowa. Some details were provided by her campaign in advance.
Clinton herself telegraphed the plan with a Twitter message Monday vowing to go after “price-gouging” by drug companies. She cited the nearly 5,000-percent increase in the per-pill cost of a drug to treat parasitic infections.
That price hike was profit-driven, Clinton said Monday at a political rally in Little Rock, Ark. The Democratic front-runner said she would crack down on such price increases because “nobody in America should have to choose between buying the medicine they need and paying rent.”
Clinton is calling her health-care ideas a way of refining the Affordable Care Act, the sprawling 2010 law that is reshaping parts of the U.S. health-care system. But her ideas would navigate the law into a realm of drug prices that its authors largely sidestepped.
Clinton is taking some political risk by a full-throated endorsement of a law that remains divisive, though polling shows sharp partisan differences in support for it. Clinton casts the issue as an example of retrograde Republican ideas that would undo progress she claims under Obama.
“All the Republican candidates for president are determined to get rid of the Affordable Care Act.  Actually, Republicans in Congress have tried to repeal it 54 times,” Clinton said Monday in Little Rock.

Big Price Increase for Tuberculosis Drug Is Rescinded

By 
A huge overnight price increase for an important tuberculosis drug has been rescinded after the company that acquired the drug gave it back to its previous owner under pressure, it was announced on Monday.
However, outrage over a gigantic price increase for another drug spread into the political sphere on Monday, causing biotechnology stocks to fall broadly as investors worried about possible government action to control pharmaceutical prices. The Nasdaq Biotechnology Index fell more than 4 percent.
“Price-gouging like this in the specialty drug market is outrageous,” Hillary Rodham Clinton, a contender for the Democratic presidential nomination, said in a tweet on Monday. She said she would announce a plan on Tuesday to deal with rising drug prices.
Ms. Clinton was referring to the actions of Turing Pharmaceuticals, which last month acquired Daraprim, a 62-year-old drug used to treat a serious parasitic infection, and raised its price to $750 per tablet, from $13.50.
The cases of Daraprim and of the tuberculosis drug, cycloserine, are examples of a relatively new business strategy — acquiring old, neglected drugs, often for rare diseases, and turning them into costly “specialty” drugs.
Cycloserine was acquired last month by Rodelis Therapeutics, which promptly raised the price to $10,800 for 30 capsules, from $500.But the company agreed to return the drug to its former owner, a nonprofit organization affiliated with Purdue University, the organization said on Monday.

Jump in Price for an Old Drug Will Be Rolled Back, C.E.O. Shkreli Says 

By  and 
Martin Shkreli is either the boy genius or the bad boy of pharmaceuticals, depending on one’s point of view.
Mr. Shkreli, the boyish-looking 32-year-old founder of two drug companies, has proved to have a sharp eye for finding obscure drugs that might be turned into lucrative moneymakers, rewarding some of his investors.
But after years of attacking drug company executives, he was vilified on social media and became the symbol for price gouging after his company, Turing Pharmaceuticals, raised the price of a 62-year-old drug it had acquired to $750 a pill from $13.50.
While not the first huge overnight price increase for a drug, this one touched a public nerve and intensified calls, including from presidential candidate Hillary Rodham Clinton and lawmakers, for measures to control the rising cost of medicines.
After fiercely defending the price increase in various interviews and on Twitter for two days, Mr. Shkreli backed down a bit late Tuesday. He told television news networks that the price of the drug, Daraprim, would be lowered, though he did not specify what the new price would be.
“I think that it makes sense to lower the price in response to the anger that was felt by people,” he told NBC News.He declined to comment for The New York Times on the pricing announcement, and did not reply to an email request for comment on other matters mentioned in this article. “I think our relationship is over,” he wrote in response to an email seeking comment on Tuesday.
This is not the first time that Mr. Shkreli, a former hedge fund manager with a reputation for outspokenness, has been at the center of a controversy.
While in his 20s, he drew negative attention for urging the Food and Drug Administration not to approve drugs made by companies whose stock he was selling short.
He was among a group of investors ordered by a New York judge to pay $2.3 million to Lehman Brothers to cover a losing bet on the markets in 2007.
Two former employees sued him for not paying their wages, while another former employee accused Mr. Shkreli of taking over his personal email and Facebook accounts and harassing his family through social media.
Continue reading the main story
The board of his first pharmaceutical company accused him of using the company as his personal piggy bank to pay back angry investors in his hedge fund.
While controversial, Mr. Shkreli is also charismatic and whip smart, according to those who know him, able to talk science without having any formal training.
“You give him a science textbook on chemistry, he’d give it back to you in nine months and he’d have it memorized,” said one early investor in Mr. Shkreli’s first drug company, Retrophin. “He’s a sponge for information.”
Mr. Shkreli has also continued to bet against, or short, biotechnology stocks, even as he has run Retrophin and Turing. He is said to have made millions shorting the stocks of Celladon and Vital Therapies after correctly predicting their products would fail in clinical trials.

‘Pharma bro’ Martin Shkreli and the very American debate over maximizing profit

Former hedge fund manager Martin Shkreli has the Internet ablaze after hiking the price of the drug that's been on the market for decades. Here's what happened. (Gillian Brockell/The Washington Post)
By now, you’ve probably heard of Martin Shkreli.
Over the past week, the 32-year-old has become public enemy No. 1 thanks to his company’s decision to raise the price of a life-saving drug by more than 4,000 percent, from $1,130 to $63,000.
Thousands of people took to the Internet to label Shkreli a “putz,” a “psychopath,” and “Big Pharma’s Biggest A–hole.” The BBC asked if he was the most hated man in America. Twitter appeared to answer in the affirmative.
Prescription pricing is a strange thing to stir such rage, however. After all, Daraprim, the drug in question, is not widely used. It treats a potentially deadly condition called toxoplasmosis that primarily affects people with compromised immune systems, such as newborns and HIV patients.
Moreover, “Pharma bro,” as Shkreli quickly became known, is not the first person to corner the market on a drug and then hike its price — although he is a frequent offender.
So, how did Shkreli become the Internet’s latest villain?
Much of the reason lies with the former hedge fund manager’s unabashed pursuit of profit.
Although Shkreli has delivered different, at times conflicting statements about why his company, Turing Pharmaceuticals, raised the price of Daraprim, his answer has often boiled down to this: because of capitalism.
It’s unlikely that Shkreli set out to stir a debate about the limits of the American economic system, but that’s effectively what he has done. The controversy comes at a time of broad concern over inequality in this country. Bernie Sanders has made a presidential campaign out of the issue. Even Donald Trump is talking about raising taxes on the wealthy.

How Patent Law Can Block Even Lifesaving Drugs

Hillary Rodham Clinton’s prescription drug policy proposal, released last week, would hold drug manufacturers accountable to their level of investment in research. But there are some potentially valuable drugs we’ll never get drug companies to invest in — those that cannot be patented.
By granting temporary monopolies to innovators, the patent system is widely credited with protecting and promoting innovation. But when it comes to pharmaceuticals, it may be preventing valuable therapies from coming to market.
To see evidence of this, just look at the behavior of pharmaceutical firms. When Benjamin Roin, assistant professor of technological innovation, entrepreneurship, and strategic management at M.I.T., did so, he discovered that drug companies discard many potentially good ideas because they’re unpatentable. By interviewing academic researchers and industry insiders and scouring medicinal-chemistry textbooks, Mr. Roin learned that “pharmaceutical companies systematically screen their drug candidates to exclude the ones lacking strong patent protection.”
It’s obvious why drug innovators would avoid unpatentable ideas: Bringing a drug to market is expensive. In addition to the costs of scientists and laboratories to discover and sift through potentially therapeutic compounds in the first place, demonstrating efficacy and safety to the Food and Drug Administration requires costly clinical trials. Without F.D.A. approval, a drug cannot be marketed.
The expense of prescription drugs has come to the forefront in the presidential campaign with proposals by Bernie Sanders and Mrs. Clinton to rein in drug prices.

Harvard Medical School puts strict ethics rules under microscope

By Melissa Bailey STAT  

Harvard Medical School is reevaluating rigid conflict-of-interest rules that aim to shield scientific research from corporate influence amid complaints by some professors that the restrictions slow the process of turning discoveries into research tools and treatments.
The school strengthened its conflict-of-interest regulations just five years ago, at a time of widespread concern about physicians and researchers accepting payments from pharmaceutical companies.

The medical research landscape has changed since then, however: Government funding for research is more difficult to obtain, and large drug companies have sharply reduced their investment in early-stage research. To fill the gap, many professors are launching startups.
There’s now a growing national debate about whether “overly strict conflict-of-interest policies have hurt innovation,” said Eric Campbell, a Harvard Medical School sociologist who studies the policies in the medical field.
Or as Dr. Donald Ingber, a Harvard Medical School professor of vascular biology, put it: “If there were conflict-of-interest policies so that Thomas Edison couldn’t be involved in the company he formed to create the electric light, we’d still have gas lamps.”
The medical school this summer began surveying all of its 10,000 faculty members about its policies, among the strictest in the nation. In a letter to faculty that raised concern among some watchdogs who want tough rules retained, dean Jeffrey Flier said the school will look broadly at the policies, with a particular focus on two restrictions.
The review will examine what’s known as the research support rule, which bars faculty who own equity in a company from receiving research grants or contributions from that company. Secondly, it will look into the clinical research rule — which Campbell said is the only one he knows in the nation to prohibit faculty from conducting clinical trials on a company’s products if they have equity in or earn at least $10,000 in income from that company.
A committee of faculty and staff is collecting feedback on whether those rules are too strict, too lenient, or just right.

A New Effort Has Doctors Turn Patients Into Donors

By 

A well-to-do cancer patient is nearing the end of her treatments. During an office visit, she says to her doctor, “I can’t thank you enough for the care you provided.”
Should the doctor simply accept the patient’s gratitude — or gently suggest a way for her to show it: “Perhaps you might consider making a donation?”
More and more these days, development offices at major cancer centers are teaching doctors to seize such opportunities to raise money for the medical center or for their own research.
In an unprecedented survey of more than 400 oncologists at 40 leading cancer centers, nearly half said they had been taught to identify wealthy patients who might be prospective donors. A third had been asked to directly solicit donations — and half of them refused. Three percent had been promised payments if a patient donated.
The study, which was published online Monday in The Journal of Clinical Oncology, was conducted by Dr. Reshma Jagsi, a radiation oncologist and ethicist at the University of Michigan, who had grown concerned about the practice and wanted to know more.

Coke Spends Lavishly on Pediatricians and Dietitians

By ANAHAD O'CONNOR
SEPTEMBER 28, 2015
When the American Academy of Pediatrics needed support for a website it created to promote children’s health, it turned to a surprising partner: Coca-Cola.
The world’s largest maker of sugary beverages, Coca-Cola has given nearly $3 million to the academy over the past six years, making it the only “gold” sponsor of the HealthyChildren.org website. Even though the pediatric academy has said publicly that sugary drinks contribute to the obesity epidemic, the group praises Coke on its website, calling it a “distinguished” company for its commitment to “better the health of children worldwide.”
The extent of the financial ties between Coke and the Academy of Pediatrics was revealed last week when the company released a detailed list of nearly $120 million in grants, large and small, given to medical, health and community organizations since 2010. Not only has Coke’s philanthropy earned it praise from influential medical groups, the soda grants appear to have, in some cases, won the company allies in anti-soda initiatives, wielded influence over health recommendations about soft drinks, and shifted scientific focus away from soda as a factor in the causes of obesity.
The list of Coke donations was released after the company’s chief executive, Muhtar Kent, promised to be transparent about its partnerships in the health community. The move was prompted by criticism that the company has paid for scientific research that plays down the role of Coke products in the spread of obesity, an issue first reported last month in The New York Times.
In addition to the Academy of Pediatrics, Coke beneficiaries include a number of respected medical and health groups, including $3.1 million to the American College of Cardiology, more than $3.5 million to the American Academy of Family Physicians, $2 million to the American Cancer Society and roughly $1.7 million to the country’s largest organization of dietitians, the Academy of Nutrition and Dietetics.


Democrats on House Panel Attack Heart Drug Price Increases

By REUTERS
http://www.nytimes.com/2015/09/29/business/democrats-on-house-panel-attack-heart-drug-price-increases.html?smprod=nytcore-iphone&smid=nytcore-iphone-share



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Monday, September 21, 2015

Health Care Reform Articles - September 21, 2015

A Huge Overnight Increase in a Drug’s Price Raises Protests

By 

Specialists in infectious disease are protesting a gigantic overnight increase in the price of a 62-year-old drug that is the standard of care for treating a life-threatening parasitic infection.
The drug, called Daraprim, was acquired in August by Turing Pharmaceuticals, a start-up run by a former hedge fund manager. Turing immediately raised the price to $750 a tablet from $13.50, bringing the annual cost of treatment for some patients to hundreds of thousands of dollars.
“What is it that they are doing differently that has led to this dramatic increase?” said Dr. Judith Aberg, the chief of the division of infectious diseases at the Icahn School of Medicine at Mount Sinai. She said the price increase could force hospitals to use “alternative therapies that may not have the same efficacy.”
Turing’s price increase is not an isolated example. While most of the attention on pharmaceutical prices has been on new drugs for diseases like cancer, hepatitis C and high cholesterol, there is also growing concern about huge price increases on older drugs, some of them generic, that have long been mainstays of treatment.
While some price increases have been caused by shortages, others have resulted from a business strategy of buying old neglected drugs and turning them into high-priced “specialty drugs.”
Cycloserine, a drug used to treat dangerous multidrug-resistant tuberculosis, was just increased in price to $10,800 for 30 pills from $500 after its acquisition by Rodelis Therapeutics. Scott Spencer, general manager of Rodelis, said the company needed to invest to make sure the supply of the drug remained reliable. He said the company provided the drug free to certain needy patients.
In August, two members of Congress investigating generic drug price increases wrote to Valeant Pharmaceuticals after that company acquired two heart drugs, Isuprel and Nitropress, from Marathon Pharmaceuticals and promptly raised their prices by 525 percent and 212 percent respectively. Marathon itself had acquired the drugs from another company in 2013 and had quintupled their prices, according to the lawmakers, Senator Bernie Sanders, the Vermont independent who is seeking the Democratic nomination for president, and Representative Elijah E. Cummings, Democrat of Maryland.
Doxycycline, an antibiotic, went from $20 a bottle in October 2013 to $1,849 by April 2014, according to the two lawmakers.


Trapped in the System: A Sick Doctor’s Story

We spend a lot of time talking about various metrics of quality or access in the American health care system. The problem with many of them is that they rarely seem to capture the issues that people face in dealing with care. Although many metrics are improving, problems remain that still seem insurmountable.
It’s true that the number of people with no insurance has gone down significantly since the Affordable Care Act was passed. But that’s only one measure of access. In many other ways, access is still surprisingly bad. I rarely use anecdotes to make my point, but in this column I’ll make an exception.
I have ulcerative colitis, and have had it for many years. When it was poorly controlled, I lived in constant fear of not being near a bathroom. The half-hour commute to my job often necessitated a stop on the way to work because I feared I would lose control of my bowels. My wife could tell you many stories about how I made innovative use of my babies’ diapers in cases of emergencies.
But a number of years ago, after I found that drug after drug didn’t work, my gastroenterologist suggested an older immunosuppressant. I’m a doctor, and I recognized it as a drug often used to treat cancer. It carried with it some significant side effects, most notably a small chance of myelosuppression, in which your bone marrow shuts down and produces too few blood cells.
That horrified my wife. But she didn’t appreciate that this was, to me, a small price to pay for the opportunity to not be constantly worried about my proximity to a toilet. I weighed the benefits versus the harms. I decided to give it a go.
The medicine changed my life. I have few, if any, symptoms anymore. It’s gotten to where I can now feel annoyance when my children need to go the bathroom when we’re out. By my last colonoscopy, my ulcerative colitis had gone into remission. I feel as if I have the bowels of a normal person, for which I am utterly grateful.
The medicine is old and it’s generic. It costs about $80 for three months even though I haven’t met my deductible. But this story isn’t about money. This is about the nightmare of how hard it is for me to get the drug.
Every three months, I run out of my medication. In order to get more, I need a new prescription. In order to get the prescription, I need to have lab testing to prove to my doctor that I don’t have anemia. This all sounds simple, and it’s the same process every three months. But it’s never the same, and it’s never easy.

What Bernie Sanders means by ‘democratic socialism.’ (You still have your choice of pajamas.)

GOFFSTOWN, N.H. -- The shorthand that the media uses to describe Sen. Bernie Sanders (I-Vt.) has changed.
“It used to be that I was known as ‘the longest-serving independent in the history of the United States Congress,’ which is true,” Sanders said during an appearance Saturday at Saint Anselm’s College here. “Now I’m a ‘self-professed democratic socialist.’ Things change when you run for president.”
In response to a student’s question, Sanders, whose campaign for the Democratic nomination has surged in recent weeks, went on to give a lengthy of explanation of what “democratic socialism” is -- and is not.
“So what does that mean?” Sanders asked the students. “Does anyone here think I’m a strong adherent of the North Korean form of government? That I want all of you to be wearing similar colored pajamas?”
Democratic candidate for president, Sen. Bernie Sander's (I-Vt.) campaign is surging, but does he even have a chance against Hillary Clinton? The Fix's Chris Cillizza explains. (Pamela Kirkland and Randolph Smith/The Washington Post)
When the laughter died down, the longest-serving independent in Congress asked how many of the students were familiar with the Scandinavian countries of Denmark, Finland and Norway.
“Are these democratic societies? Obviously they are,” Sanders said, relaying that voter turnout in Denmark tends to approach 90 percent.
“Is it a society where the government owns every mom-and-pop store?” he asked. “Of course not. You have all kinds of capitalist entrepreneurship going on, a lot of wealth being created. But what else do you have? … An effort to make sure that all people benefit from the wealth that’s being created. So you have a much more equitable distribution of wealth and income. … I talked to a guy from Denmark, and he said, ‘In Denmark, it is very hard to become very, very rich, but it’s pretty hard to be very, very poor.’ And that makes a lot of sense to me.”

Hillary Clinton to go on offense over GOP plans to repeal Obamacare

Hillary Rodham Clinton will begin filling in details this week of her proposal to tweak the Affordable Care Act, and she will attempt to use Republican presidential candidates’ opposition to the health-care-expansion law against them. 
Clinton plans a series of events in Louisiana, Arkansas and Iowa to needle Republicans over their opposition to a law that has greatly reduced the number of uninsured Americans, her campaign said. Some details of her strategy were provided exclusively to The Washington Post ahead of her first health-care-related event on Monday.
The focus on health care represents a shift for national Democrats and a full embrace of a law that had a troubled rollout and has not always polled well. Unlike in the 2012 election, when many Democrats tiptoed around their support for Obama’s namesake law, Clinton is making it a central part of her argument that she should succeed him.
Clinton frequently praises the 2010 law, often known as Obamacare, but says it does not go far enough. She wants to address the quickly rising cost of prescription drugs, for example, and has said she is examining possible changes to the Cadillac tax, as it is often called, on premium health-care plans. She also often says that mental health care and ­substance-abuse treatment need to be simpler and cheaper to obtain. Several Republicans competing for the 2016 nomination have said they would repeal the law immediately upon taking office.
Nearly 9 million people were added to the health insurance rolls last year, according to Census Bureau data released this month. That reduced the number of uninsured Americans to slightly more than 1 in 10. That is down from just over 16 percent in 2009, when President Obama took office with a pledge to pass a national health-care mandate.

Josh Freed: Time to build the Great Wall of Canada before Trumpmania explodes

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