Nix repeal--fix the Affordable Care Act?

Alexander, Murray plan bipartisan hearings to shore up Obamacare
ADAM CANCRYN | 08/01/2017

Sens. Lamar Alexander and Patty Murray plan a series of hearings aimed at crafting bipartisan legislation to shore up Obamacare markets by mid-September, in the wake of the GOP’s failed repeal efforts.

The pair said Tuesday afternoon that the Senate Committee on Health, Education, Labor, and Pensions will hold sessions beginning the week of Sept. 4, in a bid to “stabilize and strengthen” the individual health insurance markets.

Alexander, the chairman of the committee, emphasized that the work will be bipartisan and that the hearings will feature a range of health policy experts, including state insurance commissioners, patients and insurance industry representatives.

He added that he’s urged President Donald Trump to continue paying for Obamacare’s cost-sharing subsidies through September, to give Congress time to craft a stabilization plan that would include one year of funding for the payments...

http://www.politico.com/story/2017/08/01/obamacare-bipartisan-hearings-senate-24...

The Trump Administration Just Suffered Another Health Care Setback
A federal appeals court ruled that Democratic state attorney generals can defend Obamacare subsidies that reduce health care costs, even if the Trump administration decides not to.
Zoe Tillman | August 2, 2017

...The coalition of Democratic state attorneys general filed a motion on May 18 to intervene in the case. They argued that the states had a direct interest in the outcome of the case — without the subsidies, they said, insurance premiums would go up and more people would go without insurance, increasing the health care cost burdens for states.

The concern that the administration would switch sides in the case was no longer speculative, the attorneys general said, pointing to Trump’s public statements threatening to end the subsidies.

The argument proved persuasive, with a three-judge panel issuing Tuesday’s order allowing the states to intervene. The panel wrote that “the states have raised sufficient doubt concerning the adequacy of the Department’s representation of their interests.”

The case is on hold for now. The court ordered all of the parties to file status updates every 90 days. The next report is due by Oct. 30.

https://www.buzzfeed.com/zoetillman/the-trump-administration-just-suffered-anoth...

Final contracts for 2018 must be signed at end of September. In early analysis, uncertainty (enforcement of individual mandate, subsidies) is cited by health insurers proposing to increase 2018 premiums or to drop out of exchanges altogether. Expect Trump to blame Obama, but this Tar Baby belongs to the Repeal-and-Replace Republicans. May every life they blight and take with their mismanagement haunt them.

An Early Look at 2018 Premium Changes and Insurer
Participation on ACA Exchanges
Rabah Kamal, Cynthia Cox, Care Shoaibi, Brian Kaplun, Ashley Semanskee, and Larry Levitt | August 2017
(8p issue brief)

...Discussion A number of insurers have requested double-digit premium increases for 2018. Based on initial filings, the change in benchmark silver premiums will likely range from -5% to 49% across these 21 major cities. These rates are still being reviewed by regulators and may change.

In the past, requested premiums have been similar, if not equal to, the rates insurers ultimately charge. This year, because of the uncertainty insurers face over whether the individual mandate will be enforced or cost-sharing subsidy payments will be made, some companies have included an additional rate increase in their initial rate requests, while other companies have said they may revise their premiums late in the process. It is therefore quite possible that the requested rates in this analysis will change between now and open enrollment.

Insurers attempting to price their plans and determine which states and counties they will service next year face a great deal of uncertainty. They must soon sign contracts locking in their premiums for the entire year of 2018, yet Congress or the Administration could make significant changes in the coming months to the law–or its implementation–that could lead to significant losses if companies have not appropriately priced for these changes. Insurers vary in the assumptions they make regarding the individual mandate and cost-sharing subsidies and the degree to which they are factoring this uncertainty into their rate requests.

Because most enrollees on the exchange receive subsidies, they will generally be protected from premium increases. Ultimately, most of the burden of higher premiums on exchanges falls on taxpayers. Middle and upper-middle income people purchasing their own coverage off-exchange, however, are not protected by subsidies and will pay the full premium increase, switch to a lower level plan, or drop their coverage. Although the individual market on average has been stabilizing, the concern remains that another year of steep premium increases could cause healthy people (particularly those buying off-exchange) to drop their coverage, potentially leading to further rate hikes or insurer exits...

A Start-Up Suggests a Fix to the Health Care Morass

Profiles Aledade, a start-up founded in 2014 by Farzad Mostashari, a doctor and technologist

Here's another attempt to empower patients and healthcare providers--this one increases transparency on wait-times for surgeries and procedures in Ontario:

http://www.hqontario.ca/System-Performance/Wait-Times-for-Surgeries-and-Procedur...
___________________________________________________

In the works is a system to ease referrals to specialists and to other regions:

Ontario surgery wait times online comparison shows wide variance
Government hopes to improve accountability, make wait times shorter
CBC News | Aug 16, 2017

...Last week, the provincial government also announced a $13 million investment over two years to expand eReferral systems that connect patients and primary care providers to specialists and other health care services in several regions including Waterloo-Wellington, Hamilton Niagara Haldimand Brant, and across the north.

http://www.cbc.ca/news/canada/kitchener-waterloo/compare-ontario-hospital-wait-t...

Republicans have until end of fiscal year (Sept 30) to repeal and replace ACA--and slash Medicaid--with simple majority vote:

Like Other ACA Repeal Bills, Cassidy-Graham Plan Would Add Millions to Uninsured, Destabilize Individual Market
Jacob Leibenluft Edwin Park Matt Broaddus Aviva Aron-Dine |

In releasing a revised version of their legislation to repeal and replace the Affordable Care Act (ACA), Senators Bill Cassidy and Lindsey Graham, along with co-sponsors Dean Heller and Ron Johnson, claimed that their bill isn’t a “partisan” approach and doesn’t include “draconian cuts.” In reality, however, the Cassidy-Graham bill would have the same harmful consequences as those prior bills. It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, and increase out-of-pocket costs for individual market consumers. It would cause many millions of people to lose coverage, radically restructure and deeply cut Medicaid, eliminate or weaken protections for people with pre-existing conditions, and increase out-of-pocket costs for individual market consumers.

Cassidy-Graham would:

Eliminate the ACA’s marketplace subsidies and enhanced matching rate for the Medicaid expansion and replace them with an inadequate block grant. Block grant funding would be well below current law federal funding for coverage, would not adjust based on need, would disappear altogether after 2026, and could be spent on virtually any health care purpose, with no requirement to offer low- and moderate-income people coverage or financial assistance.

Convert Medicaid’s current federal-state financial partnership to a per capita cap, which would cap and cut federal Medicaid per-beneficiary funding for seniors, people with disabilities, and families with children.

Eliminate or weaken protections for people with pre-existing conditions by allowing states to waive the ACA’s prohibition against charging higher premiums based on health status and the requirement that insurers cover essential health benefits including mental health, substance abuse treatment, and maternity care.

Destabilize the individual insurance market in the short run — by eliminating the ACA’s federal subsidies to purchase individual market coverage and eliminating the ACA’s individual mandate to have insurance or pay a penalty —and risk collapse of the individual market in the long run.

Eventually result in larger coverage losses than under proposals to repeal ACA’s major coverage provisions without replacement. The Congressional Budget Office (CBO) has previously estimated that repeal-without-replace would cause 32 million people to lose coverage. The Cassidy-Graham bill would likely lead to greater numbers of uninsured after 2026, however, because it would not only entirely eliminate its block grant funding — effectively repealing the ACA’s major coverage expansions — but also make increasingly severe federal funding cuts to the rest of the Medicaid program (outside of the expansion) under its per capita cap...

https://www.cbpp.org/research/health/like-other-aca-repeal-bills-cassidy-graham-...

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Senate GOP tries one last time to repeal Obamacare
McConnell and his lieutenants will gauge support for the bill this week in private party meetings.
BURGESS EVERETT and JOSH DAWSEY | 09/17/2017

...Right now, support for the bill — which would replace Obamacare’s tax subsidies with block grants, end the law’s individual insurance mandate and scale back its Medicaid expansion — among Republican senators is short of 50 votes.

...White House officials began making calls last week to Republican Senate offices and plan to whip Senate votes this week, an administration official said. Supporters of the Graham-Cassidy bill have tried to keep their efforts to round up votes quiet so far, this official said, but the push is ramping up.

Graham has publicly begged for Trump to help build support for the bill, and it appears to be paying off. The president asked about the Graham-Cassidy proposal in conversations this weekend in Bedminster, New Jersey, and is likely to call senators this week while he is in New York at the United Nations, the administration official said, though much of the work will be done on the senior staff level.

http://www.politico.com/story/2017/09/17/obamacare-senate-republicans-repeal-242...

Aiyiyi!

Cassidy-Graham bill would cut funding to 34 states, new report shows
Amy Goldstein, David Weigel and Juliet Eilperin | September 20, 2017

...The analysis by Avalere Health, a Washington-based health-policy consulting firm, forecasts that the amount of federal money devoted to Medicaid and private insurance subsidies would shrink by $215 billion between 2020, when the plan would begin, and 2026, the last year money is provided in the bill.

More than half of the overall cuts in the legislation — named for its primary sponsors, Republican Sens. Bill Cassidy (La.) and Lindsey O. Graham (S.C.) — would come from Medicaid, the analysis shows.

States with relatively low medical costs, skimpy Medicaid benefits and no program expansion would win out. Texas would gain more than any state, about $35 billion from 2020 through 2026. On the other hand, states with higher-priced medicine and generous benefits for their low-income residents, such as California and New York, would lose billions of dollars. ( See graphic at website for state-by-state analysis.)

The Cassidy-Graham measure would kill central features of the 2010 law (ACA), including its insurance subsidies, coverage requirements for individual Americans and large businesses, and benefits and other rules for health plans sold in ACA marketplaces. Instead, in a devolution of unprecedented scale, a smaller amount of health-care money would be reshuffled around the country as block grants for much of the coming decade, with states having great freedom on how to spend it.

The plan also would transform the federal role in Medicaid for traditional recipients, ending the program’s half-century tradition as an open-ended entitlement in which the government gives each state a fixed share of whatever its costs are. Instead, federal aid would be converted to a per-person cap — a method that does not adjust as easily over time to expensive improvements in medical care or to possible economic downturns in which low-income people flock to the program.

...At its core, this latest health-care bill embraces a decades-old conservative goal: capping taxpayers’ expenditures on Medicaid and giving states full control over the program. As he sells the legislation to conservative governors and activists, Graham describes it as a way to end what he calls a progressive dream of universal health care managed from Washington.

...the coverage effect is tricky to assess because each state would gain the ability to establish its own rules to replace federal insurance regulations created under the ACA. The regulations most at risk are those limiting the premium differential that insurers can charge older customers compared with younger ones, requiring specific health benefits and blocking insurers from charging more for people with preexisting conditions.

The Avalere report also notes that the bill would lead to a “fiscal cliff” when funding ends in 2027, leaving it to a future Congress to decide whether to extend the legislation...

https://www.washingtonpost.com/national/health-science/graham-cassidy-bill-would...

As long as the ACA is in place the republicans are going to try to replace it with something much worse--just it's being associated with Obama as Obamacare is a pejorative for them. Even with no Trump they will try to do this. The democrats should fight them over that now but they also need to embrace the Sanders bill. Once people are all covered and no longer have to pay for health insurance anymore (and out of pocket for a lot of uncovered health issues besides that they're health insurance won't cover) you'll never get them to give it up and it will be pretty much society wide. Stop all the compromising with these fucks and play to win. All these idiots defending the health insurance industry and Big Pharma a couple years after single payer becomes law won't even remember their opposition. They'll find other ways to defend their capitalistic corporatism.

Canada

Ethnic demography

76.7% White
14.2% Asian
4.3% Indigenous
2.9% Black
1.2% Latin American
0.5% Multiracial
0.3% Other

Canada is a federal parliamentary democracy and a constitutional monarchy, with Queen Elizabeth II being the head of state.

Population
35,151,728

Canada spends about 5.3% of its GDP on education
According to a 2012 report by the Organisation for Economic Co-operation and Development (OECD), Canada is one of the most educated countries in the world; the country ranks first worldwide in the number of adults having tertiary education, with 51 percent of Canadian adults having attained at least an undergraduate college or university degre

According to the 2006 census, the country's largest self-reported ethnic origin is Canadian (accounting for 32% of the population), followed by English (21%), French (15.8%), Scottish (15.1%), Irish (13.9%), German (10.2%), Italian (4.6%), Chinese (4.3%), First Nations (4.0%), Ukrainian (3.9%), and Dutch (3.3%).

United States
Population
325,365,189
The U.S. spends more on education per student than any nation in the world

In a 2013 survey, the Centers for Disease Control and Prevention found that 96.6% of Americans identify as straight, while 1.6% identify as gay or lesbian, and 0.7% identify as being bisexual.

The third most populous nation in the world, after China and India, the United States is the only major industrialized nation in which large population increases are projected.

Foreign born immigration has caused the US population to continue its rapid increase with the foreign born population doubling from almost 20 million in 1990 to over 40 million in 2010, representing one third of the population increase.258 The foreign born population reached 45 million in 2015

The United States has a birth rate of 13 per 1,000, which is 5 births below the world average

As of 2012, approximately 11.4 million residents are illegal immigrant

As of 2015, 47% of all immigrants are Hispanic

Mexico has been the leading source of new residents since the 1965 Immigration Act.

#14-->17 margd:

So what do these statistics mean to you? Do you have any point to make?

According to AARP analysis, a 60 yr old Alaskan making $25K could be charged as much as $31,790 (!) in premiums and out-of-pocket costs under Graham-Cassidy legislation. Guess the Rs aren't wooing Senator Murkowski!

Graham-Cassidy Legislation Threatens Affordable Coverage for Older Americans
Lina Walker, Jane Sung, Claire Noel-Miller, and Olivia Dean (10 p)

The Graham-Cassidy (GC) bill, as proposed on September 13, 2017, threatens to make health care unaffordable and inaccessible for millions of older Americans. The bill eliminates two sources of financial assistance–premium tax credits and cost-sharing reductions–critical to ensuring that low-to moderate-income older adults are able to afford the coverage they need. For a 60-year-old earning $25,000 a year, premiums and out-of-pocket costs could increase by as much as $16,174 a year if they wanted to keep their current coverage. The bill may also allow states to charge older adults age 50-64 significantly higher premiums than under current law on the basis of their age by waiving federal protections that limit
the practice known as age rating.

...combined effect of premium and out-of-pocket increases for the average 60-year-old earning $25,000 a year
to maintain current coverage...

$16,174 more in 2020 (at the national level)...

Alaska as much as $31,790...

Arizona...as much as $22,074...

http://www.aarp.org/content/dam/aarp/ppi/2017/09/graham-cassidy-legislation-thre...

Sep 22 2017
SENATOR JOHN McCAIN ON HEALTH CARE REFORM

Washington, D.C. ­– U.S. Senator John McCain (R-AZ) released the following statement today on health care reform:

...“I cannot in good conscience vote for the Graham-Cassidy proposal. I believe we could do better working together, Republicans and Democrats, and have not yet really tried. Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it. Without a full CBO score, which won’t be available by the end of the month, we won’t have reliable answers to any of those questions.

...“I hope that in the months ahead, we can join with colleagues on both sides of the aisle to arrive at a compromise solution that is acceptable to most of us, and serves the interests of Americans as best we can.”

https://www.mccain.senate.gov/public/index.cfm/2017/9/statement-by-senator-john-...

Medicaid directors issue warning on new ObamaCare repeal bill
Jessie Hellmann | 09/21/17

The National Association of Medicaid Directors (NAMD) warned Republicans on Thursday that the Senate's latest ObamaCare repeal bill would place a massive burden on states.

...It would also change the federal government's funding of the traditional Medicaid program from an open-ended commitment to the states to a per capita cap on each enrollee.

...The NAMD, which is a coalition of Medicaid directors from every state, noted that while the proposal is intended to create maximum flexibility, it does not provide the statutory reforms necessary "commensurate with proposed funding reductions."

...The NAMD, which is a coalition of Medicaid directors from every state, noted that while the proposal is intended to create maximum flexibility, it does not provide the statutory reforms necessary "commensurate with proposed funding reductions."

The GOP bill would also require states create their own health-care programs by 2020, which the directors argue is a massive undertaking.

...The directors also hit Senate Republicans for not having a full Congressional Budget Office score before a possible vote on the bill, "which should be the bare minimum required for beginning consideration." ...

http://thehill.com/policy/healthcare/351846-medicaid-directors-warn-repeal-bill-...

Senators Revise Health Bill in Last-Ditch Effort to Win Votes
ROBERT PEAR and THOMAS KAPLAN | SEPT. 24, 2017

WASHINGTON — With time running short, the authors of the latest plan to repeal and replace the Affordable Care Act shifted money in the bill to Alaska and Maine, which are represented by Republican senators who appear reluctant to support it.

...Mr. Cassidy circulated a table on Sunday showing the state-by-state impact of the revised bill from 2020 to 2026. It indicated that Alaska would receive 3 percent more money under the bill than under current law, while Maine would get 43 percent more...

https://www.nytimes.com/2017/09/24/us/politics/susan-collins-voicing-doubt-on-he...

Medicaid Has A Bull’s-Eye On Its Back, Which Means No One Is Entirely Safe
Phil Galewitz | September 25, 2017

Map: The Medicaid Landscape: State-By-State Coverage--Percent of Population Covered By Medicaid/CHIP, 2016

...Twenty-five percent of Americans will be on Medicaid at some point in their lives — many are just a pink slip away from being eligible.

...Medicaid is the workhorse of the health system, covering:

39 percent of all children.
Nearly half of all births in the country.
60 percent of nursing home and other long-term care expenses.
More than one-quarter of all spending on mental health services and over a fifth of all spending on substance abuse treatment.

Unlike Medicare beneficiaries, who keep that insurance for life, most Medicaid enrollees churn in and out of the program every few years, depending on their circumstances.

...A recent survey by the Kaiser Family Foundation showed three-fourths of the public, including majorities of Democrats (84 percent) and Republicans (61 percent), hold a favorable view of Medicaid. That’s nearly as high as Americans’ views on Medicare. ...

But it may still have a bull’s-eye on its back.

“The fact that the House passed a bill to cut $800 billion from Medicaid and it came one vote short to passing the Senate shows Medicaid is stronger than maybe many Republican leaders anticipated,” said Oberlander. “But politically it is still in a precarious position.”

http://khn.org/news/medicaid-has-a-bulls-eye-on-its-back-which-means-no-one-is-e...

Graham-Cassidy ACA Repeal Bill Would Cause Huge Premium Increases for People with Pre-Existing Conditions
Sam Berger and Emily Gee | September 18, 2017

(See Table 1 in article for additional costs by pre-existing condition.)

....Conclusion. Graham-Cassidy would be devastating for individuals with pre-existing conditions. In looking at a similar provision in the AHCA, the nonpartisan Congressional Budget Office (CBO) projected that half the population would live in states that waived protections for pre-existing conditions by allowing insurers to charge more based on health status or exclude coverage for certain types of services, a backdoor method gutting protections for people who need care for conditions such as pregnancy or mental health issues. It’s time for the Senate to put an end to its efforts to strip millions of Americans of their coverage, and start focusing on bipartisan improvements to the individual insurance market, such as those being discussed by Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA), among others.

https://www.americanprogress.org/issues/healthcare/news/2017/09/18/439091/graham...

National Association of Medicaid Directors
National Association of Medicaid Directors

aarp

recent survey by the Kaiser Family Foundation

analysis by Avalere Health, a Washington-based health-policy consulting firm

Center on Budget and Policy Priorities (CBPP) was founded in 1981 to analyze federal budget priorities, with a particular focus on how budget choices affect low-income Americans.

Emeritus Board Members
Marian Wright Edelman
President
Children's Defense Fund

Trump administration not only fails to publicize ACA's enrollment period for 2018, it has halved it, and scheduled maintenance on all but one Sunday, etc. Meanwhile GOP's Graham-Cassidy initiative appears to have derailed bipartisan effort to stabilize ACA: http://talkingpointsmemo.com/dc/hail-mary-aca-repeal-is-killing-the-senates-bipa... .

Is Healthcare.gov Scheduled for Maintenance During Obamacare Enrollment?
News reports correctly describe the facts surrounding scheduled "Obamacare" web site downtime during November and December 2017.

The Trump administration has already cut in half the Obamacare open enrollment period, truncating the original period of 1 November 2016 to 31 January 2017 (three months) to the shorter period of 1 November to 15 December 2017 (six weeks).

As pointed out by Kaiser Health News, this year’s web site maintenance schedule means that Healthcare.gov will be online for 93% of the total time during the six-week open enrollment period. (If we assume the “overnight” downtime on 1 November will last 12 hours, then the web site will be online for 1,008 out of 1,080 hours.)

According to the United States Digital Service, which is part of the Executive Office of the President, the Healthcare.gov web site was online 99.9% of the time during the 2015 and 2016 open enrollment periods, which were themselves twice as long as the upcoming open enrollment period.

http://www.snopes.com/healthcare-gov-maintenance/

ETA______________________________________________________

Consumers should remember that buck stops on Trump's desk--and the repeal-and-replace Republicans who blocked bipartisan fixes.

How Failure of the Obamacare Repeal Affects Consumers
Margot Sanger-Katz | SEPT. 26, 2017

https://www.nytimes.com/2017/09/26/upshot/how-the-failure-of-obamacare-repeal-af...

Obamacare Is Failing the Middle Class

By Scott Flanders
September 26, 2017

Today, health insurance can cost more than a mortgage. The average family of four will face a staggering $22,622 in health insurance and related medical costs this year ($14,300 for premiums with an $8,322 deductible). The average annual cost of a mortgage (principal and interest) is about $18,000 for a $309,000 house.

Obamacare, of course, is already unaffordable for millions of Americans. It was supposed to reduce costs by $2,500 per family but costs increased by $4,372 per family between 2010 and 2016. If costs increase by just 10 percent in 2018 (some analysts are predicting 28 percent increases), Obamacare will be untenable for middle-class families.

By its own definition of affordability, Obamacare will be out of reach for families of three who don’t qualify for a subsidy in 94 percent of cities — or 47 out of 50 markets

As Congress considers what they can do to reform health care, they’d be wise to remember that Obamacare’s federalized one-size-fits all system has been failing self-employed entrepreneurs and small business owners for four straight years. It’s time for new ideas.

Meanwhile, those touting a single-payer solution ignore the fact that states like California and Vermont have already investigated single-payer and rejected it. Why? Because the costs were untenable. Single-payer means single-shopper — and that shopper isn’t you.

Program that provides low-cost health care to 9M children set to expire
Erin Dooley & Meridith McGraw | Sep 29, 2017

Amid intense debates about the Graham-Cassidy health care bill, the Senate and House missed the deadline to reauthorize the Children's Health Insurance Program (CHIP) -- meaning federal funding for the program will expire at the end of the month.

Last reauthorized in 2015, CHIP is a partnership between the federal government and states that insures American children from low and moderate-income families.

And though the program's situation isn't yet dire -- and won't be until the states begin to run out of money -- some states are starting to get nervous about paying for the program...

http://abcnews.go.com/US/program-low-cost-health-care-9m-children-set/story?id=5...

#31--if the Democrats ever dropped a single payer bill in Trump's lap--I'd bet you he'd sign it. You know why--Barnard? Well for one because he's looking to take credit for anything that he can. And for two the republicans have given him nothing to take any credit for apart from the Supreme Court judge. They've been so disafuckingpointing. And for three he never really believed in anything other than himself in the first fucking place. Eventually you might get it but probably not.

>33 lriley: Hell, if they dropped Obamacare on his desk with one change to call it Trumpcare, he'd sign it and love it.

#34--change a comma or two on Obamacare and call it Trumpcare. I agree--that's all he wants.

Mean, mean, mean, small man of few brains...

As ACA enrollment nears, administration keeps cutting federal support of the law
By Juliet Eilperin October 5, 2017

Supporters of the Affordable Care Act see the president’s opposition even to changes sought by conservative states as part of a broader campaign by his administration to undermine the 2010 health-care law. In addition to trying to cut funding for the ACA, the Trump administration also is hampering state efforts to control premiums. In the case of Iowa, that involved a highly unusual intervention by the president himself.

And with the fifth enrollment season set to begin Nov. 1, advocates say the Health and Human Services Department has done more to suppress the number of people signing up than to boost it. HHS has slashed grants to groups that help consumers get insurance coverage, for example. It also has cut the enrollment period in half, reduced the advertising budget by 90 percent and announced an outage schedule that would make the HealthCare.gov website less available than last year.

The White House also has yet to commit to funding the cost-sharing reductions that help about 7 million lower-income Americans afford out-of-pocket expenses on their ACA health plans. Trump has regularly threatened to block them and, according to an administration official who was not authorized to speak publicly, officials are considering action to end the payments in November.

The uncertainty has driven premium prices much higher for 2018. A possible move by the Treasury Department to ease the requirement that most Americans obtain coverage could further erode a core element of the law.

...HHS has told its regional administrators not to even meet with on-the-ground organizations about enrollment. The late decision, which department spokesman Matt Lloyd said was made because such groups organize and implement events “with their own agenda,” left leaders of grass-roots organizations feeling stranded.

...Administration officials make no apologies for actions scaling back federal support for the ACA, also known as Obamacare. Trump, Vice President Pence and those carrying out the law at different agencies take most every opportunity to claim that it is failing. HHS Secretary Tom Price’s abrupt resignation Friday, prompted by the furor over his use of expensive chartered planes for work trips, is not expected to shift this overall approach.

...Trump and his aides also are looking for ways to loosen the existing law’s requirements, now that the latest congressional attempt to repeal it outright has failed. The Treasury Department may broaden the ACA’s “hardship exemption” so that taxpayers don’t face costly penalties for failing to obtain coverage, a Republican briefed on the plan said. That is sure to depress enrollment among the younger, healthier consumers whom insurers count on to help buffer the health-care costs of sicker customers.

...While the law’s open enrollment period has attracted the most public attention, a more obscure battle within the administration over several states’ proposed changes for their marketplaces speaks volumes about the president’s approach to the law.

It was a Wall Street Journal article about Iowa’s request that provoked Trump’s ire, according to an individual briefed on the exchange. The story detailed how officials had just submitted the application for a Section 1332 waiver — a provision that allows states to adjust how they are implementing the ACA as long as they can prove it would not translate into lost or less-affordable coverage.

Iowa...

Oklahoma...

Minnesota...

...Sen. Patty Murray (Wash.), the top Democrat on the Health, Education, Labor and Pensions Committee, said Trump should devote time to forging a bipartisan agreement to stabilize the ACA marketplaces.

“If he is only interested in sabotaging the market, that is a dangerous road for him to ride, because he will own it,” she said.

https://www.washingtonpost.com/politics/as-aca-enrollment-nears-administration-k...

_________________________________________________________

Trump rolls back Obamacare birth control mandate
The new policy reignites the battle over one of the health care law's most controversial provisions.
BRIANNA EHLEY | 10/06/2017

...The Trump administration will allow virtually any employer to claim a religious or moral objection to Obamacare's birth control coverage mandate under a sweeping rollback announced Friday.

The new policy, which takes effect immediately, reignites a fierce battle over one of the health care law's most controversial provisions. The requirement to provide FDA-approved contraception at no cost was long opposed by religious groups that heavily favored Trump, and has been wrapped up in legal challenges for more than five years.

...One study estimated that women saved $1.4 billion on birth control pills in 2013 as a result of the coverage requirement. About 55 million women have directly benefited from no-cost birth control, according to an Obama administration report released last year.

http://www.politico.com/story/2017/10/06/trump-rolls-back-obamacares-contracepti...

OP was optimistic and wrong...

Trump will scrap critical Obamacare subsidy
Scrapping the payments to insurers, which could happen almost immediately, is likely to provide another jolt to Obamacare markets.
JOSH DAWSEY and PAUL DEMKO | 10/12/2017

President Donald Trump plans to cut off subsidy payments to insurers selling Obamacare coverage in his most aggressive move yet to undermine the health care law, according to two sources close to the discussions.

The subsidies, which are worth an estimated $7 billion this year and are paid out in monthly installments, may stop almost immediately since Congress hasn’t appropriated funding for the program.

The decision, which leaked out only hours after Trump signed an executive order calling for new regulations to encourage cheap, loosely regulated health plans – delivered a double whammy to Obamacare after months of failed GOP efforts to repeal the law. With open enrollment for the 2018 plan year set to launch in two weeks, the moves seem aimed at dismantling the law through executive actions.

...there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare...

http://www.politico.com/story/2017/10/12/trump-obamacare-subsidy-243736

Targeting the weakest and the poorest.

>38 margd: As is his wont... As the WaPo wrote, gambling with vulnerable people's lives, Trump now owns the healthcare system:

Throwing a bomb into the insurance markets, Trump now owns the broken health-care system
James Hohmann | October 13, 2017

...cutting off cost-sharing payments is reminiscent of Trump’s decision to end DACA last month. He has just created an artificial political crisis by ending another Obama-era program. He believes that Congress will swing into action so that millions of vulnerable people are not harmed by his decision. Instead of undocumented immigrants who were brought to this country as children, this time it’s the poor and chronically ill who are pawns...

https://www.washingtonpost.com/news/powerpost/paloma/daily-202/2017/10/13/daily-...

I now have the deepest and most thorough disgust for the orange headed prick we have for a pres. With his latest attack , "Targeting the weakest and the poorest", as in >38 margd: he has now set the stage for mass bankruptcies in the USA - including mine.

I think the Democrats and Republicans should "compromise" and eject his twit ass from the Presidency.

Trump to cut off key ObamaCare payments
By Rebecca Savransky and Nathaniel Weixel

President Trump will end key payments to insurers selling ObamaCare plans, the White House announced late Thursday, marking Trump's most aggressive move yet to dismantle the law after multiple GOP efforts to repeal and replace it failed this year.

The Trump administration has continued making the the disbursements to insurers, known as cost-sharing reduction payments, on a monthly basis. But Trump had consistently threatened to end the payments, which are worth an estimated $7 billion this year.

"Based on guidance from the Department of Justice, the Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare. In light of this analysis, the Government cannot lawfully make the cost-sharing reduction payments," the White House said in a statement late Thursday night.

The payments were created as part of the Affordable Care Act but were then the subject of a lawsuit by House Republicans during the Obama administration. A federal court ruled the payments were being made illegally, but the Obama administration appealed.

Congress could still decide to appropriate the payments, and there is bipartisan agreement that they should be made. But no action has been taken, and some Republicans are hesitant to vote for what they see as a bailout of ObamaCare.

"The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system. Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people," White House press secretary Sarah Huckabee Sanders said.

It’s About Time Trump Ended Obamacare’s Illegal Insurance Company Subsidies
The president's termination of illegal Obamacare subsidies is a win for those who genuinely care about the most basic workings of the Constitution.

October 13, 2017 By David Harsanyi

A day after signing an executive order that offered a small break for consumers, we learned that the White House also plans on stopping the unconstitutional subsidy payments of Obamacare.

You will now hear Democrats accusing the president of “sabotaging” the Affordable Care Act (ACA), when in reality, nothing has ever been quite as damaging to Obamacare as Obamacare itself.

And the same people who lament the breaking of norms, the end of the constitutional democracy, and all the presidents tweets will now hypocritically demand that these unconstitutional payments continue.

For Democrats, following the law as written is now a crime against the law. But Obamacare, as you may recall, was implemented in lawlessness from the get-go.

Nothing was more emblematic of this problem than the implementation of so-called “cost sharing reduction” payments, also called CSR subsidies, which are direct payments to insurance companies that were designed to hide the true cost of Obamacare by shifting cost to taxpayers while bribing insurance giants to participate in the law’s exchanges.

Shortly after the passage of Obamacare, the Obama administration realized that it would need these subsidies and asked for an appropriation from Congress in 2013. Why would it do so if it didn’t have to? No one knows.

When Congress refused, Obama’s Treasury Secretary Jack Lew, without offering any public legal justification for the move, ordered the administration to begin making CSR payments.

You can imagine the outcry if Donald Trump simply began funding a massive border wall without a congressional appropriation to authorize the funding.

Since Lew’s decision to unilaterally create a massive new appropriation, Obama (and now Trump) have been sending around $7 billion each year to insurance companies participating in the supposedly self-sufficient and competitive state health care exchanges.

They continued to do so after the House sued.

They continued to do so after a federal judge found the payments unconstitutional and ordered them stopped.

“Congress authorized reduced cost-sharing but did not appropriate monies for it,” U.S. District Court Judge Rosemary Collyer wrote. “Congress is the only source for such an appropriation, and no public money can be spent without one.”

In 2014, the Washington Post, after criticizing Republicans for their overall positioning on health care, wrote that “none of that excuses President Obama’s increasingly cavalier approach to picking and choosing how to enforce this law.” (The board must have forgotten their editorial position because this summer they, too, were using the “sabotaging” argument.)

The White House says that based on guidance from the Justice Department, the “Department of Health and Human Services has concluded that there is no appropriation for cost-sharing reduction payments to insurance companies under Obamacare.”

As health care policy expert Chris Jacobs has noted, “By complying with the law and the Constitution to end the payments, President Trump actually diminished his executive power and ability to act unilaterally—restoring a rightful balance of power between the branches.”

“Democrats fearful of the implications of three more years of a Donald Trump in the White House have reason to thank him for so doing,” Jacobs wrote.

Democrats would thank him, of course, if they were actually concerned about checks and balances rather than merely worried about Donald Trump.

It’s worth noting that the price of insurance for Obamacare consumers will not change because of the president’s actions.

Trump is stopping illegal payments to health insurance companies, not altering a word of Obamacare.

Premiums will rise because Obamacare exchanges do not lower premiums, because they don’t feature any real competition.

If you need insurance company bribes disguised as health care subsidies to keep your fabricated exchanges functioning, then perhaps you don’t have a law that’s worth saving.

Plus, insurers began fleeing Obamacare “markets” long before Trump was ever elected. The collapse of the individual market was predictable, and ongoing.

Even when everyone assumed Hillary Clinton would be president, a Kaiser Family Foundation study estimated that over 664 counties in the U.S. would feature only a single insurer on Obamacare exchanges in 2017.

Overview of immediate disarray, likely impacts, and opposition:

White House’s decision to stop ACA cost-sharing subsidies triggers strong opposition
Juliet Eilperin, Amy Goldstein and Carolyn Y. Johnson | October 13, 2017

https://www.washingtonpost.com/politics/white-house-tells-court-it-is-immediatel...

>42 margd: Nothing was more emblematic of this problem than the implementation of so-called “cost sharing reduction” payments, also called CSR subsidies, which are direct payments to insurance companies that were designed to hide the true cost of Obamacare by shifting cost to taxpayers while bribing insurance giants to participate in the law’s exchanges.

Which is a complete lie. Obamacare requires insurance companies to reduce deductibles and co-pays for low-income families and the law provides for the gov't to reimburse them for the cost.

Trump's move to end insurance subsidies jolts Washington
Fredreka Schouten | Oct. 14, 2017

...On Saturday, a broad health industry coalition, which includes health insurance companies, hospitals, the American Medical Association and the U.S. Chamber of Commerce, sent a letter to congressional leaders, urging lawmakers to "take action immediately" to revive the payments.

"Millions will face higher premiums, fewer choices and less access to the medical care they need," if Congress fails to restore the funds, the trade groups argued.

...In a pair of early morning tweets Saturday, Trump celebrated his strikes against President Obama's signature health care law and reveled in the damage it had done to insurance stock prices, which fell sharply Friday on news he was ending the subsidies...

https://www.usatoday.com/story/news/politics/2017/10/14/trump-move-end-insurance...

>40 margd: And the net responds!!!

$10 million to anyone who can provide impeachable evidence on our jerk pres.

http://www.chicagotribune.com/news/nationworld/politics/ct-larry-flynt-trump-imp...

Nix fix: the malevolent one attaches priorities such as THE WALL to bipartisan healthcare fix as well as to dreamers, Iran etc...

Trump opposes bipartisan Obamacare rescue plan
BURGESS EVERETT, RACHAEL BADE and JOSH DAWSEY | 10/13/2017

His budget chief, Mick Mulvaney, says it would take a broader health care deal for the president to revive the health care payments he canceled Thursday night.

...The administration, however, opened the door to negotiations on the now-canceled payments. After speaking to Senate Minority Leader Chuck Schumer (D-N.Y.) on Saturday, Trump said that a temporary deal could be struck on shoring up the insurance markets. Mulvaney suggested the insurance payments could be a bargaining chip in a broader negotiation with Congress to either repeal President Barack Obama’s signature health care law — or fund Trump’s long-stalled border wall with Mexico.

Mulvaney is bullish about securing Trump’s priorities in a December funding bill, and he threatened — not for the first time — a government shutdown if Trump doesn’t get them.

“The president fully expects his priorities to be funded, and the wall is one of them,” Mulvaney said. “It would be highly unlikely for the president to sign a funding bill in December that does not fund his priorities.”

Mulvaney added that members of Congress he meets with probably “think that’s a credible threat.”

“It depends on what else it’s attached to, right?” Mulvaney said of the administration's position on the bipartisan health care payments proposal. “Take it on its own, I don’t know how you describe Murray-Alexander as anything other than a continuation of these subsidies, and I don’t know how much interest there would be on that. If it’s part and parcel … of a larger discussion on health care, then maybe it’s something to look at.”...

http://www.politico.com/story/2017/10/13/trump-opposes-bipartisan-obamacare-resc...

the malevolent one

Yog-Sothoth, R’lyeh, Nyarlathotep

Bipartisan Senate Health Bill Would Reduce Deficit by About $4 Billion Over Decade
CBO finds Alexander-Murray bill wouldn’t significantly affect number of insured people
Stephanie Armour and Kristina Peterson | Oct. 25, 2017 2:07 p.m.

A bipartisan Senate health bill would reduce the deficit by almost $4 billion over the next decade without significantly affecting the number of people who have coverage, the Congressional Budget Office found in a report released Wednesday.

...The Alexander-Murray bill would restore the “cost-sharing” subsidies, federal money that helps insurers offset discounts they provide for low-income consumers. It would also give states more say in implementing the ACA and expand access to lower-cost, less-robust health plans.

But the impasse between Senate Democrats, who unanimously support the bill, and President Donald Trump, who signaled his support before declaring his opposition, is showing no signs of resolution. Many lawmakers now believe negotiations will likely be pushed to the end of the year.

A federal judge in California is expected to decide Wednesday whether the Trump administration must continue making the subsidy payments to insurers even if the legislation doesn’t pass....

The CBO assumed in evaluating the Alexander-Murray bill that it wouldn’t be enacted until after the ACA’s annual open-enrollment period launches Nov. 1. That means the bill would have no effect on premiums next year.

...The CBO also found that premiums for some people would drop because the legislation would expand access to health plans that have fewer benefits and lower costs.

...For now, Senate Majority Leader Mitch McConnell (R., Ky.) has said he would only bring the bill to a vote if it has the backing of the president...

https://www.wsj.com/articles/bipartisan-senate-health-bill-would-reduce-deficit-...

Siding With Trump, Judge Clears Way for Trial Over Health Subsidies
ROBERT PEAR | OCT. 25, 2017

WASHINGTON — A federal judge sided with the Trump administration on Wednesday in a ruling against 18 states that sought to compel the federal government to pay subsidies to health insurance companies for the benefit of millions of low-income people.

“It appears initially that the Trump administration has the stronger legal argument,” Judge Vince Chhabria of Federal District Court in San Francisco wrote in the ruling.

He refused to issue a preliminary injunction requested by the states, leaving the dispute to be resolved in a trial in his courtroom over the next few months.

The states, led by the attorney general of California, Xavier Becerra, contend that the payments are needed to prevent chaos and confusion in insurance markets during the annual open enrollment period, which starts on Nov. 1.

But Judge Chhabria said at a hearing on Monday that California and other states had found “a very clever way” to protect their residents against immediate harm from termination of the subsidies by President Trump. As a result, he said in his Wednesday ruling, many low-income people will be “better off or unharmed.’’

...To offset the expected loss of cost-sharing subsidies, California added a surcharge to the price of midlevel silver plans sold on its Affordable Care Act marketplace. When premiums go up, consumers receive more financial assistance to help with premium costs, so in many cases they will be no worse off.

“Nearly four out of five consumers will see their premiums stay the same or decrease, since the amount of financial help they receive will also rise,” California’s insurance marketplace announced earlier this month...

...Many other states have taken similar steps to minimize harm to consumers, the judge said...

https://www.nytimes.com/2017/10/25/us/politics/alexander-murray-congressional-bu...

SOBs!

Senate GOP to add repeal of Obamacare insurance mandate into tax bill
Mike DeBonis and Damian Paletta | November 14, 2017

Senate Republican leaders are adding a provision to their tax bill that would repeal the Affordable Care Act’s individual mandate, a major change as they now try to accomplish two of their top domestic priorities in a single piece of legislation.

...Trump has said the repeal should be focused on getting tax rates down for the wealthy, with any leftover money going toward cutting taxes for the middle class.

Sen. Rand Paul (R-Ky.) said Tuesday morning he would introduce an amendment to the tax bill that would repeal the individual mandate and use the savings to lower taxes for middle class families.

...Repealing the mandate would free up more than $300 billion in government funding over the next decade, but it would also eventually lead to 13 million fewer people having health insurance, according to projections from the Congressional Budget Office....

https://www.washingtonpost.com/business/economy/sen-paul-plans-amendment-to-gut-...

Trump on repeal of individual mandate (MSNBC):

"Obamacare has been repealed...I told people specifically to be quiet...I didn't want them to talk about it."
-Trump

https://twitter.com/RepJudyChu/status/943532872534843392

Obamacare was "essentially repealed". Trumpcare will eat up most of middle class tax cuts--and then some as years go by...

Trump just told the truth
Dana Milbank | December 20, 2017

...“I shouldn’t say this,” Trump said, “but we essentially repealed Obamacare.”

... “Obamacare has been repealed in this bill. We didn’t want to bring it up,” he said. “I told people specifically, ‘Be quiet with the fake-news media because I don’t want them talking too much about it.’ Because I didn’t know how people would —.” Trump didn’t finish that thought, but he said he could admit what had been done “now that it’s approved.”

...Premiums for the most popular health insurance on the individual market exchanges are estimated to rise 34 percent on average next year, according to the consulting firm Avalere Health, because of previous sabotage done by the Trump administration. Premiums in Iowa would be up 69 percent, Wyoming 65 percent and Utah 64 percent.

Employer-based health insurance costs are forecast to rise in 2018 by the most since 2011, at 4.3 percent, according to the human resources consulting firm Mercer, and overall medical costs will be up 6.5 percent, the first increase in the rate in three years, according to the consulting firm PwC. Assuming those increases are passed along to workers, they would eat up half of the $910 tax cut received next year by households with income between $55,000 and $93,000 and all of the tax cut received by households earning $27,000 to $54,000...

https://www.washingtonpost.com/opinions/trump-just-told-the-truth-he-may-wish-he...

>53 margd: Currently, by contract, my health insurance is fully paid by my employer. The last contract renewal they did try to get us to start paying a share. We're up for renewal again in October, and I think this time around we may wind up having to start paying a share. If it does happen, any raises we get will probably pretty much get eaten up for at least the first couple years.

Top 10 health care surprises from Year One of Trump
ADAM CANCRYN | 12/30/2017

From drug prices to the Tom Price travel scandal, a lot of health policy didn't go according to plan.

President Donald Trump stormed into office last January confident that he could knock off Obamacare in a nanosecond. It didn't turn out that way — and from drug prices to the Tom Price travel scandal a lot of health policy didn't go according to plan. Here's a look at 10 health care surprises from 2017.

1. Obamacare survives its seventh year

2. Price jets away from HHS

3. Tough talk and no action on drug prices

4. GOP kills the individual mandate — in a tax bill

5. Planned Parenthood’s funding goes untouched

6. The vaccine controversy that never was

7. Single payer gets serious

8. Medicaid as a wedge issue

9. Shkreli goes to jail over Hillary’s hair (offered $5,000 on Facebook for a strand of then-presidential candidate Hillary Clinton’s hair. The post qualified as a “solicitation of assault,” a judge ruled, before revoking Shkreli’s bond and sending him to prison.)

https://www.politico.com/story/2017/12/30/trump-health-care-surprises-248996

______________________________________________________________

Five ways Trump can undermine ObamaCare in 2018
Peter Sullivan | 12/30/17

The ObamaCare executive order

Cuts to outreach

Targeting essential health benefits

Allowing counties to lose insurers

Support for stabilizing ObamaCare markets

http://thehill.com/policy/healthcare/366828-five-ways-trump-can-undermine-obamac...

Shocking!

Video shows apparently incapacitated, half-naked woman put out in cold by Baltimore hospital
Justin Wm. Moyer | January 10, 2017

https://www.washingtonpost.com/news/local/wp/2018/01/10/video-shows-apparently-i...

Bernie Sanders 'Medicare for All' Town Hall 1:39:58
Jan 23, 2108
https://news.google.com/news/video/iO7ppGFXUks/dHvxasQjPrFng2MXktxlIxa4_dAcM?hl=...
____________________________________________

Bernie Sanders’ ‘Medicare For All’ Online Town Hall Draws Over 1 Million Live Viewers
Daniel Marans | Jan 24, 2108

...Sanders’ town hall, which was co-hosted by the left-leaning online video news outlets The Young Turks, NowThis and ATTN, demonstrated that a lengthy seminar on the complicated topic of single-payer health care can draw a crowd as large as many primetime cable news shows.

...The auditorium itself was packed to capacity with some 450 attendees. And together, the live audiences on the senator’s Facebook and YouTube pages, the the three news sites and some other outlets that picked up the stream added up to about 1.1 million people.

The event consisted of three expert panel discussions moderated by Sanders: the first discussing problems with the current American health care system; the second on the potential economic impact of a “Medicare for all” program; and the third comparing the American health care system with those in other countries. Each of the three segments also featured questions from the live audience and video queries submitted online.

...Sanders’ guests...

...polling shows that a majority of Americans support single-payer health care....

https://www.huffingtonpost.com/entry/bernie-sanders-medicare-for-all-town-hall_u...

Wow:

How Insulin Became Unaffordable
Drew Pendergrass | January 22, 2018

...1.25 million other Americans...diagnosed with Type 1 diabetes. Unlike Type 2, a more common condition sometimes linked to high body weight, Type 1 diabetes is an autoimmune disease caused when white blood cells attack the pancreas, killing insulin-producing cells. There is no cure for Type 1, and it can’t be treated with pills or other noninvasive procedures; artificial insulin must be injected into the patient several times per day.

...There are no generic insulins. Over the past twenty years, prices for the most commonly prescribed “analog” insulins have risen from about $20 per vial to well over $250 per 10 mL vial, an over 700% increase after accounting for inflation. In contrast, insulin today costs roughly five dollars per vial to produce. With deductibles far outpacing wages, insulin has become unaffordable even for well-off Americans.

The reasons for this price increase are as complicated as the American healthcare system. Carefully negotiated rebate systems have driven enormous increases in the list price for insulin, leading patients to pay far more than insurers for their treatment. High-deductible plans, designed using oversimplified microeconomics to encourage patients to shop for better prices, instead have driven people to decline potentially lifesaving tests and adopt dangerous practices like rationing. In a market where pricing is mind-bogglingly complex, where different entities pay different amounts for the same treatments, and where drugs are of life-saving importance, the American healthcare system has forced some diabetics to choose between death and financial ruin.

...What lies ahead

The United States does not negotiate prices with drug manufacturers. The for-profit companies who are supposed to negotiate, PBMs (Pharmacy Benefit Managers), do so in their own interests and not the interests of patients. Patients are left powerless, and are shamed publicly for their weakness.

The winners in this game are predictable. Alex Azar, president of Eli Lilly USA during its unprecedented insulin price hike, is now Trump’s nominee for Health and Human Services (since confirmed as HHS Secretary). There is reason to hope—the FDA announced in December that they would expedite applications for a generic insulin. But unlike traditional generics, the infrastructure necessary to produce insulin is complex, requiring factories of modified cells.

Organizations like the Type 1 Diabetes Defense Foundation and the Juvenile Diabetes Research Foundation are fighting to share rebates directly with patients, cutting out a cash cow for the industry. If the rebates are eliminated, US insulin prices begin to look more like those in Canada. But until something changes, Americans like Alec Raeshawn Smith will lose their lives because they can’t afford a 100-year-old drug.

“Diabetes is a treatable, manageable disease, and people shouldn’t be dying from it because they should be able to afford their life-saving medication,” said Smith-Holt. “Without it they die.”

http://harvardpolitics.com/united-states/how-insulin-became-unaffordable/

____________________________________________________________

Prescription Drug Prices Have Americans Looking To Canada
Sarah Rieger | 11/17/2016

...Diabetics are another group that has turned to Canada amid price hikes.

In the U.S, the cost of insulin has dramatically increased. Prices for Humalog, a rapid-acting insulin, has grown 700 per cent since 1996, The Washington Post reported.

...In the U.S. a 10-milliliter vial of Humalog — roughly a one month supply — can cost over US$250 out of pocket, according to U.S. prescription price comparison site GoodRx.com. The same amount costs just CA$32 on a Canadian site, a number that becomes even more tempting with the low Canadian dollar. And that doesn't include the dozens of other medical supplies diabetics rely on to survive.

An illegal, but often overlooked, practice

Importing drugs into the U.S. from Canada is technically against the law, according to the FDA.

But some states, including Maine and Kansas, have passed bills to allowing residents to buy personal prescription drugs from Canada, CNBC reported. In other states, the law is not often enforced.

CNBC added that about two per cent of Americans have bought prescription drugs from outside the country.

_________________________________________________________

Ontario to cover prescription drugs (including insulin) for under 25s (effective January 2018)
https://www.jdrf.ca/t1dhub/learn/t1d-insider/ontario-to-cover-prescription-drugs...

_________________________________________________________

...ReliOn Brand of insulin at Walmart is available without prescription in some states. However, it includes very limited types of insulin. These are the older generation of insulins, including R insulin, also called Regular (a short-acting insulin and N insulin (an intermediate-acting insulin taken twice a day). These generic OTC insulins have a very different action profile than prescribed insulins. However, generic does not by any means indicate low quality.

Having an insulin back-up plan in case you find yourself with an outdated prescription or short on funds is important. It would be beneficial to discuss with a health care provider how to go about using these generic OTC insulins before you have to use them, however...

http://insulinnation.com/treatment/medicine-drugs/insulin-over-counter/

Surely, this will end up in court. The US doesn't make treaties with races of people?

Indian Health Programs That Will Sabotage Treaty Rights
Mark Trahant • April 23, 2018

Trump administration maintains tribes are a race rather than sovereign governments and Indian Health should not be exempt from Medicaid’s ‘race-based’ work rules

The Trump administration is supporting a major policy shift on Indian health programs which could result in a loss of millions of dollars to the Indian Health Service while also sabotaging treaty rights...

https://indiancountrymedianetwork.com/news/native-news/trump-administration-supp...

3.2 million more people were uninsured at the end of 2017 than at the end of 2016
Philip Bump | January 16, 2018

More than 3 million more people lacked health insurance at the end of 2017 relative to the end of 2016, according to the Gallup-Sharecare Well-Being Index. A recent estimate of the connection between a lack of insurance and mortality suggests that for every 800 people without insurance for a year, one will die — meaning that 4,000 more people may have died during the year than would have had they been covered.

That increase in the percentage began in the first quarter of Donald Trump’s presidency. In the fourth quarter of 2016, the percentage of uninsured adults in the United States was 10.9 percent — a low after three years of declines following the passage of the Affordable Care Act (better known as Obamacare). In 2013, before the law went into effect, nearly 1 in 5 adults lacked insurance. Over the course of last year, that figure rose again to 12.2 percent...

https://www.washingtonpost.com/news/politics/wp/2018/01/16/3-2-million-more-peop...

>54 margd: The American government has never abided by a treaty with Native Americans. Why would it start now?

>55 margd:

More than 3 million more people lacked health insurance at the end of 2017 relative to the end of 2016, according to the Gallup-Sharecare Well-Being Index. A recent estimate of the connection between a lack of insurance and mortality suggests that for every 800 people without insurance for a year, one will die — meaning that 4,000 more people may have died during the year than would have had they been covered.

That reminds me of the "before" Ebenezer in A Christmas Carol saying they should "go ahead and die and decrease the surplus population." At least the book had a happy ending.

>56 pmackey: To clarify, not that the study said that, but a society that allows this to go on.

Women With Breast Cancer Delay Care When Faced With High Deductibles
REED ABELSON | MAY 4, 2018

...High-deductible plans have become commonplace, a deterrent used by companies to lower health care costs by discouraging unnecessary tests or treatments. Evidence for that link has mounted since the Great Recession 10 years ago, when deductibles began to soar: People increasingly deferred medical care, putting off elective surgeries and doctors’ visits. National health care spending slowed as a result.

...Women confronting such immediate expenses put off getting diagnostic imaging and biopsies, postponing treatment.

...And they delayed beginning chemotherapy by an average of seven months.

...While high-deductible plans are meant to encourage people to think twice about whether a test or treatment is necessary and if it can be done at a lower price, “it’s also frankly to impede their use of these services,” said Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center...

https://www.nytimes.com/2018/05/04/health/breast-cancer-insurance-deductibles.ht...

Republican Medicare proposals for FY 2019 (starts Oct 1, 2018):

"According to the RSC, the budget proposal includes input from members of Congress, Congressional Committees, conservative think tanks and the executive branch to produce more than 300 specific policy reforms and spending cuts. The Republican Study Committee is a caucus of more than 150 conservative members of the Republican Party in the House of Representatives."

“Curbing spending is the only way to control our deficits and ballooning debt. Without resolute action now, we run the risk of an unstoppable debt spiral and ultimately a sovereign debt crisis. History warns us that countries that bankrupt themselves aren't around very long,” said Budget and Spending Task Force Chairman Tom McClintock (R-CA). “The RSC budget points the way back to solvency and prosperity, but every day we delay, our choices become harder. One thing is clear: inaction is not an option.”

A Framework for Unified Conservatism
FY 2019 Budget (176 p)
The Republican Study Committee:. The House's Conservative Caucus
Released April 25, 2018

https://gallery.mailchimp.com/d4254037a343b683d142111e0/files/9adb45c5-7c68-4096...

64 Medicare Premium Support
65 Simplify Traditional Medicare by Combining Parts A & B
65 MediGap Reform
66 Phase in Increases for premiums and Means-Testing
66 Adjust Medicare Eligibility Age to Reflect Life Expectancy
67 Standardize Medicare Reimbursement across Delivery Site
67 Address Waste, Fraud and Abuse
67 Limit Medicare's Responsibility for "Bad Debt"
68 Reform Graduate Medical Education Financing

Gnawing Away at Health Care
Paul Krugman | May 7, 2018

...two main fronts.

One of these fronts involves the expansion of Medicaid, which probably accounted for more than half the gains in coverage under Obamacare. Now a number of Republican-controlled states are trying to make Medicaid harder to get, notably by imposing work requirements on recipients.

...The other front involves trying to reduce the number of people signing up for private coverage. Last year the Trump administration drastically reduced outreach

...The administration...in effect let(s) insurance companies go back to discriminating against people in poor health....Congress...eliminated the individual mandate...

...sabotage ha(s) already partially reversed the coverage gains achieved under Obama, especially among lower-income Americans....worst is yet to come.

...insurers are already proposing major premium hikes — and they are specifically attributing those hikes to G.O.P. actions that are driving healthy Americans out of the market, leaving a sicker, more expensive pool behind.

...Republicans will say, “See, Obamacare is failing.”

...they need to be held accountable.

https://www.nytimes.com/2018/05/07/opinion/republicans-obamacare-health-care.htm...

As long as there's any semblance of Obamacare the Republican party is going to try to undo it---when they're in power they are going to destroy the parts they don't like and subvert the parts that they can turn into something that serves their interests/interests of their donors and not the public good. This is happening with Trump but it would happen nonetheless without him too.

And FWIW Obamacare was always a poor compromise for a single payer system. The democrats should just come out and do what they want their supporters to do--a single payer system and no compromise at all. Get it in place and working quickly and make it as popular as you can. Educate people on how they're getting better results and saving money. Don't overcomplicate things.....and fuck their own donors that don't like it.

So anyway health care shouldn't be a for profit at every fucking level. Without cost controls at every level we'll continue to have people playing other people's health issues off to the benefit of their bank accounts. That's the way capitalism is.

>61 lriley: Amen Amen Amen!!!!

So anyway health care shouldn't be a for profit at every fucking level. Without cost controls at every level we'll continue to have people playing other people's health issues off to the benefit of their bank accounts. That's the way capitalism is.

Sure capitalism is sweet and nice... until you don't have any money. I don't object that a private company makes a profit but it's obscene as it is. I long for the day when we can get to the single payer system. Every single person in this country should have affordable health care not just "affordable" insurance.

I don't see this as a Democrat or Republican issue. The health of the American people is literally at stake. This is a national issue.

Trump calls on Congress to pull back $15 billion in spending, including on Children’s Health Insurance Program
Damian Paletta and Erica Werner | May 7, 2018

...Almost half of the proposed cuts would come from two accounts within the Children’s Health Insurance Program (CHIP) that White House officials said expired last year or are not expected to be drawn upon. An additional $800 million in cuts would come from money created by the Affordable Care Act in 2010 to test innovative payment and service delivery models.

Those are just a handful of the more than 30 programs the White House is proposing to Congress for “rescission,” a process of culling back money that was previously authorized. Once the White House sends the request to Congress, lawmakers have 45 days to vote on the plan or a scaled-back version of it through a simple majority vote...

https://www.washingtonpost.com/business/economy/trump-calls-on-congress-to-pull-...

The head swamp monster won't allow Medicare to negotiate prices directly with drugmakers, nor U.S. consumers to import lower-cost medicines from other countries, but he will pressure other countries to not negotiate lower drug prices. WTH?

Trump assails high drug prices, avoids direct hit on industry
Yasmeen Abutaleb | May 11, 2018

U.S. President Donald Trump on Friday blasted drugmakers and healthcare “middlemen” (health insurers and pharmacy benefit managers (PBMs)) for making prescription medicines unaffordable for Americans, but healthcare stocks rose as his administration avoided aggressive direct measures to cut prices.

...campaigned on lowering prescription drug prices...

...abandoned ideas to lower drug costs he supported during the campaign, including allowing the government’s Medicare plan for older Americans to negotiate prices directly with drugmakers, and enabling U.S. consumers to import lower-cost medicines from other countries...

...Shares of major drugmakers, insurers and PBMs rose after the speech. The S&P 500 healthcare index .SPXHC, a broad gauge of large healthcare stocks, closed up 1.5 percent, its biggest single-day percentage gain in a month.

https://www.reuters.com/article/us-usa-trump-drugpricing/trump-assails-high-drug...

ETA________________________________________________

American Patients First
The Trump Administration Blueprint to Lower Drug Prices
and Reduce Out-of-Pocket Costs
MAY 2018 (44 p)

https://www.hhs.gov/sites/default/files/AmericanPatientsFirst.pdf

>64 margd: Too much money spent by big Pharma in campaigns and lobbying. The Federal government could negotiate the best deal with pharmaceutical companies to get affordable medicines for all citizens. But hardly (if any) lawmaker will bite that cash cow.

Remedy for high drug costs: Let Medicare negotiate
Mark Miller | May 17, 2018

...Large majorities of Republican, Democratic and independent voters say they would be more likely to vote for candidates in this year’s midterm elections who are committed to bringing down the cost of prescription drugs, according to a poll released last week by the Kaiser Family Foundation (KFF).

...Some of (Trump's) ideas might help, but the plan bypasses an obvious remedy - one that President Donald Trump embraced as a candidate: allowing Medicare to negotiate drug prices directly with pharmaceutical companies.

...Medicare’s drug benefit...was created under the Medicare Modernization Act of 2003...Today, Medicare accounts for 29 percent of all spending for U.S. retail prescription drugs, but the law...states that the secretary of Health and Human Services “may not interfere” in negotiations between pharmaceutical companies and prescription drug insurance plan providers.

...Imagine: a buyer that controls nearly one-third of all pharmaceutical buying has its hands tied when it comes to negotiating price. Instead, it relies on the negotiating muscle of the hundreds of private Part D insurance providers who sell plans to Medicare enrollees. That makes the Medicare drug program unique among federal health programs; the Medicaid program contains mandatory drug price rebates, and the Department of Veterans Affairs (VA) requires that drug providers charge no more than the lowest price paid by any private-sector buyer. The VA pays 40 percent less than Part D, according to a 2011 research study published in Health Economics...

https://www.reuters.com/article/us-column-miller-medicare/remedy-for-high-drug-c...

I wonder what changed Mr. Trump's mind

N*v*rt*s

Anybody want to buy a vowel?

U.S. Health Care Ranked Worst in the Developed World
Melissa Hellmann | June 17, 2014

...the 2014 Commonwealth Fund survey...compares the U.S. with 10 other nations: France, Australia, Germany, Canada, Sweden, New Zealand, Norway, the Netherlands, Switzerland and the U.K.

... most expensive...lowest in terms of “efficiency, equity and outcomes”...High out-of-pocket costs and gaps in coverage “undermine efforts in the U.S. to improve care coordination” the report summarized.

...“Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home”

...positives noted include the breadth of reforms spearheaded by the Affordable Care Act, including new databases for transparent information and financial assistance for low-middle-income families in gaining coverage...

http://time.com/2888403/u-s-health-care-ranked-worst-in-the-developed-world/

That the U.S. is falling behind on health care compared to the nations cited is not surprising. Medicare can't negotiate for better prices/rates which in the Private Sector would be unthinkable. Wal-Mart negotiates regularly for a better deal for themselves, as does Amazon. The volume of their purchases from suppliers gives them the economic clout. Capitalism 101. But the Federal government is prohibited from the doing the same in the public interest? That's bullcrap. The only reason the current situation exists is that pharmaceutical companies are huge donors to political campaign funds (for both Dems & Reps) and lobby groups. The politicians and big pharma wins while the American people lose. Again, bullcrap! There has to be a balance between making a profit and fleecing your customers a la Pharma Bro.

Greed is not good. It is corrosive and ruins everything it touches.

Trump's new insurance rules are panned by nearly every healthcare group that submitted formal comments

More than 95% of healthcare groups that have commented on President Trump’s effort to weaken Obama-era health insurance rules criticized or outright opposed the proposals, according to a Times review of thousands of official comment letters filed with federal agencies.

The extraordinary one-sided outpouring came from more than 300 patient and consumer advocates, physician and nurse organizations and trade groups representing hospitals, clinics and health insurers across the country, the review found.

Kris Haltmeyer, vice president of health policy and analysis at the Blue Cross Blue Shield Assn., said he couldn’t recall a similar show of opposition in his more than 22 years at the trade group, which represents Blue Cross and Blue Shield health plans and is among the organizations that have expressed serious reservations about the administration’s proposed regulations.

“This seems to be a pretty overwhelming statement of concern,” Haltmeyer said.

State insurance regulators from both political parties have also warned that the administration’s proposals could destabilize insurance markets, raise premiums for sick Americans and open the door to insurance fraud.

And dozens of industry leaders and other experts have called on the administration to rethink moves to scale back consumer protections enacted through the Affordable Care Act, often called Obamacare.

“Basically anybody who knows anything about healthcare is opposed to these proposals,” said Sandy Praeger, a former Republican state insurance regulator in Kansas and onetime president of the National Assn. of Insurance Commissioners. “It’s amazing.”

Trump administration tells court it won't defend Obamacare against lawsuit seeking to cripple it
Tom Howell Jr. | June 7, 2018

The Trump administration told a federal court Thursday it won’t defend Obamacare against a lawsuit that’s trying to strike down most of the law.

...now up to Obamacare fans such as Democratic governors to step in and defend the Affordable Care Act against on onslaught from (20} GOP attorneys general, who say after Congress nixed the individual mandate at the heart of the law, the rest of it should follow...

https://www.washingtontimes.com/news/2018/jun/7/trump-administration-wont-defend...

ETA____________________________________________________________

These changes would take place AFTER the 2018 election...

Trump Regime Says Obamacare Shouldn't Protect People With Pre-Existing Medical Conditions
Matt Novak | June 8, 2018

The U.S. Justice Department made an unusual argument to a federal court last night, claiming that Obamacare’s protections for people with pre-existing medical conditions are unconstitutional. Roughly 1 in 4 Americans have pre-existing conditions that would make it difficult to buy insurance without those protections. If the DOJ is successful, millions of American could be denied the ability to buy health insurance.

..The new Republican-led tax cut...got rid of the individual mandate which required all Americans to buy health insurance. Sessions claims that the tax law’s elimination of the individual mandate should invalidate the requirement that health insurance companies not discriminate based on pre-existing conditions.

Texas first filed its lawsuit to completely dismantle the ACA on February 28, 2018 in the U.S. District Court for the Northern District of Texas and saw 19 other states join. But 17 Democratic-controlled states, led by California, intervened in April to fight back against the attacks on Obamacare.

...The judge overseeing the case in Texas was appointed by Republicans, and as the New York Times notes, three DOJ lawyers who were working on the case abruptly quit yesterday, presumably because they weren’t happy with the decision to dismantle Obamacare and protections for consumers...

https://gizmodo.com/trump-regime-says-obamacare-shouldnt-protect-people-wit-1826...

From TAKE CARE: Ensuring the President “shall take Care that the Laws be faithfully executed”

The Establishing Shots of a Heist: The Trump DOJ Meets the Affordable Care Act
Ian Samuel (Lecturer, Harvard Law School Lecturer), Leah Litman (Asst Prof of Law, U of CA, Irvine) | 6/7/18

Earlier today, the Justice Department filed a document in a case about the Affordable Care Act that was so radical, and so self-evidently without merit, that...three career lawyers involved in the case withdrew their appearance before it was filed, presumably to avoid the taint of being listed on a docket where it appeared.

...makes two arguments. (A) The individual mandate, which the Supreme Court upheld in NFIB v. Sebelius, is unconstitutional; and (B) because the mandate is unconstitutional, the most important provisions of the Affordable Care Act should also be struck down, on the ground that they are not severable from the now-unconstitutional mandate.

...(A)excruciatingly stupid, but has the complementary virtue of being irrelevant on its own

...real argument is (B): that if the now-toothless individual mandate is unconstitutional, then the Affordable Care Act’s “community rating” and “guaranteed issue” provisions should also be struck down...prohibit discrimination on the basis of pre-existing conditions and require insurers to sell to anyone willing to pay the listed price for a policy.

...the doctrine of “severability,”...when a court says one part of a law is unconstitutional, but the law has many other parts. The general rule is, as DOJ acknowledges, one of congressional intent: If Congress would have kept the other provisions without the unconstitutional one, then the provisions stay.

...The premise for DOJ’s argument in part (A) is that Congress repealed the mandate as it was enacted (by repealing the tax penalty for not complying with it). Yet its premise in part (B) is that the mandate is not severable from other provisions; in other words, that without the mandate, Congress would not have wanted the guarantee issue and community rating provisions. But we know the opposite is true: Congress repealed the mandate, but kept the guarantee issue and community rating provisions. There is no need to speculate what Congress might have wanted.

...DOJ’s... first argument is that it would be a very bad idea to have the ACA without an individual mandate...Because the reply “no shit, assholes” would be indelicate and inappropriate, we will simply observe that while this is true, Congress knew it—and took the risk anyway...

... DOJ’s second reply...(~) “We all know that the leadership of the Republican party would be happy to see the Affordable Care Act repealed; we also all know they couldn’t actually get the votes together to do it. Here’s where you come in.”

...All good heists must have...something daring that is not revealed until it is in progress... The market for health insurance in the United States must...be destroyed, because that is what Congress would have wanted. But not just yet. Not until January 2019—after, in other words, the midterm elections. What Congress seems to have intended, in other words, is the destruction of a law most of its members will not vote to repeal—but only when the now-impoverished electorate’s power to punish those responsible will be at its absolute nadir....

https://takecareblog.com/blog/the-establishing-shots-of-a-heist-the-trump-doj-me...

UPDATED: Trump freezes Obamacare payment program, leaving insurers scrambling
Amanda Michelle Gomez | Jul 7, 2018

The sabotage of Obamacare continues.

Georgetown health policy expert Edwin Park said should the risk adjustment program end, insurers over the long run “would be forced to sharply raise premiums or reconsider participation.”

The Trump administration is freezing a critical Affordable Care Act (ACA) insurance payment program that discourages insurers from cherry picking healthier enrollees by compensating them for sicker ones.

The move could rattle insurance companies at the very moment when they’re deciding whether to continue selling ACA plans and setting premiums for 2019. It’s not immediately clear what this means for ACA enrollees, if anything.

...a recent decision by a federal judge in New Mexico, who ruled that part of its implementation was flawed and hadn’t been adequately justified by federal regulators, people familiar with the plans said.

“We were disappointed by the court’s recent ruling. As a result of this litigation, billions of dollars in risk adjustment payments and collections are now on hold,” said the Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma in a statement released on Saturday. “CMS has asked the court to reconsider its ruling, and hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans who receive their insurance in the individual and small group markets.”
Advertisement

CMS argues the ruling prevents it from making further collections or payments in the risk adjustment program, including amounts for the 2017 benefit year which amount to $10.4 billion, until the litigation is resolved. However, outside experts are skeptical of the claim...

https://thinkprogress.org/trump-might-end-obamacare-payment-program-rattling-ins...

Risk Adjustment Payment Freeze: How much heartburn is YOUR insurance carrier experiencing this morning?
Mon, 07/09/2018 - 8:31am

Over the weekend, CMS dropped a big bombshell on everyone: In response to a federal judge siding with a small insurance carrier in New Mexico in a lawsuit over the formula for the ACA's Risk Adjustment (RA) formula, the Trump Administration has decided not to pay out any RA funds for the 2017 calendar year to anyone until...well, I'm not sure exactly, but for the foreseeable future.

Pretty much (every) expert on how the RA program (and the law) has indicated that this is completely unnecessary; there's several responses at CMS's disposal which wouldn't require throwing the entire industry into a panic (yet again). Regardless, this is where we're at.

....here's the full list of (temporary) Winners and (hopefully short-term only) Losers in every state. CMS also provided a link to a downloadable Excel version...

http://acasignups.net/18/07/09/risk-adjustment-payment-freeze-how-much-heartburn...

Trump Officials Slash Grants That Help Consumers Get Obamacare
Robert Pear | July 10, 2018

...The cuts are the second round in two years. The government will provide $10 million this fall, down from $36 million last autumn and $63 million in late 2016 — a total reduction of more than 80 percent.

Trump administration officials said the insurance counselors, known as navigators, did not enroll enough people to justify more spending. Insurance agents and brokers do much better, they said.

The announcement on Tuesday, by Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, came three days after the administration suspended a program that stabilizes health insurance markets by paying billions of dollars to insurers that enroll large numbers of unhealthy people under the Affordable Care Act. Insurers said the freeze would cause turmoil in insurance markets and drive up premiums...

https://www.nytimes.com/2018/07/10/us/politics/trump-affordable-care-act.html

U.S. the Most Dangerous Developed Country to Give Birth In: Report
Kashmira Gander | 7/27/18

..."The Global Burden of Disease 2015 Maternal Mortality" study published in The Lancet journal and cited in the USA Today's "Deadly Deliveries" report...

Between 1990 to 2015, the number of maternal deaths per 100,000 births in most developed nations—including Germany, France Japan, England and Canada—fell or plateaued to below 10. But in the U.S. the figure spiked to 26.4.

...the leading causes of death in the U.S. were hemorrhage and severe hypertension, where blood pressure and blood loss levels have to be closely monitored. And medical professionals too often “eyeball” instead of measure blood-loss levels, according to USA Today.

...fewer than half of maternity patients were treated for blood pressure high enough they could experience stroke. And less than 15 percent of women in danger received recommended treatments

...Alison Young, the investigative journalist behind (USA Today) report...called on clinicians to make the safety of pregnant women a priority, and for hospitals and practices to introduce the Alliance for Innovation on Maternal Health Programs safety checklists.

...The USA Today report (700 deaths, 50,000 severe injuries)...a "hodgepodge" of hospital protocols for dealing with potentially deadly but easily treatable complications is putting women in danger. Hospitals were also found to be unprepared for maternal emergencies.

...Black women...are three to four times more likely to die from a pregnancy-related complication...

https://www.newsweek.com/us-most-dangerous-developed-country-give-birth-report-1...

Analysis: without Trump and GOP, ObamaCare premiums would fall

The analysis from Matt Fiedler at the Brookings Institute found premiums would be 4.3 percent lower in a “stable policy environment,” which means certain ObamaCare protections like the individual mandate would still be in place, and access to short-term plans would not have been expanded.

Donald Trump is making Medicare-for-all inevitable
Matthew Yglesias | Aug 3, 2018

A market-based solution can’t work if Republicans won’t let it.

...whether the Democratic Party should pursue (“Medicare-for-all”) is no longer in doubt.

That’s in part thanks to the work of activists and organizers who’ve been working in the single-payer trenches for years.

But it’s also thanks to the Trump administration, which, having failed to repeal the Affordable Care Act, has undertaken a nearly unprecedented campaign of regulatory malfeasance that aims to prevent it from functioning and minimize the number of people on whom it bestows comprehensive health coverage...

https://www.vox.com/2018/8/3/17641560/medicare-for-all-trump

President Trump admits he’s trying to kill Obamacare. That’s illegal.
Abbe Gluck* | Aug 3, 2018

Four cities ( Baltimore, Chicago, Columbus, and Cincinnati ) have just filed suit, arguing that Trump’s attempts to undermine the law violate the Constitution.

...The president has a legal obligation, under Article II of the US Constitution, to “take Care that the laws be faithfully executed.” That means he must make sure that our laws are implemented in good faith and that he uses his executive discretion reasonably toward that end.

His agencies likewise have a legal obligation, under the Administrative Procedure Act — the statute that sets the rules for our entire federal regulatory apparatus — not to use their power to engage in arbitrary action.

...make open enrollment a failure

...cut off important cost-sharing payments that the ACA promises to insurers to compensate them for reducing what individuals have to pay in premiums.

...motive...

*Abbe R. Gluck is a professor of law and the faculty director of the Solomon Center for Health Law and Policy at Yale Law School.

https://www.vox.com/the-big-idea/2017/10/17/16489526/take-care-clause-obamacare-...

Democrats seize on cherry-picked claim that ‘Medicare-for-all’ would save $2 trillion
Glenn Kessler | August 7, 2018

...We don’t intend to pick on (Andrew Gillum, Democratic candidate for Florida governor) who (in a primary debate, Aug. 2, 2018) appears to have picked up a talking point that is circulating among Democrats. But we do want to lay down a marker because this goes too far.

All too often, politicians mischaracterize conclusions that are contained in academic or think tank studies. At the Fact Checker, we rely heavily on how a study’s author says the data should be presented. In this case, it’s clear that (Charles Blahous, a former economic adviser to George W. Bush and a public trustee for Social Security and Medicare from 2010 through 2015) bent over backward to accept Sanders’s assumptions, only to find they did not add up. Democrats cannot seize on one cherry-picked fact without acknowledging the broader implications of Blahous’s research.

Three Pinocchios (Significant factual error and/or obvious contradictions. This gets into the realm of “mostly false.” But it could include statements which are technically correct (such as based on official government data) but are so taken out of context as to be very misleading. The line between Two and Three can be bit fuzzy and we do not award half-Pinocchios. So we strive to explain the factors that tipped us toward a Three.)

https://www.washingtonpost.com/news/fact-checker/wp/2018/08/07/democrats-seize-o...

Kaiser Health Tracking Poll – Late Summer 2018: The Election, Pre-Existing Conditions, and Surprises on Medical Bills
Ashley Kirzinger | Sep 05, 2018

...KFF polling continues to find pre-existing conditions as a widespread concern and with the impending lawsuit Texas v. United States*, a majority of the public say it is “very important” that the Affordable Care Act’s (ACA) protections for people with pre-existing conditions ensuring guaranteed coverage (75 percent) and community rating (72 percent) remain law. About half (52 percent) of the public are “very worried” that they or someone in their family will have to pay more for health insurance and four in ten (41 percent) are “very worried” they will lose their coverage if the Supreme Court overturns these protections.

Over the past few months President Trump has maintained a tense relationship with drug companies over the price of prescription drugs. This month’s tracking poll finds an increase in the share of the public who say drug companies making too much profit is a “major reason” why people’s health care costs have been rising (78 percent compared to 62 percent in 2014). However, less than half of the public – four in ten (42 percent) – say they think President Trump’s strategy of publicly shaming drug companies and asking them to cut prices will be effective in reducing prescription drug costs overall and a similar share (38 percent) are confident that the president will be able to deliver on his promise that Americans will pay less for prescription drugs under his administration.

Health care costs continue to be an important issue in the 2018 midterm election and beyond. When given a list of possible worries, unexpected medical bills tops the list that includes other health care costs such as premiums, deductibles and even drug costs, as well as other household expenses. Four in ten insured adults ages 18-64 say there has been a time in the past 12 months when they received an unexpected medical bill and one in ten say they received a “surprise” medical bill from an out-of-network provider in the past year...

https://www.kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-late-s...

*Opening arguments in a lawsuit challenging the constitutionality of the ACA are set to begin in federal court in Texas on Wednesday...brought by 20 Republican state attorneys general...

https://www.cnbc.com/2018/09/04/poll-70percent-of-people-want-aca-protections-th...

Nearly 600 Russia-Linked Accounts Tweeted About the Health Law
The majority of the nearly 10,000 tweets on the Affordable Care Act seem intended to pit one side against the other
9/12/2018

https://www.wsj.com/articles/nearly-600-russia-linked-accounts-tweeted-about-the...

These Are the Economies With the Most (and Least) Efficient Health Care
Lee J Miller and Wei Lu | September 19, 2018, 10:00 AM EDT

Americans’ life expectancy of 79 years lags behind 25 nations’
Bloomberg Health-Efficiency Index tracks medical costs, value

Want medical care without quickly draining your fortune? Try Singapore or Hong Kong as your healthy havens.

The U.S. will cost you the most for treatment, both in absolute terms and relative to average incomes, while life expectancy of Americans -- about 79 years -- was exceeded by more than 25 countries and territories, according to an annual Bloomberg analysis in almost 200 economies.

...The U.S. had the second-highest per-capita spending on health care at $9,536. Switzerland’s average based on gross domestic product was $9,818. But that $282 supplement helped deliver an extra 4.2 years of life -- with the average Swiss lifespan of almost 83.

...Compared to residents of the Czech Republic -- which had an average life expectancy almost at parity with the U.S. -- Americans spent more than double on health care relative to GDP, 16.8 percent versus 7.3 percent. Health spending in the U.S. is estimated to increase to 18 percent of GDP in the U.S., according to estimates from the Altarum Institute...

https://www.bloomberg.com/news/articles/2018-09-19/u-s-near-bottom-of-health-ind...

One Big Problem With Medicaid Work Requirement: People Are Unaware It Exists

Arkansas has dropped more than 4,300 enrollees for failing to comply with the new requirements in the first three months.
...
Only 1,200 people, about 2 percent of those eligible for the requirement, told the state they had done enough of the required activities in August, according to state figures.
...
Advocates for the poor, and the state officials in charge of the program, said the low compliance numbers suggested that many eligible people probably didn’t know the program existed.
...
But it seems that not everyone opened or read their mail. Ray Hanley, the president of the Arkansas Foundation for Medical Care, which ran a call center for the state, told my colleague Robert Pear that many people never answered their phones. The state said the open rate on emails was between 20 and 30 percent.

It’s harder to measure how many people opened paper mail, but the state noted in its recent report that it knows that thousands of people in the program either move away from their recorded address or fail to answer other mail from the state. Housing instability and moves are more common among low-income Americans.

Jessica Greene, a professor of health policy at Baruch College in New York, visited three Arkansas counties last month and interviewed 18 Medicaid beneficiaries. Twelve of them were unaware of the work requirement, according to an article she published on the website of the journal Health Affairs.

Getting health insurance through work now costs nearly $20,000
Tami Luhby | October 3, 2018: 10:02 AM ET

...Although premiums have increased fairly modestly in recent years, the growth has far outpaced workers' raises over time. The average family premium has increased 55% since 2008, twice as fast as workers' wages and three times as fast as inflation, Kaiser's Employer Health Benefits Survey found.

Companies pick up most of the tab, shelling out $14,100 a year, on average. Still, workers have to pay an average of $5,550, up 65% from a decade ago.

For single coverage, total premiums have reached $6,900, on average, up 47% from 2008. Workers contribute roughly $1,200 a year.

Deductibles also continue to burn a deeper hole in workers' pockets. The average deductible now stands at $1,350, up 212% since 2008. That's eight times faster than wage growth.

Also, more workers are subject to deductibles -- some 85% in 2018, compared to 59% a decade ago. A quarter of all workers face deductibles of at least $2,000, up from 15% five years ago...

https://money.cnn.com/2018/10/03/news/economy/employer-health-insurance-cost/ind...

Fact-checking President Trump’s USA Today op-ed on ‘Medicare-for-All’
Glenn Kessler |

President Trump wrote an opinion article for USA Today on Oct. 10 regarding proposals to expand Medicare to all Americans — known as Medicare-for-All — in which almost every sentence contained a misleading statement or a falsehood...

https://www.washingtonpost.com/politics/2018/10/10/fact-checking-president-trump...

What the Lawless Obamacare Ruling Means
onathan H. Adler and Abbe R. Gluck | Dec. 15, 2018

It’s not based on a solid legal argument. It’s an exercise in raw judicial power.

... the states argued — and Judge O’Connor agreed — that the rest of Obamacare must fall, too. They claim that the (individual) mandate is so central to the A.C.A. that nothing else in it can operate without it.

That’s not how the relevant law works. An established legal principle called “severability” is triggered when a court must consider what happens to a statute when one part of it is struck down. The principle presumes that, out of respect for the separation of powers, courts will leave the rest of the statute standing unless Congress makes clear it did not intend for the law to exist without the challenged provision. This is not a liberal principle or a conservative principle. It is an uncontroversial rule that every Supreme Court justice in modern history has applied.

Sometimes severability cases are difficult because it is hard to guess how much importance Congress attributed to one provision, especially in a lengthy law like the Affordable Care Act. But this is an easy case: It was Congress, not a court, that eliminated the mandate penalty and left the rest of the statute in place...

https://www.nytimes.com/2018/12/15/opinion/obamacare-ruling-unconstitutional-aff...

I read 1,182 emergency room bills this year. Here’s what I learned.
Sarah Kliff | Dec 18, 2018

A $5,571 bill to sit in a waiting room, $238 eyedrops, and a $60 ibuprofen tell the story of how emergency room visits are squeezing patients...

1) The prices are high — even for things you can buy in a drugstore
2) Going to an in-network hospital doesn’t mean you’ll be seen by in-network doctors
3) You can be charged just for sitting in a waiting room
4) It is really hard for patients to advocate for themselves in an emergency room setting
5) Congress wants to do something about the issue

https://www.vox.com/health-care/2018/12/18/18134825/emergency-room-bills-health-...

Federal judge in Pennsylvania blocks Trump administration birth control rules
Reuters | Jan. 14, 2019

...U.S. District Judge Wendy Beetlestone in Philadelphia issued a nationwide injunction preventing the rules* (issued by the U.S. Departments of Health and Human Services (HHS), Labor and Treasury) from taking effect (on Monday), a day after another judge issued a more limited ruling blocking their enforcement in 13 states and the District of Columbia.

The rules would let businesses or nonprofits lodge religious or moral objections to obtain exemptions from the Obamacare mandate that employers provide contraceptive coverage in health insurance with no copayment.

"The negative effects of even a short period of decreased access to no-cost contraceptive services are irreversible" ...

...rules exceeded the scope of 2010's Affordable Care Act, popularly known as Obamacare, which she said prohibits HHS from providing such exemptions.

She said a nationwide injunction blocking the rules' enforcement was necessary given the harm states would face if they went into effect. Beetlestone cited the costs the states would shoulder to provide contraceptive coverage to women themselves if the rules took effect.

About 70,500 women would lose coverage, putting them at risk of unintended pregnancies...

https://www.nbcnews.com/news/us-news/judge-pennsylvania-blocks-trump-administrat...

__________________________________________________________________________

*Trump Just Made It Easier for Employers to Refuse to Pay for Birth Control
Maggie Fox | Oct. 6, 2017

...The Trump administration loosened Obama-era birth control requirements on Friday, saying most providers of health insurance could refuse to pay for an employee’s birth control if the provider shows “sincerely held” religious or moral objections.

The new regulations, which take effect immediately, protect religious groups such as the Little Sisters of the Poor from litigation if they refuse to provide contraceptive coverage, but widen the pool of those shielded to include nonprofits, for-profit companies, other nongovernmental employers, and schools and universities...

https://www.nbcnews.com/health/health-care/trump-just-made-it-so-employers-can-r...

Senator Rand Paul might be having his hernia surgery in a private clinic just outside Toronto, but his surgeons will have benefited from Ontario's public health system, I bet. In the public system, there tend to be regional centers for various surgeries, which, while a bit of a travel pain, provide state-of-the-art techniques and highly experienced surgeons. Apparently, it's "It’s next to impossible for most Canadians to (seek care at Ontario clinic that Sen Paul will use), even if they have the financial means, because of provincial laws preventing doctors from taking private money for services already covered by government." So, for Canadian doctors, foreigners are "gravy".

Marni Soupcoff: Rand Paul visits an island of 'capitalist medicine' in socialist Canada
Marni Soupcoff | January 16, 2019

There is nothing hypocritical about this vocal critic of medicare paying for his own surgery at a renowned private clinic...

https://nationalpost.com/opinion/marni-soupcoff-sen-rand-pauls-canadian-prescrip...

Trump is looking for a new way to cut Medicaid — without Congress
Dylan Scott@dylanlscottdylan.scott@vox.com | Jan 19, 201

...Seema Verma, who runs the Centers for Medicare and Medicaid Services for President Trump, has been exploring whether the agency could implement Medicaid block grants, Politico reported last week. It would represent the most aggressive action yet by the Trump White House to cut Medicaid spending.

...The details are still to be determined, and the plan might not even be legally permissible: Some experts argue CMS lacks the authority to change Medicaid’s funding formula without congressional approval...

https://www.vox.com/policy-and-politics/2019/1/17/18186676/government-shutdown-m...

As reported, healthcare coverage varies a bit by province and has changed over time. I lived in Ontario before moving to Michigan ~1980. Then, OHIP (Ontario Health Insurance Program) paid for my CONTACT LENSES (!) because I was so near-sighted. It paid for a young relative's leg braces (spinal bifida). Though it doesn't now (I don't believe), the dance is between government expenditures and what people WANT--the system seems very RESPONSIVE to voters' preferences and concerns.

Also, there are other programs that cover (in Ontario, at least) contraception for low income women and flu shot clinics. The municipality where we have summer place sponsors weekly clinic where all (including American seasonal residents) can see a nurse-practitioner for free. (The one time spouse went, he made small donation, but not required.) Years ago (1990s), there wasn't a procedure for Ontario hospitals to collect from Americans for urgent care, but that has changed. ($$$) As a veteran, my Canadian dad had (free?) insurance that, for example, paid for a private room in hospital.

Also, re "free", working people contribute via taxes.

Still, if I were to return to Ontario to live, I would be eligible for OHIP after three months. (As would anyone legally living in the country, citizen or not.)

Other countries (Norway?) have more seamless coverage.

Bernie Sanders overplays Canada's out-of-pocket health care costs
Jon Greenberg on Friday, February 22nd, 2019 at 10:00 a.m.

Medicare for All is a pillar of Bernie Sanders’ presidential campaign. In his kick-off interview with CBS News, the Vermont senator was asked if his plan was too big for the country to handle. Sanders shot back that making sure everyone has health care didn’t seem beyond the reach of other developed nations. He pointed to America’s northern neighbor.

"Somehow or another in Canada, for a number of decades, they have provided quality care to all people without out-of-pocket expenses," Sanders said Feb. 19. "You go in for cancer therapy, you don't take out your wallet. And they do it for about 50 percent per capita of the cost that we spend."

...In Canada, if you actually go into a hospital and get treated there, it is free. Across the country, hospital visits and care at the doctor's office are covered 100 percent. But prescription drugs and some outpatient care are a different matter entirely.

...The Canadian government reported that in 2018, about 36 billion Canadian dollars, or 15 percent, of all health care spending was out-of-pocket.

...We rate this claim Half True.

Americans Are Going Bankrupt From Getting Sick
Doctors’ bills play a role in 60 percent of personal-bankruptcy filings.
Olga Khazan | Mar 15, 2019

...American Journal of Public Health, nearly 60 percent of people who have filed for bankruptcy said a medical expense “very much” or “somewhat” contributed to their bankruptcy. That was more than the percentage who cited home foreclosure or student loans. (The survey respondents could choose multiple factors that contributed to their bankruptcy.)

...A 2016 study found that a third of cancer survivors had gone into debt as a result of their medical expenses, and 3 percent had filed for bankruptcy. According to a Consumer Financial Protection Bureau study from 2014, medical bills are the most common cause of unpaid bills sent to collection agencies. About a fifth of Americans have a medical claim on their credit report, and the same proportion currently has a medical bill overdue.

...half a dozen consumer advocates told me they are concerned that the problem will get worse, since the uninsured rate is going up, and more people are signing up for cheaper but skimpier health-insurance plans introduced by the Trump administration. More Americans are also now on high-deductible health plans, many of which require patients to pay thousands before insurance kicks in. Networks of doctors have grown narrower, meaning more providers are likely to be out of network.

Emergency-room visits and planned surgical procedures are the most common causes of large medical bills that patients simply can’t afford to pay, advocates told me. Often, a hospital might be covered by a person’s insurance network, but the individual doctors who work there and the ambulance company that services it aren’t, a situation that can lead to something called balance billing. Sometimes, bizarre loopholes kick in at the darkest moments, like the fact that a baby would be covered upon birth under Medicaid or the Children’s Health Insurance Program, the government insurance program for children, but a stillbirth might not be covered...(Indeed, one study found that average hospital costs for stillbirths are more than $750 higher than for live births.)...

https://www.theatlantic.com/health/archive/2019/03/hospital-bills-medical-debt-b...

The Trump Administration Now Thinks the Entire ACA Must Fall
Nick Bagley // 3/25/19

In a stunning, two-sentence letter submitted to the Fifth Circuit today, the Justice Department announced that it now thinks the entire Affordable Care Act should be enjoined. That's an even more extreme position than the one it advanced at the district court in Texas v. Azar, when it argued that the court should "only" zero out the protections for people with preexisting conditions.

...Much as it may dislike the fact, the Trump administration has an obligation to defend acts of Congress.

...sheer reckless irresponsibility...the Trump administration has now committed itself to a legal position that would inflict untold damage on the American public.

...Every reputable commentator -- on both the left and the right -- thinks that Judge O'Connor's decision invalidating the entire ACA is a joke.

...An administration that claims to support protections for people with preexisting conditions has now called for undoing not only the parts of the ACA that protect such conditions, but also the entire Medicaid expansion and parts of the law that shield those with employer-sponsored insurance from punitive annual or lifetime caps. Not to mention hundreds of rules having nothing to do with health insurance, including a raft of new taxes, mandatory labeling of calorie counts at chain restaurants, and rules governing biosimilars.

...this is not business as usual. This is far beyond the pale. And it is a serious threat to the rule of law.

https://takecareblog.com/blog/the-trump-administration-now-thinks-the-entire-aca...

_________________________________________________________________________

Trump administration now says entire Affordable Care Act should be struck down
Ariane de Vogue and Tami Luhby | March 26, 2019

...In a filing with a federal appeals court, the Justice Department said it agreed with the ruling of a federal judge in Texas that invalidated the Obama-era health care law.

In a letter Monday night, the administration said "it is not urging that any portion of the district court's judgment be reversed."

"The Department of Justice has determined that the district court's comprehensive opinion came to the correct conclusion and will support it on appeal," said Kerri Kupec, spokesperson for the Justice Department.

It's a major shift for the Justice Department from when Jeff Sessions was attorney general. At the time, the administration argued that the community rating rule and the guaranteed issue requirement -- protections for people with pre-existing conditions -- could not be defended but the rest of the law could stand.

...Because the case is before one of the most conservative appellate courts in the country, it almost guarantees that the issue will return to the newly solidified conservative Supreme Court at some point. President Barack Obama's former solicitor general, Donald Verrilli -- who once defended the law before the Supreme Court -- is now defending the law on behalf of the Democratic-led House.

Overturning the law would have far-reaching consequences -- way beyond disrupting coverage for the millions of people who get their health insurance on the exchanges or through Medicaid expansion.

Obamacare saves senior citizens money on their Medicare coverage and prescription drugs. It lets many Americans obtain free birth control, mammograms and cholesterol tests. And it allows children to stay on their parents' health insurance plans until they turn 26.

And, even the Trump administration is using the landmark health reform law to try to lower prescription drug prices.

The Trump administration would not defend the law in court so a coalition of 21 Democratic states led by California stepped in.

...After November's midterm elections, the Democratic-led House of Representatives also joined in. In briefs filed with the appellate court, House lawyers said that if O'Connor's ruling were upheld "the consequences will be devastating."

"Millions of Americans will be denied affordable health care," the House lawyers wrote. They added that "insurance costs will skyrocket" and "Medicare recipients will face steep increases in the price of drugs and other services."...

https://www.cnn.com/2019/03/25/politics/trump-administration-aca/index.html

I really don't think it makes much sense for the Democrats to try to put the Affordable Care Act back together if they win in 2020. After its implementation the Republicans railed against it and it was a focus of all their candidates running for POTUS back in 2015/2016 and Trump may have made the biggest deal out of it. If the Democrats win in 2020 and are out in 2024 or 2028 we're very likely to see the Republicans again repeating their efforts to dismantle it again when they're back in power.

Furthermore the ACA did bring health care to a lot more people than ever before but it was absolutely ineffective as far as controlling costs which continued to go up and up after its implementation which is to say that Health Insurance companies (which are unnecessary in nations with government controlled health care plans and fuck health insurance companies anyway), Pharmaceutical multinationals, HMO's, hospitals, clinics, dentist offices what have you are going to continue to look for ways to gouge more profits out of the public if only because they have corporative mindsets. The points of a National system is to 1) bring health care to everybody, kill the insurance companies, making it a walk in and walk out thing that is paid for by either by increasing sales tax such as Canada does or cutting into things like the military budget---which could use a lot of cutting and 2) to make sure gouging doesn't happen which is controlling the cost of health service should be about.

So unless we want to go through all this bullshit again and again we should just cut to the chase and bring in a universal government controlled system and cut out all the predation of pharmaceutical giants making people pay thousands of $'s for drugs that cost them very little to produce or having your insurance company (instead of your doctor) decide what kind of treatments they'll pay for instead or maybe not even pay for at all. I don't think it will take long for people to decide that this is the kind of the system they've really wanted all along.

I was very disappointed by the way that Elizabeth Warrens seems to think the ACA is the way to go. You're not going to get points for being weak on this.

In Divided White House, Trump Sided With Mulvaney in Push for Nullifying Obamacare
Maggie Haberman and Robert Pear | March 27, 2019

WASHINGTON — The Trump administration’s surprise decision to press for a court-ordered demolition of the Affordable Care Act came after a heated meeting in the Oval Office on Monday, where his acting chief of staff (Mick Mulvaney) and others convinced President Trump that he could do through the courts what he could not do through Congress: Repeal his predecessor’s signature achievement.

...Mr. Trump has played up that he has kept his promises, Mr. Mulvaney and Mr. Grogan argued, and as a candidate, they said, he campaigned on repealing the health law. His base of voters would love it. Besides, they argued, Democrats have been campaigning successfully on health care, and Republicans should try to take it over themselves. This could force the issue.

Among those with concerns was Pat Cipollone, the White House counsel, who shared that it was opposed by the new attorney general, William P. Barr. Vice President Mike Pence was concerned about the political ramifications of moving ahead without a strategy or a plan to handle the suddenly uninsured if the suit succeeds.

...Mr. Barr did not favor the move but did not object to the White House decision once it had been made

...Republicans in Congress have no obvious road forward on legislation to replace the Affordable Care Act that could pass the Democrat-controlled House...

https://www.nytimes.com/2019/03/27/us/politics/trump-aca.html

>95 lriley: What we need is something solid enough that the Republicans who push against it get burned. I don't think the ACA is it, but I think Republican attempts to dismantle it are going to earn them some backblast. If the Democrats could get six years to stabilize a solid Canadian/European style medical systems, I don't think the Republicans could overturn it, but I don't think we'll get six years.

#97--if we were going to take the Canadian model of paying for it through sales tax--yes sales tax will go way up but people won't be paying for health insurance and everybody will be covered. People will be walking into their doctor's offices and walking straight out when their appointment was over without paying anything there either or at the hospital. I would think most people (even crazy as hell right wingers) would get used to outcomes like that pretty quickly. A main part of the problem for lots of politicians will be they're going to lose a lot of campaign contributions from the health and insurance industries and big Pharma.

Anyway I wouldn't be surprised if the Democrats win POTUS and both houses in 2020. The Senate election picture is set up very favorably for the Democratic party in the next two election cycles. The Trump presidency has also set a couple new precedents and if I were an incoming Democratic POTUS I would take full advantage of that---and health care would be one place. Gun violence would be another. I wouldn't wait for the next mass shooting. I'd come right in with a national emergency on that and on the climate.

>98 lriley: You have my vote :-)

"PSST. Wanna buy a bridge???"

Donald J. Trump @realDonaldTrump | 7:23 PM - 1 Apr 2019

Everybody agrees that ObamaCare doesn’t work. Premiums & deductibles are far too high - Really bad HealthCare! Even the Dems want to replace it, but with Medicare for all, which would cause 180 million Americans to lose their beloved private health insurance. The Republicans.....

....are developing a really great HealthCare Plan with far lower premiums (cost) & deductibles than ObamaCare. In other words it will be far less expensive & much more usable than ObamaCare. Vote will be taken right after the Election when Republicans hold the Senate & win......

...back the House. It will be truly great HealthCare that will work for America. Also, Republicans will always support Pre-Existing Conditions. The Republican Party will be known as the Party of Great HealtCare. Meantime, the USA is doing better than ever & is respected again!

____________________________________________________________

>98 lriley: Friends who have lived in both the US and Canada find taxes of all kinds somewhat equivalent in total. Difficult to compare because you win a bit here, lose a bit there. Outcomes for all citizens a bit better in Canada, they think? Though depends on who you are and what your values are. Apples & oranges!

Re sales tax or Value Added Tax, it was largely sold in Ontario, at least, as a way to put domestically produced goods on same footing as imports. We pay Harmonized Sales Tax on a micro-business we own in Ontario. Combines provincial and federal sales taxes. NOTHING is missed it seems, but at the end of the year one files paperwork that makes sure no double taxation on stuff we buy and sell. (If supplier paid, we don't upon resale--if I understand correctly.) Also, there's effort to prevent sales tax's regressive load on people of modest means.

I don't fully understand the funding streams, but income tax is part of the health care funding mix:

Health Care Funding

Health care in Canada is funded at both the provincial and federal levels. The financing of health care is provided via taxation both from personal and corporate income taxes. Additional funds from other financial sources like sales tax and lottery proceeds are also used by some provinces.

Alberta, British Columbia, and Ontario also charge health premiums to supplement health funding, but such premiums are not required for health coverage as per the Canada Health Act.

At a federal level, funds are allocated to provinces and territories via the Canadian Health and Social Transfer (CHST). Transfer payments are made as a combination of tax transfers and cash contributions. The amount of funding provinces and territories receive is significant, and topped $35 billion in 2002-2003.

In 2000, the new budget injected an additional $23 billion of investment into the health care system.

www.canadian-healthcare.org/page8.html

#100--well Canada also has travelers paying into the health care system every time they buy something too. Just saying. Canada also has cost controls on medications--something that we have no grip on here. And the idea of waiting lines and outcomes is a bunch of bull--that Rand Paul who has made a career out of attacking national health care systems traveled especially to Toronto recently to get a hernia operation attests to that.

To go back to health insurance companies though--it's not just the cost of insurance but they have an effect on treatment and medications as far as options and what they'll pay for. People don't always get the best and sometimes not even close. I find it almost stunning that some people worry over their health insurance providers. With a govt. run health care system--there is no need for insurance companies and everyone is covered once and for all. Insurance companies main thing is to profit off of situations. Another point for a national system is that it would take a burden off employers paying their employees health care premiums.

There are multiple ways of looking at this but to me it's still pretty clear we need a universal govt. sponsored health system. And just to reiterate we can put Obamacare back together again if everything falls into place for the democrats in 2020 and in 2024 or 2028 when the next republican comes into power the republicans will start to dismantle it again. That's what they do. Build something that they can't or won't dismantle (because it's too popular) is the answer.

>101 lriley: Yes! Medicare is the "third rail" in Canadian politics: no sane politician would ever propose anything other than improvements.

My Cdn friends and relatives may grouse, but the government is wa-ay more responsive to the grousing than is the private sector! They never worry about being bankrupted by healthcare or going without prompt, medically necessary care. Efficiencies and centralization mean that treatment are more likely to be at experienced hospitals (regional specialization) and is data-driven. (Cdn data is basis for treatment decisions here in the US, BTW).

There are other income streams, too, e.g., contraception for low income women. The municipality where we have a summer place pays for a (free) nurse-practitioner clinic, which is open to Americans as well as card-carrying Ontarians.

No system's perfect, but theirs is so much better than what we have. Even Medicare has issues:

Medicare wellness visits are supposed to be free — unless you call it a physical.
Michelle Andrews | March 16 at 11:00 AM
https://www.washingtonpost.com/national/health-science/medicare-wellness-visits-...

NPR keeps siting polls that say that a majority of Americans love their health insurance plans. Who are these people. Every time I've had to deal with a health insurance company it's been a bureaucratic nightmare (why do Republicans think that only gov'ts have bureaucracies?). Is it because most working people are healthy enough that they don't have to use their health insurance very often? Is it because when polls ask people about their opinion of their health plan they think of their doctor and not their insurance company?

#103--I agree. I can't deal with them usually without losing my temper. My wife does all of that (and the fact is she's smarter on all this anyway) and going back to her pregnancies and a lot of stuff she had to deal with--being passed on to other connections on the phone--oftentimes though not going through or being cut off and to have to start all over again from the beginning--sometimes spending hours to get an answer or fruitlessly trying to--sometimes in tears or very angry before it's done. People like going through all that garbage? Really?

#102--the idea is to make it a right to have for everybody--not to have it continue as a big corporate profit making machine where the balance sheet is the be all and end all thing that decides everything. Look at the epi-pen thing. No way that should allowed to happen or that people should have to walk away from treatments or not buy medications they need because they can't afford to pay. I'm all for doctors, nurses and technicians in the field being well remunerated but middlemen and corporate profits need to come to a halt.

They didn't poll me but I'm completely satisfied with my HMO - and I've had major reasons to test their efficiency and process. I have not had to deal with paperwork and appointments. Everything was done for me and I was happy with my doctors. The one time I was not happy with my GP, I easily changed doctors, no fuss, no bother.

The two times in last year we were billed rather than the insurance company, it was the MD/office that improperly coded an annual/physical/wellness visit. ALWAYS CHECK paperwork to make sure they use the right words to describe the visit.

My experience was with Blue Care Blue Shield (pre-Medicare), and after a YEAR of calls to MD's reps and BCBS, I eventually paid just to make it go away. I swear my blood pressure soared on many a call, so I just gave in. My MD, who subsequently retired, asked during my visit whether I was seeing my eye dr etc., which characterized the visit as a physical and not an annual--or something like that--and BCBS denied the charge. First opportunity I got I switched from BCBS. More difficult to switch from MD practice as I'm now on Medicare and not such a desirable (remunerative) patient.

In DH's first visit under Medicare, his MD called it an annual rather than a wellness visit, so Medicare rejected the charge. DH made several visits to MD's office, patiently waiting each time until they finally covered the charge. He credits his success to TAKING NOTES and GOING IN PERSON, not just calling. I suspect being male didn't hurt either...

Scary to think that we'll no doubt encounter such errors in future as our capacities to contest fade.

I am a quite infrequent user of prescription drugs. A recent toothache sent me to the pharmacy twice last month. The first time, they had Blue Cross Blue Shield in my record as payor. I didn't argue with a 97 cent co-pay. Two weeks later, Caremark picked up the tab. I've never had either insurance coverage.

Might as well mention that big Pharma some years ago (and I believe it was during Bill Clinton's presidency) was able to block Americans from reimporting drugs from Canada. What was going on was because Canada had a national system the Canadian govt. was able to negotiate prices with American pharmaceuticals that were much much lower than in the United States and many Americans at the time were reimporting drugs sold to Canada back into the United States because they were so much cheaper. Every once in a while this pops up again but American pharmaceuticals have enough congress people in their pocket that they've been able to continue their blockade. So drugs sold from here up to Canada by our own American companies are much cheaper than they are here.

As an addendum to that when we would go on trips to Canada in the 90's I use to stop into pharmacies and by bottles of codeine aspirin--(I had off and on back issues) and I could get a bottle of 200 over the counter for something like $3. As I said it was the 90's but the same of regular aspirin back then in the United States was a lot more than that.

Medicare for All: What's in It for Seniors?
Mark Miller | 08 Apr 2019

...don’t be too quick to assume that Medicare for All would take away something that seniors enrolled in the current Medicare program now enjoy. Just the opposite: The proposals circulating in both the House and Senate would improve Medicare by eliminating the program's most glaring coverage gaps for long-term care insurance, and for dental care, vision and hearing. The bills also would eliminate cost-sharing, meaning that one of traditional Medicare's weakness would be gone--the absence of a cap on total out-of-pocket spending.

Here's a rundown of the risks Medicare enrollees currently face for each of these five areas, in rough order of their relative importance. As a proxy for Medicare for All, we'll use the Medicare for All Act of 2019, sponsored by Rep. Pramila Jayapal, D-Washington, which is widely seen as the most pure Medicare for All plan circulating in the House. Sen Bernie Sanders, I-Vermont, has long been a proponent of Medicare for All, and his Senate legislation is expected to be similar in most respects to Jayapal's bill.

Long-term Support and Services...

Out-of-Pocket Spending...

Dental Coverage...

Hearing Costs ...

Vision Care...

https://www.morningstar.com/articles/922362/medicare-for-all-whats-in-it-for-sen...

Why Europeans Don’t Get Huge Medical Bills
Other countries still have health insurers, but they avoid five-figure medical bills. The answer lies in how the insurers and doctors are regulated.
Olga Khazan | Apr 11, 2019

One reason insurance companies get a bad rap is that they’re associated with “surprise medical bills.” These billing nightmares occur when insured patients go to a hospital they thought was in-network, but then—sometimes inadvertently—see a doctor who is out-of-network while they’re there. (This is on top of the exorbitantly high medical bills that many uninsured people receive, no matter what doctor or hospital they go to.)

...There is, however, a way to eliminate those bank-busting surprise medical bills without eliminating health insurance. Just ask Europe. Several European countries have health insurance just like America does. The difference is that their governments regulate what insurance must cover and what hospitals and doctors are allowed to charge much more aggressively than the United States does.

...There are still some downsides to the health-care systems of these countries, but they are generally considered better than that of the United States...

https://www.theatlantic.com/health/archive/2019/04/do-europeans-get-big-medical-...

New Trump administration rule would weaken protections for transgender people in health care
Ariana Eunjung Cha | May 24, 2019

The Department of Health and Human Services on Friday proposed a new rule that civil rights groups worry may be used to deny care to transgender patients.

HHS’s director of the Office for Civil Rights, Roger Severino, said the change will bring the regulations in line with what lawmakers originally intended, before the definition of gender was broadened under the Obama administration.

“When Congress prohibited sex discrimination, it did so according to the plain meaning of the term, and we are making our regulations conform,” Severino said.

...The proposal is part of a broader effort by religious conservatives in the Trump administration to define gender restrictively. The result has been a weakening of protections for transgender people.

The Department of Housing and Urban Development on Wednesday proposed a new rule that would allow federally funded shelters to turn away transgender people for religious reasons or force them to use bathrooms and sleeping areas that do not conform to their gender identity. A March 12 memo from the Department of Defense outlined a new policy that bans individuals with a gender dysphoria diagnosis who are taking hormones or who have transitioned to another gender to enlist. In addition, troops already in the military would have to serve according to their sex assigned at birth.

...under the Obama administration, HHS had redefined nondiscrimination protections on the basis of sex to include one’s internal sense of being “male, female, neither, or a combination of male and female,” as well to cover termination of pregnancy. Religious groups said the provision violates the Religious Freedom Restoration Act and the Administrative Procedure Act and have challenged the definition in federal court in Texas. The court has issued an injunction on enforcement of the rule, and in a filing in April, HHS attorneys agreed that the Obama-era rule is illegal and hinted that this new rule was in the works.

...Under the federal rulemaking process, the public will have 60 days to submit comments. HHS would then consider the feedback and then move forward with finalizing the rule.

https://www.washingtonpost.com/health/2019/05/24/new-trump-administration-rule-w...

1 in 6 ER visits or hospital stays triggers 'surprise' bill
Byricardo alonso-zaldivar | Jun 20, 2019

...the nonpartisan Kaiser Family Foundation finds that millions of people with what's considered solid coverage from large employers are nonetheless exposed to "out-of-network" charges that can amount to thousands of dollars. It comes as congressional lawmakers of both parties and the Trump administration move to close the loophole, with a Senate panel scheduled to vote on legislation next week.

A patient's odds of getting a surprise bill vary greatly depending on the state he or she lives in. Texas seems like a bit of a gamble, with 27% of emergency room visits and 38% of in-network hospital stays triggering at least one such bill. Minnesota looks safer, with odds of 2% and 3%, respectively.

...Next Wednesday, the Senate Health, Education, Labor and Pensions committee plans to vote on bipartisan legislation that would limit what patients can be charged to their in-network deductibles and copays. The bill from Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., would require insurers to pay out-of-network doctors and hospitals the median — or midpoint — rate paid to in-network providers. The House Energy and Commerce committee is working on similar legislation. President Donald Trump has said he wants to sign a bill.

...Insurers and employers generally favor the approach the Alexander-Murray bill takes on how to pay out-of-network providers, using an in-network rate as the reference point. But hospitals and doctors instead want disputed bills to go to arbitration. New York has an arbitration system and a recent study found it has worked well. However, some lawmakers are concerned that on a national scale it may lead to a costly new bureaucracy.

Surprise bills can come about in different ways. In an emergency, a patient can wind up at a hospital that's not in their insurer's network. Even at an in-network hospital, emergency physicians or anesthesiologists may not have a contract with the patient's insurer. For a scheduled surgery at an in-network hospital, not all the doctors may be in the patients' plan.

Bills can amount to tens of thousands of dollars and hit patients and their families when they are most vulnerable. Often patients are able to negotiate lower charges by working with their insurers and the medical provider. But the process usually takes months, adding stress and anxiety. When it doesn't work out bills can get sent to collection agencies...

https://abcnews.go.com/Health/wireStory/er-visits-hospital-stays-triggers-surpri...

Trump issues executive order increasing transparency in hospital prices, doctor fees
Berkeley Lovelace Jr. and Ashley Turner | Jun 24 2019

Key Points

President Trump issued an executive order that would pressure insurers, doctors and other providers to disclose more information about health-care prices.
High health costs have become a rare bipartisan issue with lawmakers on both sides of the aisle demanding something be done.

...The executive order will direct the Department of Health and Human Services to require hospitals and insurers to disclose negotiated rates for services, as well as provide patients with out-of-pocket costs before their procedures.

...Along with price transparency for patients, the administration will make available to researchers and health care providers data that will “help them develop tools to provide patients with more information about health care prices and quality,” the White House said, adding the administration will improve quality measurements and make them public.

Trump said his order is the “opposite” of the Affordable Care Act, also known as Obamacare, by giving “much better pricing.” The order intends to improve consumer incentives by by expanding the benefit of Health Savings Accounts and other tax-preferred health accounts.

The order also requires HHS to determine further regulatory steps that need to be taken to address surprise billing, while looking into other barriers that impact transparency in health care costs...

https://www.cnbc.com/2019/06/24/trump-to-issue-executive-order-increasing-transp...

I'd say "YAY!" but kidney dialysis stocks soared.

Trump Proposes Ways to Improve Care for Kidney Disease and Increase Transplants
Reed Abelson and Katie Thomas | July 10, 2019

...kills more people than breast cancer.

...Mr. Trump signed an executive order directing federal agencies to educate and treat people with early forms of kidney disease, to make kidney transplants easier to get, and to shift the financial incentives for clinics and doctors away from the existing system that relies heavily on dialysis.

...Trump...also said his administration would work to encourage the development of new treatments like artificial kidneys.

...aggressively seeking to lower the costs by encouraging in-home dialysis and organ donation...

About 37 million adults have chronic kidney disease, or about 15 percent of American adults. Medicare, the federal health insurance program, covers about half a million people with end-stage kidney disease and spends disproportionately on their care. Although they are just 1 percent of Medicare beneficiaries, they account for 7 percent of the program’s medical claims, some $35 billion. The total cost to Medicare for kidney care each year exceeds $100 billion.

Medicare has covered people who need dialysis since 1973, when the federal government took the unheard-of step of covering people with a single condition — end-stage renal disease — because they would not otherwise be able to afford care. Patients who need dialysis are hooked up to a machine that filters toxins from their blood three times a week, an onerous process that disrupts people’s lives and takes a heavy toll on their health. Half of the people who are on dialysis die within five years, according to federal officials.

...Officials said they wanted 80 percent of newly diagnosed people with end-stage kidney disease to be moved from clinic-based dialysis by the year 2025, and to reduce the number of Americans who develop end-stage disease by 25 percent before 2030. Today, only about 12 percent of Americans get dialysis at home, an amount that lags other countries.

The Trump administration wants to encourage living donors by adding reimbursements for lost wages and child care, as a way to double the number of kidneys available for transplant by 2030. Organs from living donors are considered the best option for people who need transplants, but they too require recuperative time.

...If the administration is successful, the initiative could lead to a shake-up of the dialysis industry, which is dominated by two companies, DaVita and Fresenius Medical Care. They operate about 70 percent of the country’s dialysis clinics.

In singling out kidney disease, Mr. Trump has taken on an issue widely seen as overdue for reform, and appears to be adding it to his list of health initiatives, a top priority for voters.

...a major of aspect of their initiative would rely on an innovation center created under the Affordable Care Act...would create pilot programs to test alternate ways of reimbursing physicians to encourage treatment of kidney disease earlier and potentially avoid the need for dialysis.

...Companies that operate clinics, such as DaVita and Fresenius, profit from recurring visits by patients coming to their centers. In addition, many kidney specialists, or nephrologists, have a financial interest in dialysis centers in their communities, either by serving as the clinics’ medical directors or owning a stake through a joint venture with a dialysis operator.

...significant change would not be easy. Many people with end-stage kidney disease are coping with other serious health conditions or are facing other problems, such as a lack of resources or support that may make it hard to take advantage of alternative treatments...

https://www.nytimes.com/2019/07/10/health/trump-kidney-disease-transplant.html

It Just Got Harder to Get Birth Control in America
Title X made sure poor women could have access to health care. The Trump administration has compromised that.

By The Editorial Board
The editorial board represents the opinions of the board, its editor and the publisher. It is separate from the newsroom and the Op-Ed section.
Aug. 19, 2019

...The Trump administration has quietly been working to gut the Title X family planning program, which helps poor women afford birth control, cancer screenings and testing for H.I.V. and other sexually transmitted infections. On Monday, the administration’s efforts paid off: Planned Parenthood, which serves about 40 percent of Title X patients around the country, felt forced to withdraw from the program.

The nearly 50-year-old Title X program is an unsung hero of American public health. In 2017, Title X clinics served more than four million women, 42 percent of them uninsured, according to the federal Office of Population Affairs, which administers the program. The Guttmacher Institute, a research group that supports reproductive rights, found that Title X clinics helped prevent more than 822,000 unintended pregnancies in 2015. The institute estimates that for every dollar the federal government spends on family planning, it saves more than $7.

The Trump administration’s new Title X rule, announced in February, will lay waste to that progress. The rule bars facilities that receive Title X money from providing abortions, even with a separate source of money, as has been required by law for decades. It also prohibits clinics from referring patients for an abortion at a different facility — in other words, staff members would effectively have to pretend that abortion is not a legal medical option.

And that’s exactly the point for this administration: to treat abortion as though it were illegal, until perhaps that wishful thinking becomes reality...

https://www.nytimes.com/2019/08/19/opinion/planned-parenthood-title-x.html

Aren't there any in Trump's base who use this program? Don't they understand who's to blame for the services no longer available? Do they still support him? Come on, ladies. Wake the f*** up!

Eric Topol @EricTopol | 12:54 PM · Aug 25, 2019:
Life expectancy in the US has dropped 3 years in a row (unprecedented) & is the worst of all 36 @OECD countries. Nice that @BCAppelbaum put it on the economists ( https://nytimes.com/2019/08/24/opinion/sunday/economics-milton-friedman.html ), but it's really a self-inflicted deep wound

Chart: Republicans are struggling to fix America’s dysfunctional health-care system
Should Democrats win in 2020, they may not fare any better
May 22, 2019

(see chart on health spending and life expectancy in selected OECD countries, 1970-2017)

https://www.economist.com/graphic-detail/2019/05/22/republicans-are-struggling-t...

Just an fyi. Below are changes to Ontario's health care, recommended by physician-led board to improve care. These sort of tweaks are the kinds of things that, however warranted, prompt complaints from some that later appear in US political ads against universal healthcare. Centralized data informs these kinds of decisions, which are sometimes adopted in US as well as Canada. I think in private sector, far less data & physician input, less transparency, and fewer opportunities to press for reversal(?)

https://news.ontario.ca/mohltc/en/2019/08/appropriateness-working-group-recommen...

Backgrounder
Appropriateness Working Group Recommendations
August 22, 2019 3:31 P.M.

(Ontario) Ministry of Health

Established by the Kaplan Board of Arbitration, the physician-led Appropriateness Working Group (AWG) reviewed several OHIP-insured services. The AWG used evidence, best practices and expert opinion to identify and update the delivery of certain services to help ensure the most effective care for Ontario patients.

Beginning October 1, 2019, the following OHIP-insured services will be updated as a result of the working group's review.

IMPROVE THE QUALITY OF PATIENT CARE
Use More Accurate Diagnostic Imaging for Sinus Problems...
Refer Patients to Specialized Clinics for Chronic Hip and Knee Pain to Improve Arthritic Care...
Update the use of Ambulatory Cardiac Monitoring Devices (Loop and Holter Monitors)...
Improve Access to Primary and Specialty Care by Simplifying Referrals to Specialists...
Use More Effective Testing to Diagnose Infertility...

REDUCE MEDICALLY UNNECESSARY SERVICES
Perform Procedure to Remove Ear Wax Only When Medically Necessary...
Conduct Larynx Examinations During Stomach Examinations Only When Medically Necessary...
Continue Access to Urine Pregnancy Tests When Medically Necessary...
Improve Primary Care Access by Streamlining Pre-Operative Assessments...
Improve Access to Knee Arthroscopies for Patients with Degenerative Knee Disease...
Fund Physician Premiums for House Calls Only for Frail Elderly and Housebound Patients...

PREVIOUS APPROPRIATENESS WORK
Sinus ultrasound...replaced by CT or sinus endoscopy...
Pre-operative echocardiography (ECG)...only eligible for payment when the service is medically necessary...
Hyperbaric oxygen therapy (HBOT)...(approved for some) idiopathic sudden sensorineural hearing loss (ISSHL)...

Media Contacts
Ministry of Health...
OMA Media Relations...

Jeff Stein @JStein_WaPo | Nov 2
What’s the most shocking health care statistic you’ve ever seen

Leo Beletsky @LeoBeletsky | Nov 2
US has been on an accelerating "reversal of fortunes" public health trajectory since the 1980s

Image (Life Expectancy per Health Expenditure per Capita, 1970-2017, by Country)
https://twitter.com/LeoBeletsky/status/1190809740500074497/photo/1

(At ~half the expenditure, other countries' life expectancies are ~2 to 3.5 years longer than US!!!!!!!)
(Except for a small dip in Germany, US is only country in which life expectancies are declining....)

#120--continuing to go along the same path will pretty much add to more life expectancy decline and more expensive health care. There may be a point where the life expectancy decline plateaus but as far as profiting off of health the sky's the limit.

..a new analysis of more than a half-century of federal mortality data...found that the increased death rates among people in midlife extended to all racial and ethnic groups, and to suburbs and cities. And while suicides, drug overdoses and alcoholism were the main causes, other medical conditions, including heart disease, strokes and chronic obstructive pulmonary disease, also contributed...
https://www.nytimes.com/2019/11/26/health/life-expectancy-rate-usa.html

-----------------------------------------------------------------------------------------------

Steven H. Woolf and Heidi Schoomaker. 2019. Life Expectancy and Mortality Rates in the United States, 1959-2017
JAMA. November 26, 2019;322(20):1996-2016. doi:10.1001/jama.2019.16932 https://jamanetwork.com/journals/jama/article-abstract/2756187

Abstract
Importance US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.

...Findings Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.

Conclusions and Relevance US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

---------------------------------------------------------------------------------------------------

Howard K. Koh et al. 2019. Editorial: Confronting the Rise and Fall of US Life Expectancy. AMA. 2019;322(20):1963-1965. doi:10.1001/jama.2019.17303 . https://jamanetwork.com/journals/jama/article-abstract/2756159

...downward trends in life expectancy, which declined after 2014 for 3 successive years, represent a US health disadvantage compared with peer high-income nations, despite the United States having the highest per capita health care spending in the world...

The Great American Eye-Exam Scam
Yascha Mounk | November 27, 2019

Why is it so difficult to get a new pair of glasses or contacts in this country? It’s easier pretty much everywhere else.

...American optometrists spend a lot of money on lobbying. According to the Center for Responsive Politics, for example, the AOA spent $1.8 million on lobbying and another $1.4 million on campaign contributions in 2016. And although the AOA was unsuccessful in its attempt to block the laws requiring optometrists to give patients a copy of their prescription, any attempt to remove the need for frequent office visits (the exact figure depends on whether you wear glasses or contacts, among other factors) is likely to meet with stiff resistance.

Like the citizens of virtually every other country around the world, Americans should be allowed to buy any pair of glasses or set of contact lenses at a moment’s notice. While the requirement to get a medical exam from an optometrist who has spent a minimum of seven years in higher education may have good effects in some cases, it also creates unreasonable costs—and unjustifiable suffering.

Even in times of extreme polarization and a deeply broken Congress, this is one piece of sensible legislation that should be able to command bipartisan support. Republicans who believe in the free market should look on this red tape as an unnecessary intrusion on free enterprise. Democrats who care about the well-being of the socioeconomically disadvantaged—and are worried about the health disparities between different ethnic groups—should be outraged by the unreasonable burden the situation places on underprivileged Americans.

https://www.theatlantic.com/ideas/archive/2019/11/great-american-eye-exam-scam/6...

>123 margd: I've bought a couple of glasses recently. Just simple reading glasses with +0.5 if I remember correct. Picked up at the local bookshop for something like US$10. Is that really impossible in the US?

You can buy reading glasses or even scuba masks with corrective lenses without a prescription.

Otherwise one needs a prescription, I believe. Makes sense if one has astigmatism, I guess, but if one is short of money, some approximation over the counter might be better than going without for myopia?

I think (as you can tell I don't normally use glasses) that here you go to a local store that'll test your sight and get you some glasses If they find anything worrisome they'll tell you to go see a doctor. (Mind you, glasses are still expensive, but that's mostly because people like having nice looking, lightweight glasses).

The American Health Care Industry Is Killing People
Yes, transitioning to a more equitable system might eliminate some jobs. But the status quo is morally untenable.
Farhad Manjoo | Dec. 4, 2019

...Every year Americans collectively pay about $500 billion in administrative costs for health care — that is, for things like billing and insurance overhead, not for actual medical care.

These costs are significantly higher than in most other wealthy countries. One study on health care data from 1999 showed that each American paid about $1,059 per year just in overhead costs for health care; in Canada, the per capita cost was $307. Those figures are likely much higher today.

Wouldn’t lowering overhead costs be an obviously positive outcome?

Ah, but there’s the rub: All this overspending creates a lot of employment — and moving toward a more efficient and equitable health care system will inevitably mean getting rid of many administrative jobs. One study suggests that about 1.8 million jobs would be rendered unnecessary if America adopted a public health care financing system.

...researchers write that “countries with higher life expectancy outperform the United States in providing universal access to health care” and in “removing costs as a barrier to care.” In America, by contrast, cost is a key barrier. A study published last year in The American Journal of Medicine found that of the nearly 10 million Americans given diagnoses of cancer between 2000 and 2012, 42 percent were forced to drain all of their assets in order to pay for care...

https://www.nytimes.com/2019/12/04/opinion/healthcare-industry-medicare.html

See graphics at https://www.nytimes.com/2019/12/27/upshot/expensive-health-care-world-comparison....

My dad and I had cataract surgery in same year--Dad in Canada, me in the US. This was about the time that technology had greatly decreased the cost of individual procedures, and, in Ontario, the government was pressing opthalmologists for savings to return to the government (the single-payer healthcare program). Very few differences in wait-time, procedure or aftermath that I could see, but the Ontario provider (well-regarded) had much more modest office furnishings, as did the hospital. Rather than personal appointments, the day-after-office visit was a group meeting followed by quick checks of each eye to make sure all was well.

In the U.S., an Angioplasty Costs $32,000. Elsewhere? Maybe $6,400.
Margot Sanger-Katz Dec. 27, 2019

A study of international prices finds American patients pay much more across a wide array of common services.

...The International Federation of Health Plans, a group representing the C.E.O.s of health insurers worldwide, publishes a guide every few years on the international cost for common medical services. Its newest report, on 2017 prices, came out this month. Every time, the upshot is vivid and similar: For almost everything on the list, there is a large divergence between the United States and everyone else.

Patients and insurance companies in the United States pay higher prices for medications, imaging tests, basic health visits and common operations. Those high prices make health care in the U.S. extremely expensive, and they also finance a robust and politically powerful health care industry, which means lowering prices will always be hard.

For a typical angioplasty, a procedure that opens a blocked blood vessel to the heart, the average U.S. price is $32,200, compared with $6,400 in the Netherlands, or $7,400 in Switzerland, the survey finds. A typical M.R.I. scan costs $1,420 in the United States, but around $450 in Britain. An injection of Herceptin, an important breast cancer treatment, costs $211 in the United States, compared with $44 in South Africa. These examples aren’t outliers.

There are so few cases where the United States price isn’t the highest that they jump out. Cataract surgery costs more in New Zealand; Kalydeco, a new drug for cystic fibrosis, costs more in the United Arab Emirates. But for most of the studied cases, prices for services and drugs in other developed countries are less than half of those in the United States...

...Any successful effort to tamp down American prices, of course, will mean reducing someone’s paycheck. The uniquely high prices for drugs in the United States help make pharmaceutical companies profitable. The high prices paid for hospital care keep large research hospitals and small rural providers afloat. The high prices help doctors pay off extensive education debt — but also help place them among the highest-paid professions in our economy. None of those groups particularly want a pay cut.

https://www.nytimes.com/2019/12/27/upshot/expensive-health-care-world-comparison...

Sounds like electronic record-keeping has been captured by needs of insurance companies, not patients--to bane of nurses and doctors who must feed the beast. Another model might be that of countries with single payers. I see a lot of Canadian studies used as basis for standards of care--I suspect because the way data is collected.

Doctors, Nurses and the Paperwork Crisis That Could Unite Them (Opinion)
Theresa Brown and Stephen Bergman | Dec. 31, 2019

They don’t always get along. But they are both under siege by the bureaucracy of a failing health care system.

https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-cris...

Every American family basically pays an $8,000 ‘poll tax’ under the U.S. health system, top economists say
Heather Long | Jan. 7, 2020

SAN DIEGO — America’s sky-high health-care costs are so far above what people pay in other countries that they are the equivalent of a hefty tax, Princeton University economists Anne Case and Angus Deaton say. They are surprised Americans aren’t revolting against these taxes.

“A few people are getting very rich at the expense of the rest of us,” Case said at conference in San Diego on Saturday. The U.S. health-care system is “like a tribute to a foreign power, but we’re doing it to ourselves.”

The U.S. health-care system is the most expensive in the world, costing about $1 trillion more per year than the next-most-expensive system — Switzerland’s. That means U.S. households pay an extra $8,000 per year, compared with what Swiss families pay. Case and Deaton view this extra cost as a “poll tax,” meaning it is levied on every individual regardless of their ability to pay. (Most Americans think of a poll tax as money people once had to pay to register to vote, but “polle” was an archaic German word for “head.” The idea behind a poll tax is that it falls on every head.)

Despite paying $8,000 more a year than anyone else, American families do not have better health outcomes, the economists argue. Life expectancy in the United States is lower than in Europe...

https://www.washingtonpost.com/business/2020/01/07/every-american-family-basical...

Did a Study Find U.S. Healthcare Costs More Than Four Times as Much as Canadian Single-Payer?
Kim LaCapria / January 13, 2020

Claim
A study determined that Americans pay four times as much for health care as Canadians under the latter population's single-payer healthcare coverage.

Rating
True

..."In the United States, a legion of administrative health care workers and health insurance employees who play no direct role in providing patient care costs every American man, woman and child an average of $2,497 per year."

"Across the border in Canada, where a single-payer system has been in place since 1962, the cost of administering health care is just $551 per person — less than a quarter as much."...

https://www.truthorfiction.com/did-a-study-find-u-s-healthcare-costs-more-than-f...

>131 margd: Hm. The text doesn't seem to match the headline. The text says that the administration of healthcare is four times more expensive in the US, which is bad but is not the same thing as saying that healthcare costs four times as much as it says in the claim.

Makes me wonder about the bias of the truthorfiction.com site.

>132 jjwilson61: Yeah, I noticed that. Headlines written by others are often objectionable to authors.
You would think a factfinding site would do better though!

Who’s Profiting From Your Outrageous Medical Bills?
The same people who should be fixing them.
Elisabeth Rosenthal | Feb. 14, 2020

...today your hospital and doctor and insurer — all claiming to coordinate care for your health — are often in a three-way competition for your money.

...Nearly eight in 10 Americans say they want federal legislation to protect patients against surprise bills.

States are passing their own surprise billing laws, though they lack power since much of insurance is regulated at a national level.

Now members of Congress have yet another chance to tackle this obvious injustice. Will they listen to hospitals, doctors, insurers? Or, in this election year, will they finally heed their voter-patients?

https://www.nytimes.com/2020/02/14/opinion/sunday/surprise-medical-billing.html

The Lancet has come down on Sanders side on Medicare for all. It's just published a report that says Medicare for all would save 68,000 lives a year and would save people $450 billion every year while covering everybody. . From its wikipedia entry: 'The Lancet is a peer reviewed general medical journal. It's among the world's oldest, most prestigious, and best known general medical journals.

https://www.yahoo.com/finance/news/medicare-save-450-billion-68-232211541.html

It probably won't but this should end the entire argument and IMO shows Obamacare and Medicare for all who want it to be insufficient to the needs of our country. To settle for anything less would be a grave mistake.

"As “Medicare for all” is debated in the 2020 presidential race, most voters perceive that these proposals are calling for a government alternative to commercial health insurance — yet the current Medicare program is shifting toward greater privatization, not less."

Medicare’s Private Option Is Gaining Popularity, and Critics
Mark Miller | Feb. 21, 2020

As more Americans sign up for Medicare Advantage, detractors worry that it’s helping private insurers more than patients.

...one of the least understood implications of selecting Advantage when you enroll in Medicare: The decision is effectively irrevocable.

Most enrollees in traditional Medicare buy supplemental coverage to protect them from potentially high out-of-pocket costs. In 2016, out-of-pocket spending in the program averaged $3,166, excluding premiums, according to the Kaiser Family Foundation.

Supplemental coverage sometimes comes from a former employer, a union or Medicaid, although many people buy a commercial Medigap plan. But the best, and sometimes only, time to buy a Medigap policy is when you first join Medicare.

During the six months after you sign up for Part B (outpatient services), Medigap plans cannot reject you, or charge a higher premium, because of pre-existing conditions. After that time, you can be rejected or charged more, unless you live in one of four states (Connecticut, Massachusetts, Maine and New York) that provide some level of guarantee to enroll at a later time with pre-existing condition protection.

...Medicare Advantage is growing quickly — enrollment is expected to jump to 47 percent of all Medicare beneficiaries in 2029 from 34 percent this year, according to a Kaiser analysis of Congressional Budget Office projections.

Some of the growth stems from heavy investment by health insurance companies in geographic expansion and marketing. The industry points to high rates of consumer satisfaction with Advantage, noting extra services offered by many plans, such as health clubs, dental, vision and hearing care.

...The rise of Advantage has also been aided by changes in federal law and regulation in recent years. And under the Trump administration, critics say, Medicare’s administrators have been tipping the scales improperly in favor of Advantage.

The growth has occurred without much public policy debate about the effects of large-scale privatization on patient health, and on the costs to both the government and enrollees. As “Medicare for all” is debated in the 2020 presidential race, most voters perceive that these proposals are calling for a government alternative to commercial health insurance — yet the current Medicare program is shifting toward greater privatization, not less.

...an investigation by the Department of Health and Human Services’ Office of Inspector General found that Advantage plans were receiving extra payments from Medicare by adding medical conditions such as diabetes and cancer to patient records that may not have been justified...

Advantage plans have had more flexible enrollment rules than original Medicare since 2019.

...Under President Trump, some critics contend, the Centers for Medicare and Medicaid Services, which administers Medicare, has become a cheerleader for Advantage plans at the expense of original Medicare...a violation of federal law

“C.M.S. is part of the U.S. Department of Health and Human Services, which is required under the statutes governing Medicare to ‘promote an active, informed selection’ among Medicare’s plan coverage options,” he said. “A great deal of their communication material doesn’t meet that standard.”

...Which type of coverage produces better health outcomes? The evidence is mixed.

“We’ve seen a number of studies that look at the available measures and try to give some indication of how Advantage is performing compared with traditional Medicare,” Dr. Neuman said. “It does better on some indicators, and on some others, traditional Medicare does better.”

...high levels of denial of care....

Confusion about network providers is widespread...

https://www.nytimes.com/2020/02/21/business/medicare-advantage-retirement.html

As a pandemic looms:

Supreme Court to Hear Obamacare Appeal
Adam Liptak | March 2, 2020

...under its ordinary practices, arguments would be held in the fall and a decision would land in the spring or summer of 2021.

...Democrats, who consider health care a winning issue and worry about possible changes in the composition of the Supreme Court, had urged the justices to act quickly even though lower courts had not issued definitive rulings. They wanted to keep the fate of the Affordable Care Act, sometimes called Obamacare, in the public eye during the presidential campaign and to ensure that the appeal was decided while justices who had rejected earlier challenges remain the court.

...The case was brought by Republican state officials, who argued that when Congress eliminated the law’s requirement in 2017 that most Americans obtain health insurance, the law became unconstitutional. The Trump administration sided with the state officials, arguing that the rest of the health care law could not survive without the requirement, sometimes called the individual mandate.

...Democratic states and the House...“The uncertainty created by this litigation is especially problematic because individuals, businesses, and state and local governments make important decisions in reliance on the A.C.A...Prolonged uncertainty about whether or to what extent important provisions of the A.C.A. might be invalidated makes these choices more difficult, threatening adverse consequences for American families, health care markets and the broader economy.”

...In 2012, the court upheld the law’s requirement that most Americans obtain insurance or pay a penalty, saying it was authorized by Congress’s power to assess taxes.

...In 2015, the court said the federal government can provide nationwide tax subsidies to help poor and middle-class people buy health insurance, rejecting an argument that the subsidies were only available in states that had created marketplaces, known as exchanges, to allow people who lack insurance to shop for individual health plans...

https://www.nytimes.com/2020/03/02/us/supreme-court-obamacare-appeal.html

>137 margd: What is going to be very interesting to see is how minimization of disease transmission plays out against the backdrop of the U.S. business practice of no paid sick leave. If you have to work to pay the bills I suspect you will just say to h--- with it and show up for work sick. Things could get real tense with respect to the likes of fast food and any other job where face-to-face interactions with the public are part of your daily work.

When folks try to scare you about universal healthcare in Canada,
remember: Toronto General Hospital is rated #4 in the world...
Canada has 10% the population of the US.

The World's Best Hospitals 2020
Newsweek
https://www.newsweek.com/best-hospitals-2020

>139 margd: And the top three are in the US. It also seems like a system that's easily gameable by a socialist healthcare system; pour everything into one hospital. What care Justin Trudeau might get when he's sick is not really the argument for universal healthcare; I'm sure Donald Trump or Bill Gates would get just as good, if not better.

I (and most other middle-class Americans) are more worried about what happens if I got rushed to the hospital in an ambulance here in Las Vegas or if I lived in, say, Ottawa, what care I would get if I had a disease requiring specialist help that might get me transferred elsewhere, and what happens for my mother in rural Oklahoma versus rural Manitoba. I'm not saying I don't believe it would be better in Canada; I just don't think the best hospital is a good argument for that.

Transgender Health Protections Reversed By Trump Administration
Selena Simmons-Duffin | June 12, 20204:46 PM ET

...The rule focuses on nondiscrimination protections laid out in Section 1557 of the Affordable Care Act. That federal law established that it is illegal to discriminate on the basis of "race, color, national origin, sex, age or disability in certain health programs and activities." In 2016, an Obama-era rule explained that protections regarding "sex" encompass those based on gender identity, which it defined as "male, female, neither, or a combination of male and female."

In June 2019, under Trump, the HHS Office for Civil Rights proposed a rule (the one finalized this week) that reverses the one from the Obama administration. Severino explained at the time, "We're going back to the plain meaning of those terms, which is based on biological sex." He also said the rule could save hospitals and insurers and others $2.9 billion over five years, since they will be relieved of the requirement to print notices of non-discrimination in several languages and include them with any "significant" mailings.

Under the new rule, a transgender person could, for example, be refused care for a checkup at a doctor's office, explains Lindsey Dawson associate director of HIV Policy at the Kaiser Family Foundation. Other possible scenarios include a transgender man being denied treatment for ovarian cancer, or a hysterectomy not being covered by an insurer — or costing more when the procedure is related to someone's gender transition.

The Trump rule makes changes to gender-based discrimination protections beyond Section 1557 of the ACA; it affects regulations pertaining to access to health insurance, for example, including cost-sharing, health plan marketing, and benefits. Under the new rule, an insurance company could "charge higher premiums or other fees for those who are LGBTQ or cancel or deny coverage," Dawson says. The rule could also mean that those seeking an abortion could be denied care if performing the procedure violates the provider's moral or religious beliefs.

...Now that the final rule is out, Congress does have a way of invalidating it, using the Congressional Review Act. That would only happen in this case if — within 60 days that Congress is in session — Trump were no longer president, and simple majorities in both chambers of Congress voted to block the rule. Even if Democrats win big in November, it's not clear if that's a possibility given the tricky timeline — Congress is typically in recess in August, and the COVID-19 pandemic may complicate matters further

...What's much more certain, she says, is that there will be lawsuits to try to overturn the rule or block it from going into effect. LGBTQ rights organizations, Democratic attorneys general, and individuals who claim they've been harmed by the rule are all likely to sue the Trump administration and try to get the courts to strike the rule down.

Unless someone does sue and a judge puts the rule on hold, it is set to go into effect in 60 days from the date the rule is published in the federal register.

https://www.npr.org/sections/health-shots/2020/06/12/868073068/transgender-healt...

They could start with standardized codes, something the AMA could champion. Although they do much better, even single payer systems struggle with non-standard codes. The aftermath of my American's son's trip to Ontario urgent care was an eye-opener: my US insurance company and Ontario hospital didn't speak the same language! That's nothing according to a family member, then nurse manager at an Ontario hospital--Canadian provinces, e.g. Ontario and Manitoba, also use different codes!

It’s Time for a New Kind of Electronic Health Record
John Glaser | June 12, 2020

The Covid-19 pandemic presents the U.S. health care system with a mind-boggling array of challenges. One of the most urgent is coping with a simultaneous glut and dearth of information. Between tracking outbreaks, staying abreast of the latest information on effective treatments and vaccine development, keeping tabs on how each patient is doing, and recognizing and documenting a seemingly endless stream of weird new symptoms, the entire medical community is being chronically overwhelmed.

Sorting through large amounts of information and finding the nuggets that apply to a particular patient’s situation is something that computers ought to be good at. But we still have problems of knowing what data is important and what is the right treatment and prevention plan for each patient.

During the Obama administration, the federal government supplied billions of dollars — and providers kicked in billions more — to speed the adoption of electronic health records. But even though up to 96% of hospitals and 86% of physician offices have adopted them, we still don’t have EHRs that can rise to the information challenges that clinicians face every day, let alone those posed by Covid-19...

https://hbr.org/2020/06/its-time-for-a-new-kind-of-electronic-health-record

>142 margd: I analyze data from medical records from a myriad of sources all the time and I would go further and say there is no reason why you can't have a uniform system of forms as well as a uniform system for response labeling and uniform methods for data entry not only for health records but also for other things like insurance forms. Currently, all electronic forms succeed in doing is eliminating the need for manual data re-entry. The big issue with the "same" data from different sources is that of variable definition and variable entry and the effort involved in re-working the data so it can be used in a single analysis (the term for this work is data cleaning) is substantial. Indeed, it is often the case that 80% or more of the cost of the analysis is due to the time needed to clean the data.

As an example of data cleaning, let's say we need to have patient baseline blood pressure measurements - one form from one entity records the actual numbers (great this is what we need!), another form from another entity records only small intervals and has them in the form of check boxes - 110-115, 116-120, 121-125, etc. (we can sort of compensate for this and if necessary combine it with the first entity) and the third entity only has text entry categories - below normal, normal, high, very high - these only augmented with an indication of the maximum value for each category. If the last entity has the largest data base and we need to include them then we have to write code to convert the first two into the form of the third.

In addition to the time needed to do this we will have to be on the lookout for things like missing entry codes (some people just use blanks, others have entries like NA, DNR, Unk, and others have numeric codes) and these too will have to be corrected. Once we have done this for just this one variable we are now faced with an even bigger problem - the main question we were asked to assess required detailed information on blood pressure - guess what - except for the first data set we don't have this level of detail and if we have to use everyone we now have to go back to the investigators and tell them we can't do the analysis in the way that was needed because the level of detail of the entire data set is too low.

Hospitals Sued to Keep Prices Secret. They Lost.
The decision was a victory for the Trump administration, which sees pressure from patients as a way to control health costs.
Sarah Kliff and Margot Sanger-Katz | June 23, 2020

A federal judge has upheld a Trump administration policy that requires hospitals and health insurers to publish their negotiated prices for health services, numbers that are typically kept secret.

The policy is part of a major push by the administration to improve transparency in health care. Insurers and health providers usually negotiate deals behind closed doors, and patients rarely know the cost of services until after the fact.

Administration officials said more price transparency would lead to lower and more predictable prices in an industry that has huge ranges in what insurers pay for services. A simple blood test, for example, can cost $11 or $1,000. Coronavirus tests show a similar variation, with prices from $27 to $2,315.

But in a lawsuit, the American Hospital Association said the administration did not have the legal authority to require the publication of negotiated prices, arguing that the publication of the prices could have perverse effects. On Tuesday, the judge, Carl Nichols, disagreed.

In his decision, Judge Nichols found that the hospitals were “attacking transparency measures generally” in a bid to limit patients’ insight into medical prices...

https://www.nytimes.com/2020/06/23/upshot/hospitals-lost-price-transparency-laws...

Obamacare Must 'Fall,' Trump Administration Tells Supreme Court
Mark Katkov | June 26, 2020

...Solicitor General Noel Francisco, the government's chief advocate before the Supreme Court, said in a brief* that the other provisions of Obamacare are impossible to separate from the individual (individual tax penalty for failing to purchase medical insurance) and that "it necessarily follows that the rest of the ACA must also fall."

...The case before the high court began with a lawsuit brought by 20 states, led by Texas, calling for the elimination of the ACA. It has been consolidated for argument with another case brought by 17 states, led by California, seeking to preserve the law. The court is likely to hear the case in the fall.

...Eliminating the ACA would end medical insurance for more than 20 million Americans. It would also end widely popular provisions of the law, such as extending parents' coverage to children up to the age of 26, and prohibiting insurance companies from denying coverage based on pre-existing conditions...

https://www.npr.org/2020/06/26/883819835/obamacare-must-fall-trump-administratio...

* (82 p) https://www.supremecourt.gov/DocketPDF/19/19-840/146406/20200625205555069_19-840...

Wendell Potter (former CIGNA VP) @wendellpotter | 10:21 AM · Jun 25, 2020
https://twitter.com/wendellpotter/status/1276158510955401216

Amid America's #COVID19 disaster, I must come clean about a lie I spread as a health insurance exec: We spent big $$ to push the idea that Canada's single-payer system was awful & the U.S. system much better. It was a lie & the nations' COVID responses prove it. The truth: (1/6)

Canada's doing much better than the U.S. when it comes to #COVID19 testing & treatment. On a per capita basis, more Canadians are being tested & fewer getting sick & dying. This may shock Americans who still believe the lies I told about the Canadian health care system. (2/6)

Here’s the truth: Our industry PR & lobbying group, AHIP, supplied my colleagues & me with cherry-picked data & anecdotes to make people think Canadians wait endlessly for their care. It’s a lie & I’ll always regret the disservice I did to folks on both sides of the border. (3/6)

In Canada, no one gets turned away from doctors due to lack of funds. In America, exorbitant bills are a defining feature of the system. What about quality of care? When it comes to #COVID19, there's been ~ 21 deaths per 100,000 in Canada, versus 34 per 100,000 in the U.S. (4/6)

Remember, in Canada there are no co-pays, deductibles or co-insurance ever. Care is free at the point of service. And those laid off in Canada don’t face the worry of losing their health insurance. In the U.S., millions are losing their jobs & coverage, and scared to death. (5/6)

You learn a lot about a healthcare system when a global crisis hits & different nations have different results. Canada’s single-payer system is saving lives. The U.S. profit-driven corporate model is failing.

I'll regret slandering Canada's system for the rest of my life. (6/6)

Canadian truck driver shocked to see Texans with COVID symptoms denied test because they couldn't afford $199:

3:40 ( https://www.facebook.com/jeff.henderson.106/videos/10157063339681681 )

ETA: Sounds like his company sent him to a commercial lab that does alcohol/drug screening, workmen's compensation claims, etc. I took my high schooler to one as prerequisite for a summer job, and it was obvious that people in waiting room were not the real clients... No pay, no play. Heck, I couldn't get him a vaccine there, though I could pay.

#146--Amen.

Trump Program to Cover Uninsured Covid-19 Patients Falls Short of Promise
Abby Goodnough | Aug. 29, 2020

Some patients are still receiving staggering bills. Others don’t qualify because conditions other than Covid-19 were their primary diagnosis.

...The program has drawn little attention since, but a review by The New York Times of payments made through it, as well as interviews with hospital executives, patients and health policy researchers who have examined the payments, suggest the quickly concocted plan has not lived up to its promise. It has caused confusion at participating hospitals, which in some cases have mistakenly billed patients...who should be covered by it. Few patients seem to know the program exists, so they don’t question the charges. And some hospitals and other medical providers have chosen not to participate in the program, which bars them from seeking any payment from patients whose bills they submit to it.

Large numbers of patients have also been disqualified because Covid-19 has to be the primary diagnosis for a case to be covered (unless the patient is pregnant). Since hospitalized Covid patients often have other serious medical conditions, many have other primary diagnoses. At Jackson Health in Miami, for example, only 60 percent of uninsured Covid-19 patients had decisively met the requirements to have their charges covered under the program as of late July, a spokeswoman said.

Critics say the stopgap program is among the strongest evidence that Mr. Trump and his party have no vision for improving health coverage, and instead promote piecemeal solutions, even in a national health crisis. Mr. Trump had promised a plan to replace the Affordable Care Act by the beginning of August, but none has been announced and he and other Republicans barely mentioned health policy in their national convention last week.

...Health care providers in all 50 states had been reimbursed a total of $851 million from the fund as of last week — $267 million for testing and $584 million for treatment— with hospitals in Texas and New Jersey receiving the most.

But the Kaiser Family Foundation, a nonpartisan research organization, has estimated that hospital costs alone for uninsured coronavirus patients could reach between $13.9 billion and $41.8 billion, far more than what the program has paid out so far.

...Unlike previous administrations during public health emergencies, Mr. Trump’s has not encouraged even temporary expansions of Medicaid — except for limited Covid testing — in states where the program covers few poor adults. It also declined to broadly reopen enrollment for Affordable Care Act plans once the pandemic began, although people who lose job-based coverage can enroll...

https://www.nytimes.com/2020/08/29/health/Covid-obamacare-uninsured.html

RIP, RBG...

In 2012, there were five votes to uphold Obamacare.
One of them just died.
Obamacare is headed back to the Supreme Court one week after Election Day.

- Sahil Kapur (NBC) @sahilkapur | 12:36 AM · Sep 19, 2020

>150 margd:, contd. RIP, RBG...

Elie Mystal (The Nation) @ElieNYC | 1:48 AM · Sep 19, 2020:
I just realized the ACA is toast.

The case is in front of the court the week after the election. The lower court ruling (5th circuit) kills the ACA. With RBG gone, even if Roberts votes to uphold it, it's 4-4.

In the event of a tie, the lower court ruling stands. So...

If Trump pushes a judge on the Court, or looks like he is, they can hold the case for re-argument with a full Court. But, if it's a Trump judge, that's likely a 5th vote to kill the ACA anyway. So...

The only way to save it would be for McConnell to FAIL to replace RBG, Biden to win in November, Roberts agree to hold or re-argue the case, Biden to replace RBG, and Roberts to vote to uphold it.

Which... I mean... if I had wheels I'd be a wagon.

The ACA sucks. A Democratic Senate, a Democratic House, and Democratic President should be able to give us something better. If nothing else, reinstating the mandate would make the court challenge moot.

#152--Agreed. If they take down the ACA---stack the Supreme Court and go for the whole M4A shebang. Most people IMO will get use to that pretty damn soon when there's no longer any of the hassles about medical care that practically everyone has to live with one way or another now. Need to treat this not so much as a bad thing but as an opportunity to make something better.

There's a lot of people whose medical care is based on the ACA. It's the way we do things now - if it's allowed to be "taken down", what happens to those people while it's all getting sorted out?

Medicare for all is a fine idea, but don't expect it to just sort of fall out of a tree. Even with a trifecta election (which is possible but not guaranteed) there's going to be a lot of politics to be done before it happens.

And if you have to "just stack the supreme court" before you get there... well, you might be waiting a while for that.

Do you really think that Congress has the cajones to wipe out a half-dozen major companies and the probably tens of thousands of jobs from them?

>155 jjwilson61: Tangentially, a "cajon" is a box that people sit on and use as a percussion instrument. "Cojones" is the slang term for, well, for "los huevos", which I think you were looking for.

>156 kiparsky: There's a group for that, and it isn't this one.