Articles Posted in Health Care Reform

ryanMembers of Congress are home in their districts for a week-long break, and many lawmakers are expected to get an earful from voters upset over many issues at the start of the Trump Administration, especially this: What the heck’s going on with health care?

Republicans have insisted for years now—counter-factually, as the evidence has amply demonstrated—that they had a cheaper, better, more inclusive alternative to the Affordable Care Act, aka Obamacare. The promised to repeal the ACA on the day they gained control of Congress and the White House. That hasn’t happened. Nor has the GOP proffered its vaunted replacement. Instead, the party had talked in recent days about an ACA repair.

But under fire from their most conservative party members, Republican leaders have thrown up what they call an outline of Trumpcare. The GOP has moved from lots of R’s—repeal, replace, and repair—to some C’s and D’s: Costly, callous, divisive, and cruel. Those are some ways their retread plan elements (dubbed “déjà vu all over again” in one report) could be described. The outline still faces major challenges, not the least of which is whether a chaotic White House and a lumpen Congress can conduct the nation’s business and enact public policy.

thomas-price-225Republicans jammed through their health policy guru in the middle of the night, and they and their new HHS Secretary are still trying to figure out what to do with the Affordable Care Act, aka Obamacare. Insurance markets are on the brink of chaos, and the mess is angering increasing number of Americans who may soon see their costs rise, their medical care decline, and their health imperiled.

The president and the speaker of the house continue to be at odds as to the timing of the GOP’s long-promised pledge to repeal and replace Obamacare, with the timeline stretching to the year’s end or beyond before the public gets to see the outlines or details of Republicans’ Trumpcare.

Proposals for ACA ‘repair’

10650-insulin-diabetes-300x169Just under a century ago, a team of Canadian scientists made the breakthrough that led to widely available insulin as an effective treatment for diabetes, which then was a deadly disease. The researchers, who won the Nobel Prize, also made a jaw-dropping gesture to ensure their discovery would benefit the afflicted: They handed over their lucrative patent on insulin to the University of Toronto to ensure the fearsome illness would be conquered.

The university, alas, turned quickly to commercial drug makers, licensing them to produce the life-saving medication. And flash forward to now, and, after years of rising anger, a group of diabetes patients has sued three drug makers, asserting they systematically and fraudulently price-gouged them for their must-have treatment.

Insulin has become a $24 billion global market, with myriad profit-grabbing hands of distributors and supposed cost-controllers moving it from makers to patients, each middleman taking his piece. Patients say they’re aggravated that the various Big Pharma players appear to work in concert to send insulin’s price, in lockstep, skyrocketing. One vendor’s product carried a sticker price of $21 per vial two decades ago. It now costs $255 for the same amount.

harlanYes, there can be progressive steps in health care—and with all the controversy and change going on in the sector it’s worth spotlighting some of these:

Patients should get access to own health records, researchers say

  • Three researchers—Dr. Harlan Krumholz of Yale Medical School (photo right), Connecticut lawyer Jennifer L. Cox, and Yale student Austin W. Jaspers—deserve credit for publishing a pointed opinion piece in the JAMA Internal Medicine detailing the costs and needless obstacles patients confront when they want copies of their own health records. As Krumholz told Reuters of the study’s message about excessive records fees charged by doctors and hospitals:  “Higher costs are a higher barrier for people to get their own information. Without that information it is not possible to correct errors in the record, get informed second opinions, donate your data to research – or share with others what is happening with your care.”  That’s spot on, doctor, as I have written recently and in my book,  The Life You Save: Nine Steps to Getting the Best Medical Care, and Avoiding the Worst. Uncle Sam has stepped in and tried to make it easier and more affordable for patients to get their own records, which Krumholz and company point out should be even more available now that they are digitized (he’s working on software to help, too). But states aren’t doing enough to help, except for Kentucky, which requires a free first copy on request, he and his colleagues say. My firm’s site contains information that may be helpful to those struggling to get their records. Here’s hoping that doctors, hospitals, and other caregiving facilities read the Jaspers, Cox, and Krumholz viewpoint, and, because it appears in one of their publications and Krumholz is a physician-researcher of growing influence, they heed it more.

Frank_luntz_2009-214x300With its furious attack on the Affordable Care Act, aka Obamacare, has the GOP become the proverbial barking dog that finally caught the bus it has chased for so long? Partisans continue to proffer notions for what might be part of Trumpcare.

But for the R’s in the House and Senate who have insisted for seven years that they would swiftly repeal and replace Obamacare, two more R’s, uncomfortably, are intruding: Reality, and the new buzzword Repair.

The Trump Administration—no surprise—hasn’t provided details. But it  told the federal Office of Management and Budget that it soon will submit proposed regulations aimed at stabilizing health insurance markets during any Obamacare transition.

price-245x300We’re dizzily trying  to keep track of all the ways that the new administration is defying the best hopes that it will pursue a health care policy that is fair, open, responsive, and based in evidence, research, and scientific expertise — not partisanship and knee-jerk. Compounding the confusion is that as soon as many of these missteps occur, they then are reversed, or maybe re-reversed. Is this the way to build the public’s confidence in any new course on health care?

A prospective leader with big ethical challenges

  • Yes, every president deserves the privilege of selecting his Cabinet officers, and the U.S. Senate, while advising and consenting, must to a degree defer to presidential picks. But Tom Price, the nominee to head the trillion-dollar Health and Human Services Department, even if confirmed, has launched poorly into his prospective top position. He did say he supports vaccinations and does not believe the debunked theory that shots cause autism or diseases. But he has offered a woeful lack of information about the administration’s plans on the much-publicized GOP repeal and replacement of Obamacare. He’s been equally blank about what’s ahead for Medicaid and Medicare, as well as how vigorously he might protect the public from bad drugs or dangerous medical devices.

But why bother? That’s what some might think even once they know that today, January 31, is the absolute final day they can enroll in health insurance through the Affordable Care Act.

Yet even with an uncertain future for Obamacare, consumer advocates say the answer today is crystal clear:

Yes, you should sign up.

Kellyanne_Conway-214x300Don’t  tune out because conventional wisdom suggests it’s “just” a program for the poor. The partisans’ planned push for changes to Medicaid could have significant consequences for millions of Americans, many of them middle-class, older, disabled, and sick.

The Medicaid changes, as various officials like counselor to the president Kellyanne Conway, have described them without detail for now, also could stagger state and local governments’ finances, including the already strapped District of Columbia, which might see a half-billion- to billion-dollar hole blown in its budgets.

Although significant and merited public attention has focused on the GOP’s crusade to repeal and replace the Affordable Care Act, aka Obamacare, and especially how it affects health insurance, many Americans may not be as riveted by what happens to Medicaid. Republicans have reviled for years now a part of the ACA’s reforms that expanded the government program, but only, as a result of a U.S. Supreme Court decision, if states agreed. Thirty-one states and the District of Columbia did so, 19 did not. This meant that 11 million Americans, most of them the working poor, received health care coverage via Medicaid.

sen-collins-288x300Bill_Cassidy_headshot-237x300Will the partisans who promised and now can’t deliver on a blitzkrieg to repeal and replace the Affordable Care Act, aka Obamacare, end up deeply dividing the country in even more disturbing ways?

GOP leaders, after conceding that they cannot legislate their hoped-for Obamacare replacement until much later this year (reversing their pledge to do so on Day One of the new Administration), huddled in Philadelphia, nervously, to develop strategies and tactics. As they develop “Trumpcare,” they’re confronting growing and significant restiveness about the potential destructiveness of their current course, including the possibility their repeal may cost 43,000 American lives annually.

Meantime, the health care policy proposals that have floated up, including the Patient Freedom Act of 2017 from Republican senators Susan Collins of Maine and Bill Cassidy of Louisiana, raise as many questions as they offer, including:

pthiel-200x300Although attention has focused on the GOP-promised repeal and replacement of the Affordable Care Act, other big changes also are afoot in the federal government that will have significant effects on health care in this country.

There are appointments pending from President Trump at the federal Food and Drug Administration and the Centers for Disease Control and Prevention. Sonny Perdue, the administration’s pick for Agriculture secretary, also will play a big public health role, as will the personnel decisions that may be made at the troubled National Institutes of Health, where, for now, Francis Collins will continue to lead.

Will the FDA be run by a venture capitalist?

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