Tom Price, Dr. Personal Enrichment
by David Leonhardt - NYT
Each year, a publication called Medscape creates a portrait of the medical profession. It surveys thousands of doctors about their job satisfaction, salaries and the like and breaks down the results by specialty, allowing for comparisons between, say, dermatologists and oncologists.
As I read the most recent survey, I was struck by the answers from orthopedic surgeons. They are the highest-paid doctors, with an average salary of $443,000 in 2015 — which, coincidentally, was almost the exact cutoff for the famed top 1 percent of the income distribution.
Yet many orthopedists are not happy with their pay. Only 44 percent feel “fairly compensated,” a smaller share than in almost every other specialty. A lot of orthopedists aren’t even happy being doctors. Just 49 percent say they would go into medicine if they had to make the decision again, compared with 64 percent of all doctors.
I know that many orthopedists have a very different view: They take pride in helping patients and feel fortunate to enjoy comfortable lives. But despite those doctors, it’s clear that orthopedics suffers from a professional culture that does not live up to medicine’s highest ideals. Too many orthopedists are rich and think it’s an injustice that they’re not richer.
This culture helped shape Dr. Tom Price, the orthopedic surgeon and Georgia congressman who is Donald Trump’s nominee for secretary of health and human services.
Price had a thriving practice near Atlanta before being elected to Congress in 2004. His estimated net worth of more than $10 million (and possibly a lot more) makes him one of the House’s wealthier members.
Yet he hasn’t been content to make money in the standard ways. He has also pushed, and crossed, ethical boundaries. Again and again, Price has mingled his power as a congressman with his desire to make money.
So far, the nominee receiving the most attention is Betsy DeVos, Trump’s choice for education secretary, and she definitely deserves scrutiny. Still, I think Democrats have made a mistake focusing so much on her rather than on Price. He could do more damage — and his transgressions are worse than those that have defeated prior nominees.
Last March, Price announced his opposition to a sensible Medicare proposal to limit the money doctors could make from drugs they prescribe their patients. The proposal was meant to reduce doctors’ financial incentives to prescribe expensive drugs. (And, yes, if you’re bothered that your doctor has any stake in choosing one drug over another, you should be.)
One week after Price came out against the proposal, he bought stocks in six pharmaceutical companies that would benefit from its defeat, as Time magazine reported. At the time, those same companies were lobbying Congress to block the change. They succeeded.
It’s a pattern, too. Price has put the interests of drug companies above those of taxpayers and patients — and invested in those drug companies on the side.
Last year, he also bought shares in Zimmer Biomet, a maker of hip and knee implants. Six days later, according to CNN, he introduced a bill that would that have directly helped Zimmer.
In his defense, a spokesman for Price has said that his broker bought the Zimmer stock and Price didn’t find out until later. That’s certainly possible, but still not acceptable. Members of Congress bear responsibility for their personal stock transactions, period.
A third episode may be the worst. Price accepted a special offer from an Australian drug company to buy discounted shares, as The Wall Street Journal and Kaiser Health News reported.
He told the Senate that the offer was open to all investors, although fewer than 20 Americans actually received an invitation to buy at the discounted price. The stock has since jumped in value, and Price underreported the worth of his investment in his nomination filings. It was a “clerical error,” he says.
Even without any larger context, his actions are disqualifying. He’s repeatedly placed personal enrichment above the credibility of Congress. The behavior is substantially worse than giving money to an illegal immigrant (which defeated a George W. Bush nominee) or failing to pay nanny taxes (which scuttled a Bill Clinton nominee).
But of course there is a larger context. Price has devoted much of his political career opposing expansion of health insurance. His preferred replacement of Obamacare would reduce health care benefits for sicker, poorer and older Americans.
His views have a long history within the medical profession. For decades, doctors used their political clout to help block universal health insurance. They offered many rationales, but money was the main reason. Many doctors feared that a less laissez-faire health care system would reduce their pay.
It’s to the great credit of today’s doctors that they have moved their lobbying groups away from that position and helped extend insurance to some 20 million people. They understand that some principles matter more than a paycheck.
Or at least many of them do.
AMA Statement on the Nomination of Rep. Tom Price to be HHS Secretary
For immediate release:
Nov 29, 2016
Statement attributable to:
Patrice A. Harris, M.D.
Chair, AMA Board of Trustees
Patrice A. Harris, M.D.
Chair, AMA Board of Trustees
“The American Medical Association strongly supports the nomination of Dr. Tom Price to become the next Secretary of Health and Human Services (HHS). His service as a physician, state legislator and member of the U.S. Congress provides a depth of experience to lead HHS. Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs.
“We urge the Senate to promptly consider and confirm Dr. Price for this important role.”
About the AMA
The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care to patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America. For more information, visit www.ama-assn.org.
The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care to patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America. For more information, visit www.ama-assn.org.
HOW DOCTORS COULD THWART HEALTH-CARE REFORM
Over the years, doctors have behaved like a classic political interest group, and they’ve been very successful at it.
by James Surowiecki - The New Yorker
On the campaign trail, Donald Trump made many promises he doubtless won’t keep and a few he apparently doesn’t remember. But his nomination of Representative Tom Price, a hard-core conservative from Georgia, to be Secretary of Health and Human Services is a sign that repealing Obamacare is one promise he’d like to carry out. In every Congress since the Affordable Care Act was passed, Price has sponsored a bill to replace it. And there’s something else that should worry supporters of Obamacare: he’s a doctor.
To be fair, that makes Price more qualified than most of Trump’s Cabinet picks. But doctors have a history of opposing health-care reform of all kinds. The most famous instance is the American Medical Association’s campaign against the creation of Medicare. (In 1961, it hired an actor named Ronald Reagan to warn of the dangers of socialized medicine.) But the pattern emerged much earlier. In 1917, during the First World War, Californians voted on whether to institute universal health insurance. As Paul Starr recounts in “The Social Transformation of American Medicine,” a doctors’ group called the League for the Conservation of Public Health denounced the idea as a “dangerous device” imported from Germany and helped defeat the initiative. New Dealers pushed for Social Security to include health insurance, but public attacks by the A.M.A. convinced Franklin Roosevelt to steer clear, in order to save the rest of the bill. When Harry Truman proposed a universal-insurance plan, after the 1948 election, the A.M.A. put an end to it with the most expensive lobbying campaign that America had seen. And it helped derail Bill Clinton’s health-care plan, too.
It’s not only government reforms that doctors have resisted; it’s almost any plan that has threatened to reduce their income or autonomy. In the thirties, there were experiments with “pre-paid medical groups,” in which customers paid a flat fee to a set of doctors in exchange for care. The A.M.A. did its best to drive these groups out of business—it was fined for antitrust violations—and state medical societies ostracized doctors who joined up. The A.M.A. did tentatively endorse Obamacare, in a break with tradition, but only after helping nix the so-called public option. Since then, doctors have been among the program’s loudest critics.
Doctors have typically framed their opposition to reform in terms of the need to protect the doctor-patient relationship from outside interference. That’s understandable and legitimate. But many doctors have also fought reform because it runs counter to their financial interests. As an A.M.A report once said, doctors “display a consistent preoccupation with their economic insecurity”; more bluntly, “They think about money a lot.”
There’s plenty of evidence that financial considerations affect medical decisions: for instance, studies show that doctors who have a financial stake in imaging equipment like MRI machines order many more unnecessary MRIs. So it’s no surprise that the medical establishment’s criticism of reforms often hinges on money. The 1917 California insurance plan was attacked for offering treatment “at bargain counter prices.” The pre-paid medical groups were competition for traditional fee-for-service doctors. Doctors opposed universal health insurance in part because they feared that government involvement would drive down fees, and they tried to stop Medicare for the same reason. (They needn’t have worried: doctors’ incomes rose steadily in the years after Medicare was enacted, because they added more patients without having to cut their fees.)
Doctors, then, have behaved like a classic political interest group, and they’ve been very successful. They are now more likely to be in the top one per cent of earners than members of any other industry. They don’t have things all their own way—there are more administrative burdens, and insurance companies and the government are more intrusive than before—but the profession has been the single biggest beneficiary of the boom in medical spending in the past four decades, and doctors’ incomes have remained relatively untouched by attempts to rein in health-care costs.
There’s nothing inherently wrong with this; it’s how interest-group politics work. But what’s fascinating is that doctors are a powerful lobby in part because voters think of them as above the fray. Doctor regularly ranks as one of the three most trusted professions. People love their doctors and respect their expertise and work ethic. So it’s easier for politicians to go after reliable villains like insurance companies and drug companies. Suggesting that doctors might not always be disinterested policy advocates is a losing tactic.
We can expect to hear Tom Price invoke his medical background as he tries to roll back Obamacare. (He’s an orthopedic surgeon—according to one study, the most politically conservative field in medicine.) But let’s hope that doctors’ groups think twice before going along with him. Those groups have said that they support expanding access to medical care and giving people with preëxisting conditions affordable options, and doctors’ valid complaints about aspects of Obamacare are a reason to reform the program, not abandon it. After decades of using their political leverage to kill reform, it might be time for doctors to use that power to keep it alive. ♦
On the campaign trail, Donald Trump made many promises he doubtless won’t keep and a few he apparently doesn’t remember. But his nomination of Representative Tom Price, a hard-core conservative from Georgia, to be Secretary of Health and Human Services is a sign that repealing Obamacare is one promise he’d like to carry out. In every Congress since the Affordable Care Act was passed, Price has sponsored a bill to replace it. And there’s something else that should worry supporters of Obamacare: he’s a doctor.
To be fair, that makes Price more qualified than most of Trump’s Cabinet picks. But doctors have a history of opposing health-care reform of all kinds. The most famous instance is the American Medical Association’s campaign against the creation of Medicare. (In 1961, it hired an actor named Ronald Reagan to warn of the dangers of socialized medicine.) But the pattern emerged much earlier. In 1917, during the First World War, Californians voted on whether to institute universal health insurance. As Paul Starr recounts in “The Social Transformation of American Medicine,” a doctors’ group called the League for the Conservation of Public Health denounced the idea as a “dangerous device” imported from Germany and helped defeat the initiative. New Dealers pushed for Social Security to include health insurance, but public attacks by the A.M.A. convinced Franklin Roosevelt to steer clear, in order to save the rest of the bill. When Harry Truman proposed a universal-insurance plan, after the 1948 election, the A.M.A. put an end to it with the most expensive lobbying campaign that America had seen. And it helped derail Bill Clinton’s health-care plan, too.
It’s not only government reforms that doctors have resisted; it’s almost any plan that has threatened to reduce their income or autonomy. In the thirties, there were experiments with “pre-paid medical groups,” in which customers paid a flat fee to a set of doctors in exchange for care. The A.M.A. did its best to drive these groups out of business—it was fined for antitrust violations—and state medical societies ostracized doctors who joined up. The A.M.A. did tentatively endorse Obamacare, in a break with tradition, but only after helping nix the so-called public option. Since then, doctors have been among the program’s loudest critics.
Doctors have typically framed their opposition to reform in terms of the need to protect the doctor-patient relationship from outside interference. That’s understandable and legitimate. But many doctors have also fought reform because it runs counter to their financial interests. As an A.M.A report once said, doctors “display a consistent preoccupation with their economic insecurity”; more bluntly, “They think about money a lot.”
There’s plenty of evidence that financial considerations affect medical decisions: for instance, studies show that doctors who have a financial stake in imaging equipment like MRI machines order many more unnecessary MRIs. So it’s no surprise that the medical establishment’s criticism of reforms often hinges on money. The 1917 California insurance plan was attacked for offering treatment “at bargain counter prices.” The pre-paid medical groups were competition for traditional fee-for-service doctors. Doctors opposed universal health insurance in part because they feared that government involvement would drive down fees, and they tried to stop Medicare for the same reason. (They needn’t have worried: doctors’ incomes rose steadily in the years after Medicare was enacted, because they added more patients without having to cut their fees.)
Doctors, then, have behaved like a classic political interest group, and they’ve been very successful. They are now more likely to be in the top one per cent of earners than members of any other industry. They don’t have things all their own way—there are more administrative burdens, and insurance companies and the government are more intrusive than before—but the profession has been the single biggest beneficiary of the boom in medical spending in the past four decades, and doctors’ incomes have remained relatively untouched by attempts to rein in health-care costs.
There’s nothing inherently wrong with this; it’s how interest-group politics work. But what’s fascinating is that doctors are a powerful lobby in part because voters think of them as above the fray. Doctor regularly ranks as one of the three most trusted professions. People love their doctors and respect their expertise and work ethic. So it’s easier for politicians to go after reliable villains like insurance companies and drug companies. Suggesting that doctors might not always be disinterested policy advocates is a losing tactic.
We can expect to hear Tom Price invoke his medical background as he tries to roll back Obamacare. (He’s an orthopedic surgeon—according to one study, the most politically conservative field in medicine.) But let’s hope that doctors’ groups think twice before going along with him. Those groups have said that they support expanding access to medical care and giving people with preëxisting conditions affordable options, and doctors’ valid complaints about aspects of Obamacare are a reason to reform the program, not abandon it. After decades of using their political leverage to kill reform, it might be time for doctors to use that power to keep it alive. ♦
Doctors Can’t Be Trusted About Healthcare
by Wade Rathke blog
Cancun Of all of the bad nominations coming our way, the notion of Georgia Congressman Tom Price running the Health and Human Services has the most impact on millions of people because of the impact of his virulent opposition to the Affordable Care Act and the jeopardy it places not only on 30 million beneficiaries there, but also on millions more because of additional threats to Medicare for the elderly and cutbacks in Medicaid for the poor generally. Some hold out a sliver of hope because Price keeps saying that he’s a doctor, and he wants that to mean something along the lines that he cares about peoples’ health. He’s taken the Hippocratic Oath, so he’ll “do no harm.”
James Surowiecki points out in the current New Yorker, that in fact the record of doctors and the American Medical Association has been to oppose virtually every governmental medical program providing health security for Americans for a century now. Doctors organized to oppose universal health care when it came to the ballot in California in 1917 during the First World War, claiming it was a “dangerous device imported from Germany.” The AMA in the 30’s opposed pre-paid medical groups where customers paid a flat fee in exchange for care and was fined for anti-trust violations. The AMA campaigned against the creation of Medicare, and hired Ronald Reagan to go on the air and warn us about so-called “socialized medicine.” The AMA was in the thick of the fight to oppose the Clinton health plan during his first term and only supported Obamacare after the so-called “public option” was off the table.
Ten thousand doctors have already organized in opposition to Price and his plan to scuttle the Affordable Care Act, and though the AMA has endorsed his nomination as a former member of their delegate board and a long-time friend in Congress, there is a schism mounting within the AMA over its stand as harmful to patients. Most hospital associations have been silent over Price’s nomination, but have come out strongly in opposition to the plans to end Obamacare as catastrophic in terms of patient care, hospital closings, job loss, and economic ruin within the healthcare industry. Nurses’ unions have been pretty unanimous in opposing the end of Obamacare.
Price is likely to hide behind the public’s assumption that as a doctor he’s an expert on healthcare. Reading Michael Lewis’ new book, The Undoing Project: A Friendship That Changed Our Minds, might take away any notion that doctors should be seen as our modern day priests. Experiments conducted under the influence of work by Daniel Kahneman and Amos Tversky found that fairly simply algorithms outperformed doctors in making diagnoses of many medical conditions, largely because of the unchecked biases of doctors for the way they are used to seeing and working. That’s scary, but true.
And, as Surowiecki points out repeatedly, the AMA is little more than a very effective special interest group, a closed shop union for doctors, if you will, and their own reports indicate repeatedly that their primary purpose is protecting the income security of doctors. Putting money in doctors’ pockets should never be confused with providing basic healthcare for Americans. We don’t need an algorithm to know the facts about that.
Republicans Have Lost the Plot on Their Obamacare Repeal
The Editorial Board - NYT
President Trump and Republican lawmakers have never been able to explain how they would improve on the Affordable Care Act, which they’ve promised to quickly repeal and replace with something better. Now, it’s increasingly evident that they have no workable plan and might never come up with one.
Congress blew past a self-imposed Jan. 27 deadline to introduce legislation to end the health law. Mr. Trump told Fox News in an interview that ran Sunday that a replacement for the health law might not be ready until next year. Meanwhile, Republican senators like Lamar Alexander and Orrin Hatch have started talking about “repairing” the A.C.A., or Obamacare, rather than removing it root-and-branch. And while House Speaker Paul Ryan still insists that Congress will repeal and replace it this year, his wishful statements are clearly meant in large measure just to placate the burn-it-all-down wing of his caucus.
After campaigning for years against the health care law, Republicans seem to be realizing that it will be incredibly difficult to deliver on Mr. Trump’s promise of providing a program that is better, cheaper and covers more people.
The law has extended health insurance to more than 22 million Americans. Plenty of them are calling lawmakers, showing up at town halls and marching in the streets demanding that Obamacare be preserved. Public support for it has never been higher, according to an NBC News/Wall Street Journal poll. Another poll, by the Pew Research Center, found that 60 percent of Americans say the government should make sure that everybody has health coverage.
None of the Republican plans would accomplish anything close to what the A.C.A. has achieved. A bill introduced by Representative Tom Price, Mr. Trump’s pick to run the Department of Health and Human Services, would greatly reduce the federal subsidies that help people buy health insurance. It would also eliminate the expansion of Medicaid, the health program for the poor, disabled and elderly, that has covered more than 11 million new people. Mr. Price and other Republicans also want to turn Medicaid into block grants to states, which would result in governors and legislatures cutting benefits and covering fewer people. And House Republicans have proposed privatizing Medicare by giving beneficiaries vouchers to buy private insurance.
Given the political predicament, some Republicans are now trying to constrict the program without repealing it. The Trump administration, for instance, is reportedly considering allowing insurers to charge older people who buy insurance on the federal health care exchanges premiums that are 3.49 times as much as they charge younger people, up from three times as much currently.
Another approach is to chip away one provision at a time. Congress could, for example, eliminate mental health care or contraceptive coverage, which is required of health plans under the current law. The Trump administration already tried to sabotage the law by pulling about $5 million in ads in the last few days of open enrollment at the end of January. Analysts say that decision helped drive down the number of people who bought policies on HealthCare.gov this year, compared with 2016.
If Republicans are at all concerned about the public interest and their own political futures, they ought to pull back from the chaos they have sown.
- Editor's Note
Ready for Improved Medicare for All, yet, anybody??
-SPC
Issues Facing Republicans in Replacing Affordable Care Act
by Robert Pear - NYT
WASHINGTON — Ever since Democrats began pushing the Affordable Care Act through Congress more than seven years ago, Republicans have been trying to come up with an alternative. Candid conversations leaked from a conclave of Republican lawmakers in Philadelphia last month, and public comments since, show they are nowhere near agreement.
The leaked audio recordings revealed that Republicans recognize the technical complexity and political difficulty of the task they have set for themselves: repealing the law known as Obamacare and replacing it with a new plan that, in the words of President Trump, provides “better health care for more people at a lesser cost.”
What follows is a summary of the thorny questions with which Republicans in Congress are struggling. These are not just academic quandaries. People’s lives could depend on the answers. And time is short. Insurance companies have about three months to decide what kinds of health plans, if any, they will sell to the public in 2018.
Many of the choices facing Republicans are variations of a fundamental question: how much of the Affordable Care Act to keep, and how much to discard?
Future of Medicaid
More than half of the 20 million people who gained coverage through the Affordable Care Act did so through Medicaid, the federal-state program for low-income people. Medicaid, begun as an adjunct to the main cash welfare program a half-century ago, has gradually become a pillar of the American health care system, covering more than 70 million people and financing more than 40 percent of all births.
The 2010 health care law, as written by Democrats, required all states to expand Medicaid eligibility. But the Supreme Court said that requirement violated the Constitution by placing “a gun to the head” of states. So the expansion became voluntary.
To date, 31 states have expanded Medicaid, and 19, including Florida and Texas, have not. The federal government pays at least 90 percent of the costs for newly eligible beneficiaries. Governors who supported the expansion of Medicaid eligibility, including Republicans like John R. Kasich of Ohio, Rick Snyder of Michigan and Brian Sandoval of Nevada, want to keep it. That would be impossible if congressional Republicans repeal this part of the law, as they tried to do in a budget bill that was vetoed by President Barack Obama last year.
Many who gained coverage under Medicaid are poor adults who were not previously eligible. Republicans in Congress have not decided whether to let states continue such coverage. Nor have lawmakers decided whether additional states will be allowed to expand eligibility, with the same generous contribution of federal funds.
Medicaid is now an open-ended entitlement. Anyone who meets federal and state eligibility criteria is entitled to benefits.
Many Republicans in Congress, including Speaker Paul D. Ryan, would like to roll back the expansion of Medicaid and give each state a fixed amount of money for each beneficiary or a lump sum for all of a state’s Medicaid program — a block grant. Under such proposals, states would have more freedom to set benefits and program rules, but the federal government would probably cut Medicaid spending compared with the amounts projected under current law.
“Governors should be exceedingly wary of block grants” for the Medicaid program, said former Gov. Steven L. Beshear of Kentucky, a Democrat. If Congress gives states more discretion but less money, he said, “governors will have to use their enhanced flexibility to make impossible choices — which individuals to cut from the program, or which benefits to eliminate.”
Pre-existing Conditions
One of the more popular provisions of the Affordable Care Act prohibits insurers from denying coverage or charging higher premiums because a person has a pre-existing condition like cancer, heart disease, diabetes or AIDS. President Trump has said he would like to keep this provision. Many Republicans in Congress agree, but the version they propose is, in some ways, different from the existing law.
Congressional Republicans would provide some protection against discrimination based on pre-existing conditions. To obtain full protection, consumers would need to maintain “continuous coverage.” Under some Republican proposals, consumers with chronic illnesses could be charged higher premiums if they had a significant break in coverage lasting, say, more than nine or 10 weeks.
Republicans say this more limited form of protection would provide an incentive for consumers to obtain and maintain coverage. But Democrats say it is unfair because people have gaps in coverage for many legitimate reasons, and they may be unable to pay the premiums needed to maintain it.
Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society, said: “Research suggests that between 40 percent and 85 percent of cancer patients stop working while receiving cancer treatment, with absences from work ranging from 45 days to six months depending on the treatment. Sometimes they lose their jobs and their employer-sponsored coverage.”
In such cases, he said, patients could be charged “a premium they cannot afford.”
Representative Greg Walden, Republican of Oregon and chairman of the Energy and Commerce Committee, is drafting a bill to encourage continuous coverage, but said he wanted to make sure that people with pre-existing conditions would always have access to care.
“I’ve seen cancer up close,” Mr. Walden said. “My mother died of ovarian cancer, my sister-in-law of brain cancer.”
Taxes and Fees
One of the biggest questions dividing Republicans is what to do about the taxes and tax increases adopted as part of the Affordable Care Act to help pay for the coverage of millions of low- and moderate-income people.
The new revenue comes from taxes and fees imposed on consumers who go without health insurance; high-income taxpayers; manufacturers of brand-name prescription drugs; makers of certain medical devices; and insurance companies. In addition to an annual fee on insurers, the law imposes a tax on high-cost employer-sponsored health coverage, the “Cadillac tax” opposed by labor unions and employers.
Some Republicans, like Senator Bill Cassidy of Louisiana, say the government should keep some of the revenue collected under the Affordable Care Act to help pay for a replacement plan.
By contrast, House Republican leaders and some Republican senators want to eliminate most or all of the taxes. “After spending seven years talking about the harm being caused by these taxes, it’s difficult to switch gears now and decide that they’re fine, so long as they’re being used to pay for our health care bill,” said Senator Orrin G. Hatch of Utah, chairman of the Finance Committee.
“All of the Obamacare taxes need to go as part of the repeal process,” Mr. Hatch said.
Republicans are also divided over a proposal to limit the value of health benefits that employers can provide to employees tax-free. Under current law, employees do not have to pay federal income tax on contributions that employers make to their health insurance. House Republicans say this tax break amounts to an open-ended subsidy for employer-sponsored insurance, encouraging employers and employees to choose more expensive coverage than they otherwise would.
Mr. Ryan reaffirmed his support for limiting the tax break last week, but said that whether Congress would approve the change “was an open question.”
Transition and Timing
Several other questions vex Republicans as they try to write a replacement. How will they ensure a smooth transition to the market-oriented health care system they want to create? How much time should elapse between the passage of a repeal bill and its effective date?
If the federal government spends tens of billions of dollars to subsidize the purchase of health insurance, will it set standards for that insurance? Will it still require insurers to cover maternity care, mental health services and treatment for drug abuse?
Should Congress cut off funds for Planned Parenthood clinics, which receive Medicaid money for birth control, cancer screenings, treatment of sexually transmitted diseases and many other services? Mr. Ryan has said that federal funds for Planned Parenthood would be cut off in a repeal, but some Republicans say that would be a political mistake.
From ‘Repeal’ to ‘Repair’: Campaign Talk on Health Law Meets Reality
by Michael D. Shear and Robert Pear - NYT
WASHINGTON — Asked at a confirmation hearing two weeks ago if he was working with President Trump on a secret plan to replace the Affordable Care Act, Representative Tom Price, Mr. Trump’s nominee for secretary of health and human services, smiled broadly and answered: “It’s true that he said that, yes.”
The committee room, filled with health care lobbyists, consumer advocates and others with a vital stake in the future of the health care law, erupted with knowing laughter at Mr. Price’s careful formulation. For those following the issue closely, it has been an open secret that the fledgling Trump administration is a long way from fulfilling one of Mr. Trump’s most repeated campaign promises.
In a brief aside in an interview with Bill O’Reilly of Fox News broadcast before the Super Bowl on Sunday, Mr. Trump went further than he ever has in acknowledging the reality that any hope of quickly replacing the Affordable Care Act has been dashed.
“Yes, I would like to say by the end of the year, at least the rudiments, but we should have something within the year and the following year,” the president said.
That admission is sure to be a serious disappointment for the president’s most fervent supporters, who sent him to Washington believing that he would move quickly to dispatch the health law.
Soon after he was elected, Mr. Trump reacted to Republican suggestions of a delay in replacing the health act by insisting that repealing and replacing the law must happen at about the same time.
Now, Mr. Trump and his Republican allies on Capitol Hill have recast their ambitions for a rapid-fire repeal, talking privately and publicly about a more deliberative process that could be phased in over weeks or months.
“The political uncertainty surrounding repeal is growing,” said Dan Holler, a spokesman for Heritage Action for America, the advocacy arm of the conservative Heritage Foundation. “If the House has not passed a repeal bill and sent it to the Senate by mid-March,” Mr. Holler added, “that would be serious cause for concern.”
The uncertainty is already reflected in the way Republicans talk about the health care law. Some now talk about “repairing” the law, rather than repealing it entirely. And in a twist of fate, many are facing tough, angry questions at town hall meetings — the mirror image of 2009, when Tea Party activists assailed Democrats who supported the law.
A crowd of protesters gathered outside a town meeting in California held over the weekend by Representative Tom McClintock, who was escorted by police officers as he left the event, according to news reports. Representative Gus Bilirakis of Florida faced 200 angry supporters of the health care law at a meeting on Saturday.
In the interview that aired on Sunday, Mr. Trump appeared to admit that his get-it-done braggadocio about a swift repeal of President Barack Obama’s signature legislation was instead becoming a drawn-out Washington process that could stretch for months or even years.
Mr. Trump’s comment prompted what is becoming a ritual on Capitol Hill: trying to interpret the words of a president who is not steeped in the rhythms of the legislative process.
“I don’t really know what he’s referring to in terms of a year,” said Senator John Cornyn of Texas, the No. 2 Senate Republican. He added that Republicans hoped to get their replacement plan in place “well before that.”
Senator John Thune of South Dakota, the No. 3 Republican in the chamber, said the Senate hoped to work “systematically, in a step-by-step way.” But he conceded “that may take longer than, you know, than people at first thought.” He expressed hope that “at some point,” if Mr. Trump has a health care proposal, “he’ll engage and that we’ll be able to work together with him on it.”
Few of Mr. Trump’s campaign promises rivaled the one he made to dismantle the Affordable Care Act. He repeatedly called it a “disaster” and vowed that, if elected, he would immediately replace it with a new and better overhaul of the health care system.
Mr. Trump issued an executive order on his first day in office directing agencies to do what they could to provide relief from the health care law to people and businesses. But his power to unravel the law unilaterally is limited.
Michael F. Cannon, the director of health policy studies at the libertarian Cato Institute, warned that the delay in taking action in Congress threatened to undermine the momentum for significant change.
“Every day they delay,” he said, “the problems of the Affordable Care Act get worse.”
Insurance executives say immediate action is needed to stabilize insurance markets, or else more insurers will withdraw from the public marketplaces created under the Affordable Care Act. Insurers deciding whether to participate in the market in 2018 face a May deadline for submitting rate proposals to the federal government.
The turnabout has made Democratic lawmakers gleeful. Their refusal to work with Republicans unless a full-blown repeal is taken off the table has helped to ratchet up pressure on the president and his allies to come up with a replacement before eliminating a health care program that delivers insurance to about 20 million Americans.
“The reality of the difficulty of getting things done is sinking in,” Senator Chuck Schumer of New York, the Democratic leader, said of Mr. Trump and Republicans in Congress. “Democrats are feeling much better that there’s some chance of success.”
Democrats have also been encouraged by opinion polls showing that the public is increasingly supportive of the health care law. A Quinnipiac University poll released last month found that 84 percent of people believe Congress should not repeal the Affordable Care Act until a replacement plan is in place.
That is proving especially difficult for Republicans to accomplish in the time frame that Mr. Trump once called for.
In the first 10 days of the new Congress, lawmakers passed a budget resolution clearing the way to repeal major provisions of the law and neutralize the threat of a Democratic filibuster. By Jan. 27, four congressional committees were supposed to have drafted legislation gutting the 2010 health care law. But it soon became clear that the deadline was neither realistic nor enforceable.
Republican leaders in the House and the Senate now envision a more conventional legislative process. In an interview on Sunday, Speaker Paul D. Ryan insisted that Republicans believed it was their duty to “step in front of this crash and rescue people from this collapsing health care system and replace it with something better.”
But Mr. Ryan has also been clear for weeks about the reality of the legislative timeline.
“The question there is: How long will it take for markets to be put in place, for markets to adjust?” Mr. Ryan told reporters on Jan. 5. “That question we don’t know the answer to.”
What are Republicans going to do about Obamacare? ‘No idea.’
by Dana Milbank - Washington Post
The Obamacare repeal effort was already in unstable condition. Now its status must be downgraded to critical — and completely unserious.
After years of Republican yammering about the urgent need to repeal the Affordable Care Act and months of fruitless pursuit of an alternative, President Trump now says he may not unveil a replacement this year at all. And from Capitol Hill comes new word that Republicans aren’t even talking about a plan.
“To be honest, there’s not any real discussion taking place right now,” Sen. Bob Corker (R-Tenn.) told reporters Tuesday at the Capitol. Corker, according to the Huffington Post, said he has “no idea” when Republicans might start drafting an alternative to Obamacare, adding, “I don’t see any congealing around ideas yet.”
For seven years, opponents of the Affordable Care Act vowed to make its repeal their top concern, warning that the law would turn America overnight into a socialist dystopia. Now these opponents have unfettered control of the government and they aren’t even talking about repealing.
On Nov. 1, a week before the election, Trump gave a speech pledging “to immediately repeal and replace Obamacare.”
But in his weekend interview with Fox News’s Bill O’Reilly, Trump said that “maybe it’ll take till sometime into next year” for his administration to unveil a new health-care plan. It is, the president said, “very complicated.”
So complicated, in fact, that he apparently wants nothing to do with it. At Trump’s meeting with congressional leadership, Trump told the lawmakers Obamacare would be replaced with something better, and then he turned to House Speaker Paul Ryan (R-Wis.). “And Paul’s going to fill in the details. Right, Paul?”
Right.
A secret recording of Republican lawmakers’ Obama-repeal talks late last month revealed angst and uncertainty about how to proceed and a great deal of worry that they would be blamed for whatever went wrong in the health-care market. Corker, in his talk with reporters this week, said that “you would have heard more of the same” in other meetings that weren’t recorded.
What Republicans don’t seem to have come to terms with is that, as a political matter, they already will be held responsible for whatever happens to health-care markets, even if they don’t introduce a replacement soon. An executive order Trump signed relaxing enforcement of Obamacare, and the constant talk of repeal, have injected a debilitating uncertainty into the health-care market — essentially beginning the unraveling of Obamacare with nothing to replace it.
The executive order Trump signed directed federal agencies to do what they could to “minimize” the burdens of the act by exercising their authority “to waive, defer, grant exemptions from or delay” parts of the law. Insurers have warned that the uncertainty is deterring them from participating in Obamacare. The head of Anthem told Wall Street analysts that he would be deciding about “extracting” his company from health-care exchanges if it doesn’t see stability.
This means that Republicans, while waiting for their alternative to “congeal,” have already set in motion the disintegration of the current health-insurance market. “It’s worse than the dog who caught the car,” said Jesse Ferguson, a strategist advising Democrats on health care. “It’s the dog who somehow is now driving the car.”
That would explain the series of erratic maneuvers we’ve seen from GOP lawmakers lately.
Take Sen. Ron Johnson (R-Wis.), who in 2011 called Obamacare “the single greatest assault on our freedom in my lifetime. It will destroy our health-care system. . . . It must be repealed.”
Now Johnson has shed the hysteria. “Let’s start working with Democrats,” he said on CNBC. “Let’s transition to a system that will actually work, that, you know, Democrats are talking about. . . . It’s way more complex than simply repeal and replace.”
Then there’s Rep. Tom McClintock (R-Calif.). In 2014, he proclaimed that Obamacare’s “damage cannot now be undone by delaying it or tinkering with it — it must be repealed and replaced with the patient-centered plan proposed by House Republicans.”
These days he’s not so bold. “We’d better be sure that we’re prepared to live with the market we’ve created,” McClintock said in the recorded session with Republicans. “That’s going to be called Trumpcare. Republicans will own that lock, stock and barrel, and we’ll be judged in the election less than two years away.”
Or sooner. Arguably, Republicans already own the instability in the health-care system that their inaction has caused. Now that Trump is talking about delaying a health-care rollout for another year and Republican legislators aren’t even talking about an Obamacare alternative, it’s becoming clear what “Trumpcare” will look like: chaos.
No Backward Steps in Health Care - Forward to Single Payer
By Kay Tillow
Daily Kos, Feb. 4, 2017
Daily Kos, Feb. 4, 2017
Life expectancy in the United States just went down. We were already several years behind other advanced countries. People in Italy live four years longer. Life expectancy is one of the fundamental ways to measure the health of a nation.
We are not doing well at taking care of our people. This decline is after the implementation of the Affordable Care Act (ACA) and prior to the assault on the ACA, Medicaid, and Medicare planned by the new Congress for 2017.
Maintenance of a failing status quo in health care does not inspire a winning movement. We must say no backward steps as we battle to place the real solution on the nation’s agenda. That solution is national single payer health care set forth in real legislation, HR 676, an Expanded and Improved Medicare for All. HR 676 will remove the insurance industry from control of our care and publicly fund all medically necessary care—for all of us—no exceptions—everybody in, nobody out.
In Kentucky, 440,000 gained coverage under the ACA Medicaid expansion. Governor Bevin has asked the federal government for a Medicaid waiver like that of Indiana that would force monthly premiums on those who have the least and kick them off if they fail to pay. The architect of Indiana’s Medicaid waiver, Seema Verma, has now been named by President Trump to head the Commission on Medicare and Medicaid Services.
Verma, and Tom Price, Trump’s appointee to Health and Human Services, are likely to give Bevin the waiver he seeks. Bevin says if he doesn’t get the waiver he will abolish the expansion program totally, ending health care for the 440,000 who just gained it.
Medicare, too, is on the chopping block, with Speaker Paul Ryan seeking to turn our best program, our example that single payer works, into vouchers.
But fighting for the status quo won’t save it. We have to project a bolder, braver plan to expand it to all. Already Medicare is 30% privatized, with changes supported by both Democrats and Republicans. Medicare’s new means testing and changes in payment to physicians are undermining our nation’s most beloved program. We are losing it little by little, as Grover Norquist gleefully reported.
The drug part of Medicare is a nightmare for seniors and a gold mine for pharmaceutical companies. The Part D drug plan is not a New Deal Social Security type plan. It is a market-based plan with outrageous profits placing the new life-saving drugs beyond the reach of many. We can now cure Hepatitis C with a drug called Solvadi. It costs $84,000 for the cure. Many insurers have said it will not be available or not covered until the patient goes into liver failure. The drug costs $300 in India.
HR 676 would bring drug companies to heel with monopsony buying power.
The ACA was designed to leave in place our employer-based health care system. Now even that coverage is rapidly deteriorating. The average plan has a deductible over $1,000 accompanied by drastic limitations on what doctor patients can see and what hospitals they can use. For millions the deductibles and co-pays place care beyond their means.
In the industrial heartland, the coal and rust belt, employers have dropped retiree coverage and shirked their responsibilities by mergers, lockouts, forced concession bargaining, and bankruptcies. The once secure industrial workers whose strong unions lifted the entire nation’s standards for health care are now battling to hang onto any care at all.
“We are sick of a criminal system based on profit that leaves people hanging without the health care they deserve,” said Mark Dimondstein, President of the 200,000 member American Postal Workers Union at a recent protest at Big Pharma.
The Affordable Care Act essentials were crafted by the Heritage Foundation, a conservative think tank, implemented by Mitt Romney in Massachusetts and promoted as the alternative to the single payer and national health service systems that have brought universal care to the rest of the industrialized world. The ACA was designed to serve the insurance industry rather than patients. It has brought coverage to 20 million who did not have insurance before, but the remaining 28 million with no coverage will not have it even if the ACA were to be fully implemented.
We can best avoid a backward slide by fighting for improvement of Medicare and expanding it to all.
People will not fight for a shriveled up dream. Only an inspiring, bold, and beautiful plan to cover all can galvanize a movement to power the rusted wheels of democracy and bring the humane care worthy of this great nation.
Some say that’s not feasible. On the contrary, it’s the only plan that is feasible. It’s the only plan that can expand care while reining in the costs.
Power concedes nothing without a demand. Frederick Douglass did not counsel us to reduce our demands when we face opposition. He remained steadfast in his demand working to spark the fight to do what’s right.
Our wealthy country is capable of providing great care for all of us. A free people does not allow insurance corporations to dictate, deny care, and control elected officials. They stand up to change it.
Kay Tillow is coordinator, All Unions Committee for Single Payer Health Care—HR 676.
Kay Tillow is coordinator, All Unions Committee for Single Payer Health Care—HR 676.
Medicare Should Leverage Buying Power To Pull Down Drug Prices, White House Says
by Alison Kodjak - Maine Public
Drug companies could be forgiven if they're confused about whether President Trump thinks the government should get involved in negotiating the price of prescription drugs for Medicare patients.
Just a few days before Trump was sworn in, he said the pharmaceutical industry was "getting away with murder" in the way it prices medicine, and he promised to take the industry on. It was a promise he'd made repeatedly on the campaign trail.
"We're the largest buyer of drugs in the world and yet we don't bid properly," he said at a news conference in early January. "We're going to start bidding and we're going to save billions of dollars over a period of time."
But last week, Trump appeared to walk that vow back when he met with the leaders of several giant pharmaceutical companies at the White House.
"I'll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing a product to a vibrantly competitive market," he said, sitting around a table in the Roosevelt Room, flanked by leaders of five large drugmakers. "That includes price fixing by the biggest dog in the market — Medicare — which is what's happening."
So on Tuesday, White House spokesman Sean Spicer cleared up the confusion, for now at least.
When asked during his daily news briefing whether the president is in favor of having Medicare negotiate lower prices for prescription medicine, Spicer said: "He's for it, yes. Absolutely."
Spicer went on to say that the U.S. should be doing what other countries do — bring the government's purchasing power to bear to get a better deal on medicine prices.
"So his commitment is to make sure that he does what he can," Spicer said, "and, I think rather successfully, use his skills as a businessman to drive them down."
Current U.S. law prohibits Medicare officials from interfering in the negotiations between drugmakers and the insurance companies that administer Medicare's prescription drug plans.
Medicare accounts for about 29 percent of all spending on prescription medicines in the U.S. each year. So, would bringing Medicare's huge purchasing power to bear in talks over prescription drug prices actually reduce those prices?
The only government report that looks at the issue is a 2007 Congressional Budget Office study that concluded that it would have a "negligible effect" on prices.
Dr. Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, disagrees.
"There's a reason why the pharmaceutical industry does not want Medicare negotiation to happen," Gellad told NPR. "And the obvious reason is because it will lower prices."
Gellad said the CBO report doesn't take into account the ability the government would have to say no to some particularly high-priced medicines.
If Medicare, for example, said it would pay for only one of the two major hepatitis C medications on the market today — drugs that cost upwards of $40,000 for a course of treatment — Gellad estimates the drugmakers would cut the price by at least $10,000 to win the government's business.
That sort of negotiating is already allowed at the U.S. Department of Veterans Affairs.
"If Medicare were to get the same prices for drugs as in the VA you'd have billions, tens of billions of dollars of savings," Gellad told NPR.
The Medicare prescription drug program was created in 2003; the program's drug coverage is handled exclusively by private insurance companies. There is no direct government pharmacy coverage.
That means each insurer negotiates prices for medications separately. If one insurance company strikes a deal regarding one drug, another company may negotiate a better price for a competing medication.
A 2015 study jointly published by Carleton University and the public advocacy group Public Citizen showed that Medicare pays, on average, 73 percent more than Medicaid pays for brand-name drugs, and 80 percent more than the VA pays.
Copyright 2017 NPR. To see more, visit http://www.npr.org/.
Anthem-Cigna health insurance merger rejected by judge
The ruling said that the merger would have significantly reduced competition causing higher costs to consumers.
by Jonathan J. Cooper and Thomas Murphy - AP
Predicting diminished competition and likely higher costs, a federal judge rejected health insurer Anthem’s bid to buy rival Cigna.
U.S. District Judge Amy Berman Jackson on Wednesday said the merger would significantly reduce competition in the already concentrated insurance market, particularly for large national employers. Cigna and the Blue Cross-Blue Shield carrier Anthem are two of just four insurers selling coverage to big companies with employees spread across multiple states, and they compete aggressively for business, the judge wrote.
Anthem said it was “significantly disappointed” by the decision and plans to appeal.
Berman Jackson was unconvinced by Anthem’s argument that the $48-billion deal could save money for customers by combining the two insurers’ different approaches to cost saving. Anthem has negotiated lower payments to doctors and hospitals, while Cigna has higher upfront expenses for wellness programs in the hopes of reducing future health expenses.
“Eliminating this competition from the marketplace would diminish the opportunity for the firms’ ideas to be tested and refined, when this is just the sort of innovation the antitrust rules are supposed to foster,” she wrote.
Last month, another federal judge rejected insurer Aetna’s roughly $34-billion bid to buy Medicare Advantage coverage provider Humana Inc., also citing competition concerns.
U.S. District Judge John Bates said federal regulation would probably be “insufficient to prevent the merged firm from raising prices or reducing benefits.” He added that neither new competitors nor an Aetna plan to sell some of the combined company’s business would be enough to ease competitive concerns.
Aetna Inc. has said it is strongly considering an appeal. The insurer expects to make a decision on that by next week.
The Justice Department sued last summer to block both deals, and the cases went to trial late last year. Federal regulators have pushed aggressively in recent years to block deals in several industries that they say will reduce competition.
The health insurance deals would consolidate the nation’s five largest insurers into three, a list that includes UnitedHealth Group Inc., currently the biggest
The insurers have argued that by getting bigger they will be able to negotiate better prices with pharmaceutical companies, hospitals and doctor groups that also are growing. They also expect to cut expenses and add more customers, which helps them spread out the cost of investing in technology to manage and improve care.
Industry experts have said any consumer impact from these deals would take years to materialize and could lead to savings in some areas, along with higher costs elsewhere.
The American Medical Association cheered the ruling, saying the merger would have created a health care behemoth too big to regulate and with too much control over consumers’ lives.
Anthem CEO Joseph Swedish also has said the Cigna deal would help stabilize pricing in the volatile public exchanges created by the Affordable Care Act. He has said that would enable his company to keep its commitment to the public exchanges, a statement seen by some as a sign Anthem might slash that business if the deal falls through.
The insurer sells coverage on exchanges in 14 states. Swedish said last week that his company is waiting to see whether the government can make some sort-term fixes to these markets before it decides how much it will participate next year.
The judge’s decision surprised few on Wall Street.
Shares of Indianapolis-based Anthem Inc. climbed 65 cents to $159.25 after markets opened Thursday, while Bloomfield, Connecticut-based Cigna Corp. slipped $1.33 to $146.51. Broader indexes were nearly flat.
Bernie Sanders and Ted Cruz Debate Health Care: Live Analysis
by Matt Flegenheimer - NYT
ReplyDeleteI don't even understand how I ended up right here, but I believed this submit was great. I do not realize who you might be but definitely you are going to a famous blogger for those who are not already. Cheers! The Gaming Club bears a license from the giving out of Gibraltar, and claims to be one of a prefer few casinos that have a license from the Gibraltar government. A advocate of the Interactive Gaming Council magnum 4d live (IGC), The Gaming Club follows all the guidelines laid by the side of by the organization, something that has taking into consideration a long showing off in it living thing official as a great area to gamble online.
Everything about The Gaming Club feels good; be it the promotions, the huge number of games, the multiple banking options upon offer, the futuristic security measures, or the fair and liable gaming practices the casino adopts.
The Gaming Club motors along on software developed by one of the giants of online gaming software go forward Microgaming. The software it uses is innovative and has a range of features designed to swell your online gambling experience and make you want to come help after every round of gambling you reach here.
Another hallmark of a fine casino is the character of its customer support team, and The Gaming Club does not disappoint upon this front.