As Americans struggle with soaring medical costs, top health officials bicker over their expense reports

alexahhs-150x150cmsseemav-150x150Here’s a point to ponder: A quarter of Americans say they or someone they know has put off treatment for a serious medical condition due to cost. That’s the worst such response pollsters at Gallup have gotten on this matter in almost three decades.

Two people have a lot to say about Americans’ health care finances, including their insurance, drug prices, and protections if they are poor, old, young, or chronically ill, physically or mentally. But, gee, the duo of Alex and Seema just can’t get along. They’re not playing nice. It’s gotten so bad that their big bosses, Don and Mike, have called them both in for a tough chat about working together.

carecostdelaychart-300x215Now, if it were you and me, and the office politicking got so out of hand that it attracted enough national attention to potentially embarrass majordomos of the organization, wouldn’t there be a screen door banging with some suits also getting tossed to the curb?

Is it maybe time to ask why Alex Azar (top right), the Health and Human Services secretary, and Seema Verma (top left), the head of the Centers for Medicare and Medicaid Services, both aren’t out looking for work — off the taxpayer dole?

They’re building their own case to be yet two more dubious hires by the president in dealing with a top concern of American voters: health care. The public might ignore their shenanigans, if their work outcomes dictated otherwise. But since everyone seems to be riveted when executives’ dirty laundry flies out the windows, why not?

As various news organizations reported, Verma has been taking considerable heat recently. It has included disclosures that she ordered CMS to fork over millions of dollars to GOP-favored communications consultants to buff up her public profile, including paying for — gee whiz! — media plans to plant favorable profiles of her in glossy women’s magazines. Verma defended the spending, saying she was reorganizing CMS and needed outside help until the agency had its own communications staff.

Before that dust had settled, Verma found herself in yet another dubious situation: It seems that, while on a speaking trip to San Francisco, her luggage was stolen. She put in paperwork for the government to reimburse her for her losses. She wanted $47,000 for the lost goods. That included payment for an “Ivanka Trump-brand pendant, made of gold, prasiolite and diamonds, that Verma’s jeweler valued at $5,900,” the news site Politico reported. She also insisted Uncle Sam should replace her $325 bottle of moisturizer and $349 noise-canceling headphones.

Verma first reported to police that the goods, stolen from her rented vehicle and parked at the tony Commonwealth Club’s Embarcadero site, were valued at $20,000, before submitting a fuller and twice as expensive inventory to her agency for loss compensation.

Ah, no, CMS officials decided. They paid her a little less than $3,000 for her lost items.

Now, no sooner had commentators begun to slap at Verma then, lo, did a story appear in the Wall Street Journal reporting that an “internal review” of negative press about CMS pointed at its parent agency, HHS, for blame. Azar has denied that he’s leaking bad stuff about Verma.

At this point, the president’s chief of staff talked to Azar and Verma to tell both to, um, knock it off, trying to put to rest, for example, news articles reporting that the HHS secretary had gotten so tired of his direct report going around him to the president that he had tried to bar Verma from flights on Air Force One.

The negative news, of course, did not stop, either, with news stories reporting that Verma earlier had triggered major concern with HHS watchdogs, raising issues of sexual discrimination and harassment and possible problems within the agency when headed by former agency head Tom Price. Those stories also made clear, though, that Verma declined to talk to investigators and, with no follow-up, the matter had died away.

Still, the cabinet-level infighting had gotten awful enough that President Trump and Vice President Mike Pence called Azar and Verma into the White House woodshed. Pence intervened because he knows both Azar and Verma well from Indiana and had been the administration mentor to both.

Now, gossip is one thing, public policy and its execution are another. And, as the Washington Post reported, the administration’s lamentable health care record, if not already a problem, may be a big problem — along with everything else, of course — when the 2020 elections roll on.

The feuding between Azar and Verma, the newspaper noted, has undercut all manner of administration efforts on: crafting a health insurance plan that meets the president’s boast of being far better than the Affordable Care Act, aka Obamacare; putting forth a way to reduce skyrocketing prescription drug prices — a matter that’s growing even more glaring for the GOP, as House Democrats have just advanced their plan (which faces poor prospects in the Republican-controlled Senate); and of course less major initiatives. The president hasn’t advanced his plan, for example, to get drug companies to include pricing information in their product ads. Momentum has stalled on his idea to import more drugs to increase supplies and curb prices.

And, of course, as 10 conservative states keep rolling ahead — with Verma’s assent — with plans to slash assistance to the sick, elderly, young, poor, and working poor via draconian work and bureaucratic requirements for Medicaid, the courts have held up their proposals. Or they have been found to be more costly and harsh than effective.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the soaring cost, complexity, and uncertainty of therapies and prescription medications, too many of which prove to be dangerous drugs. Health insurance is a leading, though not the singular way that most of us seek to shield ourselves and our loved ones from burdensome medical debt and crushing medical bankruptcy.

Unfortunately, due to the GOP obsession with Obamacare, health coverage has dominated the political discussions for almost a decade, including the presidential campaign for now. This makes a lot of sense, when not just policies’ life changing but their life saving benefits of health insurance become even more established by rigorous evidence.

While it is vital, to ensure that health care is a right and not a privilege, politicians, regulators, and policy makers also may need to step up their work exponentially to deal with the rising unaffordability of medical services. Here are a few more datapoints to ponder:

“Data from the Kaiser Family Foundation’s Employer Health Survey underscores the severity of the health-care spending problem. In 2019, 82% of covered workers must meet a deductible before health-care coverage kicks in, up from 63% a decade ago. ‘The average single deductible now stands at $1,655 for workers who have one,’ according to KFF, ‘similar to last year’s $1,573 average but up sharply from the $826 average of a decade ago.’ Deductibles have surged 162% since 2009, data show — more than six times the 26% climb in earnings over the same period. There are many factors driving up the cost of care for most American families. Administrative costs are a big part of the issue: Health insurance is largely a for-profit industry, meaning insurance companies and their shareholders are reaping a percentage of your deductibles and co-pays as profit. Many hospitals, too, are raking in profits. In recent years, surprise billing practices and outrageous markups for simple drugs and services have drawn the ire of lawmakers looking for ways to reduce health-care spending. Physician pay is another significant expense. The Commonwealth Fund, a health-care research group, estimates American doctors earn ‘nearly double the average salary of doctors in other wealthy nations … The American health-care system, in other words, works pretty well for the powerful players in the health-care industry … But what are the rest of us getting in return …  The national Centers for Disease Control and Prevention has an answer, and it’s an indictment of our health-care system: The United States is in the midst of the longest sustained drop in life expectancy in at least 100 years. Relative to other wealthy countries, lives in America are short and getting shorter. The disparities domestically are perhaps even more shocking: In the nation’s wealthiest places, where the high cost of modern health care remains within relatively easy reach, life expectancies are literally decades longer than in America’s poorest places.”

We’ve got a lot of work to do on health care, and it may be ever more important for voters to remember who’s getting what done for them? Do we need more cabinet-level rasslin’ from Alex and Seema? Do we need more Trump-appointed trough-feeders like onetime HHS chief Tom Price? Or heads of the Centers for Disease Control and Prevention like tobacco stock-buying Brenda Fitzgerald? Hmm, nope.

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