Complete Freedom of Choice for Healthcare Costly
By Paul F. delespingasse - NewsMax - August 2, 2017
Many decades ago an acquaintance had a serious accident but wasn't badly hurt. She wasn't wearing a seat belt. She was told that if she had been wearing a seat belt, her accident probably would have been fatal.
Seat belts improved chances of surviving almost all accidents, but before airbags seat belts occasionally increased the likelihood of dying. So how should we have chosen back then whether to wear a seat belt on any particular trip? The answer was easy: before setting out, determine which type of accident you will have and choose accordingly.
Of course this easy answer is facetious, it being impossible to know ahead of time whether we will have an accident or what kind it will be. A wise person would therefore forego making a retail choice before each trip, and instead make a wholesale choice to go with the odds and always wear the seat belt.
Recent discussions about medical insurance brought this episode back to mind. We are told that young people are less interested in insurance than those who are older. And on average, younger people are indeed less likely to have a serious illness. But this is only on average. Two students in my daughter's high school orchestra, for example, died of brain tumors.
Furthermore, not all medical costs are caused by illness. Recently a young person who lost a leg in a lawnmower accident had to be helicoptered 90 miles to a more suitable hospital; the transportation charge was $67,000.
Although freedom to choose is desirable in general, it may not be a good idea for people to have to choose whether to have medical insurance. Most of us are unwilling to stand by and watch people who don't insure themselves suffer untreated illnesses and die. And what of parents who choose not to insure their children? The Affordable Care Act (ACA) decided that such freedom is a bad idea, imposed penalties on people who remain uninsured, and provided subsidies to people who could not otherwise afford insurance.
The ACA still allowed freedom to choose what insurance to buy. But people had to choose among insurance policies that were impossible to compare systematically. And choosing a particular insurance policy automatically reduced ability to choose doctors and hospitals, since each insurer covered treatment only at narrow networks of providers.
Which kind of choice is more important: the ability to make a guess among complex insurance products, or the ability to choose our doctors and hospitals? I think most of us would opt for choosing our doctors and hospitals.
But if the law requires that people be insured, why put people to the bother of buying it? Why not just provide insurance to everybody and pay for it from general taxes? For nearly ten years I have been urging conservatives to reconsider their knee-jerk hostility to single-payer insurance programs like an improved Medicare-for-all. The conservative values of simplicity and cost-efficiency would be served by a properly designed program.
Any policies that decrease complexity make government more understandable and thus controllable by the electorate. But any national insurance policy short of single-payer increases governmental complexity, as the ACA obviously did.
People who value cost-efficiency should be be critical of a system in which insurance companies employ large staffs to figure out how to avoid paying claims. A large portion of current medical bills also pays for staffing — costing about $80,000 annually for every doctor — needed by doctors and hospitals to bill dozens of different insurance companies. Experience with Medicare indicates administrative costs would be much lower than with private insurance.
Large tax increases will be necessary to pay for an improved Medicare-for-all, but the average American will come out ahead financially thanks to elimination of four costs they now bear: insurance premiums, reductions in wages to cover so-called "employer-provided" coverage, deductibles, and most co-pays.
We should remember that single-payer insurance need not create a governmental monopoly on the provision of medical services. Many problems associated with single-payer systems in other countries result from governmental monopolies in providing treatment.
One more step may be required to develop a viable medical system in the U.S.: turn medical providers like doctors, hospitals, and pharmaceutical companies into regulated utilities. Treat them like many states treat gas and electric companies, which provide excellent service at reasonable prices while allowing decent rewards for their workers and investors.
Sometimes the best choices can be made by individuals. Sometimes it is best to make choices collectively, through our political system, and medical insurance is probably an example of this.
Bill Nemitz: Sen. Collins’ courage isn’t just a talking point
by Bill Nemitz - Portland Press Herald - July 31, 2017
It’s no secret that politicians like to talk about themselves. Point them toward a gaggle of cameras and microphones and you can almost guarantee they’ll drone on ad nauseam about all they’ve done, how they did it, what they plan to do next …
Not so for Sen. Angus King on Friday, moments after he touched down in Portland aboard the morning shuttle from Washington, D.C.
“In my public life, or in my life generally, I don’t think I’ve ever seen a public official manifest greater courage and commitment to their constituents as Susan Collins has over the last week,” King said. “And the people of Maine need to understand that.”
Hear, hear, Senator. And then some.
The whole nation still buzzes – and rightfully so – about Sen. John McCain’s dramatic, post-brain-surgery arrival on Capitol Hill and his even more dramatic vote in the wee hours Friday to drive a stake through Republican efforts to repeal the Affordable Care Act.
But the award for pure courage in this partisan debacle goes, first and foremost, to Maine’s own Sen. Collins.
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From Tuesday’s vote to reopen debate on the repeal, to the two failed measures to replace it with Scotch tape and bubble gum, to the final “skinny repeal” showdown around 1:30 a.m. Friday, Maine’s senior senator never wavered.
She thought it was a bad deal and she said so, as did so many of her Republican colleagues who trusted, for no apparent reason, that the House would negotiate a real bill in conference committee rather than simply pass the Senate’s stinker outright and send it on to the White House.
But unlike all of them save McCain and Sen. Lisa Murkowski, R-Alaska, Collins chose principle over pragmatism. Of the three Republican votes it took to send President Trump, Vice President Mike Pence and Senate Majority Leader Mitch McConnell packing, it was Collins who said “no” first.
Quoting from a text he’d just sent to his son, King observed, “I hope when my moment comes, I’ll have as much guts as she had.”
There have been times during her 20 years in the Senate when critics, myself included, have chided Collins for not taking a strong enough stand against her party’s leadership. Others within her party, on the other hand, have branded her a “RINO” – the Tea Party moniker for a “Republican in name only” who sits too close to the center and thus gives “real conservatism” a bad name.
But last week was different. Despite overwhelming pressure from McConnell and Pence to get with the program and kill Obamacare because … well, just because, Collins staked her ground and never wavered until finally, a half hour or so before the climactic vote, Pence waved the white flag.
“He said to me, ‘You sure are tough,’ ” Collins, still operating on two hours of sleep, recalled in an interview late Friday afternoon. “And he softened it by putting his arm around me when he said it.”
No calls from the Oval Office? No threats of retribution such as those leveled against Murkowski – at the president’s behest – by Interior Secretary Ryan Zinke?
“Obviously they wanted my vote, but none of them have been in any way comparable to what Lisa has experienced,” said Collins, who was lobbied directly by both Pence and now-departed White House Chief of Staff Reince Priebus.
Her only contact with Trump came late last month when the president hosted an arm-twisting lunch with Republican senators and conspicuously seated Collins and Murkowski on either side of him. In a photo from the event, Collins appears, shall we say, less than comfortable.
“I know,” she said with a chuckle. “I’ve got to work on being more relaxed, I guess.”
Not here in Maine, she doesn’t.
Back on July 4, both Collins and King traveled to Washington County to march in Eastport’s Independence Day parade. On Friday, both recalled how, from start to finish, it was all health care all the time – punctuated by pleas that they stand fast against the House repeal bill that had landed with a thud in the Senate.
“Keep in mind that that’s a county that went heavily for Donald Trump,” noted Collins. “And what I found as I walked the length of the parade is that over and over, people were calling out to me, ‘Thank you, Susan,’ and ‘Thank you for opposing the House bill,’ and ‘Stay strong, Susan,’ and coming out and literally hugging me.”
One woman, a longtime Republican who went all the way back to Collins’ run for governor in 1994, spotted the senator at the end of the parade and made a beeline for her.
“Uh-oh,” thought Collins, expecting an earful about her well-publicized opposition to the House bill.
“Instead, she was bringing her grandson, who has cystic fibrosis, to meet me,” Collins said. “And she said, ‘That bill is terrible. And my grandson has cystic fibrosis, he’s going to have it his entire life – it’s a pre-existing condition for him. And I’m really worried about what’s going to happen to him and whether he’s going to be protected and be able to get insurance.'”
That encounter, more than any other, hit home. It reinforced Collins’ belief that health care “really cuts across party lines” and directly impacts people of all political stripes.
And so it came down to this: On this most critical of issues, Collins’ constituents spoke loudly and clearly. And when it truly counted, much to her credit, she listened.
That said, Collins’ breakaway vote will not soon be forgotten on Capitol Hill. Mused King, ‘How she’ll be treated in the (Senate Republican) caucus and what comes next by the administration, who knows?”
Still, echoing Pence, King added: “Susan is tough. She’s really tough. I think she’ll be fine.”
Friday morning, as she wearily walked off her plane at Bangor International Airport, Collins stepped out into a terminal gate packed with passengers waiting to board their outbound flight.
She recognized no one. But several of them recognized her and began to applaud.
Within seconds, the whole terminal was clapping, many people rising to their feet as their sleep-deprived senator passed.
Never before, throughout her two decades and 6,300 votes in the Senate, had Collins received such a spontaneous welcome home.
“It was absolutely extraordinary,” she said. “It was just so affirming of what happens when you do the right thing.”
Hope, in this summer of our discontent, springs eternal.
In GOP’s repeal failure, Democrats find a potential game plan
by David Wiegel - Washington Post - July 30, 2017
Outnumbered but emboldened, progressive Democrats who watched Republicans fail to unwind the Affordable Care Act are thinking harder about passing major expansions of health-care coverage. For many younger activists and legislators, the push to undo the ACA with just 51 Senate votes is less a cautionary tale than a model of how to bring about universal coverage.
The ambitious idea, discussed on the congressional backbenches and among activists, is not embraced by Democratic leaders. In the hours after the repeal push stalled, Senate Minority Leader Charles E. Schumer (D-N.Y.) suggested that Republicans “sit down and trade ideas” with Democrats. House Minority Leader Nancy Pelosi (D-Calif.) suggested that Republicans fully fund subsidies for current ACA exchange plans — money that President Trump frequently threatens to cut off.
But for many younger Democrats and activists, the Republicans’ near miss on repeal demonstrated boldness from which a future left-wing majority could learn. Democrats passed the ACA through regular order, with a fleeting, fractious Senate supermajority. Republicans proved that major health-care policy changes can be pushed nearly to the finish line in the reconciliation process, with just 50 supportive senators and a vice president ready to break a tie.
Rep. Ro Khanna (D-Calif.), a freshman who favors universal Medicare coverage, said that Republicans have rewritten the playbook. “When we do have a Democratic president, and when we do have a Democratic majority, I’d support getting this through with 51 votes in the Senate,” said Khanna of a universal coverage, single-payer plan. “That will diminish the role of lobbyists and special interests in trying to get a few senators to block something that everyone in this country will want.”
Democrats who endured previous efforts to expand health insurance had rarely considered a reconciliation strategy. In 2009, the Obama administration andDemocrats in the House and Senate included veterans of the failed 1993-1994 health-care push, who remembered the insurance industry’s effectiveness in sinking their bills.
What’s next for the GOP’s health-care efforts? White House, senators respond.
Trump administration officials on July 30 said the Senate should continue to try passing legislation to revise the Affordable Care Act despite previous failures. (Video: Bastien Inzaurralde/Photo: Melina Mara/The Washington Post)
The 2009 approach brought insurers on board; it adopted the mandate for individuals to obtain health insurance, an idea cooked up in conservative policy circles, and went into affect slowly to avoid piling up costs.
“How much time and effort did they spend in trying to make the ACA bipartisan?” asked Rep. Ruben Gallego (D-Ariz.), a rising Democratic star elected in 2014. “It’s never going to happen. Our bills shouldn’t be about getting the most amount of Republicans on board; they should be about insuring the biggest number of people.”
When Democrats lost control of the House in 2010, it taught party activists that there was little to gain from compromise. This year, the ACA policy that proved most intractable was not the mandate — a “skinny bill” to repeal it got 49 Senate votes — but instead the expansion of Medicaid, which up to nine Republican senators refused to roll back.
To progressives, this was proof that they’d been right to demand more in 2009 — from a public option to a Medicare buy-in for younger people to single-payer health care itself. Adam Green, co-founder of the Progressive Change Campaign Committee, recalled that Democrats had ridiculed the “professional left” for supporting a public option in reconciliation. In conversations since the start of the repeal debate, they’ve come to agree with him.
“In 2009, what we consistently got from Democratic senators was: Hey, reconciliation was a procedural can of worms. We don’t want to go there,” Green said. “Republicans have made very clear that you can go there and push your ideas into law. But our ideas will be more popular. It’s pretty clear that the center of gravity has shifted.”
This week, as the Senate debated then waylaid the repeal bills, the PCCC held all-day training sessions for 2018 Democratic candidates in a hotel near the Capitol. Many swing-district hopefuls said they either embraced single-payer health care or described it as an obvious goal to work toward.
“The image I have in my head is that everyone who wants to see a doctor can see one, without going to the ER or going bankrupt,” said Rick Neal, an international aid worker who was exploring a run against Rep. Steve Stivers (R-Ohio). “Health care doesn’t fit in this free-market fantasy that people have, because people will do anything to see a doctor. The high premiums we’re seeing right now are an indication of market failure.”
Andy Kim, a former National Security Council staffer running against Rep. Tom MacArthur (R-N.J.), described the ideal process for passing a bill in now-common progressive terms — starting with what voters want, not what might win over Republicans.
“The way you start something that’s bipartisan is by starting with the American people,” he said. “Bipartisanship starts with them.”
Democrats have not yet formed a consensus on how to approach health care again. On Thursday, as the repeal effort headed for the cliff, Sen. Steve Daines (R-Mont.) needled Democratic senators — 10 of whom face reelection next year in states Trump won — by introducing the text of a single-payer bill sponsored by Rep. John Conyers Jr. (D-Mich.). For the first time, most House Democrats have co-sponsored Conyers’s bill; 43 members of the Senate minority, including Sen. Bernie Sanders (I-Vt.), voted “present,” while five voted “no” on the Daines amendment.
Sanders did so because he intends — barring yet another jolt of life in the repeal campaign — to release a “Medicare for All” bill before the Senate’s August recess. The bill will be designed to reframe single-payer, which enjoys tentative support in public polls, as cost-effective and sensible.
If Sanders’s bill gets a favorable Congressional Budget Office score, it would become a starting point for Democrats in future health-care debates. Even some progressive Democrats worry about the story getting ahead of the storytellers.
“The reconciliation rules may allow you to squeeze through something, but it doesn’t allow you to do lawmaking the way it’s supposed to be done,” said Sen. Brian Schatz (D-Hawaii), who was endorsed by the PCCC. “When it comes to repeal, reconciliation is the tool that they’ve used; there’s every reason to think we’d use reconciliation to undo it. But it’s not a path we should go down with enthusiasm.”
Rep. John Yarmuth (D-Ky.), who would chair the House Budget Committee if Democrats won control of Congress, was similarly cautious about reconciliation. In an interview with The Washington Post and the New York Times, taped for C-SPAN’s “Newsmakers,” Yarmuth said that he supports universal Medicare and could see it becoming law “in five to 10 years,” as employers realized that they would gain flexibility if they were taxed slightly higher but could save on insurance costs. But he would not copy the process Republicans had tried to use for repeal.
“It’s not good for the country, whether you’re Democrat or Republican, when you pass a bill with only partisan votes,” Yarmuth said.
Conyers, meanwhile, was trying to make universal health insurance the party’s default position. On Friday, as most House members left town for their recess, Conyers joined Khanna at an event to launch a pledge for 2018 Democrats. Raising his right hand, the Capitol peering over his shoulder, Conyers said he would “stand up for ‘Medicare for All.’ ”
“We’re seeing a crumbling of the Republican legislative program,” Conyers said. “We may not be in the minority much longer.”
Behold the Trump boomerang effect
by Fred Hiatt - Washington Post - July 31, 2017
Did your head spin when Utah’s Orrin Hatch, a true conservative and the Senate’s longest-serving Republican, emerged last week as the most eloquent spokesman for transgender rights? Credit the Trump boomerang effect.
Much has been said about White House dysfunction and how little President Trump has accomplished in his first six months. But that’s not the whole story: In Washington and around the world, in some surprising ways, things are happening — but they are precisely the opposite of what Trump wanted and predicted when he was sworn in.
The boomerang struck first in Europe. Following his election last November, and the British vote last June to leave the European Union, anti-immigrant nationalists were poised to sweep to power across the continent. “In the wake of the electoral victories of the Brexit campaign and Donald Trump, right-wing populism in the rich world has appeared unstoppable,” the Economist wrote. Russian President Vladimir Putin would gain allies, the European Union would fracture.
But European voters, sobered by the spectacle on view in Washington, moved the other way. In March, the Netherlands rejected an anti-immigrant party in favor of a mainstream, conservative coalition. In May, French voters spurned the Putin-loving, immigrant-bashing Marine Le Pen in favor of centrist Emmanuel Macron, who went on to win an overwhelming majority in Parliament and began trying to strengthen, not weaken, the E.U.
Meanwhile, German Chancellor Angela Merkel, whom Trump belittled for having allowed so many refugees into her country, has grown steadily more popular in advance of a September election.
The Senate on July 27 passed a bill that increases sanctions on Russia, North Korea and Iran. The White House hasn’t said whether President Trump will veto the bill.(U.S. Senate)
Trump’s win seemed certain to bring U.S.-Russian ties out of the deep freeze. Again, the opposite has happened. Congress, which can’t agree on anything, came close to unanimity last week in endorsing tough, Trump-proof sanctions against the Putin regime. Russia is expelling diplomats and seizing U.S. diplomatic properties. The new Cold War is colder than ever.
The third sure thing, once Republicans took control, was the quick demise of Obamacare. We saw last week how that turned out. But here’s the boomerang effect: Obamacare is not just hanging on but becoming more popular the more Trump tries to bury it. And if he now tries to mismanage Obamacare to its death, we may boomerang all the way to single-payer health insurance. This year’s debate showed that most Americans now believe everyone should have access to health care. If the private insurance market is made to seem undependable, the fallback won’t be Trumpcare. It will be Medicare for all.
Once you start looking, you find the boomerang at work in many surprising places. Trump’s flirting with a ban on Muslim immigration encouraged federal judges to encroach on executive power over visa policy. Firing FBI Director James B. Comey entrenched the Russia investigation far more deeply. Withdrawing from the Paris climate treaty spurred states from California to Virginia to toughen their policies on global warming. Threatening the research budget may have strengthened the National Institutes of Health’s hand in Washington. And so on.
The boomerang effect is no panacea. Trump can still do grave damage at home and abroad in the next 3½ years. If he undermined Obamacare, millions of people would suffer before we got to single-payer. Nationalist governments ensconced in parts of Eastern Europe could still draw strength from Trump. The absence of U.S. leadership in the world leaves ample ground for others to cause trouble.
But Trump’s policies are turning against him, and not only because his execution has been so ham-handed. The key factor is that so many of his policies run so counter to the grain of cherished values and ideals.
It turns out that Americans really don’t like the idea of poor people not being able to see a doctor. We don’t feel right cozying up to a dictator whose domestic opponents are rubbed out and whose neighboring countries are invaded and occupied.
And even if some Americans don’t know all that much about transgender people, it turns out we are less comfortable treating anyone as a “burden,” as Trump said in his tweet, than in valuing every individual’s service, a spirit that Hatch captured in his straightforward, humane response.
“I don’t think we should be discriminating against anyone,” Hatch said. “Transgender people are people, and deserve the best we can do for them.”
And Americans aren’t unique. Millions of people in Europe and around the world are just as appalled by the scapegoating of minorities and the celebration of police brutality.
That has an effect. Maybe Newton’s third law of motion doesn’t translate perfectly into the political sphere, but a version of it applies: For every malignant or bigoted action, there will be an opposite reaction. And you can never be sure where it will begin.
The Americans Who Saved Health Insurance
by David Leonhardt - NYT - August 1, 2017
Many Americans look back on the heroic political fights of the past — for suffrage, Social Security, civil rights, Medicare — and wonder why today’s politics never produce inspiring victories. Well, we just witnessed one.
If one of the Senate or House health care bills had become law, millions of people would have lost their coverage. Ultimately, many would have been denied medical care. Birth defects, cancer, diabetes and other conditions would have gone untreated.
And it came depressingly close to happening. But it didn’t — because of a lot of hard work from a lot of people. Today, I want to give them their due. They are the people who have helped save decent medical care for their fellow citizens. They are an antidote to cynicism in this often cynical time.
The Citizens
Jessi Bohon isn’t a political activist. She is a teacher in central Tennessee who grew up poor in rural Virginia. But President Trump’s victory led her to join a grass-roots group called Indivisible, which encouraged people to attend town hall meetings on health care.
On Feb. 9, Bohon went to one in Murfreesboro, Tenn. There, she asked her House representative, Diane Black, to fix Obamacare’s problems instead of taking away insurance. “As a Christian, my whole philosophy in life is pull up the unfortunate,” Bohon told Black. “We are effectively punishing our sickest people.” The remarks went viral.
Bohon was one of thousands of citizens who took time to attend meetings, visit congressional offices and call those offices, often repeatedly. This sustained action worked better than any poll to show Congress how unpopular the bills were. It was a reminder of how democracy can work.
The Organizers
Jessi Bohon was able to join Indivisible because of a group of millennials who reacted to Trump’s election not with despair or blame games but by trying to make a difference.
At an Austin, Tex., bar during Thanksgiving week, three friends got together to talk about stopping Trump’s agenda. The friends — Sara Clough along with Leah Greenberg and Ezra Levin, a married couple who had both worked in Congress — envisioned a Google document with tips for citizen action. Others were involved, too, and the document began circulating online. It led to the formation of Indivisible, with chapters around the country trying to replicate the Tea Party’s success, albeit to different ends.
The various groups and organizers fed off one another. Health care wonks like Andy Slavitt (who had run Medicare and Medicaid) and Topher Spiro used Twitter to explain what Congress was doing — and urge action. The hosts of a hit podcast, Pod Save America, implored their audience to stay engaged. AARP ran ads and mobilized members. It was a vast health care conspiracy.
The Experts
I’ve never seen a major political fight inspire such an expert consensus, across the ideological spectrum.
Groups representing doctors, nurses, hospitals and patients of virtually every disease criticized these bills. So did both liberal and conservative policy experts. Congressional Budget Office analysts refused to be bullied and provided dispassionate, and devastating, analyses.
The bills had virtually no independent defenders. This intellectual honesty — the avoidance of false balance — helped the public understand that this wasn’t a classic partisan fight with each side making some good points. It was a case of cynical politicians willing to hurt their constituents in order to keep a misguided campaign promise.
The Unintimidated
At least nine Republican senators expressed grave doubts about the bills. But only two voted no consistently: Susan Collins of Maine and Lisa Murkowski of Alaska.
They were clearly affected by the outpouring of public opinion. Murkowski has citeda constituent who said she would not be alive without Obamacare. Collins, marching in a Fourth of July parade in a remote part of Maine, heard shouts of “Stay strong, Susan!”
But many senators ignored such voices. What set Collins and Murkowski apart was a willingness to buck intense pressure from Republican leaders. “Boy, are you tough,” Vice President Mike Pence ruefully said to Collins before the final vote. Senator Chris Murphy, a Connecticut Democrat, told me that he thought the two senators’ history of partisan independence was crucial: “Susan and Lisa knew you could stand up to the Republican leadership and survive.”
The Institutionalists
Chief Justice John Roberts is a movement conservative. Yet he cast the vote that saved Obamacare in 2012 partly because he understood that a partisan shredding of the safety net could undermine his institution — the Supreme Court.
John McCain is also deeply conservative. Yet, like Roberts, he realized that taking health coverage from millions, in a hasty, secretive process, could damage his favorite institution — the Senate.
When his colleagues didn’t heed his warning to abandon that approach, McCain flipped his vote. “No,” he announced at 1:30 a.m. on Friday, shocking Democrats who had given up on him and Republicans who had assumed he wouldn’t really break ranks on principle.
The Democrats
I know it’s unfashionable to praise a political party, and I have plenty of complaints about the Democrats. But the fact is, many Americans would soon lack health insurance were it not for the unity of elected Democrats.
Not a single one wavered in recent months. On the left, Bernie Sanders, who’s technically an independent, worked to poke procedural holes in the bills. Every red-state Democrat stood firm, too. Why? They thought their Senate leader, Chuck Schumer, was listening to them and their concerns. They had also held their own town halls, and they knew the bills were deeply unpopular.
The unity was a fitting echo of 2010, when Barack Obama, Joe Biden, Nancy Pelosi and Harry Reid kept their party together to pass the most important social policy in decades. Today, it remains the law of the land.
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No one should think the fight is over. Murphy, the Connecticut senator, says he wakes up every day fearful of a new repeal effort. Even without one, Obamacare needs to be improved, and defended from Trump’s sabotage. There’s much more work to do.
But I hope everyone who played a role in last week’s victory sets aside some time to savor it. It was a big deal, and it was not inevitable. One day, Americans will look back on it with respect and, yes, nostalgia.
Tomgram: Ann Jones, Can the Age of Trump Spur Medicare for All?
by Ann Jones - Tom Dispatch - August 1, 2017
Over the years, Ann Jones has confronted some of the most daunting and depressing issues on the planet: the abuse of women, African civil wars, the disaster that is Afghanistan, and -- as reflected in her book They Were Soldiers: How the Wounded Return From America’s Wars -- the plight of American casualties of the fighting there. She’s put on her flak jacket and combat boots to “embed” with U.S. troops at forward operating bases near the Pakistani border. (“I... got a checklist of things to bring along. It was the sort of list moms get when sending their kids off to camp: water bottle, flashlight, towel, soap, toilet paper [for those excursions away from base], sleeping bag, etc. But there was other stuff too: ballistic eyewear, fireproof gloves, big knife, body armor, and Kevlar helmet. Considering how much of my tax dollar goes to the Pentagon, I thought the Army might have a few spare flak jackets to lend to visiting reporters, but no, you have to bring your own.”) She’s been in trauma units in Afghanistan and on U.S. C-17 cargo planes taking the desperately wounded home. (“Here again is Marine Sergeant Wilkins, just as he was on the flight from Afghanistan: unconscious, sedated, intubated, and encased in a vacuum spine board... He remains in cold storage, like some pod-person in a sci-fi film.”) In the heat of summer, she’s ventured off to watch U.S. advisers trying to whip Afghan military recruits into shape. (“Hundreds of little Davids to the overstuffed American Goliaths training them... Like me, many sag under the weight of a standard-issue flak jacket.”)
So, honestly, who could blame her for finally seeking out a little time in Norway, a country that just took first place in the annual World Happiness Report of the U.N.'s Sustainable Development Solutions Network? Not me. She spent several years in Norway, in fact, returning to her own land with a strong sense of what might raise the American happiness quotient. As it happened, she was just in time to watch her country’s slo-mo dive off the edge of a cliff in a fit of plutocratic triumphalism. In response, she offered a little advice about what actually works when it comes to a better life from one of the happiest, most satisfied countries on Earth, a place where welfare isn’t a dirty word and the social safety net isn’t the preferred place for budget cuts. (Check out her “Social Democracy for Dummies.”) Of course, not many were listening to such suggestions at the time, not at least until Bernie Sanders came on the scene as a presidential candidate.
Having paid another visit to Norway recently, she’s home again, infused with hope in these grim times. In that spirit, she offers her own uplifting antidote to Trumpcare (that is, to the various Republican deathcare bills) and a striking sense of how resistance to The Donald & Co. might proceed on a state-by-state basis. For me at least, her perspective feels like tonic in a desperately down time. Tom
You may have noticed that quite a few of the formerly united states of America have been choosing to go their own way. My own state, Massachusetts, now blooms with sanctuary cities sworn to protect residents from federal intrusion. Its attorney general, Maura Healey, was among the first to raise the legal challenge to President Trump’s Muslim bans. She also sued Education Secretary Betsy DeVos and the Department of Education for abandoning rules meant to protect students from exploitation by private for-profit schools. (Think Trump University, for instance.) Even my state’s Republican governor, Charlie Baker, announced well before the presidential election that he wouldn’t vote for Donald Trump.It’s been like the Boston Tea Party all over again, with citizens and public officials refusing to abide by the edicts of their supposedly lawful rulers. And Massachusetts is not alone. Hawaii, Washington State, New York, Minnesota, and Oregon all joined the legal battle against Muslim bans, while many other states have denounced federal policies that threaten the nation’s international reputation, the environment, or what’s left of democracy itself. So far at least 10 states (as well as Puerto Rico) and more than 200 cities have committed themselves to work toward the environmental goals of the Paris Accord, just as the United States as a nation had promised to do before Trump trashed the deal.
We should recall that our founding fathers cobbled together our federal union -- our United States -- because they were convinced that the revolutionary colonies, each standing on its own, could not survive. For a time, the Civil War did then tear the union apart, and, a century and a half later, here we are, overstretched and teetering under the rule of an administration whose allegiances, if any, are far from clear. But there’s no denying a new spirit in many states worthy of the Gadsden Flag of revolutionary times which warned, beneath a drawing of a distinctly American rattlesnake: Don’t Tread on Me.Some prospective political challengers to the current feckless crew in Washington go even further. Take, for example, Ben Jealous, former head of the NAACP, a Democrat now vying to become governor of Maryland in 2018. He’s not the only Democrat running for that position, but he’s the one endorsed by Bernie Sanders. Jealous advocates something a bit vague called “climate action” plus a $15 minimum wage, an end to mass incarceration, the protection of immigrants, and -- get this -- statewide single-payer Medicare for All.Let’s talk about that health care possibility. Recent polls and reporting by the New York Times indicate that a lot of voters -- including Trump voters -- who opposed Obama’s Affordable Care Act have changed their minds. They now not only like Obamacare but want to keep it and improve upon it. As one man in Pennsylvania told the Times, “I can’t even remember why I opposed it.” What’s more, a Pew survey reports that fully 60% of Americans now say that health care for all is the responsibility of the government.This awakening has been prompted by the unexpectedly enlightening spectacle of belligerent Republicans smuggling tax cuts for the rich into their very own totally man-made plan to deprive tens of millions of Americans of their bodily well-being. West Virginia Senator Shelley Moore Capito, a Republican, drove a stake through the heart of her party’s second “health” care plan with a single comment: “I didn’t come to Washington to hurt people.” (After Trump harangued a crowd of 40,000 at the Boy Scout Jamboree held in Capito’s home state, telling them that they “better get Senator Capito to vote for” a third Republican health care plan, she changed her mind, opting to hurt people rather than the President.)The Stars AlignThis combination of circumstances -- the newly rebellious spirit of the states, the collapse of the corrupt Republican Congress, and the absence of executive leadership (as opposed to tweetstorms) -- comes as part of a propitious realignment of astral constellations in America’s natal chart. It suggests an opportunity to change course and take action.
Bernie Sanders argued for just such a change during the Democratic presidential debates last year. Remember? He tried hard to push lessons to be learned from the Scandinavian social democracies: Denmark, Sweden, and Norway. Every international evaluation rates those countries among the most successful and happiest on the planet, but Sanders proved unable to sell their ideas to Americans. His own understanding of social democracy was on the foggy side and that taboo word “socialist” kept getting in his way. But right now might be just the moment to try again.
Take Ben Jealous and his statewide Medicare for All plan. We’re talking about a single-payer universal system that would cover every resident of his state, regardless of the condition of his or her health, and with no insurance companies jockeying for profits in the mix. Such a simple system is the one used by all the Scandinavian countries. If Maryland and other states adopted it, they would be delivering at the state level what most developed nations already provide for their citizens.
Isn’t it worth a try? American politicians who refuse to learn lessons from Scandinavia usually dismiss those countries as too “small” to be relevant to America’s exceptionally grand experience. And they do have a point: it’s surely easier to implement a big plan on a smaller scale.
If that’s true, however, then applying Medicare for All at the state level should be easier. And of all the states, only eight have a population greater than that of Scandinavia’s biggest country, Sweden (nine million), while 30 states have fewer residents, most far fewer, than either Denmark (5.5 million) or Norway (5.3 million). In short, the most popular argument against single-payer health care for the nation -- the contention that we’re way too big for such a system -- simply vanishes if you start at the state level.
But hold on. If a state becomes a single payer, where does it get the money?
Taxes, of course. Progressive income taxes. And let’s not forget taxes on corporations and financial transactions. In most states, the money’s there, even if it has a way of clinging to the pockets of the rich and disappearing from circulation. The job of any good government should be to collect its fair share of the wealth and redistribute it for the good of all. That’s what social democracies do. That’s why they’re called social democracies.
Raising taxes on the rich in the United States, however, would take some persuasion at first, partly because so many of them seem to have lost all sense of obligation to others, and also because most millionaires claim to have worked hard for the money, and dammit, it’s theirs.
Not that you would know it in this country, but a larger tax bill more than pays for itself in the social benefits it buys: an overall population in better condition (and probably significantly less desperate, angry, and violent); a healthier, more reliable work force; kids in better shape who don’t miss school as often; and a widespread feeling of well being, of knowing that you will indeed get the care you need and that no one will be left behind. When Senator Capito claimed that she didn’t want to hurt people, surely she spoke for most Americans.
Nonetheless, there’s another reason that American politicians disdain the Scandinavian example and it may, on first glance, seem far more compelling. Those countries are not only small but to a significant degree ethnically homogeneous. So naturally, Norwegians don’t mind helping each other, since they’re all essentially alike -- or so the argument goes anyway. On the other hand, diverse and polarized Americans are never going to be persuaded to let the state pick their pockets for the good of other, very different and presumably less deserving people.
And let’s admit it: the opposition does seem to have a point. Scandinavian social democracies are indeed among the most stable in the world. What’s more, they are economic democracies; that is, they have the world’s smallest gap between their upper and lower income earners. Their citizens are just about as equal to one another as it’s possible to become on our present planet.
Considered more carefully, though, that’s hardly a reasonable basis for arguing against trying to redistribute the wealth in a diverse American state. Quite the reverse, in fact. Historically speaking, Scandinavians weren’t born equal. Well into the twentieth century, many of them languished in isolated pockets of rural poverty, while others dined in style in prospering cities. Some were healthy, some not; some well educated, others unschooled. Some had good jobs, others none.
To overcome such disparities and engage all their citizens in the project of democracy, Scandinavians worked hard to create forms of government and social policies that made people ever more socially and economically equal. In Norway, for example, workers led the struggle for fair employment laws, gaining compensation for accidents in 1894, unemployment in 1906, and illness in 1909. Socially conscious political leaders worked to harness the nation’s wealth and used it to meet the basic needs of all men and women for health care, education, and employment, as well as for the special needs of children, the elderly, the disabled, and others. In short, when you radically equalize wealth in a country, even in increasingly multicultural ones like those of Scandinavia, you unite disparate people. When most poeple have plenty of money, populations begin to feel downright “homogeneous” -- especially if they’re healthy, well educated, and happily employed in the bargain.
Scandinavian economists will tell you that social democracy developed out of pure self-interest. These were, after all, poor countries that learned one simple lesson fast: their strength and well being lay in solidarity. They invested in the future by investing heavily in children. Just think for a moment about all those well established Scandinavian programs that American feminists keep talking about: paid parental leave; early childhood education; and excellent, free, equally well funded public schools (and universities) for all. Could such giveaways be in the nation’s self interest? You bet. Scandinavian societies were, and still are, intent on developing a work force of the future that eventually will care for the very elders preparing the way.
The Road Ahead?
Were he elected, could Ben Jealous actually put any of these ideas to work in Maryland? The state has already laid some significant groundwork for his ideas. But really, who knows?
Instituting a single program statewide like Medicare for All or equal investment in public schools could prove to be a breakthrough experiment for this backpedaling nation. It might also be a reminder that such acts of solidarity worked well once upon a time, even in America -- under both President Franklin Roosevelt’s New Deal in the 1930s and President Lyndon Johnson’s Great Society in the 1960s.
Real social democracy, however, is far more than a few isolated programs. It’s a complete system of reciprocation that is incessantly subjected to adjustment and fine-tuning. Today, the comprehensive welfare state that characterizes Scandinavian social democracies has largely moved beyond political ideology. Always open for discussion, it’s nonetheless taken for granted and favored by every party, across a broad range of political opinion. It is simply the way things are.
Yet social democracy might not have developed at all had it not been for the leadership of the working class, a strong alliance of labor and farmers, and the undeniable claims of women. In that Democratic presidential debate last year, Bernie Sanders argued that “we should look to countries like Denmark, like Sweden and Norway, and learn from what they have accomplished for their working people.” But he’s got that slightly backwards. For a real lesson in inspirational history, we should learn from what the working people of Denmark, Sweden, and Norway accomplished -- and are still accomplishing -- for their countries. Social democracy doesn’t come from the top down; it’s people’s politics at its best.
Unfortunately, it seems way too late to count on America’s working class to lead this country to social democracy. Here in the U.S., the plutocrats crushed labor long ago and corporatized the farms; women were turned back in the 1970s, social welfare in the 1990s. Who even remembers exactly when the working class or the poor fell -- or were pushed -- off the edge of the political map? A woman worker in an Indiana factory where candidate Trump promised to save jobs, speaks now (as workers are let go and the plant moves to Mexico) of his having “blown smoke up our asses” with a “sneaky kind of shit-eating grin” on his face. The Democratic Party -- once the party of the working class, lest you’ve forgotten -- has just announced yet again its intention to “devise an agenda that will resonate” not with workers but with the “middle class.” Meanwhile, working-class Americans, some still wearing their Trump hats, turn their gazes upward and wait for something -- anything -- to trickle down.
So have no illusions. A single experimental program like statewide Medicare for All, coupled with the taxes to pay for it, won’t transform this country into a social democracy. Nor, on the other hand, is it likely to lead to the dissolution of the Union and a second civil war.
Still, a single program launched by a single state is better than none. And it just might work.
If it does, states can look to the Scandinavian toolbox for other projects. What’s more, a good idea in one state may prove contagious, as we’ve seen with the rise of sanctuary cities and pledges of allegiance to the Paris Accord. (States are learning from the consequences of bad ideas too, including the catastrophic financial collapse of Kansas after its Republican governor’s stubbornly stupid Reaganomics tax-cutting regime.)
Some states, like Massachusetts, are even taking inspiration from their own feistiness. In California, Governor Jerry Brown told the Los Angeles Times that if Trump shut down the U.S. satellites gathering climate change data, “California will launch its own damn satellite.”
Sounds good to me, but for now, as a healthy, happy Medicare recipient myself, I’ve got my eye on Maryland and statewide Medicare for All.
Ann Jones, a TomDispatch regular, went to Norway in 2011 as a Fulbright Fellow and stayed on for years because it feels good to live in a social democracy where politics matter, gender doesn’t, and peacemaking is the nation’s project. She is the author most recently of They Were Soldiers: How the Wounded Return from America’s Wars -- the Untold Story, a Dispatch Books original.http://www.tomdispatch.com/post/176314/tomgram%3A_ann_jones%2C_can_the_age_of_trump_spur_medicare_for_all/#more
Republicans in Congress Bypass Trump to Shore Up Health Law
by Robert Pear and Thomas Kaplan - NYT - August 2, 2017
WASHINGTON — Congressional Republicans moved on Tuesday to defuse President Trump’s threat to cut off critical payments to health insurance companies, maneuvering around the president toward bipartisan legislation to shore up insurance markets under the Affordable Care Act.
Senator Lamar Alexander of Tennessee, the influential chairman of the Senate Health, Education, Labor and Pensions Committee, announced that his panel would begin work in early September on legislation to “stabilize and strengthen the individual health insurance market” for 2018. He publicly urged Mr. Trump to continue making payments to health insurance companies to reimburse them for reducing the out-of-pocket medical expenses of low-income people.
In the House, two Republicans, Representatives Tom Reed of New York and Charlie Dent of Pennsylvania, teamed with Democrats to promote incremental health legislation that would also fund the cost-sharing subsidies.
The moves were a remarkable response to the president’s repeated threats to send health insurance markets into a tailspin. They offered tangible indications of cooperation between the parties after Republican efforts to scrap the Affordable Care Act collapsed in the Senate last week, all but ending the seven-year Republican quest to overturn President Barack Obama’s signature domestic achievement. Lawmakers from both parties concede that the health law needs improvement, as consumers face sharp premium increases and a shrinking number of insurance options in many states.
These problems have been exacerbated by a president who has publicly predicted that the Affordable Care Act will “implode” and appears determined to help fulfill that prophecy. Mr. Trump has repeatedly threatened to cut off the subsidies, known as cost-sharing reduction payments, which reimburse insurers for cutting deductibles and other out-of-pocket costs for millions of low-income people. Without them, insurers would almost certainly raise premiums not only for poor consumers but also for many other people buying plans on the individual insurance market.
In California, the state agency that runs the insurance marketplace announced on Tuesday that rates would increase by 12.5 percent on average next year. That is slightly lower than the rate increases Californians saw this year. But Peter V. Lee, the executive director of the agency, Covered California, said the average increase would be twice as high for popular “silver” plans if the Trump administration blocked the cost-sharing payments.
“This policy allowed health plans to stay in the market when they might have left otherwise,” Mr. Lee said of the potential additional increase, which he called a “surcharge.”
He added, “By the end of this month, we have to hear there’s clarity that the cost-sharing reductions will be made, or we will apply the surcharge.”
In Kentucky, according to data posted by the federal government, Anthem has requested rate increases averaging 34 percent for plans covering 69,500 people. BlueCross BlueShield of South Carolina has sought rate increases averaging 33 percent.
And Blue Cross and Blue Shield of Texas is seeking rate increases that average about 23 percent, and it said 389,800 people may be affected. The company cited uncertainty about cost-sharing subsidies as a factor, along with medical inflation.
In the House, a group of members known as the Problem Solvers Caucus announced agreement this week on a bipartisan set of proposals to stabilize insurance markets and revise the Affordable Care Act to provide relief to consumers and small and midsize businesses. The proposals would provide money for cost-sharing reduction payments, repeal a tax on medical devices and exempt businesses with fewer than 500 employees from the law’s requirement to offer health insurance to workers.
“My hope is that maybe the president will take this into consideration in regards to the upcoming decision” on cost-sharing subsidies, said Mr. Reed, a co-chairman of the caucus, whose members are split roughly evenly between the two parties.
“Many in our parties don’t want us to do this,” Mr. Reed said of the bipartisan initiative. “Many of us still retain our philosophical opposition and substantive opposition to the Affordable Care Act. But it’s clear to us that what we have to do is come together, find that common ground and govern for the American people.”
Under the proposal, funds for the cost-sharing payments would be guaranteed, and Congress could review use of the money each year, just as it reviews other federal spending.
Mr. Alexander said that it was important for Mr. Trump to approve the payments for August and September, and that Congress should approve “in a bipartisan way” a continuation of the payments for at least a year.
“Without payment of these cost-sharing reductions,” he said, “Americans will be hurt. Up to half of the states will likely have bare counties with zero insurance providers offering insurance on the exchanges, and insurance premiums will increase by roughly 20 percent, according to America’s Health Insurance Plans,” a trade group for insurers.
Senator Patty Murray of Washington, the senior Democrat on the health committee, welcomed Mr. Alexander’s statement.
Mr. Alexander said the committee would hold hearings starting the week of Sept. 4 “on the actions Congress should take to stabilize and strengthen the individual health insurance market, so that Americans will be able to buy insurance at affordable prices in the year 2018.”
He said the committee expected to hear from state insurance commissioners, patients, governors, health care experts and insurance companies.
Mr. Alexander said his proposal was a necessary response to an imminent crisis.
“In my opinion,” Mr. Alexander said, “any solution that Congress passes for a 2018 stabilization package would need to be small, bipartisan and balanced. It should include funding for the cost-sharing reductions, but it also should include greater flexibility for states in approving health insurance policies.”
Payment of the cost-sharing subsidies is a top priority for insurers and for Democrats in Congress, who say that cutting off the payments would cause havoc in insurance markets.
The president has the power to stop the payments because a federal judge ruled last year that the Obama administration had been illegally making the payments, in the absence of a law explicitly providing money for the purpose.
The Obama administration appealed the ruling, and the case is pending before the United States Court of Appeals for the District of Columbia Circuit.
House Republicans, who filed suit to stop the payments in 2014, and the Trump administration have told the court that they are discussing “measures that would obviate the need for judicial determination of this appeal, including potential legislative action.”
The appeals court on Tuesday allowed California, New York and 15 other states to intervene in the case. The states have shown a substantial risk that termination of the cost-sharing payments “would lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the states will have to provide health care,” the court said.
Mr. Alexander said he hoped Congress would eventually approve long-term measures to create a more robust market for people who buy insurance on their own. But first, he said, “we need to put out the fire in these collapsing markets.”
The cost-sharing payments help people with incomes of 100 percent to 250 percent of the federal poverty level (about $12,060 to $30,150 a year for an individual). But some Republicans say that providing the money would amount to “a bailout for insurance companies,” in the words of Senator Ted Cruz of Texas.
“It’s what the Democrats want,” Mr. Cruz said on Tuesday. “The Democrats are the party of the big insurance companies.”
John Kasich: The Way Forward on Health Care
by John Kasich - NYT - July 19, 2017
COLUMBUS, Ohio — Washington’s approach to health care over the past decade is yet another example of our lawmakers’ increasing distance from the rest of America. First one party rams through a rigid, convoluted plan that drives up costs though unsustainable mechanisms that are now unraveling. Then the other party pursues fixes that go too far the other way — and again ignores ideas from the other side.
Neither extreme is cutting it, and the quick opposition that doomed the Senate plan reflects how unacceptable its ideas are to so many. The American people want and deserve reasonable, balanced, sustainable health care so that they can live without the fear of bankruptcy if they get sick, our most vulnerable neighbors are treated with compassion and those who seek to improve their lives can get healthy, confront addiction and get work.
Despite weeks of hard effort, the Senate plan was rejected by governors in both parties because of its unsustainable reductions to Medicaid. Cutting these funds without giving states the flexibility to innovate and manage those cuts is a serious blow to states’ fiscal health at a time when most — Ohio included — are feeling headwinds from a softening national economy. And, unlike the federal government, states must balance their budgets. Particularly problematic was the bill’s failure to adequately meet addiction and mental health needs — which often occur together. Diverting funds away from the comprehensive, integrated physical and mental health care that is proving effective is a step backward.
The Senate plan also failed to repair Obamacare’s damage to the insurance markets. Insufficient tax credits would make coverage unaffordable for many lower income Americans: Two of the subsidies in the bill would be temporary and a third would likely be unsustainably underfunded. Congress should avoid doing anything likely to cause further instability in the huge and complex private insurance market.
In the uncertainty created by the Senate plan’s collapse, Congress should guard against a hasty next step. Just taking up the fatally flawed House plan is not an answer, and this idea should be immediately rejected for the same reasons senators rejected the Senate’s own proposal. Also, simply repealing Obamacare without having a workable replacement is just as bad. Both would simply yank health coverage out from under millions of Americans who have no other alternative.
After two failed attempts at reform, the next step is clear: Congress should first focus on fixing the Obamacare exchanges before it takes on Medicaid. If we want to move Americans off Medicaid, there must be somewhere stable for them to go. For all its faults, at least Medicaid is currently a stable system for those who need it. The exchanges are anything but, and need immediate improvements.
One vital improvement would be to provide adequate tax credits, which would help keep health plans in the individual market and encourage — not undermine — robust competition. Companies should also be required to continue following reasonable guardrails like ensuring minimum coverage that is genuinely useful and covers pre-existing conditions. Once we see these repairs taking hold, Congress should then take up needed improvements to Medicaid as part of comprehensive entitlement reform.
States are willing to assume greater financial risk by transitioning to a block grant or per-capita cap, but will also need new flexibilities, such as tools to manage the rising cost of pharmaceuticals — the fastest growing component of Medicaid. And states cannot expect the federal government to continue paying 90 percent of Medicaid expansion costs given our nation’s historic debt; they must accept a gradual return to traditional cost-sharing levels.
Finally, we can never truly fix the rising cost of health care unless we start paying for value rather than volume. We are making this transition in Ohio by paying physicians for providing better care, not simply more care, in order to pursue better health outcomes.
In resetting health care reform in these ways — and I don’t rule out that other, balanced approaches bear consideration also — Congress can surmount the fatal flaws of both Obamacare and the current approaches: the reflection of a single partisan point of view. Health care policy is only partisan in the abstract. When you or your loved one is sick and needs care, ideology is irrelevant; getting well is all that matters. That same common sense must be reflected in the way we fix Obamacare. Another one-sided plan, driven hard by one party against the wishes of another, can never succeed because it will essentially maintain the status quo: partisan opposition and no real solutions.
The best next step is for members of both parties to ignore the fear of criticism that can come from reaching across the aisle and put pencil to pad on these and other ideas that repair health care in real, sustainable ways. America needs it, and I know that a bipartisan group of governors, including myself, stands ready to help in any way we can to provide an affordable, sustainable and responsible system of health care for the American people.
A Republican Health Care Fix
by J.D. Vance - NYT - July 21, 2017
COLUMBUS, Ohio — Imagine a young father stepping into the street. He is alert and conscientious. Then, a government truck speeds around the corner. The man lunges out of the way, but it’s too late: The truck runs him over, causing serious injury. Absent government misconduct, the man would have been just fine.
While the primary effect of the government’s conduct is an injured man, there are significant secondary consequences. His children will lose his emotional comfort and financial support. His neighborhood loses a valued contributor to its social fabric. His employer must find at least a temporary replacement for the man’s labor.
This scenario is a simplistic version of how many conservatives view the health care market. According to them, there was a time when the market worked reasonably well: Providers competed to offer quality services and consumers shopped around, curbing prices. Then the government, with its mandates and subsidies and regulations, wounded the market, driving up costs and decreasing quality. Everyone — the poor and elderly, the businesses — lost something significant.
I happen to be a conservative, but one need not accept the right’s theories wholesale to acknowledge the sometimes negative effects of government action on health care. The regulatory approach of the Food and Drug Administration and the Patent and Trademark Office has driven up the costs of generic drugs. The subsidy for employer-sponsored coverage has tethered health care to employment in a way that virtually no economist endorses. Even the most committed progressive would have to admit that the government has injured American health care — just as the reckless government truck injured our young father.
That raises an obvious question: How do we fix health care? A patient bleeding on the pavement requires some plan for medical intervention. The conservative policy world has offered a number of ideas, but elected Republicans have failed to coalesce around any particular strategy. And this is because they’re unable to accept that the government must play a role in paying to solve this problem. It’s tough to endorse a universal catastrophic coverage plan, for instance, when much of your caucus cares only about cutting government spending on health care.
This is where the Republican Party hits an ideological barrier that it simply must power through before meaningful reform can happen. Yes, solving problems can be expensive, and yes, that money always comes from taxpayers. But that’s true when a government truck plows into a pedestrian. You break it, you buy it, and the logic applies equally whether the broken thing is an individual or a complex marketplace.
This proposition didn’t use to be so controversial, at least among conservatism’s leading lights. In his influential “The Road to Serfdom,” the economist Friedrich Hayek argued that the state should “assist the individual in providing for those common hazards of life” — among them poor health and unexpected accidents. And in his illuminating analysis of Ronald Reagan’s legacy, “The Working Class Republican: Ronald Reagan and the Return of Blue-Collar Conservatism,” the political scientist Henry Olsen uncovered some timely insights. “Any person in the United States,” Reagan said in 1961, “who requires medical attention and cannot provide it for himself should have it provided for him.”
These sentiments conflict with recent iterations of Republican health care reform. The “full repeal” bill is nothing of the sort — it preserves the regulatory structure of Obamacare, but withdraws its supports for the poor. The House version of replacement would transfer many from Medicaid to the private market, but it doesn’t ensure that those transferred can meaningfully purchase care in that market. The Senate bill offers a bit more to the needy, but still leaves many unable to pay for basic services. In the rosiest projections of each version, millions will be unable to pay for basic health care. This wasn’t acceptable to Reagan in 1961, and it shouldn’t be acceptable to his political heirs.
It is true, as Republicans argue, that health care costs too much. And it is also true that Obamacare has failed to take care of this problem. But if Republicans fail to accept some baseline provision of care, we’ll find ourselves mired in internal contradictions — arguing, for instance, that a bill that cuts subsidies for the poor somehow makes care more accessible. We’ll rail against the way the government has destroyed our health care market in one breath and resist the support offered to the poor and middle class to navigate this brokenness with the other. This is not conservative; it is incoherence masquerading as ideological purity.
Many problems — the monopolization of provider networks, a regulatory framework that forces Americans to overpay for generic drugs — require both a positive Republican vision and a more robust majority to carry it out.
But devising that vision is impossible when we refuse to accept that the government bears some financial responsibility in solving a problem it helped create.
Conservatives and Health Care
Letters to the Editor - NYT - July 29, 2017
To the Editor:
Re “A G.O.P. Fix for Health Care” (Op-Ed, July 21):
J. D. Vance’s appreciation that federal efforts are required for the health of our citizenry is refreshing, particularly given his emerging role as an independent conservative voice. He correctly acknowledges that existing policies (such as subsidized employer-sponsored coverage) are problematic. His suggestion, however, that government broke health care and so needs to fix it is both oversimplified and dangerous.
It is oversimplified in that the causes of health care cost inflation are myriad: provider duplication, inefficiency and error; inadequate prevention and primary care; patient demand, etc. Government occupies only one place in a queue of responsible parties.
It is dangerous in that Mr. Vance echoes a profoundly destructive conservative worldview — that “government is the enemy,” rather than a blunt tool that some thoughtful citizens see as underreaching even while other thoughtful citizens see it as overreaching.
To right ourselves as a society, liberals and conservatives must come together respectfully and creatively to reimagine the role of government in society. I implore Mr. Vance to join such a dialogue.
ERIC LISTER
PROSPECT HARBOR, ME.
PROSPECT HARBOR, ME.
The writer is a retired psychiatrist working as a consultant to large health care systems.
To the Editor:
J. D. Vance correctly argues that conservatives have an obligation to recognize responsibility for providing health care for all Americans. He reminds us of Ronald Reagan’s articulation of this government obligation. Unfortunately, too many American conservatives wrongly define a single-payer system of universal care as “socialism” and something to be avoided as diminishing individual freedom.
In fact, advanced Western industrial democracies all have some form of universal health care. What American conservatives refuse to acknowledge is that European conservative political parties and governments do support systems of government health care — much as we do with Social Security or Medicare. Even Margaret Thatcher did not seek to repeal the National Health Service. Yes, safety net schemes differ, but they share this in common: provision of universal care.
As Mr. Vance notes, even that ultra-free-market, anti-big-government individualist Friedrich Hayek understood that government had health care obligations. When will American conservatives take a lesson from their cousins in Europe, Australia and elsewhere?
HENRY STECK, HOMER, N.Y.
The writer is emeritus professor of political science at SUNY Cortland.
To the Editor:
Contrary to some conservatives’ view that the government should just get out of the health care business, J. D. Vance argues that the “government bears some financial responsibility in solving a problem it helped create.” This argument rests on the faulty assumption that the government “created” the health care problem.
However, the major elements of the health care problem are the insurance companies’ desire for healthy profits and the pharmaceutical companies’ and medical device manufacturers’ insistence that they can raise the prices of their products to whatever level the market will bear, which, given their patents, can keep the prices high for the foreseeable future.
The health care crisis is caused not by the government, but by market forces, and the solution is for the government to step in to solve the problem.
DORIAN BOWMAN
CAMBRIDGE, MASS.
CAMBRIDGE, MASS.
To the Editor:
In blaming “government” for the high cost of health care and generic drugs, J. D. Vance fundamentally misunderstands how we got to this situation. The federal government began its involvement in health care after World War I in order to provide care and insurance for veterans because of a concern that private insurers would not cover them.
That involvement grew after World War II as those insurance companies failed to provide coverage for growing numbers of senior citizens and poor people. The first principle of the Rube Goldberg system we have today is to protect and preserve private insurance companies, not to provide efficient access to care, and the federal government has been forced to clean up the mess that private insurers won’t.
Mr. Vance also quotes Ronald Reagan from 1961 advocating a role for the federal government in providing access to care. He neglects to note that Reagan campaigned relentlessly against the creation of Medicare, something he later denied doing.
STEVEN CONN
YELLOW SPRINGS, OHIO
YELLOW SPRINGS, OHIO
To the Editor:
J. D. Vance is right when he states that government has a responsibility to provide health care, but wrong when he suggests the responsibility exists only because government broke the system. The system was broken before the Affordable Care Act came along, with tens of millions uninsured, countless more underinsured and health care costs spiraling out of control.
Obamacare addressed a lot of these problems, though admittedly further tweaks are needed. However, the experience of the past few months has shown that the Republicans are not the slightest bit interested in achieving Mr. Vance’s goal.
PERRY GERSHON
EAST HAMPTON, N.Y.
EAST HAMPTON, N.Y.
The writer is a Democratic candidate for Congress.
To the Editor:
In recent Op-Ed articles, J. D. Vance and Gov. John Kasich of Ohio (“The Way Forward on Health Care,” July 19) wrote about health care from the conservative point of view. Commendably, they criticize the Republican proposals to “repeal and replace” the Affordable Care Act.
But, significantly, they offer virtually nothing in the way of a conservative vision that they would substitute for the current law. This is not an oversight, or an omission due to lack of space. This is simply because the Affordable Care Act is, at its core, a conservative law. It preserves the free market insurance system, allows personal choice and requires personal responsibility. These are all supposedly conservative principles.
Until conservatives acknowledge this, we cannot have a serious discussion about the ways in which Obamacare can be improved.
BARRY J. BELLOVIN
BAYSIDE, QUEENS
BAYSIDE, QUEENS
The writer is a cardiologist.
To the Editor:
I thought Gov. John Kasich might have some useful suggestions on health care. Boy, was I wrong. He is sounding shrill in his partisan attacks disguised as a “way forward.”
If Republicans are not going to consider single-payer, maybe the governor could get his colleagues to: 1) eliminate the tax break for companies providing health care that covers over 170 million Americans, which is a government subsidy; 2) eliminate advertising of pharmaceuticals; 3) strengthen Medicaid rather than preach destruction; 4) fully fund the National Institutes of Health and basic research around the country; and 5) stop lying to the American people about offering better, beautiful, cheaper health care. That’s insulting.
STEPHEN R. FELDMAN
WHITE PLAINS
WHITE PLAINS
To the Editor:
Gov. John Kasich has some reasonable proposals for fixing health care, such as paying doctors for quality of care, not quantity, and making sure there are adequate tax credits for lower-income people.
But I take issue with the way he characterizes Obamacare. Positioning himself as nonpartisan, Mr. Kasich calls Obamacare a “rigid, convoluted plan” that, like the Republican plans, reflects “a single, partisan point of view.”
Whatever its flaws, Obamacare is not an extreme leftist system. It uses the once-conservative idea of the individual mandate to fund a mixture of private and public insurance exchanges. Congressional Republicans fought its passage tooth and nail not on its merits, but simply because it was being advanced by a Democratic president.
Single-payer health care is the leftist answer. And maybe it’s time we took a serious look at it.
JEREMY KAPLAN, BROOKLYN
We will survive this
by Garrison Keillor - Washington Post - August 1, 2017
So. We have a vulgar, unstable yo-yo with a toxic ego and an attention-deficit problem in the White House, and now we can see that government by Twitter is like trying to steer a ship by firing a pistol at the waves — not really useful — but what does it all add up to? Not that much, if you ask me, which you didn’t, but I’ll say it anyway.
Play Video 6:17
Every Russia story Trump said was ‘fake news’ or a ‘witch hunt’
President Trump continues to insist the Democrats are responsible for any story relating to Russian interference in the 2016 election despite a year's worth of evidence to the contrary. (Video: Meg Kelly/Photo: Jabin Botsford/The Washington Post)
We will survive this. He will do what damage he can, like a man burning books out of anger that he can’t read, but there will still be plenty of books left.
I went to my high school class reunion last week and the gentleman’s name never came up. He has been front-page news for months, every bleat, blurt, yelp and belch. His every gaseous eruption is played over and over on cable news. But among my old classmates, not a word. They spoke with awe and reverence of their grandchildren (we’re the class of 1960), some about travel, plumbing projects, beloved old cars, stories of youth and indiscretion, nothing about death or President Trump. After five hours with them, I have no idea whether they lean left or right. Remarkable.
Marvin Buchholz and Wayne Swanson are still farming, though they, like the rest of us, are 75 or close to it. They both know what sweet corn is supposed to taste like. Dean Johnson is still tinkering with cars. Rich Peterson is in terrific shape, thanks to teaching physical education all these years. His parents ran Cully’s Cafe out back of the Herald office where I wrote sports when I was 16, and I’d come in to eat hot beef and gravy on white bread and potatoes while reading my own immortal words in black type. They loved that boy, and he turned out well.
Bob Bell and I discussed some classmates whom I considered lowlifes and hoods because they wore black shirts with white ties and drove old cars with flame decals and loud mufflers, but he saw a better side to them and stood up for them, and good for him. His dad was an attorney, so Bob grew up with the idea that everyone deserves a good defense.
Carol Hutchinson was a librarian, Vicky Rubis a schoolteacher, Mary Ellen Krause worked at the town bank, one of the spark plugs who kept our hometown’s enormous Halloween parade going all these years. Carl Youngquist and I remembered our basketball team of 1958, a good bet to win State, but we lost in the early prelims to a bunch of farm boys from St. Francis. St. Francis! It was like Rocky Marciano being KOed by Mister Peepers.
It’s a privilege to know people over the course of a lifetime and to reconnoiter and hear about the ordinary goodness of life. By 75, some of our class have gotten whacked hard. And the casualty rate does keep climbing. And yet life is good. These people are America as I know it. Family, work, a sense of humor, gratitude to God for our daily bread and loyalty to the tribe.
If the gentleman stands in the bow and fires his peashooter at the storm, if he appoints a gorilla as head of communications, if he tweets that henceforth no transcendentalist shall be allowed in the armed forces, nonetheless life goes on.
He fulfills an important role of celebs: giving millions of people the chance to feel superior to him. The gloomy face and the antique adolescent hair, the mannequin wife and the clueless children of privilege, the sheer pointlessness of flying around in a 747 to say inane things to crowds of people — it’s cheap entertainment for us, and in the end it simply doesn’t matter.
What matter are tomatoes. There is an excellent crop this year, like the tomatoes of our youth that we ate right off the vine, juice running down our chins. There is nothing like this. For years, I dashed into supermarkets and scooped up whatever was available, tomatoes bred for long shelf life that tasted like wet cardboard, and now I go to a farmers market and I’m astonished all over again. A spiritual experience. The spontaneity of the tomato compared to the manufactured sweetness of the glazed doughnut. An awakening takes place, light shines in your soul. Anyone who bites into a good tomato and thinks about Trump is seriously delusional.
The generic drug industry has brought huge cost savings. That may be changing.
by Carolyn Y. Johnson - Washington Post - August 2, 2017
A decade ago, physicians who treat epilepsy got what seemed like a piece of good news: Eight companies had received federal approval to sell a generic version of an injectable lifesaving drug.
Doctors liked the brand-name drug Cerebyx because it was safer and easier to use than a previous medicine that stopped seizures but could cause terrible skin reactions. The only problem was that it was too expensive for many hospital pharmacy budgets. A widely available and cheaper generic version would remove those cost barriers — or so doctors thought.
But the introduction of Cerebyx’s generic form, fosphenytoin sodium, in 2007 — called “fospheny” for short by some doctors — did not over the long term produce the robust marketplace competition that is one of the main arguments for the generic industry.
The trajectory of generic Cerebyx shows the limitations of relying on the market alone to bring down drug prices and ensure supply — particularly for hard-to-make injectables or low-volume drugs, which are critical to the people who need them.
It’s the flip side of the low prices in the generic industry: Thin profit margins can turn temporary challenges such as active ingredient shortages or manufacturing delays into decisions to discontinue a drug altogether.
Companies stopped making fosphenytoin for several reasons, including technical challenges, production problems and decisions to concentrate on producing other drugs.
And Cerebyx was not an outlier. Recent studies of the generic drug industry show that low levels of competition may be far more normal than the public appreciates.
“More than 50 percent of generic drugs are supplied by one to two manufacturers; that really turns on its head the idea this is a competitive, commodity-like market, like widgets or milk or things that people use every day,” said Rena Conti, a health economist at the University of Chicago. “While there may be robust entry into these markets, over time these markets degenerate into monopoly or duopoly supply.”
Concerns about high drug prices often focus on the lack of generic competition, a problem the Trump administration has decided to tackle head on. The Food and Drug Administration last month hosted a day-long meeting devoted to understanding how companies may be gaming the approval process to delay or prevent competition from emerging.
Overall, generic drugs have been a major source of savings to the American health-care system, accounting for nearly nine out of 10 of all prescriptions filled but only about a quarter of the total spending on prescription drugs, according to the Association for Accessible Medicines, a trade group for the industry. But concerns that the market isn’t functioning as intended have been sparked by drug shortages and old drugs that have risen in price.
When it came to Cerebyx, generic competition blossomed — at first. Then, it withered. The drug’s price plummeted initially, but makers, facing production and commercial problems, left the market and the drug’s price crept back up. It has cycled through various shortages over the years.
The fading of competition has meant that years after it went generic, the lifesaving emergency drug wasn’t always easily available.
“We would have loved to use the fospheny and have it available,” said Tricia Ting, regional director of epilepsy at MedStar Georgetown University Hospital. “We were always told it’s so expensive . . . it wasn’t in our control as clinicians. I think we would have used it like gangbusters.”
Only two of the 13 approved generic versions of Cerebyx are being sold, according to Erin Fox, director of drug information at University of Utah Health. The list price, which plunged from $65 for a 10-milliliter vial of the brand name in 2007 down to a few dollars for the generic, according to Truven Health Analytics, has swung back up. Today, the generic price is $48 and Cerebyx is nearly $100 a vial.
Most people think about the drug price problem in simple terms: new cancer drugs or other specialty medicines with eye-popping price tags. For years, huge savings have been wrung from producing generic versions of old drugs.
But over the past few years, drug shortages and a few extreme cases in which companies have raised old drug prices to an outrageous level have fueled concern that this spending cliff isn’t working as well as it should. A Government Accountability Office report last year found that more than 300 of 1,441 generic drugs had at least one “extraordinary price increase” over a five-year period.
Most of the focus centers on the tactics companies use to actively delay or quash competitors, and regulatory obstacles thatmake it harder or less attractive for drugs to get approved in the first place.
But according to the FDA, more than half of its approved generics are not being sold and another 14 percent are of “unknown marketing status.” The agency said that less than a third of the generics it approved are being actively marketed. For some old drugs that have been eclipsed by newer and better drugs, that drop-off makes sense. But it also highlights a less obvious barrier to robust competition in the generic market: keeping competition going.
A consolidated market
The modern generic drug industry was kick-started by the Hatch-Waxman Act of 1984, considered one of the most important pieces of legislation in American health care. The reward for pharmaceutical companies investing in risky research and development was the power to set prices and reap the rewards of government-granted monopolies for a limited amount of time. Once their patents expired, competition could rush in.
Over the years, that set off a cottage industry of firms trying to outmaneuver one another. Drug companies use the legal system to try to discourage or delay generic competitors. They file “citizen petitions” with the FDA to raise questions about competitors’ products. They limit the distribution of their drugs so that other companies can’t obtain enough of the product to prove to regulators that their version is equivalent. They merge with competitors. Some took advantage of well-meaning policy incentives, finding old drugs that had never gone through the approval process, collecting the data to have them approved — and then raising the price.
“In the 1980s, when we passed the Hatch-Waxman Act, we thought we were getting a good balance between incentives for innovation and development of new drugs with the ability to have competition, which would have the advantage of giving us market forces to lower drug prices,” said Henry Waxman, a former congressman who co-sponsored the law. “I think that balance worked for a number of years, but it’s clearly not in balance today.”
Many of those problems would be amenable to policy or legislative fixes. A bill proposed in the Senate would expedite the review of drugs that are facing a shortage or that lack competition. But there is growing evidence that the generic market has become extremely consolidated, and it is far less clear what the FDA can do to change that.
A recent study in the Annals of Internal Medicine found that of 1,120 generic drugs, half were sold by just two companies. Low levels of competition were typical for drugs that were used by smaller numbers of people — and those drugs with the least competition experienced the biggest increases in price.
“It was surprising to me that the generic market looked as consolidated as it did,” said Aaron Kesselheim, an associate professor of medicine at Harvard Medical School who co-wrote the study. “That’s been building over the last 10 to 20 years, and I think it’s something that policymakers are going to have to look at now, given the fact the system relies so much on generic drugs to save money. This seems like a trend that should raise a red flag.”
What happens when the industry consolidates? A clue may lie in the injectable generics industry, where mergers, production problems and manufacturing delays have led to shortages.
Fox, at the University of Utah, said that when she is researching a drug shortage, she almost inevitably finds herself tracking down a drug that is made by just one or two, or even three producers — one of which has had some kind of a glitch. Maybe the active ingredient has had a shortage, or the producer suffered a problem with its manufacturing process.
“The same characteristics that make a product susceptible to shortages are the same characteristics that make a product susceptible to high price spikes,” Fox said.
In the case of a generic version of Cerebyx, fosphenytoin shortages were caused at various times by companies discontinuing products , voluntary recalls, manufacturing delays and production lines that went offline for various reasons.
The price didn’t spike, but after the price of the generic plunged, to as low as $3.45 for a 10-milliliter vial in 2011, it crept back up.
Where did the competition go?
The low price may have been too low for some companies to make money, or the thin margins may have led companies to make a business decision to devote their infrastructure to making a more lucrative drug.
Apotex stopped selling the drug in 2009 when the company ceased making injectable products due to “market dynamics,” the company said in a statement. But a spokeswoman said the drug was not profitable when the company discontinued it and was selling at less than $7 a vial.
Sun Pharmaceutical Industries received approval from the FDA in 2008, but didn’t launch the generic drug because of “technical challenges,” a company spokesman said.
Teva Pharmaceutical Industries put the production facility where it made the drug on a voluntary manufacturing hold in 2010. Fosphenytoin, which last sold for $6.60 for a 10-milliliter vial, was one of the drugs that the company did not bring back online. A Teva spokeswoman did not explain why.
Fresenius Kabi in 2014 recalled lots of the drug because of potential “glass delamination” which can leave glass particles in the vial.
The company has been working to change the vial to make it safer and is waiting for the FDA’s response, spokesman Matt Kuhn said in an email.
Pfizer had discontinued Cerebyx, but brought it back in 2013 “in response to a public need identified by regulators,” spokeswoman Rachel Hooper said in an email.
“Given the complexity of the production process, significant investment was required to produce reliable supply while ensuring the highest quality and safety standards,” Hooper said.
Mylan Pharmaceuticals and Amneal Biosciences launched their versions of the drug last year, at $48 a vial.
Mylan’s FDA approval for the drug, however, isn’t new — it dates back to 2010 and came with a company it acquired in 2013. A spokeswoman said that it launched the drug in December “upon operational readiness.”
Cerebyx and its generic aren’t a big, top-selling drug. Total annual sales of the drug were about $36 million, according to data disclosed by Mylan when it launched its generic in December. In part, Ting said, the early pricing challenges meant fosphenytoin wasn’t as widely used as it might have been, and she said many physicians may not even be aware that it is available in generic form. Meanwhile, other drugs have also gained popularity in treating seizures.
In that way, fosphenytoin is representative of the ups and downs of the generic industry — a big one that is made up primarily of small markets. A new analysis by Conti found that the median market size for any particular form of a drug is about $10 million in annual sales revenue — a far cry from the billion-dollar, blockbuster brand- name drugs. Keeping that industry vibrant will not only require more companies to be able to enter, but also keeping them in the game.
“The big thing is to prevent more erosion of competition in these markets,” Conti said. “The second piece, about what to do about markets that already have very limited competition, is a harder nut to crack.”
LePage Takes to National Press to Blast Collins, King
by Steve Mistler - Maine Public - August 2, 2017
In an opinion piece for the Wall Street Journal, LePage blasted Collins and King for their recent votes to deep-six a controversial Republican bill that would have dismantled key parts of the Affordable Care Act, also known as Obamacare.
Collins and King opposed the bill, saying it would have increased deductibles, jeopardized protections for people with pre-existing conditions and stripped thousands of Mainers from their health insurance.
But LePage, who also previously opposed the bill, wrote that the senators’ vote was “downright dangerous,” adding that the senators were more interested in “preening for the cameras” than pursuing meaningful changes to the health care system.
The governor’s WSJ commentary echoed his multi-day broadside against King and Collins. On Tuesday he used his weekly radio address to blast the two senators, as well as his weekly radio appearance on Bangor radio station WVOM.
The radio appearance prompted a response from Collins’s spokeswoman Annie Clark, who noted that the governor originally opposed the Senate health care bill before he supported it.
“Senator Collins met with countless people prior to these votes, including: hundreds of consumers, employers, rural nursing home and hospital executives, insurance regulators and actuaries, and health care providers,” Clark wrote in an email Tuesday. “She believes strongly that she cast the right votes on behalf of the people of Maine. We must now work together on a bipartisan bill that fixes the serious flaws in the ACA and works for all Americans.”
Clark also jabbed LePage’s apparent nostalgia for how U.S. senators were chosen during the 19th Century. Prior to the 17th Amendment, state legislatures elected senators, a process that the governor appeared to endorse in comments he made to WVOM.
“We were surprised to hear the Governor opposes having Senators elected directly by the people of Maine, as they have been for more than 100 years, and would rather go back to the system where the legislature handpicked Senators,” Clark wrote.
King’s office has not responded to LePage’s attacks.
The governor’s attack against King and Collins came amid speculation about his own political ambitions. For the past year he has repeatedly expressed a desire to challenge King during the 2018 election. That speculation diminished slightly in the spring. LePage told Portland radio station WGAN in April that he didn’t think he would be a very good legislator, and in May, his political advisor released a statement saying LePage will not run for the senate next year.
Nonetheless, LePage has recently said he’s rethinking his decision and may challenge King. On Tuesday he insinuated that someone associated with state Sen. Eric Brakey, an Auburn Republican who already is challenging King, leaked a video of the governor to the Bangor Daily News criticizing Collins during a Somerset County Republican pig roast.
LePage said the resulting news story made him want to run against King.
The governor has also said that he believes Collins will run for governor in 2018, potentially setting up a GOP primary between Maine’s senior senator and LePage’s former health and human services commissioner, Mary Mayhew.
Mayhew launched her gubernatorial bid early this summer, promising to continue the aggressive conservative agenda LePage has attempted to advance since his first term began in 2011.
Collins is one of the most popular politicians in the country. But the governor suggested during the Somerset County event that she could be vulnerable in a Republican primary if his base of supporters voted for someone else - presumably Mayhew.
Collins has not decided if she will pursue a gubernatorial run. She’s expected to make a decision sometime this fall.
Some political observers aren’t convinced LePage wants to run for the Senate and that he is instead angling for a job in the Trump administration.
That speculation was further fueled by a report in the Portland Press Herald,which used the state’s public records law to find that the governor and his staff spent more than $35,000 on luxury hotels, restaurants and travel during repeated trips to Washington, D.C. this year.
LePage was seeking an audience with members of Congress and the Trump administration during those trips.
The paper found that taxpayers paid for most of the trips, including a four-night stay at the Trump International Hotel.
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