The Politics of Health Care

[ccp]

I don't know.  I kind off resent these fabulously rich companies asking for tax paid government handouts to research drugs that are needed but as profitable.

I don't believe they cannot fund research in the area of superbugs.  I just do not buy it but feel like we are being played again.

http://www.bizjournals.com/philadelphia/morning_roundup/2016/01/pharma-firms-worlwide-unite-to-battle-superbugs.html?ana=yahoo

[ccp]

American College Of Physcians

If they had their way they would ban all guns so they have toned it down some recently.  I agree their is a connection between mental health and guns but I wish ACP would stay in the bounds of that link rather than agreeing with Da Bamster about "closing loopholes".  As usual the medical organizations have sold us down the politically correct toilet.   That is my opinion on this board before that also gets flushed down the toilet.  From the ACP in my email box helping cheer my day:

*****Advocacy and policy news for internists

Presidential Action on Firearms Meets With Approval From ACP

Steps to address health consequences of gun violence are in sync with College policies, officials note

President Obama's executive order aimed at lowering the toll of gun violence in the United States has elicited positive reactions from the American College of Physicians.

"The president's actions are consistent with ACP advocacy and policy positions in support of improved background checks, more resources for the FBI to conduct those checks and expanded research at the CDC and other centers into firearm violence," said Dr. Wayne J. Riley, president of ACP.

But, Dr. Riley said, more work still needs to be done.

"Although the president's actions are clearly helpful, it is important that Congress pass commonsense legislation to curb firearm violence, given its epidemic proportions," he said. "Legislation alone cannot totally stop firearm deaths and violence, but we know it has the real prospect of markedly decreasing such events."

Noting that gun violence has resulted in more than 100,000 deaths in the United States in the past decade, President Obama announced on Jan. 4 a series of executive actions regarding firearms:

The federal government is clarifying who qualifies as a gun seller and thus must get a license and conduct background checks. It's also clarifying who must undergo a background check when buying a weapon.
The FBI is overhauling its system for doing background checks, with an eye toward creating a 24/7 program. More than 230 examiners and other staff members will be hired.
The president will seek budget funding for 200 new agents and investigators for the Bureau of Alcohol, Tobacco and Firearms who would be devoted to firearms issues.
The president will seek $500 million in new funding to improve access to mental health care and to improve background checks on people who should be prohibited from owning weapons because of mental health issues.
Federal agencies will conduct or sponsor research into gun safety technology.
"We're very supportive," said Bob Doherty, ACP's senior vice president for governmental affairs and public policy. "Our support is based on ACP's policies dating back to the 1990s, which focus on the need to address the consequences of firearm violence from a health standpoint."

ACP has emphasized the importance of closing loopholes in the system that allow some people to buy guns despite potentially dangerous mental health issues -- a stance in line with the president's actions, Doherty said.

However, ACP has cautioned that improvements in restrictions on firearm ownership should not cast a wide net. The law shouldn't further stigmatize the mentally ill by labeling people as dangerous if they are not a danger to themselves or others, Doherty said.

"The vast majority of people with mental illness are not at risk of committing gun violence," he said. "In fact, they're more likely to be victims of gun violence."

In addition, "we support more research into making guns safer so they're less likely to be set off by a toddler or child in a house," Doherty said. "We want more progress toward safety precautions, like guns that can't be fired except by the owner."

The problem, he noted, is that commonsense firearm regulations have not gotten congressional support. But Doherty said he's hopeful that Congress will work in a bipartisan way to increase funding for mental health care, as the president has proposed.

What about critics who say the new executive order is an abuse of power?

"Actually, what it does is better enforce current law," Doherty said. "This doesn't go around current law. Instead, it enforces current law."

Going forward, ACP plans to continue its advocacy toward smart restrictions on firearms.

"We still need legislation from Congress, and we need to see the states step up and make improvements in their policies, including legislation to close loopholes," Doherty said. "This is not the end of the story."*****

[Crafty_Dog]

Not much word on why herein , , ,

================

http://www.nytimes.com/2016/01/29/us/drug-shortages-forcing-hard-decisions-on-rationing-treatments.html?emc=edit_na_20160129&nl=bna&nlid=49641193&te=1&_r=0

Drug Shortages Forcing
Hard Decisions on
Rationing Treatments

Such shortages are the new normal in American medicine. But the
rationing that results has been largely hidden from patients and the public.

By SHERI FINKJAN. 29, 2016

Advertisement
Continue reading the main story
Continue reading the main story
Share This Page

    Email
    Share
    Tweet
    Save
    more

Continue reading the main story

CLEVELAND — In the operating room at the Cleveland Clinic, Dr. Brian Fitzsimons has long relied on a decades-old drug to prevent hemorrhages in patients undergoing open-heart surgery. The drug, aminocaproic acid, is widely used, cheap and safe. “It never hurt,” he said. “It only helps.”
From Our Advertisers

Then manufacturing issues caused a national shortage. “We essentially did military-style triage,” said Dr. Fitzsimons, an anesthesiologist, restricting the limited supply to patients at the highest risk of bleeding complications. Those who do not get the once-standard treatment at the clinic, the nation’s largest cardiac center, are not told. “The patient is asleep,” he said. “The family never knows about it.”
Continue reading the main story
Related Coverage

    F.D.A. Faulted for Problems With Drug TrackingJAN. 14, 2016
    Senators Condemn Big Price Increases for DrugsDEC. 9, 2015
    F.D.A. Regulator, Widowed by Cancer, Helps Speed Drug ApprovalJAN. 2, 2016
    Public Health: Even Insured Can Face Crushing Medical Debt, Study FindsJAN. 5, 2016
    The New Health Care: Even Talking About Reducing Drug Prices Can Reduce Drug PricesJAN. 18, 2016

In recent years, shortages of all sorts of drugs — anesthetics, painkillers, antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drugmakers abandoning low-profit products. But while such shortages have periodically drawn attention, the rationing that results from them has been largely hidden from patients and the public.
Photo
When a shortage developed for a decades-old drug to prevent hemorrhages in patients undergoing open-heart surgery, “We essentially did military-style triage,” said Dr. Brian Fitzsimons, an anesthesiologist at the Cleveland Clinic, restricting the limited supply to patients at the highest risk of bleeding complications. Credit T.J. Kirkpatrick for The New York Times

At medical institutions across the country, choices about who gets drugs have often been made in ad hoc ways that have resulted in contradictory conclusions, murky ethical reasoning and medically questionable practices, according to interviews with dozens of doctors, hospital officials and government regulators.

Some institutions have formal committees that include ethicists and patient representatives; in other places, individual physicians, pharmacists and even drug company executives decide which patients receive a needed drug — and which do not.

An international group of pediatric cancer specialists was so troubled about the profession’s unsystematic approach to distributing scarce medicine that it developed rationing guidelines that are being released Friday in The Journal of the National Cancer Institute.

“It was painful,” said Dr. Yoram Unguru, an oncologist at the Children’s Hospital at Sinai in Baltimore and a faculty member at the Berman Institute of Bioethics at Johns Hopkins University. “We kept coming back to wow, we’ve got that tragic choice: two kids in front of you, you only have enough for one. How do you choose?”
Continue reading the main story

“Two kids in front of you,
you only have enough for
one. How do you choose?”
Dr. Yoram Unguru

At the Cleveland Clinic, which has been unusually proactive in dealing with shortages and allowed a reporter access to personnel making decisions about them, one scarce leukemia drug, daunorubicin, was saved for patients in clinical trials, to avoid making the results invalid by substituting another drug. But when a different drug, methotrexate, was in short supply, pediatricians stopped giving it to all patients who required high doses, including those in research trials. “We didn’t want to say just because you’re on a clinical trial you get an advantage,” Dr. Rabi Hanna said.

Advertisement
Continue reading the main story

Patients’ weight can be taken into account. Obese patients, who researchers found needed up to three times the amount of an antibiotic before surgery than average-size patients, were given only the standard dose at the Cleveland hospital until a shortage subsided.

Some institutions prioritize based on age; others do not. Marc Earl, a Cleveland Clinic pharmacist, said children were not favored over adults during chemotherapy shortages. But at other hospitals, they have been, because of their potentially longer life span or because they sometimes require smaller doses of a drug.

“We do play the pediatric card for sure,” said Alix Dabb, a pharmacy specialist in pediatric oncology at Johns Hopkins Hospital. Dr. Kenneth Cohen, director of pediatric neuro-oncology there, and his colleagues were close to being forced into making “very, very hard decisions,” he said. “The discussions became, ‘Why are two kids more important than one adult?’”

Ning-Tsu Kuo, a pharmacist at the Cleveland hospital’s home infusion pharmacy, said children came first during shortages of nutritional products such as intravenous vitamins and fats for patients who cannot absorb food. The logic was that adults have more reserve. But after one man pleaded not to have his dose cut, Dr. Kuo agreed. When reprimanded by colleagues, she recalled saying: “Patients are not equally the same. You need to look case by case.”
‘Downright Scary’

Such decisions have real consequences. For some shortages, doctors can soon see the effects of rationing, such as increased pain or nausea when drugs typically used to control symptoms are withheld, or patients who have to undergo invasive surgery to control cancer when anti-tumor medications are delayed.

Studies have associated alternative treatments during drug shortages with higher rates of medication errors, side effects, disease progression and deaths. For example, children with Hodgkin’s lymphoma who received a substitute to the preferred drug had a higher rate of relapse, researchers found, and adults with a genetic disorder called Fabry disease had decreased kidney function when their medication was cut by two-thirds. One alternative guideline adopted during a shortage of intravenous nitroglycerin “was downright scary from a clinical perspective,” according to Dr. Nicole Lurie, a senior federal health official.
Continue reading the main story

“Patients are not equally
the same. You need
to look case by case.”
Ning-Tsu Kuo

Physicians say that many of the changes they are compelled to make appear to do no harm. But, they acknowledge, typically no one is tracking outcomes in patients who get a drug and others who get a substitute or delayed treatment.

Doctors and hospitals often do not tell patients about shortages and the resulting rationing because they do not want them to worry, especially when alternative drugs are available, or because they feel it would stir up too much anger.

Dr. Ivan Hsia, an anesthesiologist in Ontario, Canada, said many physicians in his field adopt what he called “the paternalistic model — like I’ll inform them when I think it’s unsafe enough to inform them.”

Advertisement
Continue reading the main story

When he and his colleagues surveyed hundreds of patients at the Mayo Clinics in Arizona and Florida and others in Canada about their preferences, the results surprised him. Most wanted to know about a drug shortage that might affect their care during elective surgery, even if there was only a minor difference in potential side effects, and many said they would delay surgery.

When the study was published last year in the journal Anesthesia and Analgesia, an accompanying editorial urged health professionals to disclose shortages and their implications. “Patients want to know and they should know,” the editorial said. “There is no ethical ambiguity.”

Advertisement
Continue reading the main story
Photo
Beverly Smith, a Cleveland Clinic patient who has Crohn’s disease, said she had no idea that an important ingredient had been removed from the daily intravenous nutritional treatments she depends on until she developed side effects from the deficiency. “Why didn’t anybody tell me?” she asked. Credit Andrea Bruce for The New York Times

Dr. Eric Kodish, a children’s cancer doctor who heads the Cleveland Clinic’s center for ethics, humanities and spiritual care, said patients should be told. “It’s their bodies and their lives that are on the line.”

Indeed, Beverly Smith, a Cleveland patient who has Crohn’s disease, said she had no idea that an important ingredient had been removed from the daily intravenous nutritional treatments she depends on until she developed side effects from the deficiency. “Why didn’t anybody tell me?” she asked.
Who Gets Preference?

In a basement storeroom filled with plastic crates and cardboard boxes, Chris Snyder, a Cleveland Clinic pharmacist and the point man for drug shortages, spends part of each workday poring over the hospital’s drug orders.

He tracks a list of shortages that included more than 75 drugs the first week of January. Dr. Snyder moves stocks among the hospital’s campuses, identifies alternatives, and — in the most dire situations — helps devise and enforce restrictions on which drugs can be ordered for which types of patients.
Photo
Top, Chris Snyder, a pharmacist at the Cleveland Clinic, tracks a list of shortages that included more than 75 drugs the first week of January. Bottom, pharmacy technicians in a compounding clean room that is used to prepare drugs for use within the clinic. Credit T.J. Kirkpatrick for The New York Times

Many drugs are made by only one manufacturer, so production or safety problems at a single plant can have big effects. For another company to begin making the products and getting them approved by regulators requires the right combination of manufacturing capabilities and economic incentives.

The chances of getting a drug also depend in part on where a patient happens to live, how adept the local hospital is at finding — and hoarding — scarce drugs, or a patient’s access to a major medical center.

The Cleveland Clinic, for example, has an advanced compounding room where workers swaddled in disposable gowns, bouffant caps and blue gloves mix up remedies from raw ingredients. During a shortage of papaverine, a drug used for surgery on blood vessels, the clinic produced its own version. When other hospitals began asking about it, Dr. Snyder said he had to tell them, “It’s a franchised recipe we can’t give out.”

At Cleveland, decisions about conserving, substituting and allocating scarce drugs typically are made by small groups of doctors and pharmacists; Dr. Kodish’s ethics committee is not involved. But such decisions are not always made by doctors or hospitals. One company, Janssen, chose to ration its ovarian cancer and multiple myeloma drug Doxil on a first-come-first-served basis during a prolonged shortage.
Continue reading the main story

“We’ve been forced into
what we think is a
highly unethical corner.”
Dr. Peter Adamson

Advertisement
Continue reading the main story

Another company, Jazz Pharmaceuticals, recently consulted a small group of oncologists to recommend how to allocate its cancer drug, Erwinase, if it ever became necessary. “Who deserves the drug more than anyone else?” said Dr. Wendy Stock, a leukemia specialist at the University of Chicago Medicine, who participated in the discussion. “We gave them some guidelines on that. ”
Continue reading the main story
Recent Comments
Grossness54 15 minutes ago

This is exactly what to expect when profits are considered more important than people's lives. And to think we actually hanged people who...
Science Teacher 15 minutes ago

This isn't the sole fault of the Republicans although many will try to pin all the blame on them - put a lot of the fault in Obamacare -...
Jeff Byrne 15 minutes ago

Any supply chain expert (and there are loads of them in the pharm industry) could tell you that these shortages are a direct result of...

    See All Comments Write a comment

In a survey of cancer doctors conducted in 2012 and 2013, 83 percent of respondents who regularly prescribed cancer drugs reported having been unable to provide the preferred chemotherapy agent at least once during the previous six months. More than a third of them said they had to delay treatment “and make difficult choices about which patients to exclude,” according to a letter published in The New England Journal of Medicine.

The threat of future shortages in children’s treatments is serious enough that Dr. Peter Adamson, who leads the Children’s Oncology Group, the largest international group of children’s cancer researchers, assigned his organization to set priorities. “We’ve been forced into what we think is a highly unethical corner,” he said in an interview.

The effort, led by Dr. Unguru, the Baltimore oncologist, recommended that the drugs be rationed based on the ability to save lives or years of life, including curability of a child’s cancer and the importance of the drug in improving the chances. It also recommended that children participating in clinical research should not get priority over those who are not, because of concerns about coercing families into trials. The group also advised that allocation decisions be public.
Photo
Dr. Yoram Unguru, an oncologist at the Children’s Hospital at Sinai in Baltimore, said that developing rationing guidelines for scarce medicines “was painful.” Credit Matt Roth for The New York Times

A recent shortage of a therapy for bladder cancer, BCG, demonstrates how the lack of national guidance can lead to very different decisions. One Cleveland Clinic urologist, Dr. Andrew Stephenson, said he came up with BCG rationing guidelines that were used with dozens of patients after being shared with colleagues. “We tried to reserve the BCG for those patients who needed it the most,” he said.

Merck, the manufacturer, said it filled requests from a waiting list in the order received, and left rationing decisions to doctors. Some cancer centers reduced the length of BCG treatment from three years to one, because the benefit may be smaller after the first year. Others restricted BCG to patients whose tumors were mostly likely to spread or recur. And still others decided to reduce the typical dose so that each vial could be used for three patients instead of one, which some experts say raises questions about efficacy. Some outpatient clinics just ran out.

In interviews and comments on a support website, Inspire, patients seemed confused about why they were or were not getting BCG. “I found out people were getting it in different parts of the country,” said Don Keating, whose bladder cancer was diagnosed in 2014. He was told by his doctor in Boston that he needed BCG, but that it was not available.
Continue reading the main story

“I believe if I had gotten it
when it was first prescribed,
I wouldn’t have had to go
through those operations.”
Don Keating, a cancer patient

Mr. Keating had to wait about six months before obtaining the drug, during which time his cancer recurred. “I believe if I had gotten it when it was first prescribed, I wouldn’t have had to go through those operations,” he said.

Advertisement
Continue reading the main story

Advertisement
Continue reading the main story

Many urologists said they saw similar recurrences possibly due to the shortage, and that some patients underwent high-risk bladder removal surgery that probably would have been avoided if BCG had been fully available.

Dr. Kamal Pohar, a urologist at Ohio State University’s cancer hospital, said he remembered driving home, wondering if he was making the right calls for his patients. “I can still feel the stress,” he said. “I’ve never been faced with this.” Supplies of BCG are again adequate, Merck and doctors report.

The vagaries in distribution and inconsistencies in rationing have led to calls for change. Doctors and others have suggested the creation of a clearinghouse of scarce drugs and voluntary sharing to promote equitable access for patients. Others argue that there should be a registry of patients given nonstandard treatments so the results can be tracked.

Dr. Lurie, the federal health official in charge of emergency preparedness and response, said that the government was working to encourage hospitals to conserve and substitute drugs to avoid a crisis and trying to fill gaps in manufacturing. Steps taken by the Food and Drug Administration have also helped reduce the number of shortages, she said.

Still, she argued that tools developed for disaster response, including ethical and procedural guidelines, should be applied. “Different places around the country are each doing their best to patch together their own guidelines,” she said, adding, “if they’re doing anything at all.”

[ccp]

Mark Levin has pointed out  for years that the ban on DDT was junk science and proven false yet the left trumpets this as some sort of progess:

http://www.breitbart.com/big-government/2016/02/09/physician-mosquito-borne-zika-virus-should-prompt-rethinking-of-ddt-ban/

[Crafty_Dog]

http://thelibertarianrepublic.com/sweden-is-evolving-to-private-healthcare/

[ccp]

I wonder if part of the reason for this is their idiotic open borders to migrants.  I think the Swedes are figuring out they are stooges to invite all these people in and then have to shell out money to pay for their health care.

Here, being stupid is as per the left,  "the right thing to do".

Especially when it is always *other* people's money that gets spent.

[ccp]

I moved this post over from the Clinton thread where it is pointed out that emails to Clinton showed Obama new full well it would not control costs.  We in health care also assumed it would not.  Maybe bending the rise in costs down some was about as good as we expected. 

But the health companies have all done great.  And the mergers and acquisitions among health insurance companies and providers will just keep squeezing any small players out and those at the very top will do great as pan all the gold out of the system for themselves they can.  And the "pay for performance" line is all about trying to control costs.

It is very similar to what HMOs did in the 80s and 90s.   Cost do start to come down for awhile.  Then they will start to go up again.  At that point we will see more rationing of care , more denials, more restrictions,  more control from the bid data elites at the policy level and people will start getting more and more pissed off.  Those who have never had care will be content because something is better than nothing.  The rest will be then grudgingly get what they need but necessarily want they want.  The system will become an adversary to many.  Like I saw seniors do with the brutally cost controlling Humana Health system when I was in Florida in the early 90's they would come in ready to do full out battle with us to get "approved" every little thing. 

Fro example I still recall one patient who a specialist was told to get a soft neck brace for the neck pain he had from arthritis.  I wrote him the referral and it turned out it was not covered.  The guy spent the next 2 or 3 weeks fighting this with administration who kept telling him we don't supply those.  Finally just to get him to stop they finally agreed to pay for it if he goes to a medical supply store and then gives them the receipt.  The total cost - $12.  They guy had spent all this time and effort to save a grand total of $12.  He was so proud of himself .  He won his case with the big bad HMO.

This seems to me to be likely what we are headed for.

Now if we go single payer it will be like in England where the people are all brainwashed and used to being on the dole.  they seem to accept their lot and figure well it is "free" (as two Brits told me) like Sanders tells the kids - "free" college, health care etc.

They don't seem to connect the dots that they are paying massively in taxes for all this - at least some are.

[ccp]

I have no opinion on this analysis though it sounds reasonable:

http://www.foxnews.com/opinion/2016/03/03/physicians-take-on-trumps-health-care-plan.html

[DougMacG]

I have no opinion on this analysis though it sounds reasonable:

http://www.foxnews.com/opinion/2016/03/03/physicians-take-on-trumps-health-care-plan.html

It at least solves the problem for him politically t get through the primaries.  It's similar enough to Cruz and Rubio and also to whatever Paul Ryan comes out with shortly.  His problem is that knowing nothing about it just days ago means he won't be the best person to defend it in the general election.

Republicans have to face the contradiction that people want no consequence for pre-existing conditions and they want no mandate:

In a Feb. 18 interview with CNN, Trump indicated he would keep ObamaCare’s individual mandate, which makes you pay a fine if you don’t have health insurance. But the next day he tweeted that he would remove the mandate (a central piece of ObamaCare) and install a “backstop for pre-existing conditions."

What is a 'backstop for pre-existing conditions' and how do we all get one?

[ccp]

Medical EconomicsEHRLog in to save to my locker
Your Voice: EHRs can’t replace face-to-face patient care
February 25, 2016   
Elizabeth Pector, MD, regrets that electronic health record (EHR) interoperability is sub maximal. (“An interoperability report from the field: It’s not pretty,” October 10, 2015) That prevents the flow of continuity of care documents and hence clinical usefulness.  She ascribes this to those who insist on using old technologies such as “Egyptian papyrus” and even ‘facsimiles.”
I am, however, perplexed. All doctors, even technomanics, are heavily besieged to practice EBM (evidence-based medicine) and we should. EBM is based on clinical studies, either randomized clinical trials, or retrospective studies.
But there are few studies for EHRs. So would it not be instructive and useful, if the profession had a large study, 100% interoperable with CCD’s, over many years using a large cohort?  That would prove that EHRs lower costs, and improve morbidity and mortality (M&M).
But we are in luck. There is such a study–retrospective–35 million people over three years, in my native Canada. And did it reduce M&M? Nope. But it did save a lot of money–$750 million. But that is only 0.2% of all medical spending in Canada.
So Canada presses ahead with the folly but at least has made EHRs optional, except in hospitals. And so has Western Europe, including the UK after spending billions on interoperability, CCDs and other acronymic addictions.
So once again the U.S. insists on mandatory EBM but not EBSM (evidence based social engineering.) In return for such folly the technomanics have again conned the profession into another Trojan horse.  The winners are the EBCPV, (ecosystem of bureaucrats, coders, publishers and vendors).
The losers, once again, are physicians who are forced to spend billions on systems, and of course, lose more autonomy. And above all, the sacred patient/doctor interface is further dehumanized by morphing doctors into sterile wedges.

February 25, 2016   

But there is hope for Dr. Pector and real clinicians.  It is the mother of all acronyms, TAHBLATTOTD (taking a history by listening and talking to other treating doctors.) It was a technology developed by an ancient teacher – Sir William Osler. It is accomplished by two simple actions:
1) Sitting face to face, rather than face to keyboard, with a live subject and talking and listening.
2) Using a device called a telephone. It’s very simple. And it has great advantages over the other EHRs. It is hack resistant, HIPAA compliant, costs much less than $50,000 per user, seldom needs IT repair, is user friendly, interoperable, portable, and reaches all 50 states in real time.
Above all, it excludes about 95% of the vapid, useless information in current EHRs. It is also Osler compliant: “observe, record, tabulate, communicate use your five senses.  Learn to see, hear, feel, smell and become expert” (ancient adage, circa, 1920).
I am far from being a Luddite but the current infatuation with EHRs to the exclusion of all else borders on lunacy. It should not and must not subsume clinical medicine.  It should augment and not replace face to face.  Such is rarely mentioned in articles by technocrats.
Unfortunately  the combo probably won’t catch on. It prevents profiteering by EBCPV. So the profession will absorb this latest Trojan horse fostered upon us by those who created 40 years of acronyms “HMO, PPO, HPS, DRG, RPR, PQRS, MU, etc., none of which have slowed costs or improved much care.
Which reminds me, in keeping with Dr. Pector’s theme, of another ancient papyrus.  It is an observation although non-Egyptian – “there is no new thing under the sun” (Ecclesiastes 1:9, circa 300 BCE.)

Calvin Ennis, MD
Pascagoula, MiSsissippi

[ccp]

In boxing this has been called "punch drunk" for decades.  Remember the scene in 'Requiem for a Heavyweight' where there are a bunch of retired old professional boxers standing around sounding like total retards?  Remember Jerry Quarry?

If one looks at some of the hits these giants on steroids take this is not surprise.  Just wait to see what the UFC guys will look and sound like in another 10 or 20 years.

I am not sure what is new about it other than a whole lot of money at stake:

http://espn.go.com/espn/otl/story/_/id/14972296/top-nfl-official-acknowledges-link-football-related-head-trauma-cte-first

[Crafty_Dog]

Please post on the concussion/head injury thread on the MA forum.

[ccp]

Check out the advisors and board on Theranos.  You will see many familiar political names.  Now they have fund raiser for Hillary.  Apparently some think it worth $700 to 2,700 to meet Chelsea.

The nepotism is just so rampant. 
The public still is not apprised as to exactly what these corporations get in return for bribes.  If it is just the chance to market their interests or open some exposure I am ok with it.  But one cannot help but suspect there is much more behind the scenes.   

No one has been able to get past the facades on this:

http://fortune.com/2016/03/14/chelsea-clinton-theranos-fundraiser/?xid=yahoo_fortune

[ccp]

I don't why the CDC is issuing guidelines on pain management.  They have gotten increasingly political over the years.  Pollution, gun control, cigarettes, and more.  Stick to infectious disease IMHO:

http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1er.htm?s_cid=rr6501e1er_w

[Crafty_Dog]

http://www.judicialwatch.org/blog/2016/03/12-obamacare-insurance-co-ops-fold-after-getting-1-2-bil-from-govt/?utm_source=SilverpopMailing&utm_medium=email&utm_campaign=Judicial%20Watch%20Tipsheet%20-%20Template%202%20%2813%29&utm_content=

[ccp]

At a bargain at 14K per year.  Oh but think of the money they save from preventing heart attacks.  What a rip off.

http://www.seattletimes.com/business/breakthrough-cholesterol-drugs-fizzle-amid-price-pushback/

[ccp]

Hurricane Katrina used as  a 'climate change' phenomenon and doctors who then are identifying Hurricane Katrina mood disorder.  Thus these nut jobs now can claim this as a connection to people's healths and climate change.  I thought we were trained to use logic. 

The only disease I can establish is "liberal thought delusional disorder":

http://associationsnow.com/2016/04/physicians-take-strong-stance-on-climate-change/

[Crafty_Dog]

http://aclj.org/human-rights/aclj-calls-decision-by-army-to-retain-decorated-green-beret-hero-a-significant-victory-saying-justice-has-been-served?utm_content=sf46024154&utm_medium=spredfast&utm_source=facebook&utm_campaign=Informational&sf46024154=1

[ccp]

Want to spend over $1500 to hear Jeb speak?  Bizarre speaker at a healthcare forum.  I guess he has to earn some cash to payback those he fleeced.  I guess when he is not giving bankers advice his vision of the problems facing the country today qualify him to be main speaker at some sort of busines of health care forum:
https://www.ahip.org/events/instituteexpo/?gclid=CKbR7fv-vcwCFVFZhgod8L0Hrg

[ccp]

https://www.yahoo.com/news/federal-ban-on-gay-blood-donors-causes-confusion-among-lawmakers-163120735.html

"“There were so many gay victims involved with the attack, and so many of their loved ones were moved to step up and help their fellow Americans — but were unable to,” Rep. Jared Polis, D-Colo., told the Daily Beast. “All of the pretenses of this policy are gone — it was never based on science in the first place"

Oh really!  No science to back it up?  Wrong.  Amazing how liberals want to stick science in our conservative faces every day except when it is not convenient for their agendas: 

1 - http://www.cdc.gov/std/syphilis/stats.htm

2 - http://www.cdc.gov/hiv/statistics/overview/ataglance.html

Book showing how politics trumped science in the early spread of AIDS in NYC back in the 1980s.
http://www.nejm.org/doi/full/10.1056/NEJM199302113280623#t=article

[DougMacG]

"how politics trumped science in the early spread of AIDS in NYC back in the 1980s"

That was the story of Arthur Ashe.  At 36, he was in NYC working with inner city youth, suffered a heart attack that he survived.  He was given HIV through NYC's contaminated blood supply during a transfusion.  Dead at age 49. 
https://en.wikipedia.org/wiki/Arthur_Ashe

[Crafty_Dog]

http://freebeacon.com/issues/most-obamacare-coops-have-now-failed/

[ccp]

Like I have posted before.  The major medical organizations seem to have become tools of the Left's propaganda.  Surprising this is in the LA TImes:

http://www.latimes.com/opinion/op-ed/la-oe-berezow-hartsfield-obama-jama-20160718-snap-story.html

[ccp]

Challenges Mount for Affordable Care Act as Fourth Year Approaches

Election outcome seen as key to resolving latest marketplace issues

Premium increases and the departure of several large companies from the health insurance marketplaces are among an assortment of issues paving a bumpy path to 2017 for the Affordable Care Act.

"I don't think the marketplace is particularly healthy," said Zack Buck, an assistant professor with the University of Tennessee College of Law, who studies health insurance. "This year in particular has shown a jarring amount of turbulence, and whenever you have companies leaving a market, it's not a good sign."

However, that doesn't mean it's time to play Taps for the Affordable Care Act, which is nearing the end of its third year in operation. Rather, the November election is being seen as crucial to the future of the marketplaces.

"It really depends on who's elected and what happens to the makeup of Congress," said John R. Bowblis, an associate professor of Economics at Miami University of Ohio, who also studies health insurance.

If Republicans are ascendant, "there doesn't seem like there's much willingness to add to subsidies or change the system," Bowblis said. "If that's the case, Obamacare looks like more of a failure." If Democrats take power, he said, there might be attempts to fix the system, such as adding the so-called public option (an alternative insurance plan offered by the federal government), increasing subsidy payments and boosting the non-participation penalty to force more people to buy insurance.

With the fourth-annual marketplace open enrollment period set to begin Nov. 1, three major insurers -- Aetna, Humana and UnitedHealthcare -- have announced plans to withdraw partially or fully from the marketplaces.

"The issue is that some of the smaller players seem to have been potentially successful, but the larger for-profit insurers haven't been," Bowblis said. This may be because larger insurers have traditionally been more focused on serving the needs of employers who are self-insured and less on accepting the financial risk from insuring individuals. "They don't have the same experience at tweaking expenses to try to control costs," he said.

Also, "when it came to the people who were selecting to buy plans, the people who were more expensive by being sicker tended to choose the big-name plans like Aetna," Bowblis said. That increased costs for the major insurers.

However, Buck said that one school of thought holds that the departure of the big insurers might not be as bad as it seems. It "suggests that this may be a realignment, that the national insurance companies may not be the best equipped to sell insurance plans on the exchanges, and that smaller, regional carriers are better at selling these plans," he explained.

Even if that's true, "it is not a great sign that Aetna and others are pulling out," Buck said. In late September, "Blue Cross/Blue Shield of Tennessee left the exchanges in Tennessee's three largest markets, leaving one insurer on the exchange for a huge swath of counties in this state," he said. "That is not a good thing for the consumer."

Another issue raising questions concerns the penalties for not buying insurance.

Tax penalties are typical for Americans who don't buy insurance, but Bowblis said the penalties don't seem to be high enough to force enough people to buy coverage in order to avoid paying a penalty.

"The penalties are significantly lower than the cost of insurance, especially in light of deductibles," he said. As a result, "insurers wound up getting sicker people than expected, and it disproportionately affected the bigger insurers."

Subsidies are available to people with lower incomes, but they're not a draw for everyone. Subsidies have the biggest influence at the bottom of the income scale, where they're largest, but "enrollment figures suggest that higher-income people who receive smaller subsidies or none at all have not seen insurance as such a bargain," according to a report published Oct. 2 in The New York Times.

Younger people are another challenge: They aren't signing up for insurance in large enough numbers, although the Obama administration recently began a push to get millennials to sign up for coverage.

The major presidential candidates differ on what should be done. Republican candidate Donald Trump wants to eliminate the health insurance mandate, boost the use of health-savings accounts and encourage insurers to sell across state lines. Democratic contender Hillary Clinton supports the public option, which would make government-run insurance plans available on the marketplaces as an alternative to coverage from private insurers.

"I think the creation of a public option would help hold down cost increases, but I'm not sure that Congress has the political will to provide a fix that would work," Buck said. "I would prefer congressional inaction to the wrong action -- i.e., removing the individual mandate, limiting tax subsidies, etc. Those reforms are essential for the law to work, and removing them would be disastrous."

In addition, "one also has to be careful about allowing reforms that water down the quality of insurance plans," he said. "We don't want to open up the marketplaces to low-quality insurance plans that don't provide enough coverage for their beneficiaries. That, I think, would be a step backward."

For their part, American College of Physician members are being urged to keep an eye on relevant issues before Congress -- like the public option, which has been introduced in the Senate -- and, most importantly, to vote.

"It is said that all elections have consequences, and that is especially true in 2016, including for American health care," said Bob Doherty, ACP's senior vice president for governmental affairs and public policy.

"To become better informed voters, we encourage ACP members to look to independent sources to learn more about the potential impact of Mrs. Clinton's and Mr. Trump's proposals on access to health insurance coverage for tens of millions of Americans, the affordability of prescription drugs, and much more," Doherty said. "Such issues are simply too important to rely on the candidate's own talking points. And we encourage them to check out ACP's own guide to the top 10 health care issues being debated in this election."

More Information

ACP's 2016 Presidential Election section on its website includes information on how the ACA affects internists, their practice and their patients as well as information on critical issues in health care facing candidates this fall.

[DougMacG]

http://www.weeklystandard.com/fewer-americans-have-private-health-insurance-now-than-in-2007/article/2004964#.WAgDIBgX0rY.facebook

Fewer Americans Have Private Health Insurance Now Than in 2007
-------------------------------------------------------------------------

No progress whatsoever in 10 years since Democrats took Washington.  More people can't stand on their own, need government assistance.  Remember when we used to judge their effectiveness by how many people no longer need the program?

[G M]

http://www.weeklystandard.com/fewer-americans-have-private-health-insurance-now-than-in-2007/article/2004964#.WAgDIBgX0rY.facebook

Fewer Americans Have Private Health Insurance Now Than in 2007
-------------------------------------------------------------------------

No progress whatsoever in 10 years since Democrats took Washington.  More people can't stand on their own, need government assistance.  Remember when we used to judge their effectiveness by how many people no longer need the program?

Now lefties tout how popular free sh*t is with the public.

[ccp]

https://www.acponline.org/advocacy/acp-advocate/issue/article/715888

Keep in mind that many of the policy makers and evaluators are in their hearts, for a single payer system.

[DougMacG]

http://www.weeklystandard.com/fewer-americans-have-private-health-insurance-now-than-in-2007/article/2004964#.WAgDIBgX0rY.facebook

Fewer Americans Have Private Health Insurance Now Than in 2007
-------------------------------------------------------------------------

No progress whatsoever in 10 years since Democrats took Washington.  More people can't stand on their own, need government assistance.  Remember when we used to judge their effectiveness by how many people no longer need the program?

Now lefties tout how popular free sh*t is with the public.

Yes, rob Peter to pay Paul.  And Amanda, Julia, Maria, Laquisha, Jose and Youssef.  And only getting the latter group's consent.

We made private healthcare unaffordable through government interference while pushing tens of millions into healthcare subsidies.

The argument their side makes is do more of it.  Kill off other people's money while making nearly everyone dependent on it.

The argument our side fails to make is that shutting down the vibrant and dynamic private sector that allows wealth creation to pay for public benefits hurts the recipients of the public benefits system more than it hurts the wealthy - if you can look past your next check.  How are the public benefits recipients doing in Haiti, Venezuela and Republic of the Congo - where wealth doesn't exist?  Not possible that could happen here?  We went from 6% growth to 1% growth and it is the low growth that is unsustainable, held up only by temporary, artificial measures like quantitative expansion and massive debt spending schemes.  We jeopardize our real safety net when we shut down our productive, private economy.

Free shit in Sweden including health care (along with open border migration) eventually brought in crime, riots, violence, police no-go zones and civil war. Native people quit reproducing and new people came for the wrong reasons.  Generous Minnesotans have known that for decades.  Murders in the worst areas have a Chicago migrant connection to them and dozens of Somalis have been arrested for joining al Qaida.  Screw up the price, cost and incentive systems and people respond with the rewarded, unproductive behaviors.

No one aspires to be Peter anymore, the one they all want to rob from.  But without Peter's continued income, we don't pay Paul and all the rest.

[DougMacG]

ccp:  "Keep in mind that many of the policy makers and evaluators are in their hearts, for a single payer system.

That's right.  Isn't it sick that it's actually the left, the designers and supporters of Obamacare who wish it to fail, oblivious to the human tragedy of that.  Conservatives just want it repealed, not wish harm on the recipients.

Government healthcare in every other nook of the world is helped by what's left of private sector innovation here.  When we go under, there isn't some other US for people to turn to.  The leading edge treatments are the most expensive and scarcity is always rationed one way or another.  If not by price then by queuing.

Waiting times for medically necessary treatments in Canada are up 97% in 20 years.
4 week wait for oncology radiation, that doesn't hurt outcomes, does it?
Waits for orthopedic procedures are far worse.
43.1 week on Prince Edward Island for "medically necessary treatments"?
8.4% of the populations in Newfoundland & Labrador are waiting for treatment.
https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-in-canada-2015-report
Same system here would yield far worse results.

The top 1% don't wait, at least 52,000 came to the US last year for non-emergency treatment, up 25% in one year.
https://www.fraserinstitute.org/sites/default/files/leaving-canada-for-medical-care-2015.pdf
Where would Americans go after we abandon private care?

In the UK, the top 10% buy private coverage in addition to their NHS membership.  
https://www.quora.com/What-percentage-of-the-UK-population-buys-private-healthcare-insurance

62% in the UK believe the private sector has a role to play in reducing NHS waiting lists.
https://yougov.co.uk/news/2013/06/17/healthcare-choices-nhs-versus-private/

I wonder if anyone has polled Venezuelans recently (or socialist North Koreans) on healthcare satisfaction.  Hugo chose Cuba over the Mayo Clinic for his treatment, ideology over outcomes.  How is that working out?

[Crafty_Dog]

Democrats are already looking beyond ObamaCare’s slow-motion failure, and Colorado is showing where many want to go next: Premiums across the state are set to rise 20.4% on average next year, and some have concluded that the solution is more central planning and taxation. Voters will decide on Nov. 8 whether to try the single-payer scheme that blew up in Vermont.

Amendment 69 would alter the state’s constitution to create a single-payer health system known as ColoradoCare. The idea is to replace premiums with tax dollars, and coverage for residents will allegedly include prescription drugs, hospitalization and more. Paying for this entitlement requires a cool $25 billion tax increase, which is about equal to the state’s $27 billion budget. Colorado would introduce a 10% payroll tax and also hit investment income, and that’s for starters. California would look like the Cayman Islands by tax comparison.

Every other detail is left to the discretion of a 21-member panel. The board of trustees would determine what benefits are offered—say, whether your pricey cancer drug makes the cut. The board would also set reimbursement rates for doctors and hospitals, as well as patient co-payments.

Trustees would be elected to four-year terms and not subject to recall elections. In other words, ColoradoCare would evade nearly all democratic accountability. Amendment 69 stipulates that the entity is “not an agency of the state and is not subject to administrative direction or control by any state executive, department, commission, board bureau or agency.” ColoradoCare could bust constitutional limits on tax increases and spending.

No one thinks this project will float on its planned $38 billion budget. An analysis from the Colorado Health Institute found that ColoradoCare would post a $253 million loss in its first year and would then “slide into ever-increasing deficits in future years unless taxes were increased.” The other options are reducing benefits or cutting payments to doctors—assuming providers haven’t fled the state. ColoradoCare will have evicted whatever remains of the private insurance market, so residents may have nowhere to turn.

The best independent study on single payer is Vermont, which abandoned the idea in 2014: Governor Peter Shumlin, a Democrat, dumped his signature campaign issue once he figured out it’d require an 11.5% payroll tax and an individual levy as high as 9.5%. Mr. Shumlin admitted that “the risk of economic shock is too high at this time to offer a plan I can responsibly support.”

Remarkably, Colorado has managed to build on Vermont’s failures. For one, the plan aspires to cover more than five million people, not Vermont’s 625,000. Anyone who claims to live in Colorado qualifies, so get ready for a crush of beneficiaries who don’t pay anything. ColoradoCare would be enshrined in the constitution, which is much harder to scrap than legislation.

The good news is that Amendment 69 has created a rare moment of bipartisanship: Former Democratic Governor Bill Ritter is working with Colorado’s Republican Treasurer, Walker Stapleton, to defeat the measure. Democratic Governor John Hickenlooper is also opposed. Voters hate the idea the more they learn: A September poll showed only 27% support, down from 43% in January.

Then again, Bernie Sanders supports it, and Hillary Clinton wants a “public option” that is another giant step toward single payer. Coloradans have the opportunity to reject what progressives would love to achieve if they didn’t have to bother with voters: socialized medicine.

[DougMacG]

Obamacare Premiums Up 30% In TX, MS, KS; 50% In IL, AZ, PA; 93% In NM

http://www.zerohedge.com/news/2016-10-21/obamacare-premiums-30-tx-ms-ks-50-il-az-pa-93-nm-when-does-death-spiral-blow

http://www.wsj.com/articles/rate-increases-for-health-plans-pose-serious-test-for-obamas-signature-law-1476822335

Approved Hikes Just Under 20%: Colorado, Florida and Idaho
Approved Hikes 20% to 29%: Connecticut, Georgia, Indiana, Kentucky, Maine, Maryland
Approved Hikes 30% to 49%: Alabama, Delaware, Hawaii, Kansas, Mississippi, Texas
Approved Hikes 50% to 92%: Arizona, Illinois, Montana, Oklahoma, Pennsylvania, Tennessee
Approved hikes 93%: New Mexico

[ccp]

Hillary will "fix " AHA " by expanding the government control of more and more of us until the [claimed] only "hope" is *single* payer.

And the Liberal's dream will come true:  We will be *a people for the government, of the government, and by the government*:

********From my post of March 8,2015:

At least some knew the AHA would fail if not all of them.  From posts I made in early 2015:

this from a speaker to a medical conference who is for single payer (Medicare for all):


The speaker I heard today could answer this.   The numbers and stats above are probably all distortions.  The Affordable Health Care Act has done little if anything to reduce costs.  The administrative costs could be as high as 30%.  The only ones who did well are the same ones who havce done well in the rest of the economy - big companies who have the resources to squeeze out all competition and soak the system.   Without the input of tax dollars to supplement these companies they would go out of business.  We are supplementing them with tax money.

I ask everyone who reads this board:

How much less are you paying for your insurance and is your plan better than last year or the year before that?

I know the answer.

The speaker I heard advocates for single payer.   He made a strong case and almost has me convinced he may be right.

If I can find the website he recommended I'll post but I lost the site when I left a piece of paper somewhere while answering a page.


Based on what his presentation concluded based on a lot of statistics and sources the Newsweek piece is exactly what one would expect from a veiled Democrat outlet - pure propaganda.


ccp
Power User
***
Posts: 6202

At least some knew the AHA would fail if not all of them.  From posts I made in early 2015:

Re: The Politics of Health Care
« Reply #1404 on: March 08, 2015, 09:47:41 AM »
This is one article from the organization the speaker (I noted in the previous post) was promoting.  I am not a member and would not.  

A rather socialistic group.  Yet they are right about pointing out the large layer of administrative costs.  

He thinks the AHA is going to fail in a few years.   One could argue it is designed to fail in the march to single payer.  I don't know.

http://www.pnhp.org/news/2015/march/health-care-law-did-not-end-discrimination-against-those-with-pre-existing-condition
 Logged

[DougMacG]

http://www.realclearpolitics.com/video/2016/10/26/obama_architect_jonathan_gruber_obamacare_is_not_imploding_working_as_designed.html

October 26, 2016

Obamacare Architect Jonathan Gruber: "Obamacare Is Not Imploding," "Working As Designed"
 
MIT professor Jonathan Gruber, a well-known architect of President Obama's Affordable Care Act, tells CNN that the law known as 'Obamacare' is working exactly as intended.

Full transcript, via CNN:

JONATHAN GRUBER: Obamacare's not imploding. The main goal of Obamacare was two-fold. One was to cover the uninsured, of which we’ve covered 20 million, the largest expansion in American history. The other was to fix broken insurance markets where insurers could deny people insurance just because they were sick or they had been sick. Those have been fixed, and for the vast majority of Americans, costs in those markets have come down, thanks to the subsidies made available under Obamacare...

The 22% increase [in health care premiums], let’s remember who that applies to. That applies to a very small fraction of people, who have to buy insurance without the subsidies that are available.

85% of people buying insurance on the exchanges get subsidies. And for those people, this premium increase doesn’t affect them.

Now, for those remaining people, that is a problem, and that’s something that we need to address, but it’s not a crisis. It doesn’t mean the system’s collapsing. And most importantly, it doesn’t affect the 150 million Americans who get employer insurance, who have actually seen their premiums fall dramatically, relative to what was expected before Obamacare.

CAROL COSTELLO, CNN: OK. So let's talk about how exactly you can fix Obamacare. And I just need you to be specific, because I think people really want answers. So Hillary Clinton says she can fix Obamacare. So what would be one fix that would drive premiums down.

GRUBER: Look, once again, there's no sense of oh it just has to be fixed. The law is working as designed; however, it could work better, and I think probably the most important thing experts would agree on is that we need a larger mandate penalty. We have individuals who are essentially free riding on the system. They're essentially waiting until they get sick and then getting health insurance. The whole idea of this plan which was pioneered in Massachusetts was that the individual mandate penalty would bring those people into the system and have them participate. The penalty right now is probably too low and that's something ideally we would fix.

COSTELLO: So somebody who is president could go to congress and say, "You know what, lawmakers, this is a fix. Can you pass this?" Is that what would have to happen to put that fix into place?

GRUBER: Basically, it's hard to know what dramatic fix we could do without congress participating in the process. We could do things like a stronger mandate is one. We could do things like increasing the pressure on states to expand their Medicade programs, a horrible act of political malpractice where states have left millions of people of their lowest income citizens uncovered. We could do things like that, but a lot of that would involve congressional participation. It's hard to know what you can do just on your own as a new administration.

COSTELLO: What about the insurers who have fled the system? How do you convince them to come back or new companies to sign on? GRUBER: Once again, I think the press here has been misleading. Some insurers are leaving. Other insurers are thriving. I think what you have is a system where we've shaken up the status quo, exactly what we expect of new innovation, disruptive innovation if you will, to do. Insurers who were thriving in the old system are finding this new system sort of hard for them. Other insurers are doing really well and what's going to happen is the natural process as the market evolves. These premiums are going to increase. That's going to allow profitable opportunities for new insurers to enter they are(ph) and bring premiums back down. So we're just seeing the ups and downs of a new market. What you have to remember is that premiums in 2014 came in way below what we expected. In fact, where they are today is exactly where they thought they'd be today. It's just they came in lower than we thought and they rose faster than we thought. And that's just some of the unpredictability of a new market. That will settle down over time. And new insurers will enter.

COSTELLO: OK. So hindsight is 20/20, right?

GRUBER: Yes.

COSTELLO: Looking back, is there one thing that you wish was done differently?

GRUBER: I think there's really probably two things I wish was done differently. One is I wish the mandate penalty was stronger. The other, I wish the federal government had done more to get states to expand their Medicaid programs. I think that this is a fundamental flaw in our system that states are leaving so many systems uncovered and citizens who are sick who are coming into this exchange pool and making it more expensive.

COSTELLO: So realistically, you know, after the next president is put into office, what do you think will happen with Obamacare?

GRUBER: I think nothing much is going to happen, to be honest. I think that basically a system that largely works , that the flaws your seeing now or the premium increase you're seeing now are just the natural dynamics of a market as it transitions to its new state, and I think that we're just going to let it go for a couple years and it's going to get better on its own. And basically I think it's a system which largely works.

COSTELLO: What if Donald Trump becomes president, he has a republican congress, and he does repeal it? What happens then?

GRUBER: Well, first of all he won't repeal it. Remember, the whole argument and public debate against this law is that people didn't get to keep insurance they liked. Well, you're going to have 20 million Americans or more who are now getting insurance that they like. You're not going to take that away from them. And let's be clear, there is no replace. There is only repeal. There is no Republican alternative to this law, and the reason is because this is fundamentally a bipartisan legislation that was originally drafted on Republican principles, to be honest. And so there is no Republican alternative. And so his repeal and replace is just repeal and leave people uninsured. That's not going to happen.

[Crafty_Dog]

"The main goal of Obamacare was two-fold. One was to cover the uninsured, of which we’ve covered 20 million, the largest expansion in American history. The other was to fix broken insurance markets where insurers could deny people insurance just because they were sick or they had been sick."

Name me a Rep who answers this cogently and tell me what he says.

"Well, first of all he won't repeal it. Remember, the whole argument and public debate against this law is that people didn't get to keep insurance they liked. Well, you're going to have 20 million Americans or more who are now getting insurance that they like. You're not going to take that away from them. And let's be clear, there is no replace. There is only repeal. There is no Republican alternative to this law, and the reason is because this is fundamentally a bipartisan legislation that was originally drafted on Republican principles, to be honest. And so there is no Republican alternative. And so his repeal and replace is just repeal and leave people uninsured. That's not going to happen."

How is this wrong?

Even Trump has not noticed that Dr. Ben has a very good alternative or maybe he has but lacks the verbal skills to describe and explain it.  Maybe we need to give Dr. Ben a pot of coffee and put him in front of a video camera and then play it at accelerated speed.
 

[Crafty_Dog]

By Gerard Baker and
Monica Langley
Updated Nov. 11, 2016 3:33 p.m. ET
WSJ

NEW YORK—President-elect Donald Trump said that, after conferring with President Barack Obama, he would consider leaving in place certain parts of the Affordable Care Act, an indication of possible compromise after a campaign in which he pledged repeatedly to repeal the 2010 health law.

In his first interview since his election earlier this week, Mr. Trump said one priority was moving “quickly” on the president’s signature health initiative, which he argued has become so unworkable and expensive that “you can’t use it.”

Yet, Mr. Trump also showed a willingness to preserve at least two provisions of the health law after the president asked him to reconsider repealing it during their meeting at the White House on Thursday.

Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.

[Crafty_Dog]

Apparently Trump was too fact unaware to realize that the plan passed by Ryan and the House included protection of pre-existing  conditions.
 

[G M]

Apparently Trump was too fact unaware to realize that the plan passed by Ryan and the House included protection of pre-existing  conditions.
 

Never his strong suit. We knew this long ago.

[ccp]

"Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies."

I agree with this.  I don't see any choice. 

[DDF]

"Mr. Trump said he favors keeping the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies."

I agree with this.  I don't see any choice.  

I'm going with.... no one knows anything that will happen until Trump is actually in office. He didn't change his tune until after the election and after he met with BO.

Anything Trump does or says until he actually takes office can be taken as nothing more than strategy.

Trump still has the Left rioting, attempting to get the electoral college voting to support Clinton, Clinton and Soros still lurking around, the media STILL against him (though they say otherwise), some politicians acting like they like Trump (when they hated him just days previosuly), and BO still in office all the way until January.

Personally, I am buying nothing at face value until then.

[ccp]

Trump Indicates He May Preserve Some Parts Of ACA
The Wall Street Journal (11/11, A1, Baker, Langley, Subscription Publication) reported that during an interview, President-elect Donald Trump signaled an openness to keeping at least two provisions of the Affordable Care Act intact while repealing other parts of President Obama’s signature healthcare law.
        The New York Times (11/11, Hulse, Davis, Rappeport, Haberman, Subscription Publication) reported that during the Wall Street Journal interview, “Trump said he told the president that he would consider keeping two provisions of the law: the prohibition against insurers denying coverage because of a patient’s pre-existing condition; and the one that allows parents to keep their children on their insurance plans until they turn 26.” But, according to the Times, if the ACA mandate were eliminated, this “could send insurance companies into a tailspin, because their costs would rise with sicker customers, and that would not be offset by healthy consumers forced to buy insurance.”
        The Washington Post (11/11, Goldstein) reported that just a few days after the election, Trump began “to revise his health-care agenda in ways that conform more closely to the heart of Republican thinking in recent decades.”

[ccp]

https://www.yahoo.com/news/donald-trump-walks-back-stance-205921490.html

[DougMacG]

https://www.yahoo.com/news/donald-trump-walks-back-stance-205921490.html

Making a provision for pre-existing conditions is quite popular.  The individual mandate is not, but perhaps needed to keep people from waiting until they need expensive treatment to buy a policy.

Does someone, Trump, Ryan, McConnell, have another way of solving this?

I can think of some ways but they wouldn't be popular.

[Crafty_Dog]

Go for it!   

Also, does someone have a good summary of Dr. Carson's proposed solutions?

[DougMacG]

Emphasis on Health Savings Accounts supplemented with major medical insurance policies.  He is right in the general concept, pay as much of the nation'a healthcare expenses with people's own money, first party pay.  Then let them buy policies they choose to cover their major medical with high deductibles, if that is what will bring their monthly and annual costs down.

This does not answer all the questions.

https://www.bencarson.com/issues/health-care/

First-dollar coverage for out-of-pocket expenses and premiums to buy the insurance of your choice.
Your Money. Your Account belongs to you, whether you change jobs or cross state lines.
Transferable between family members, because each of us has different medical needs.
Save Medicare and Medicaid by putting beneficiaries in control:

Give Medicare beneficiaries a fixed contribution to buy the health insurance they actually want and need.
Give Medicare and Medicaid enrollees HEAs to cover first-dollar expenses and insurance premiums for coverage they get to choose
Modernize Medicare to keep pace with medical advances by gradually increasing the eligibility age (by 2 months each year) until it reaches age 70.
Treat Medicare and Medicaid beneficiaries like the rest of us. Give Medicaid beneficiaries the same insurance coverage, doctors and choices that other Americans enjoy, with HEAs to provide first-dollar coverage, supplemented by a major medical insurance plan of the patient’s choice.
Save Medicaid by providing fixed-dollar support to the states, which must use the funds for premium payments and HEAs for beneficiaries — not wasteful state bureaucracies.

[DougMacG]

For people without insurance through their jobs, the Republicans would establish a refundable tax credit. Obamacare also provides subsidies for people to buy insurance if they do not qualify for Medicaid.

It also includes long-held Republican proposals such as allowing consumers to buy health insurance across state lines, expanding health savings accounts, reforming medical liability rules and giving block grants to states to run Medicaid programs for the poor.
http://www.reuters.com/article/us-usa-election-healthcare-ryan-idUSKCN0Z80AQ

https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf

Also does not have all the answers.

[DougMacG]

http://www.nationalreview.com/article/442233/obamacare-repeal-preexisting-conditions-affordable-care-act-donald-trump-republicans

Yes, We Should Protect People with Pre-existing Conditions

by RAMESH PONNURU   ,  November 16, 2016 4:13 PM

There is a way to repeal Obamacare that accomplishes that goal.

President-elect Donald Trump has repeatedly said that he wants to replace Obamacare while keeping its protections for people with pre-existing conditions. I agree with Trump that Obamacare should be repealed and that people with pre-existing conditions should be protected, and recently wrote here about how these goals could be reconciled.

The key, in my view, is to alter an Obamacare regulation that prevents insurers from charging the sick more than the healthy. That regulation gives healthy people an incentive not to buy insurance: They can always buy it when they get sick. But insurance markets won’t work if only sick people buy insurance. That’s the reason the Obamacare legislation coupled this regulation with the infamous “individual mandate” requiring most people to buy health insurance.

Many Republicans have suggested a different regulation: Insurers could be required to charge people with pre-existing conditions the same as healthy people so long as those people had maintained their insurance coverage. That regulation would not create an incentive to forgo coverage; it would add to the incentive to get it. And so the mandate would no longer be needed.

At the same time, I suggested, the government should give people who do not have access to employer-based coverage a tax credit that would allow them to purchase catastrophic health insurance (or more extensive coverage if they supplement that credit with their own money). This coverage would no longer be subject to Obamacare’s definition of essential benefits; the states would return to being the primary regulator of benefits, as they were before Obamacare. But individuals would be free to buy insurance from other states, which would be particularly helpful if their own states’ regulations were too costly.

Michael Cannon, the Cato Institute’s health-policy expert (and a friend of mine), disagrees with both Trump and me. He raises four objections to my suggestions and advances his own alternative.

The first objection is that the new regulation would create perversities of its own. Every year the sickest people would choose the most generous plan, and insurers would try to make their policies unfriendly to the sick to counteract their efforts. This concern seems greatly overstated. The regulation should be drawn to provide a narrow protection: If you had maintained your insurance coverage, getting sick would entitle you to get coverage comparable to what you had at the same rate as healthy people. That should nullify this objection.

Cannon’s second point is that the tax credit is the equivalent of an individual mandate. The mandate fines you for not buying insurance. The credit gives you a tax break for buying insurance. Either way, you pay more taxes if you don’t buy insurance. So are they really the same thing? No. Obamacare attempted to make it illegal for people to choose not to buy health insurance. That’s why the individual mandate went to the Supreme Court. The mortgage-interest deduction didn’t, even though you could apply the same argument to try to present it as a “house-buying mandate.” Maybe the mortgage-interest deduction is good policy and maybe it isn’t, but it’s not a mandate. The same goes for a tax credit to buy catastrophic health insurance.

Third, Cannon argues that getting rid of Obamacare’s employer mandate and providing a tax credit to people who don’t have employer-based coverage would give employers an incentive to drop their plans. But we have had very little of such employer dumping even though the employer mandate has not been put into effect and individuals without employer coverage have been able to use tax credits on Obamacare’s exchanges. Again, the concern seems exaggerated. Republicans are leery of simply abolishing Obamacare’s protections for people with pre-existing conditions for both humanitarian and political reasons.

Fourth, Cannon says that replacing Obamacare along the lines I’ve discussed would “entrench Obamacare’s worst features into federal law, permanently, by giving them a Republican imprimatur.” To accept this conclusion requires both buying those three prior points and losing all sense of perspective. The replacement I’m talking about would get rid of the individual and employer mandates, the essential-benefits regulations, federal support for the exchanges, the medical-device tax, the Independent Payment Advisory Board, and more. The federal government would have a smaller distortionary role in health care than it did before Obamacare, let alone than the one it has played since then. For example, the federal government would no longer be giving people with access to employer coverage a much larger tax break than people without such access, and it would do a lot less to push people to buy the most expensive health plans available.

Republicans are leery of simply abolishing Obamacare’s protections for people with pre-existing conditions for both humanitarian and political reasons. Cannon proposes a way to handle that problem: Abolish as much of Obamacare as possible except for its regulations on pre-existing conditions. “Americans will see the actual costs of those supposedly beneficent and popular provisions when they cause insurance markets to collapse. The damage would be so swift and severe, Congress would quickly repeal the pre-existing-conditions provisions, filibuster or no filibuster.”

Either you can see instantly that this strategy is a terrible one or you can’t, so there’s not much to say about it. Besides this: I cannot imagine House and Senate Republicans’ pursuing it. — Ramesh Ponnuru is a senior editor at National Review.

[G M]

https://pjmedia.com/trending/2016/12/04/va-scandal-4-quit-after-ok-veteran-dies-with-maggots-in-wound/

https://www.buzzfeed.com/andrewkaczynski/7-times-barack-obama-promised-to-reform-the-va?utm_term=.br3g8nYWX#.ccx8EdZp7

[G M]

https://pjmedia.com/trending/2016/12/04/va-scandal-4-quit-after-ok-veteran-dies-with-maggots-in-wound/

https://www.buzzfeed.com/andrewkaczynski/7-times-barack-obama-promised-to-reform-the-va?utm_term=.br3g8nYWX#.ccx8EdZp7

http://abc7chicago.com/news/va-hospital-dentist-may-have-exposed-veterans-to-hiv-hepatitis/1636473/

Perhaps Obama will fix the VA in the next week or two...

[Crafty_Dog]

The excrement hits the fan:

http://www.washingtontimes.com/news/2016/dec/15/obamacare-subsidies-increase-by-10-billion-as-cost/?mkt_tok=eyJpIjoiWm1ZeE5HVmhOVGd4WVRreiIsInQiOiIrbTQ2Y0Rhb0g1dnlRcmZJSkRTTDFLd3lJOWlEeVNhUG5hNENkcGRCcFVVNkY2a1J5XC9TWmNXMGlJMlhWVURKM2NLaHJXRFJWeGJ3QmtjXC9rV3dCN0JDR2VcL0IyZ1BBdU5vZFlBQVJWMmNFZENwTUhuQVlYZlJDTWsxTHBYTFk4MSJ9

[ccp]

https://finance.yahoo.com/news/gop-universal-access-health-care-164900664.html