Maine Voices: Today’s Republicans overlook conservative case for universal health care
They hesitate to state their views even though it's an idea consistent with conservative principles – respect for tradition, Judeo-Christian values, sanctity of life and individual freedoms.
by Daniel C. Bryant - Portland Press Herald - October 25, 2018
CAPE ELIZABETH — A May Maine Voices column that I co-authored discussed a poll of Maine gubernatorial and Cumberland County legislative candidates’ health care policies. No Republicans had responded. In a Sept. 17 letter, Barry Salter, M.D., wrote that Republican gubernatorial candidate Shawn Moody had not attended the Maine Medical Association annual meeting, while the other candidates had. On his website, Mr. Moody devotes to health care less than 20 percent of the space the other candidates do.
Why do Republicans seem so reluctant to state their views on such a vital issue, especially when an idea consistent with conservative principles – respect for tradition, Judeo-Christian values, business, sanctity of life, individual freedoms – is out there: government-funded, privately provided universal health care (Medicare for all)?
Prominent conservatives have accepted government responsibility for health care since at least the 1880s, when Chancellor Otto von Bismarck established universal health insurance in Germany as a way to stimulate the economy and resist socialism.
In 1944, economist Friedrich von Hayek, one of House Speaker Paul Ryan’s heroes, wrote that there is not “any reason why the state should not assist individuals in providing for those common hazards of life against which, because of their uncertainty, few individuals can make adequate provision. … There is no incompatibility in principle between the state providing greater security in this way and the preservation of individual freedom.” Winston Churchill included in the 1945 Conservative Party General Election Manifesto: “We propose to create a comprehensive health service covering the whole range of medical treatment from the general practitioner to the specialist.”
Ronald Reagan wrote in 1979, “I have always felt that medical care should be available to those who cannot otherwise afford it,” and proceeded to expand Medicare. A 1989 Heritage Foundation report stated that “all citizens should be guaranteed universal access to affordable health care,” and a goal of the 2016 Republican platform was “to ensure that all Americans have improved access to affordable, high-quality health care.”
That platform also emphasized “our country’s Judeo-Christian heritage.” The Bible gives healing of the sick top priority, from “I (God) will take sickness away from the midst of thee,” to Jesus’ granting his disciples power “to heal all manner of sickness,” to the “Go and do likewise” instruction of the Good Samaritan parable. Given Scripture’s importance to Republicans, they have good reason, if not the moral imperative, to act on it any way they can.
Warren Buffett argues for a government-funded, privately provided system because of the drain (“tapeworm“) that health insurance puts on American business, and his (Republican) business partner Charlie Munger told Yahoo Finance that he’s for it because of the waste and profiteering he sees in our present system.
MCS Industries CEO Richard Master and other members of the Business Initiative for Health Policy believe that “it is crucial to build a political movement behind Medicare for All, with candidates who are willing to take on the insurance and pharmaceutical industries’ oversized political influence.” In other words, business leaders advocate for a system in which health care no longer distorts competitiveness.
“Lack of health insurance is associated with as many as 44,789 deaths per year in the United States,” a 2009 study found. To support government-guaranteed universal health care, then, is to affirm the sanctity of life.
Such a system would free workers from a drag on raises as well as from the dependence on workplace health benefits that discourages workers from taking more rewarding jobs or becoming entrepreneurs themselves. It would free some of the uninsured, who are limited by illness, to enter the workforce. It would free patients from restrictive networks, and their providers from complex billing and restrictions on treatment plans. Freedom, in fact, is what this system, like conservatism itself, is all about.
Let’s hope that in the future, Republican candidates will be more forthcoming about their health care positions. Support of a government-funded, privately provided universal health care system would certainly be consistent with many conservative principles.
What Could Kill Booming U.S. Economy? ‘Socialists,’ White House Warns
by Binyamin Applebaum and Jim Tankersley - NYT - October 23, 2018
Karl Marx. Vladimir Lenin. Mao Zedong. Elizabeth Warren?
The White House Council of Economic Advisers on Tuesday published a 72-page report criticizing what it described as the socialist ideas of leading Democratic Party politicians, and seeking to link President Trump’s political rivals with figures reviled by most Americans.
The document departs from the council’s long tradition of delivering sober, albeit partisan, studies on current questions confronting economic policymakers, such as the value of tax cuts or the effects of increased corporate concentration. Instead, the report seeks to tar Democrats by linking them with the failed economic policies of communist governments in China, the Soviet Union and other countries.
The word “socialism” appears 144 times — on average, twice a page.
In case the point was lost on anyone, the message was driven home by a follow-up release from the White House press office with the headline “Congressional Democrats Want to Take Money From Hardworking Americans to Fund Failed Socialist Policies.”
The report does not shy away from lumping in liberal politicians and their policy proposals, such as Medicare for All and tuition-free college, with the atrocities committed by authoritarian regimes. For example, it compares Lenin’s demonization of kulaks, or yeoman farmers, to Ms. Warren’s critiques of the behavior of some large corporations. The report asserts that both are attacks on “oppressors of the vulnerable.”
The Soviet government seized land from kulaks, killing many of them. Ms. Warren says corporations should pay higher taxes and be subject to more stringent government regulation. So, not exactly beets to beets.
“It feels like the C.E.A. has a lot of free time on its hands,” said Austan Goolsbee, an economist at the University of Chicago’s Booth School of Business, who chaired the council under President Barack Obama. “Normally, the C.E.A.’s time is spent as a think tank for the president, adding up numbers. There’s not time to be contemplating Karl Marx.”
Here’s a snapshot of what the White House put out on Tuesday:
Socialism = bad
The meat of the council’s report is a detailed accounting of the human costs of oppressive socialist governments throughout history, and it summarizes the results of one of the greatest natural experiments in economic history: During the half-century after World War II, economic growth of the Western democracies and a few countries in East Asia vastly outstripped growth in the communist bloc.
Even into the 1980s, some prominent liberals continued to insist that communism was delivering superior economic results. But the fall of the Berlin Wall ended that argument. The conclusions of the report regarding the 20th century are essentially undisputed, at least by mainstream politicians in the United States: “While socialism was supposed to make people more equal and allow the poor to escape oppression, it was the end of socialism that brought more than a billion people out of poverty and made world incomes more equal.”
Hammering away on that point, the report mentions Cuba, China and the U.S.S.R. more than 30 times each. But the star of the report is Venezuela, which is mentioned nearly 60 times. The report estimates that emulating Venezuelan economic policies would cause the American economy to shrink by 40 percent. It’s something that Mr. Trump has repeatedly suggested Democrats want to do, but neither the president nor the report presents any evidence and no Democratic candidate has come anywhere close to embracing Venezuela’s policies.
Bernie, meet Mao
The report opens by asserting that “socialism is making a comeback in American political discourse.” The word itself is certainly enjoying a revival. A handful of high-profile politicians, including Senator Bernie Sanders of Vermont and Alexandria Ocasio-Cortez, a candidate for a House seat from New York, call themselves “democratic socialists.” A Gallup poll this year found that 51 percent of respondents between the ages of 18 and 29 had a positive view of socialism, however they defined the term.
The report acknowledges that these democratic socialists don’t see themselves as the heirs of, say, Lenin. It specifically notes that they’re not advocating violence. But it nonetheless seeks to connect liberals and their policy proposals to past socialist regimes.
“There are proposals on the table, like the ‘Medicare for All’ proposal, that are very consistent with the design of socialism,” Kevin Hassett, the chairman of the council, told reporters during a conference call to discuss the report on Tuesday.
The report frequently adopts the facile tactic of comparing or lumping leading liberal politicians and demagogues. For example:
The Chinese leader Mao Zedong, who cited Marxism as the model for his country, described “the ruthless economic exploitation and political oppression of the peasants by the landlord class” (Cotterell 2011, chap. 6). Expressing similar concerns, current American senators Bernie Sanders and Elizabeth Warren have stated that “large corporations . . . exploit human misery and insecurity, and turn them into huge profits” and “giant corporations . . . exploit workers just to boost their own profits.
And here:
The socialist narrative names the oppressors of the vulnerable, such as the bourgeoisie (Marx), kulaks (Lenin), landlords (Mao), and giant corporations (Sanders and Warren). Piketty (2014) concludes that the Soviet approach and other attempts to “abolish private ownership” should at least be admired for being “more logically consistent.”
And even in the footnotes:
“Speculators” are also blamed for high prices and other social problems, as by Marx, Stalin, Senator Sanders, Senator Warren, and Fidel Castro, who said that they “have turned the planet into a giant casino.”
Sweden is no paradise, especially for pickup trucks
When liberals speak fondly of democratic socialism, they often point to Scandinavia — and a set of higher-tax countries that provide more robust government services and safety nets to their citizens. The report acknowledges this — and then walks a fine line around it.
First, the council notes all the ways that Nordic countries don’t necessarily comport with a liberal ideal of government, including a heavy middle-class tax burden and lighter-than-you-might-expect regulation of business.
But even then, it contends, Nordic economies do not deliver in the way that the American economy does. That’s true in terms of per-capita income …
… and in terms of pickup truck ownership.
That’s right. Pickups.
The report leaves out some other stats that make Nordic countries look better than the United States, including several measures that show far fewer of their residents live in poverty.
What is socialism, anyway?
It’s a strange question to ask at the end of a 72-page report, but it’s one that the authors leave up for debate. Most important, they don’t define as “socialist” anything that the United States government currently does.
The federal government has long embraced important elements of a socialist agenda, such as providing retirement benefits and health care for poor children and older people. The report finesses this inconvenient truth by defining socialism as any effort to increase the government’s involvement in the economy. Thus the current Medicare program, which provides socialized medicine for older Americans, is defined as ideologically acceptable, while proposals to expand Medicaid are termed “socialized medicine.”
Let’s be clear, though: The report is decidedly not about “communism.” The authors detail why, in a footnote on Page 4:
For classical socialists, “communism” is a purely theoretical concept that has never yet been put into practice, which is why the second “S” in U.S.S.R. stands for “Socialist.” Communism is, in their view, a social arrangement where there is neither a state nor private property; the abolition of property is not sufficient for communism. As Lenin explained, “The goal of socialism is communism.” The supposed purpose of the “Great Leap Forward” was for China to transition from socialism to communism before the U.S.S.R. did (DikÓ§tter 2010). The classical definition therefore stands in contrast to vernacular usage of communism to refer to historical instances of socialism where the degree of control was the highest, such as the U.S.S.R., Cuba, North Korea, or Maoist China. This report therefore avoids the term “communism.”
https://www.nytimes.com/2018/10/23/us/politics/socialist-democrats-trump-elections.html
Are the Danes Melancholy? Are the Swedes Sad?
The truth about the Nordic economies.
by Paul Krugman - NYC - October 27, 2018
The recent report by the White House Council of Economic Advisers on the evils of socialism has drawn a great deal of ridicule, and rightly so. It boils down to something along the lines of “You want Medicare for All? But what about the terrible things that happened under Mao Zedong?” That’s barely a caricature.
However, one issue raised by the report has drawn some sympathetic appreciation even from liberals: the discussion of the Nordic economies, which are widely seen by U.S. progressives as role models. The report points out that real gross domestic product per capita in these economies is lower than in the U.S., and argues that this shows the costs of an expansive welfare state.
But is a negative assessment of the Nordic economies really right? That’s not at all clear. That lower G.D.P. number conceals two important points. First, by any measure people in the lower part of the income distribution are much better off in Nordic societies than their U.S. counterparts. That is, there is a lot less misery in Scandinavia — and because everyone has some chance of falling into low income, this reduces the risk of misery for a much larger share of the population.
Second, much of the gap in real G.D.P. represents a choice, not a cost. Nordic workers have much more vacation, much more time for family and leisure, than their counterparts in our “no vacation nation.”
So I thought it might be useful to put together some information on how the Nordic economies actually compare to the U.S.
First of all, the Nordics really have made drastically different choices in public policy. They aren’t “socialist,” if that means government control of the means of production. They are, however, quite strongly social-democratic: as Exhibit 1 shows, they have high taxes, which finance much more generous social benefits than we have here. They also have policies on wages, working hours, and more that tilt the balance toward workers in a number of dimensions.
So how do these policy choices affect individual incomes? Exhibit 2, put together with the help of my Stone Center colleague Janet Gornick, shows how incomes at different percentiles of the income distribution in Denmark and Finland countries compare with the US. (These are “equivalized” household incomes adjusted for household size. Unfortunately, for bizarre legal reasons the LIS Center, the source of these data, doesn’t have recent numbers for Sweden, but they presumably look similar.) Clearly, the Nordic economies are better for lower-income families — roughly the bottom 30 percent of the population.
But this understates the case, because these data don’t include “in kind” benefits like health care and education. All of the Nordic countries have universal health care — not just single-payer, but for the most part direct government provision (a.k.a. “socialized medicine.”) This compares with the U.S. where — especially before the Affordable Care Act went into effect — lack of health insurance was common even for families near median income, and high deductibles are an obstacle to care even for many of the insured.
Nordic education also lacks the glaring inequality in quality all too characteristic of the U.S. system.
Once you take these benefits into account, it’s likely that at least half the Nordic population are better off materially than their U.S. counterparts. But what about the upper half?
As the CEA notes, real G.D.P. per capita is lower in the Nordics than in the U.S., and that’s reflected in those lower incomes for the upper half of the income distribution. But it’s worth looking at why G.D.P. is lower.
Exhibit 3 shows how real G.D.P. per capita in Denmark, Finland, and Sweden compares with the U.S., and the sources of that difference. It turns out that a large part of the difference — in the case of Denmark, more than all of it — comes from a lower number of hours worked annually per worker. This does not reflect mass underemployment. Instead, it reflects policy: all of the Nordic countries require that employers give workers a minimum of 25 days of paid vacation every year, while the U.S. has no leave policy at all.
Once you take vacations into account, Denmark and Sweden basically look comparable in performance to the U.S. Finland looks worse, but this is something of a special case: the Finnish economy has been ailing for a number of years, not because of socialism, but because its two premier exports — Nokia and wood pulp — were hit hard by technological change, and membership in the euro has made adjustment difficult.
The point for welfare comparisons is that while Nordic families at, say, the 60th percentile of the income distribution have lower purchasing power than their American counterparts, they also have much more free time and an arguably better work-life balance. Are they really worse off? You can make a good case that taking all of this into account, the majority of Nordic citizens are actually better off than Americans.
And for what it’s worth, they think so too. The O.E.C.D. publishes measures of self-reported “life satisfaction”; all of the Nordic nations rank above the U.S. Objective measures like life expectancy and mortality rates are also much better in Scandinavia.
The bottom line is that real G.D.P. per capita isn’t everything, and you shouldn’t uncritically use that measure to judge how social democracy is working in Scandinavia.
California nurses move their ‘Medicare-for-all’ fight to the national stage
by Angela Hart - Capitol Alert - October 26, 2018
The union representing 100,000 nurses across California has shifted its “Medicare-for-all” campaign from California to the national stage, perhaps relieving political pressure on Democratic gubernatorial candidate Gavin Newsom to fulfill what the union sees as his top campaign promise: Delivering a single-payer health care system in the nation’s largest state.
The California Nurses Association, which led the coalition behind the high-profile 2017 push for a single-payer system, has re-branded its campaign with the slogan “Fight to Win Medicare-for-All!” Its social media feeds reflect the new national scope of their efforts.
Until this month, the coalition, previously called “Campaign for a Healthy California,” was focused solely on passing a single-payer health care bill in California. Their campaign reached a fervor in late 2017 and early 2018, when nurses and single-payer activists stormed the California Democratic Party convention and later, the state Capitol, calling on Democratic lawmakers to approve their single-payer bill.
Representatives for the union, joined by its parent organization, National Nurses United, are now expanding their efforts to Congress and other states, such as Florida, Maine, Minnesota and Texas. They say they’re not letting up in California.
“We’re not conceding or taking a loss here. There will be a single-payer bill next year,” said Stephanie Roberson, a spokeswoman for the California nurses union. “Our aim is to put strategic pressure on states where we see opportunities to provide health care for all, so we can make that national shift.”
“California is a starting point,” Roberson said.
Still, individual states face steep challenges in creating, within their borders, a new health care system that operates under a different set of rules and laws than the nation as a whole, said Gerald Kominski, a professor of health policy at the UCLA Center for Health Policy Research.
He said the nurses’ new efforts to apply pressure on Congress, and national candidates, could also be an acknowledgment that California can’t do it alone.
To create and pay for a single-payer system, under which the government would be the sole “payer” of health care services, California would need multiple approvals from the federal government to both collect federal health care dollars for the state-run system and to bypass regulations on employer-based private health plans. It would also have to amend the state Constitution.
“I think it’s the realization that developing a single-payer system at the state level faces significant legal barriers that maybe they’ve acknowledged…are more substantial than they were willing to admit publicly a year ago,” Kominski said. “It also might be a recognition that you’re pushing the next governor out too far on a limb, where you’re likely to be left hanging.”
Newsom has shifted his tone on single-payer, a system under which government, generally, becomes the primary payer of all health care services. Before the primary he said of single-payer: “It’s about time, Democrats.” He now says universal health care is the ultimate goal.
Nurses say they plan to hold Newsom accountable on his earlier comments and expect him sign a single-payer health care bill into law should he become governor. But their shift to a national focus could also be an opening to letting Newsom off the hook, Kominski said.
“Part of what this shows is the fight really does need to take place in Washington,” he said.
Holly Miller, a spokeswoman for the national nurses union, said the expansion into other states also aligns the push for a nationwide single-payer system, championed by Sens. Bernie Sanders and Kamala Harris.
“We did the re-branding of the social media feeds so we could show the much broader focus of the ‘Medicare-for-all’ campaign,” Miller said. “We’re using the movements in California and Florida to talk about the national fight. We’re for single-payer health care, whether we get it at the state level, or nationally.”
President Donald Trump, meanwhile, has blasted the idea of single-payer as an expensive fantasy for Democrats.
“In practice, the Democratic Party’s so-called Medicare for All would really be Medicare for None,” Trump wrote in a USA Today editorial earlier this month. Large portions of it have been widely discredited as false and misleading.
Critics say the nurses’ move could aid efforts underway to steer the next governor and the Legislature away from single-payer.
“It may...clear some space for more constructive discussions about how to achieve universal health care,” said Ned Wigglesworth, a political strategist working with doctor and hospital groups to oppose state single-payer efforts.
Newsom has acknowledged the political and financial challenges he’d face should he and others lawmakers decide to push for a single-payer system.
“We need partners in the federal government, so I’m not Pollyannaish about any of this. I’m a hard-headed pragmatist about it,” Newsom said in an interview last month.
Still, he said, “I do believe single-payer financing, as broadly defined in (a) “Medicare-for-all” type system, is an advantageous system compared to our multi-payer system, and I’m deeply engaged in figuring out the how…I’m not walking away from this.”
He said ultimately, his goal is “universal health care, regardless of pre-existing condition, ability to pay, immigration status.”
Nurses are not letting up. The unions say universal health care — extending coverage to everyone — alone does not go far enough. Universal health care can be achieved through a single-payer financing system, or under California’s current multi-payer system.
“We are absolutely aware of what appears to be waffling with respect to Newsom’s stance on single-payer,” Roberson said. “But we are going to hold him to what we know to be the case, which is if there is a single-payer bill — which there will be in the state of California — that gets to his desk, he will sign it and we will hold him to that.”
Health Care, Hatred and Lies
by Paul Krugman - NYT - October 25, 2018
Until recently, it looked as if the midterm elections might be defined largely by an argument about health care. Over the past few days, however, the headlines have been dominated instead by hatred — hysteria over a caravan of migrants a thousand miles from the U.S. border, and now the attempted assassination of multiple prominent Democrats.
But whoever sent the bombs and why, the caravan hysteria is no accident: creating a climate of hatred is how Republicans avoid talking about health care. What we’re seeing in this election is a kind of culmination of the strategy the right has been using for decades: distract working-class voters from policies that hurt them by promoting culture war and, above all, racial antagonism.
When it comes to substance, the modern conservative policy agenda, which centers on cutting taxes and tearing up the social safety net, is consistently unpopular. By large margins, voters want to raise, not lower, taxes on corporations and the wealthy. They overwhelmingly oppose cuts in Social Security, Medicare and Medicaid. Even self-identified Republicans favor preventing insurers from discriminating against people with pre-existing medical conditions — something Obamacare does, but Republican health proposals wouldn’t.
So how do Republicans manage to win elections? Partly the answer is that gerrymandering, the Electoral College and other factors have rigged the system in their favor; Republicans have held the White House after three of the past six presidential elections, despite winning the popular vote only once. And they will probably hold the House unless Democrats win by at least 6 percent.
Also, let’s not forget about voter suppression, which is putting an increasingly heavy thumb on the scale. Still, given how unpopular Republicans’ policy positions are, how do they even get close enough to cheat?
One way they have traditionally gotten there is with red-baiting, portraying any and all progressive policies as the next thing to Communism. More than half a century ago, Ronald Reagan warned that Medicare would destroy American freedom. (It didn’t.) A few days ago, the Trump White House issued a report equating Medicare for All with Maoism.
Another key tactic involves lying about both their own positions and those of their opponents. During the administration of George W. Bush, the lies were relatively subtle by current standards, involving things like pretending that tax cuts favoring the rich were actually aimed at the middle class. These days, the lies are utterly shameless, with candidates who have worked nonstop to dismantle protections for pre-existing conditions posing as champions of such protections, and accusations that Democrats are the ones trying to destroy Medicare.
But lies about policy, while they may confuse some voters, aren’t enough. Hate has always been part of the package.
Let’s not romanticize the past. When Reagan talked about welfare queens driving Cadillacs, or a “strapping young buck” using food stamps to buy steaks, he knew exactly what he was doing.
Under Trump, however, the strategy of hatred has gone to a whole new level.
For one thing, after decades of cloaking its strategy in euphemisms, the G.O.P. is back to letting racists be racists. Hardly a week goes by without the revelation that some Trump official or prominent Republican supporter is a bigot and/or white nationalist.
At the same time, the mainstream G.O.P. has gone all in on the kind of conspiracy theorizing — tinged with anti-Semitism — that used to be restricted to the fringe. For example, not only Trump but also senior senators like Charles Grassley have bought into the false claim that people protesting Brett Kavanaugh were paid by George Soros.
Finally, threats of retribution against political opponents and critics have become standard fare on the right, and not just in the chants of “lock her up” — which Trump led on the same day someone sent Hillary Clinton a bomb. Ted Cruz may have been joking when he suggested sending Beto O’Rourke to jail, but that kind of joke would have been unthinkable not long ago.
And it’s hard to see calling the news media “enemies of the people” as anything other than an incitement to violence.
So will this ramped-up strategy of hate work? It might, in part because those same news media still dance to the haters’ tune. Take the story of the migrant caravan. The right’s hysteria is obviously insincere; it’s clear that it is hyping the story to take attention away from health care and other substantive issues: Never mind pre-existing conditions! Look at those scary brown people!
Yet major news organizations have given the caravan saturation coverage, more than they’ve ever given health care, all the same.
The thing is, if this strategy of hate works in the midterms, the right will pursue it even more avidly. Don’t expect anyone involved to experience any pangs of conscience. Indeed, after CNN and several prominent critics received bombs in the mail, Trump blamed … the media.
I have seen the future, and it’s full of menace.
Trump Rule Would Compel Drug Makers to Disclose Prices in TV Commercials
by Robert Pear - October 15, 2018
WASHINGTON — Over vehement objections by drug companies, the Trump administration proposed on Monday a new federal regulation that would require them to disclose the list prices of prescription drugs in their television advertisements.
The proposal sets the stage for a battle with the pharmaceutical industry, which said the requirement would be a form of “compelled speech” in violation of the First Amendment.
“Patients deserve to know what a given drug could cost when they’re being told about the benefits and risks it may have,” Alex M. Azar II, the secretary of health and human services, said in a speech at the National Academy of Medicine. “They deserve to know if the drug company has pushed their prices to abusive levels.”
Mr. Azar compared the proposed rule to longstanding requirements for automakers to disclose sticker prices.
“You buy a car every once in a while,” Mr. Azar said. “But millions of American patients buy expensive drugs every month. And a year’s worth of the most advertised drugs, mind you, can cost more than a car.”
The chief lobby for the drug industry, the Pharmaceutical Research and Manufacturers of America, announced earlier on Monday that its 33 members would voluntarily include information in TV ads directing viewers to company websites where they could find data on list prices and estimates of the typical out-of-pocket costs for patients.
Mr. Azar said that this was “a small step in the right direction,” but that voluntary action was not enough. “The drug industry remains resistant to providing real transparency around their prices, including the sky-high list prices that many patients pay,” Mr. Azar said.
Stephen J. Ubl, the president and chief executive of the drug makers’ lobby, known as PhRMA, said the industry’s proposal was much more feasible. To require the disclosure of list prices in TV commercials would be “very confusing and misleading, lack appropriate context and isn’t what patients want or need,” he said.
The Centers for Medicare and Medicaid Services proposed the new rule under federal laws that govern the two huge health programs, which between them cover nearly all prescription drugs, officials said.
The proposed rule would apply to any drug if the list price, also known as the wholesale acquisition cost, was greater than $35 for a month’s supply or for the usual course of therapy. The 10 most commonly advertised drugs have list prices ranging from $535 to $11,000 for a month or for a course of therapy, the administration said.
Asked about enforcement, federal officials said they would maintain a public list of drug products found to be in violation of the price disclosure requirement. But, the proposal says, the “primary enforcement mechanism” would be the threat of lawsuits under a 1946 law known as the Lanham Act, for unfair competition in the form of false or misleading advertising.
The proposed requirement would not apply to drug advertising in magazines and newspapers or on websites or social media.
The public will have two months to comment on the proposal. The government will consider the comments before issuing any final rule with the force of law.
The list price is generally understood to be the sticker price set by a drug manufacturer, before discounts and rebates to middlemen and financial assistance to patients.
Drug company executives and some consumer advocates say that the disclosure of list prices in ads, without more information, could perversely discourage patients from considering helpful medicines, especially those with high price tags.
Moreover, the price that patients pay depends on many factors: Do they have insurance? Have they met the deductible? Is the drug on the insurer’s list of preferred medicines?
Federal officials said the list price was meaningful because patients, including Medicare beneficiaries and people with high-deductible health plans, often pay the list price or a price based on it.
Under the proposal, drug companies would have to disclose price information “in a legible textual statement” at the end of each TV ad. The statement would have to appear on the screen long enough, in large enough type, so that it could easily be read.
The proposed rule would carry out ideas set forth in May in Mr. Trump’s blueprint to lower drug prices, but it is a sharp departure from his usual efforts to promote market-based solutions and slash federal regulations.
Under the PhRMA proposal, drug prices would not necessarily appear in ads, as Mr. Trump wants.
The group’s member companies voluntarily endorsed a declaration of principle stating, “All direct-to-consumer television advertising that identifies a medicine by name should include direction as to where patients can find information about the cost of the medicine, such as a company-developed website, including the list price and average, estimated or typical patient out-of-pocket costs, or other context about the potential cost of the medicine.”
It is unclear how useful the information would be to consumers. Each company would disclose the prices of its advertised products on its own website.
Holly Campbell, a spokeswoman for PhRMA, said, “A given product may have different list prices depending on the dosage of a medicine, and companies will have to determine how to report a list price if this is the case.”
It may therefore be difficult for patients to compare the prices of similar drugs.
James C. Stansel, the general counsel for PhRMA, said that any effort by the government to force drug makers to disclose prices in their ads would be subject to legal challenge. “If the government is compelling companies to speak, that violates the First Amendment,” Mr. Stansel said.
It is not unusual for drugs now to cost $50,000 or $100,000 a year. Mr. Azar said Mr. Trump was determined to bring “price transparency” to the market in an effort to stimulate competition and overturn the current convoluted, opaque system in which everyone but the consumer benefits from higher prices.
Ben Wakana, the executive director of Patients for Affordable Drugs, a consumer group, supported the administration’s effort, but said: “Disclosing list prices in ads does not lower drug prices. There is no evidence that providing patients and consumers access to list prices will result in lower prices.”
What Big Pharma Fears Most: A Trump Alliance With Democrats to Cut Drug Prices
by Robert Pear - NYT - October 20, 2018
WASHINGTON — The pharmaceutical industry, pilloried by President Trump for the last two years, is war-gaming for the possibility that its worst fear is realized: that Democrats, if they flip control of the House, find common ground with the president to rein in drug prices.
Democrats say they are determined to squeeze the industry’s prices and profits, and they have a stack of legislative proposals that could do so. Drug makers are quietly making contingency plans.
“As the midterm elections approach, a feeling of foreboding has settled over the pharmaceutical industry,” said John E. McManus, a Republican health care lobbyist whose clients include major drug companies, as well as their trade association, the Pharmaceutical Research and Manufacturers of America.
“Combine the rising blue wave — the Democrat fixation on pharmaceutical pricing — with President Trump’s populist focus on getting credit for cutting patients’ drug costs, and the industry could be confronting a perfect storm in 2019,” Mr. McManus said.
Soon after his election, Mr. Trump bucked his party and accused drug companies of “getting away with murder.” In May this year, he unveiled a blueprint to lower drug prices. He followed through this past week with a proposal to force drug companies to disclose list prices in their television advertisements.
Democrats’ ideas include allowing Medicare to negotiate lower drug prices; putting a cap on Medicare beneficiaries’ out-of-pocket drug costs; requiring manufacturers to disclose and justify any significant price increases; and outlawing tactics used by brand-name drug makers to delay the development and marketing of lower-cost versions of their products.
If Democrats retake the House, the gavel of the Health Subcommittee of the Ways and Means Committee could go to Representative Lloyd Doggett of Texas, an unyielding critic of what he calls price gouging by pharmaceutical companies.
Drug companies say they are counting on the Senate — which political forecasters say is more likely to remain in Republican control — to stop legislation they oppose. But changes are coming there, too.
Pharmaceutical companies will be losing one of their most powerful allies, Senator Orrin G. Hatch, Republican of Utah and the chairman of the Finance Committee, who is retiring after more than 40 years in Congress.
He is likely to be succeeded as chairman by Senator Charles E. Grassley, an Iowa Republican who is more of a populist on health policy. In 2015, he and Senator Ron Wyden, Democrat of Oregon, issued a blistering report on their 18-month investigation of the high prices charged by Gilead Sciences for two hepatitis C drugs.
Mr. Grassley has long supported allowing importation of prescription drugs from Canada — anathema to the industry. He wrote the provisions of federal law that require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment. Mr. Grassley is also the foremost champion of whistle-blower laws, under which drug companies have paid billions of dollars to resolve allegations that they defrauded the government or engaged in illegal marketing practices.
The challenges facing the industry were laid out in stark terms this month by Covington & Burling, a Washington law firm that has been advising pharmaceutical companies for more than 75 years.
Rujul Desai, a lawyer, said in a webinar that the firm had done “war-gaming exercises” with senior drug company executives to prepare them for possible congressional investigations and hearings on drug prices. The goal, he said, is to help clients “communicate the value of their innovative medicines.”
One of his colleagues at Covington, Jennifer L. Plitsch, explained how the government could try to use existing laws to force a reduction in the prices of drugs developed with the help of taxpayer funds.
The government has rarely used this authority, Ms. Plitsch said, but that could change. “It is,” she said, “a very easy sound bite for price control advocates: Why should American taxpayers both contribute to drug development and then pay the highest prices in the world as patients?”
She suggested how drug companies could answer that argument: “The sound bite is misleading and simplistic. The proposal would chill innovation and hurt patients. A vast majority of the investment in drug development comes from private industry, not the government.”
The politics of drug prices cross party lines. Senator Richard J. Durbin of Illinois, the No. 2 Senate Democrat, was among the first to praise Mr. Trump’s plan to mandate the inclusion of drug prices in TV ads.
Representative Jan Schakowsky of Illinois, a liberal Democrat, said she was “surprised and happy” to receive a phone call from the Trump administration notifying her of its price-disclosure proposal, which resembles a bill she introduced in July.
“Despite their army of lobbyists,” Ms. Schakowsky said, “drug companies should be very, very worried. Drug costs will be one of the first things on our agenda.”
Another Democrat poised to pounce is Representative Elijah E. Cummings of Maryland, who is in line to become chairman of the Committee on Oversight and Government Reform if Democrats take control of the House. In the last four years, he has aggressively investigated the industry, peppering drug makers and the Trump administration with numerous requests for information.
Doctors, patients and insurers support many of the efforts to hold down drug costs. Researchers are making significant progress against cancer and other diseases, but “access is meaningless without affordability,” said Dr. Victor J. Dzau, the president of the National Academy of Medicine.
Mr. Trump’s latest budget would provide Medicare beneficiaries with better protection against high drug costs by limiting their out-of-pocket expenses. Under another Trump proposal that could appeal to Democrats, Medicare beneficiaries would receive more of the savings that insurers extract from drug manufacturers.
The Democrats’ proposal for the government to negotiate drug prices for millions of Medicare patients is their preferred solution. But it would also face the most opposition, from drug makers and Republicans who see it as a step toward price controls.
As he campaigned for the presidency, Mr. Trump said he would “negotiate like crazy” to secure lower drug prices for Medicare. The idea — opposed by administration officials who have worked in the pharmaceutical industry — has dropped off his agenda.
“President Trump has seemingly abandoned his campaign promise to have Medicare negotiate like crazy,” said Nancy Pelosi, the House Democratic leader. But, she added, “we hope he would work with a Democratic majority to deliver on negotiation authority and lower drug prices.”
Drug companies seek to maintain their influence and access in the Capitol with campaign contributions and platoons of lobbyists recruited from both parties.
The drug industry has contributed nearly $12 million to candidates in this year’s congressional races, about 60 percent of it to Republicans, according to data compiled by Kaiser Health News. That sum is dwarfed by the $267 million that drug makers report having spent on lobbying in 2017-18, according to the Center for Responsive Politics, an independent group that tracks money in politics.
“Drug companies have been in such a strong position, and they have contributed so generously to people in both parties, they’ve been pretty well able to block anything,” Mr. Doggett said. “But I do believe that there is now a public outcry, a real pent-up demand, that we take action.”
Trump’s Ignoring Our Real ‘National Emergies’
Instead of migrants fleeing Central America, maybe the real “National Emergy,” to use the president’s spelling, is drugs, homelessness, gun deaths and lack of health insurance.
by Nicholas Kristof - NYT - October 24, 2018
It’s not about immigration. It’s about bigotry.
That’s the real story — to the extent there is a story at all — about the caravan of 5,000 impoverished Central Americans rampaging toward the United States border at, er, two miles an hour.
President Trump, ever the champion speller, declares this to be a “National Emergy”! He may call out the Army! He’s talking about sealing the border!
So, here’s some perspective, by my back-of-envelope calculations:
- More than 1.4 million foreigners immigrate to the United States each year. If, say, half the caravan reaches the border, and half of those people actually enter the U.S., they would represent less than one-tenth of 1 percent of this year’s immigrants.
- If the caravan proceeds by foot, during the period of its journey 16,800 Americans will die from drugs.
- In the period of the caravan’s journey, perhaps 690,000 Americans will become homeless, including 267,000 children.
- In the period of the caravan’s journey, 8,850 Americans will die from guns, including suicides and murders.
- In the period of the caravan’s journey, perhaps 9,000 Americans will die from lack of health insurance (people die at higher rates when they’re uninsured, although there’s disagreement about how much higher).
Maybe the real “National Emergy” is drugs, homelessness, gun deaths and lack of health insurance?
Trump’s trumpeting isn’t protecting America, and the number of people is so modest that the issue isn’t really even immigration. Rather, it’s fearmongering. Scholars have found that reminding people of dangers makes them temporarily more conservative, so this kind of manipulation can be an effective campaign tactic.
Remember the 2014 midterm elections? This is a replay. In the run-up to voting, Republicans ratcheted up fears of a “border crisis” with terrorists sneaking in from Mexico to attack us, plus alarm about Ebola and the risk that the outbreak in West Africa could reach America.
“President Obama, you are a complete and total disaster, but you have a chance to do something great and important: STOP THE FLIGHTS!” tweeted Donald Trump at the time. His public health vision: Let Ebola destroy Africa and much of the rest of the world, but try to seal off the United States from infection.
Trump also tweeted then that if a New York physician who returned from West Africa developed Ebola (as he later did), “then Obama should apologize to the American people & resign.” And a Fox News contributor, Dr. Keith Ablow, said in a radio broadcast that Obama maybe wanted Americans to suffer Ebola because his “affiliations” were with Africa rather than America.
In the 2014 elections, Republican candidates ran hundreds of ads denouncing the Obama administration’s handling of Ebola. News organizations chronicled this “debate,” but in retrospect they were manipulated into becoming a channel to spread fear — and win Republican votes.
Politically, this was quite effective, and Republicans won sweeping gains across the country and seized control of the Senate. Yet Ebola, like the Central American caravan, is a reminder of the distinction between grandstanding and governing.
Obama’s technocratic Ebola program — working with France and Britain, plus private aid groups — may have worried voters, but it was effective. Instead of careening around the world to kill millions and devastate the global economy, the Ebola virus was contained and eventually burned out. Good governance often turns out to be bad politics, and vice versa.
The same is true of immigration.
Perhaps the approach with the best record is aid programs to curb gang violence in countries like Honduras, to reduce the factors that lead people to attempt the dangerous journey to the United States. Yet it’s not tangible and doesn’t impress voters. So Trump instead is talking about an expensive wall and about cutting aid to Central America, even though this would magnify the crisis there and probably lead more people to flee north.
“Cutting off U.S. aid to these humanitarian organizations will just push more children into desperation and silence the most persistent voices for reform,” said Kevin Ryan, president of Covenant House, which assists children in the United States and Central America. “It’s exactly the wrong move.”
I fear that we in the media have become Trump’s puppets, letting him manipulate us to project issues like the caravan onto the agenda.
Trump is right that, although there’s no evidence of it, “there could very well be” Middle Easterners hiding in the caravan. It’s equally true that the Easter Bunny “could very well be” in the caravan. Speaking of Easter, Jesus Christ “could very well be” in the caravan.
So let’s stop freaking out about what “could very well be” and focus on facts. Here are two: First, the Caravan won’t make a bit of difference to America. Second, we have other problems to focus on, from drugs to homelessness to health care, that genuinely constitute a “National Emergy.”
Advice From Health Care’s Power Users
When you’re sick, the health care system can be scary and confusing. But in a recent survey, seriously ill Americans shared some hard-won wisdom.
by Margot Sanger-Katz - NYT - October 20, 2018
If the health care system seems confusing to you, you are not alone. In a large recent survey of the most seriously ill people in America, we learned that they, too, find it difficult to navigate. But they have developed a few strategies for getting through. Here are some tips and pitfalls about how to be sick from a group with lived experience.
If the health care system seems confusing to you, you are not alone. In a large recent survey of the most seriously ill people in America, we learned that they, too, find it difficult to navigate. But they have developed a few strategies for getting through. Here are some tips and pitfalls about how to be sick from a group with lived experience.
Keep records and bring them
Among the seriously ill people we surveyed with the Commonwealth Fund and the Harvard T.H. Chan School of Public Health — those who had been hospitalized twice and seen three or more doctors in recent years — bringing documents with them to doctor’s appointments was common. Seventy-eight percent of them carried a list of medications. Seventy percent brought a list of questions.
Many people in our survey had seen more than five doctors in the last year. So bringing records with them made sense, to ensure that each physician knew what others were doing. In an ideal world, every doctor would have a patient’s complete medical records. But, in many cases, medical records remain siloed and hard to share digitally.
Some patients in our survey said working on questions in advance was empowering. Doctor’s visits are often over before you know it, and it can be hard to follow up afterward.
“The doctor is just going to come in poke you and go, and you can’t let them go until you feel comfortable with everything,” said Tristan Berger, 47, of Tucson, who has had numerous orthopedic operations for complications from spina bifida.
Among the seriously ill people we surveyed with the Commonwealth Fund and the Harvard T.H. Chan School of Public Health — those who had been hospitalized twice and seen three or more doctors in recent years — bringing documents with them to doctor’s appointments was common. Seventy-eight percent of them carried a list of medications. Seventy percent brought a list of questions.
Many people in our survey had seen more than five doctors in the last year. So bringing records with them made sense, to ensure that each physician knew what others were doing. In an ideal world, every doctor would have a patient’s complete medical records. But, in many cases, medical records remain siloed and hard to share digitally.
Some patients in our survey said working on questions in advance was empowering. Doctor’s visits are often over before you know it, and it can be hard to follow up afterward.
“The doctor is just going to come in poke you and go, and you can’t let them go until you feel comfortable with everything,” said Tristan Berger, 47, of Tucson, who has had numerous orthopedic operations for complications from spina bifida.
Find an advocate
More than half the people in our survey said they brought a friend or family member with them to every appointment. When you’re sick, you may not remember everything that is said to you. A second set of eyes and ears can be helpful.
People who are very ill, said John Benson, a senior research scientist at Harvard who helped devise the survey, “need somebody who will be able to function who is not ill.”
About a third of people in our survey said they had a friend or family member in the health industry whom they could go to for advice. Those people were often used as sounding boards for finding the best doctors, or troubleshooting problems with treatments. Of course, not everyone has the good fortune to have a medical professional in the family.
Another group of patients — just under half — had a professional attached to their doctor’s office or insurance company in charge of coordinating their care. According to the results, such people had an easier time navigating the system than those who did not. They were less likely to report having duplicate tests or procedures and more likely to understand the costs associated with their care. Ninety-five percent of people with such a coordinator found that person helpful.
Dana Lewis, 59, of Edmond, Okla., who has helped to care for her ill daughters and husband, says that outside health advocates have made a big difference when she has been faced with large bills or confusing messages from medical providers. “If it weren’t for the health advocates, I couldn’t do it,” she said.
More than half the people in our survey said they brought a friend or family member with them to every appointment. When you’re sick, you may not remember everything that is said to you. A second set of eyes and ears can be helpful.
People who are very ill, said John Benson, a senior research scientist at Harvard who helped devise the survey, “need somebody who will be able to function who is not ill.”
About a third of people in our survey said they had a friend or family member in the health industry whom they could go to for advice. Those people were often used as sounding boards for finding the best doctors, or troubleshooting problems with treatments. Of course, not everyone has the good fortune to have a medical professional in the family.
Another group of patients — just under half — had a professional attached to their doctor’s office or insurance company in charge of coordinating their care. According to the results, such people had an easier time navigating the system than those who did not. They were less likely to report having duplicate tests or procedures and more likely to understand the costs associated with their care. Ninety-five percent of people with such a coordinator found that person helpful.
Dana Lewis, 59, of Edmond, Okla., who has helped to care for her ill daughters and husband, says that outside health advocates have made a big difference when she has been faced with large bills or confusing messages from medical providers. “If it weren’t for the health advocates, I couldn’t do it,” she said.
Ask questions, and listen
We asked people in our survey whether they’d developed any special tricks or workarounds in navigating the system. The most common answers fell into two categories. One group said it was important to follow doctors’ advice. The other said it was important to do outside research, ask questions and get second opinions.
That split reflects just how hard it can be to navigate the health care system when you’re sick. The people in our survey tended to have very serious health problems, sometimes several at once. They counted on the system to help them, but also recognized that it often let them down.
We might think of the seriously ill as the most experienced users of our health care system. They are. But they are also sick. Despite the above advice, patients in the survey described the health care system as perplexing and overwhelming. Sixty-two percent said they’d been rendered “anxious, confused or helpless” by the experience.
When asked about specific types of misunderstanding, 18 percent said advice by different medical professionals conflicted, and 15 percent said they couldn’t even understand what was being done to them. Twenty-two percent said that hospital staffers weren’t responsive to their needs.
Perhaps that’s why seven of the survey’s respondents also offered the following advice: Pray.
My Wife Was Just Diagnosed with Cancer: What this means under Universal Healthcare
by dfh1 - The Daily Kos - October 15, 2018
My wife has always been one of my heroes. She is a strong woman who confronts challenges with a combination of courage, hope and humour. And now, after her diagnosis of Uterine Cancer, she is approaching this latest fight with this same combination of strengths. I really am in awe of her. We have been married now for 27 years. Even with this diagnosis, we believe our journey will continue into a healthy retirement and for many years to come.
She will need all her strength, just as anyone would, to beat this disease. But as we move through this fight, I see that so many of the stresses that confront those in the US who face a similar diagnosis are one’s that, thankfully, because we live in Canada, neither she nor I will have to endure.
When the first symptoms appeared, she quickly made an appointment to see her doctor, who then referred her to an ObGyn. These visits were completely covered by Medicare. No one was able to deny coverage on the basis of a pre-existing condition.
When referred for a number of tests, including blood work, an EKG and a CT scan, the doctors had no need to consult a private insurance company to see if they would all be considered necessary. Although the tests are conducted by private companies, rates are negotiated by the provincial government and are completely covered.
Upon her diagnosis, she was referred to a gynaecological oncologist. Surgery is recommended. The decision to go ahead with surgery was one made by my wife and her doctor based only on health care needs. Again, there was no interference from an insurance company demanding a less expensive procedure.
Like all Canadians regardless of wealth or status, we do not have to worry about the financial implications of this diagnosis and her upcoming surgery. We don’t have to think about re-mortgageing our home, raiding our retirement funds, or declaring bankruptcy because this disease struck our family. We don’t have to set up a crowdfunding account to help us.
Although not directly linked to Universal Healthcare, my wife also does not have to worry about losing her job because of this diagnosis. She has access to sick leave (and I have access to care and nurturing leave), so neither her absence from work for up to six weeks, nor mine, will result in additional financial harm. No one needs to lend her sick days.
The potential implications of a cancer diagnosis and the stresses that naturally arise — most importantly on my wife but also on our children and myself, are overwhelming. I can’t imagine what they would be like were we to also have to work through the stresses associated with a system of private insurance or, worse, the stresses involved in having no coverage at all.
The Canadian system is far from perfect. We do not have a Pharmacare program, for example, so prescription drugs require private insurance coverage. Still, not just the financial benefits, but also the emotional benefits, Canadians receive from our Universal Healthcare system are considerable. Most in Europe, regardless of whether they utilize single payer or another system of universal care, experience the same financial and emotional benefits from this support.
That the citizens of richest nation on the planet are denied this is shameful.
We asked people in our survey whether they’d developed any special tricks or workarounds in navigating the system. The most common answers fell into two categories. One group said it was important to follow doctors’ advice. The other said it was important to do outside research, ask questions and get second opinions.
That split reflects just how hard it can be to navigate the health care system when you’re sick. The people in our survey tended to have very serious health problems, sometimes several at once. They counted on the system to help them, but also recognized that it often let them down.
We might think of the seriously ill as the most experienced users of our health care system. They are. But they are also sick. Despite the above advice, patients in the survey described the health care system as perplexing and overwhelming. Sixty-two percent said they’d been rendered “anxious, confused or helpless” by the experience.
When asked about specific types of misunderstanding, 18 percent said advice by different medical professionals conflicted, and 15 percent said they couldn’t even understand what was being done to them. Twenty-two percent said that hospital staffers weren’t responsive to their needs.
Perhaps that’s why seven of the survey’s respondents also offered the following advice: Pray.
My Wife Was Just Diagnosed with Cancer: What this means under Universal Healthcare
by dfh1 - The Daily Kos - October 15, 2018
by dfh1 - The Daily Kos - October 15, 2018
My wife has always been one of my heroes. She is a strong woman who confronts challenges with a combination of courage, hope and humour. And now, after her diagnosis of Uterine Cancer, she is approaching this latest fight with this same combination of strengths. I really am in awe of her. We have been married now for 27 years. Even with this diagnosis, we believe our journey will continue into a healthy retirement and for many years to come.
She will need all her strength, just as anyone would, to beat this disease. But as we move through this fight, I see that so many of the stresses that confront those in the US who face a similar diagnosis are one’s that, thankfully, because we live in Canada, neither she nor I will have to endure.
When the first symptoms appeared, she quickly made an appointment to see her doctor, who then referred her to an ObGyn. These visits were completely covered by Medicare. No one was able to deny coverage on the basis of a pre-existing condition.
When referred for a number of tests, including blood work, an EKG and a CT scan, the doctors had no need to consult a private insurance company to see if they would all be considered necessary. Although the tests are conducted by private companies, rates are negotiated by the provincial government and are completely covered.
Upon her diagnosis, she was referred to a gynaecological oncologist. Surgery is recommended. The decision to go ahead with surgery was one made by my wife and her doctor based only on health care needs. Again, there was no interference from an insurance company demanding a less expensive procedure.
Like all Canadians regardless of wealth or status, we do not have to worry about the financial implications of this diagnosis and her upcoming surgery. We don’t have to think about re-mortgageing our home, raiding our retirement funds, or declaring bankruptcy because this disease struck our family. We don’t have to set up a crowdfunding account to help us.
Although not directly linked to Universal Healthcare, my wife also does not have to worry about losing her job because of this diagnosis. She has access to sick leave (and I have access to care and nurturing leave), so neither her absence from work for up to six weeks, nor mine, will result in additional financial harm. No one needs to lend her sick days.
The potential implications of a cancer diagnosis and the stresses that naturally arise — most importantly on my wife but also on our children and myself, are overwhelming. I can’t imagine what they would be like were we to also have to work through the stresses associated with a system of private insurance or, worse, the stresses involved in having no coverage at all.
The Canadian system is far from perfect. We do not have a Pharmacare program, for example, so prescription drugs require private insurance coverage. Still, not just the financial benefits, but also the emotional benefits, Canadians receive from our Universal Healthcare system are considerable. Most in Europe, regardless of whether they utilize single payer or another system of universal care, experience the same financial and emotional benefits from this support.
That the citizens of richest nation on the planet are denied this is shameful.
Doctors Should Tell Their Patients to Vote
by Danielle Ofri - NYT - October 20, 2018
In the winter of 1847-48, a typhus epidemic raged through Upper Silesia. The Prussian king dispatched a young Dr. Rudolf Virchow to investigate the outbreak. Dr. Virchow would later achieve scientific sainthood for disposing of Hippocrates’ idea that humors caused disease, solidifying the idea that cells were the basis of biology and coining terms like leukemia, spina bifida, thrombosis and embolism. But in 1848, he was a 26-year-old lecturer in pathology at the CharitĂŠ hospital in Berlin — a disposable junior faculty member who could be banished to the hinterlands.
What Dr. Virchow found in Upper Silesia was a district ravaged by famine and economic depression. The germ theory of disease hadn’t yet been fully accepted, so Dr. Virchow couldn’t pinpoint a bacterium as the agent of the outbreak. He was, however, able to identify the conditions that promulgated the disease — poor sanitation, terrible working conditions, inadequate housing, meager education and unhealthy diet. In other words, all the concerns of modern public health.
In his report, Dr. Virchow cited exploitation and lack of self-governance as the sources of those disease-promoting conditions. He excoriated the aristocrats who “expropriated great wealth from the Upper Silesian mines” but regarded the workers “not as human beings,” the government functionaries who served “the interests of the state” instead of the people, and the church that demonstrated “contemptible selfishness and lust for power.”
“There cannot be any doubt,” Dr. Virchow concluded, that the epidemic was a result of “the poverty and underdevelopment of Upper Silesia.” The prescription, he stated, should be “free and unlimited democracy.”
A prescription for democracy — not something you get at your average doctor’s visit — is increasingly on the minds of medical professionals these days.
The goal of doctors and nurses is, of course, to improve the health of our patients. We treat the immediacies of illness — antibiotics for pneumonia, inhalers for asthma — but good health requires much more than medications. We have to think about lifestyle: what our patients eat and how much they exercise. But a healthy lifestyle requires adequate housing, so some health centers are now helping homeless patients find a place to live and asthmatic patients rid their homes of mold. And in a country like ours, without universal health care, helping our patients stay healthy means that we have to be concerned about whether they have health insurance.
Suddenly, like Dr. Virchow, we are recognizing that our purview extends to the entire structure of our society and that politics is, as he put it, “nothing else but medicine on a large scale.” Political decisions that affect insurance coverage, access to medical care, housing, minimum wage, immigration law, water sources — just to name a few examples — exert medical effects that are comparable with those of major diseases. Just ask the people of Flint, Mich.
Like many doctors and nurses, I became politically active for the first time during the summer of 2017, when Congress tried to repeal the Affordable Care Act. I could see the direct risk to my patients — all of whom, inconveniently, had pre-existing conditions — and realized that protecting health care coverage was as critical as prescribing insulin.
Now, as our society feels increasingly fractured, the health threats seem even more alarming. Growing income inequality, disregard of environmental hazards and the undermining of social safety nets all stand to harm our patients’ health. Dr. Virchow’s words from 170 years ago about the creep of religion into state affairs, the outsize power of the wealthy and the autocratic impulses of government feel unsettlingly contemporary.
So is it time for doctors to pull out our prescription pads and, like Dr. Virchow, start prescribing democracy?
This may seem like a radical extension of the medical mandate, but the poorer and the sicker our patients are, the more likely they are to be disenfranchised. Those with the most to lose are least likely to have their voices heard.
Of course no one should be advocating political viewpoints in the exam room — patients need a neutral, nonjudgmental atmosphere to feel secure. But civic engagement is nonpartisan.
When patients say they can’t afford their medicine, fear being bankrupted by medical bills or struggle to find treatment for an addiction, we typically offer sympathy for these heartbreaking and seemingly intractable issues.
But might it be our responsibility to point out that these problems are not just bad luck but also the result of political decisions? Instead of giving a kindly pat on the shoulder, perhaps we should inform our patients that they can call their elected officials to get answers. In addition to our medical counsel, perhaps we should also encourage them to vote.
When patients are admitted to the hospital, they are asked about their tobacco use and their flu shots, their employment status and their religious affiliation. Why not ask if they are registered to vote? Just as hospitals and clinics help the uninsured obtain coverage, they should also help eligible voters register. Waiting rooms are filled with brochures — there’s no reason voter registration materials can’t be in the mix.
In 2014, two clinics in the Bronx conducted a nonpartisan voter registration effort.Many of the volunteers were doctors, nurses or medical students, but the outreach took place outside the exam room. The efforts paid off; 90 percent of patients who were eligible to vote but had not yet registered did so. More than half of them were first-time voters.
And we medical professionals must ourselves vote in all elections. We cannot sit them out — our votes directly affect our patients’ health. Groups like On Call for Democracy and Med Out the Vote offer resources and help identify candidates with strong health care platforms.
Dr. Virchow wrote, “If you want to achieve anything, you have to be radical.” Many of our now-standard medical treatments seemed radical at the time (even handwashing).
He also said, “You must start by inciting the population.” He returned to Berlin just in time for the March Revolution of 1848. He joined in and even helped construct street barricades.
Doctors today don’t necessarily have to be stacking gurneys in the streets, but we do have to recognize that the health of the community is part of our medical mission. Civic engagement is integral to that. When our patients ask what they can do to improve their health, in addition to sunscreen, exercise and five servings of fruits and vegetables, we should advise voting.
This is one prescription that doesn’t require prior authorization from the insurance company.
