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By Dr. Carol Paris
Common Dreams, Feb. 11, 2017

The Senate’s vote to confirm Rep. Tom Price, R-Ga., as secretary of health and human services, while widely expected, should set off national alarm bells.

Price’s congressional track record, combined with his extensive health-policy paper trail, have shown him to be unabashedly pro-big-business and contemptuous of human needs – particularly when it comes to women’s and poor people’s needs. But the damage he will be able to do as HHS secretary will go far beyond that.

His appointment to the helm of HHS means he is now poised to wreak havoc on our already dysfunctional health care system, jeopardizing the lives of additional millions of Americans who desperately require medical care but can’t afford to get it.

Consider Price’s hostility to traditional Medicare, one of our nation’s most beloved social insurance programs. Together with Speaker Paul Ryan, R-Wis., Price has pushed for “premium support,” i.e. vouchers, whereby seniors would exchange their guaranteed health coverage under traditional Medicare (which they’ve paid into throughout their working lives) for a lump sum of money to go out shopping for a health policy on the private insurance market.

Can you imagine the chaos such vouchers would create among millions of seniors and their families? How much more precarious their health care – even their survival – would become?

“Premium support” is an underhanded prescription for the dismantlement – the destruction – of traditional Medicare. It would be the beginning of the end. The implementation of such a scheme would sharply increase out-of-pocket costs of our nation’s seniors and severely disabled, some of the most vulnerable parts of our population, even as it would bolster the profits (and CEO salaries) at the private health insurance, Big Pharma, and financial services industries.

Or take Price’s views on Medicaid. Much like President Trump’s nominee to head the Centers for Medicare and Medicaid Services, Seem Verma, has done, Price would embrace the conversion of today’s Medicaid program into federal block grants to the states. These block grants would give state governments wide latitude on how to use the money, opening the door to greater patient cost sharing among the poor (introducing copays, deductibles, or work requirements), even as it would enhance the already egregious profiteering by parasitic private Medicaid managed care companies.

Family planning? Price has displayed unconcealed hostility to women’s reproductive health, and his new position will allow him to literally place the health of millions of women at risk. His extreme views include opposition to abortion under almost all circumstances, a preference for “religious freedom” over access to contraception, and an obsession with eliminating federal funding for Planned Parenthood.

According to this week’s Monmouth University poll, Americans’ top worry today is with their mounting health care costs, more so than their job security, taxes or other household bills. With Price at the helm of HHS, this worry will mushroom.

I could go on – his unbridled animus toward LGBTQ rights, his fascination with discredited policies such as high-deductible health plans and allowing private insurers to sell policies across state lines, the threat he poses to our safety-net hospitals, etc. – but you get the picture.

Make no mistake: if Price’s policies are carried out, he will make an already bad system much worse. Research shows that repealing the Affordable Care Act, a cause for which Price has been a primary standard-bearer in the House, would likely result in 43,000 excess, preventable deaths.

In short, Price’s confirmation vote on Friday was a body blow to our nation’s health and welfare.

This is precisely the wrong direction we should be taking in health care. Rather than augmenting the power and profits of the medical-industrial complex (which, by the way, Price has a distinct affinity for), and cutting back on our people’s access to health care, we should be expanding high-quality care to one and all.

What we need to do – now more than ever – is to replace our fragmented dysfunctional system of health care with a streamlined, single-payer, Medicare-for-All system. The savings we’d reap from eliminating the wasteful bureaucracy and paperwork generated by our current multi-payer system – savings now estimated to be $500 billion annually – would be sufficient to cover everyone in the United States and to eliminate all copays and deductibles.

There were those in the 2009 health care debate who said, “Support the Affordable Care Act; it’s the only politically feasible plan; we’ll get to Medicare for All later.” But Congress passed the ACA, and six years later we’re still saddled with the most serious structural deficiencies of a private-health-insurance-based system, including 28 million uninsured. The ACA didn’t get us where we need to be.

Today, there are those who would say that all we should ask for is to retain the ACA. I’m sorry. As a physician, 28 million uninsured is unacceptable. Now is the time to go beyond the ACA, and to replace it with H.R. 676, the Expanded and Improved Medicare for All Act.

Unrealistic, you say? It’s remarkable what millions of people in motion – which is what it will take – can do. What’s truly unrealistic is thinking we can have truly universal care and control costs without a single-payer system.

We can’t afford to delay any longer. Too much is at stake. We have no time to lose.

Dr. Carol Paris is a psychiatrist and president of Physicians for a National Health Program. She was one of the “Baucus 8″ arrested with Dr. Margaret Flowers and others for protesting the absence of representation for single payer universal health care on the Baucus Senate Panel hearings.

This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License

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By Phil Galewitz
NPR, Feb. 10, 2017

The confirmation of Tom Price, the orthopedic surgeon-turned-Georgia congressman, as secretary of Health and Human Services on Friday represents the latest victory in the ascendancy of a little-known but powerful group of conservative physicians in Congress — the GOP Doctors Caucus.

During the Obama administration, the caucus regularly sought to overturn the Affordable Care Act, and it’s now expected to play a major role determining the Trump administration’s plans for replacement.

Robert Doherty, a lobbyist for the American College of Physicians, the professional organization for internal medicine doctors, says the GOP Doctors Caucus has gained importance with Republicans’ rise to power. “As political circumstances have changed, they have grown more essential,” Doherty says.

“They will have considerable influence over the discussion on repeal and replace legislation,” he says.

Price’s supporters have touted his medical degree as an important credential for his new position, but Price and the caucus members are hardly representative of America’s physicians in 2017.

The “trust us, we’re doctors” refrain of the caucus obscures its conservative agenda, critics say.

“Their views are driven more by political affiliation,” says Mona Mangat, an allergist-immunologist and chair of Doctors for America, a 16,000-member organization that favors the current health law. “It doesn’t make me feel great. Doctors outside of Congress do not support their views.”

For example, while the American College of Obstetrics and Gynecology has worked to protect access to abortion, the three obstetrician-gynecologists in the 16-member House caucus are anti-abortion and oppose the ACA provision that provides prescription contraception without copays.

While a third of the U.S. medical profession is now female, 15 of the 16 members of the GOP caucus are male, and only eight of them are doctors.

The other eight members are from other health professions, including a registered nurse, a pharmacist and a dentist. The nurse, Rep. Diane Black of Tennessee, is the only woman.

On the Senate side, there are three physicians, all of them Republican and male: Sen. John Barrasso, an orthopedic surgeon from Wyoming; Sen. Bill Cassidy, a gastroenterologist from Louisiana; and Sen. Rand Paul, an ophthalmologist from Kentucky.

While 52 percent of American physicians today identify as Democrats, just two out of the 14 doctors in Congress are Democrats, Reps. Ami Bera and Raul Ruiz, both of California.¹

About 55 percent of physicians say they voted for Hillary Clinton and only 26 percent voted for Donald Trump, according to a survey by Medscape in December.

Meanwhile, national surveys show doctors are almost evenly split on support for the health law, mirroring the general public. And a survey published in the New England Journal of Medicine in January found almost half of primary care doctors liked the law, while only 15 percent wanted it repealed.

Rep. Michael Burgess, R-Texas, a caucus member first elected in 2003, is one of the longest serving doctors in Congress. He says the anti-Obamacare Republican physicians do represent the views of the profession.

“Doctors tend to be fairly conservative and are fairly tight with their dollars, and that the vast proportion of doctors in Congress [are] Republican is not an accident,” he says.

Price’s ascendency is in some ways also a triumph for the American Medical Association, which has long sought to beef up its influence over national health policy. Less than 25 percent of practicing physicians are in the AMA, the organization says.

Price is an alumnus of a boot camp the AMA runs in Washington each winter for physicians contemplating a run for office. Price is one of four members of the caucus who went through the candidate school. In December, the AMA immediately endorsed the Price nomination, a move that led thousands of doctors who feared Price would overturn the health law to sign protest petitions.

Even without Price, Congress will have several GOP physicians in leadership spots in both the House and Senate.

Those include Rep. Phil Roe of Tennessee, the caucus co-chair, who also chairs the House Veterans Affairs Committee, and Burgess, who chairs the House Energy and Commerce subcommittee on health. Sen. Cassidy sits on both the Finance and the Health, Education, Labor and Pension Committees. Sen. Barrasso chairs the Senate Republican Policy Committee.

Roe acknowledges that his caucus will have newfound influence. Among his goals in molding an ACA replacement are to kill the requirement that most people buy health insurance (called the individual mandate) as well as to kill the requirement that 10 essential benefits, such as maternity and mental health care, must be in each health plan.

He says the caucus will probably not introduce its own bill, but rather evaluate and support other bills. The caucus could be a kingmaker in that role. “If we came out publicly and said we cannot support this bill, it fails,” Roe says.

The GOP Doctors Caucus has played a prominent role in health matters before.

For example, in 2015, when former House Speaker John Boehner needed help to permanently repeal a Medicare payment formula that threatened physicians with double-digit annual fee cuts, he turned to the GOP Doctors Caucus. It got behind a system to pay doctors based on performance — the so-called “doc fix.”

“When the speaker had a unified doctors’ agreement in his coat pocket, he could go to Minority Leader Nancy Pelosi and show that, and that had a lot to do with how we got this passed,” Roe says.

But not all doctors are unified behind the caucus. Ruiz, one of the two physicians in the House who are Democrats, says he worries because few doctors in Congress are minorities or primary care doctors.

Ruiz, an emergency room physician who was elected in 2012, says he is wary about Price leading HHS because he is concerned Price’s policies would increase the number of Americans without insurance.

Indeed, many doctors feel the caucus’ proposals will not reflect their views — or medical wisdom.

“My general feeling whenever I see any of their names, is that of contempt,” says Don McCanne, a family medicine physician in California who is past president of the Physicians for a National Health Program. “The fact that they all signed on to repeal of ACA while supporting policies that would leave so many worse off demonstrated to me that they did not represent the traditional Hippocratic traditions which place the patient first.”

This story was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation. Follow Phil Galewitz on Twitter: @philgalewitz.

http://www.npr.org…

1. Doctors In The 115th Congress

House

Ralph Abraham, R-La., family doctor
Larry Bucshon, R-Ind., heart surgeon
Michael Burgess, R-Texas, ob-gyn
Scott DesJarlais, R-Tenn., family doctor
Neal Dunn R-Fla., urologist
Andy Harris R-Md., anesthesiologist
Roger Marshall, R-Kan., ob-gyn
Phil Roe, R-Tenn., retired ob-gyn
Ami Bera, D-Calif., internal medicine
Raul Ruiz, D-Calif., emergency medicine

Senate

Rand Paul, R-Ky., ophthalmologist
Bill Cassidy, R-La., gastroenterologist
John Barrasso, R-Wyo., orthopedic surgeon

Source: American Medical Association

By Lisa Rapaport
Reuters, Feb. 9, 2017

(Reuters Health) – Black patients are half as likely as white patients to get care at academic medical centers in New York City even after accounting for differences in health insurance, a recent study suggests.

Compared to privately insured patients, people with coverage through Medicaid, the government health program for the poor, are three times less likely to receive treatment at these elite New York hospitals, the study also found. Uninsured patients are five times less likely to get care at academic hospitals.

“Academic medical centers are generally better able to provide highly specialized care for patients with complex or rare illnesses,” said lead study author Roosa Sofia Tikkanen, a researcher at the University of Massachusetts Medical School in Worcester who completed the work while at City University of New York School of Public Health at Hunter College.

“Most experts believe unequal access to high-quality health care contributes to disparities in health outcomes,” Tikkanen added by email. “In New York City, life expectancy can differ by up to 10 years between two neighborhoods that are located just six subway stops apart.”

About 18 percent of patients at academic medical centers are black, compared with almost one-third at other hospitals in the city, the analysis of discharge data from 2009 and 2014 found.

At the same time, 22 percent of patients were insured by Medicaid at academic hospitals, compared with 42 percent at other hospitals in the city. And only 1 percent of academic hospital patients were uninsured, compared with 4 percent elsewhere.

While Medicaid and uninsured patients accounted for nearly half of all patients at non-academic hospitals in the city, they made up less than one-quarter of inpatients at academic medical centers. At one-third of academic hospitals, less than 10 percent of patients had Medicaid or were uninsured.

To see how race, ethnicity and payer status affect the likelihood of being treated at an academic medical center, researchers analyzed data on adults discharged from hospitals in New York City in 2009 and 2014, and they also looked at similar data for Boston hospitals in 2009.

In Boston, uninsured and Medicaid patients were just as likely to be treated at academic medical centers as at other hospitals. And racial and ethnic minorities were slightly overrepresented at academic hospitals.

It’s possible some of the differences between the two cities might be explained by the extensive public hospital network in New York, the authors note in the International Journal of Health Services.

All of the academic medical centers in Boston and New York are nonprofit hospitals, however, and enjoy tax exemptions worth tens of millions of dollars, the researchers point out. In exchange, they are expected to provide community benefits, including caring for Medicaid and uninsured patients.

One limitation of the study is that researchers didn’t account for patients’ diagnoses or severity of illnesses, which could influence which hospital they went to for care, the authors add. The analysis of two cities also might not reflect what happens in other communities.

The study also didn’t examine the role of residential segregation or neighborhood poverty on use of academic medical centers, noted Asal Mohamadi Johnson, a public health researcher at Stetson University in Florida who wasn’t involved in the study.

“The issue of equity and fairness is at stake here,” Johnson said by email. “Academic medical centers should be held to higher levels of ethical standards in providing care for low income and minority patients.”

When there are disparities in patients’ access to care, academic medical centers may not offer the best possible education to new doctors, Johnson added.

“Active participation of academic medical centers in caring for non-whites and the poor prepares a more qualified and culturally competent generation of physicians and health care providers who will have more familiarity with the unique circumstances and barriers confronting these patients,” Johnson said.

SOURCE: bit.ly/2kvPClc International Journal of Health Services, online February 2, 2017.

http://www.reuters.com…

By Nancy J. Altman
The Huffington Post, Feb. 7, 2017

No one voted to destroy Medicare. Yet, the first battle in the war over Medicare has arrived.

Why would anyone want to destroy Medicare? It has stood the test of time. The smart policy is to expand it to everyone. Medicare shows government at its best.

Government at its best! There’s the rub: Given Medicare’s proven success — its low administrative costs, its efficient coverage of those with the greatest medical needs and costs, and its enormous popularity — it is no wonder that anti-government zealots hate the program.

Medicare demonstrates that there are some services that the federal government provides better than the private sector. The mere existence of Medicare (and Social Security) puts the lie to the claim that everything should be privatized. For that reason, today’s Republicans, who hate government and want to privatize everything, are determined to end Medicare as we know it.

One of those anti-government zealots, Representative Tom Price (R-GA), has been nominated by Donald Trump to be the fox in the Medicare hen house — Secretary of Health and Human Services, the Department responsible for the administration of Medicare. He has made his antagonism to Medicare clear.

Against all evidence, Price claims that “nothing has had a greater negative effect on the delivery of health care than the federal government’s intrusion into medicine through Medicare.” Of course, the exact opposite is true. Medicare saves lives. It allows seniors and people with disabilities, those with the greatest health needs, to obtain life-saving health care.

With true radical zeal, Price has said “we will not rest until we make certain that government-run health care [e.g., Medicare] is ended.” If confirmed by the Senate, Price will be in a powerful position to carry out his threat to end Medicare.

There are two ways to destroy Medicare. One is legislatively. The other is administratively. If Representative Tom Price is confirmed to be the Secretary of Health and Human Services, he will be in a position to destroy it both ways, and along with it, Medicaid, the Affordable Care Act, and so many other programs vital to the health and well-being of all of us.

Let’s start with destruction by legislation. Right after the election, Speaker Paul Ryan made clear his plan to end Medicare legislatively. He falsely announced that repealing Obamacare requires “reforming” Medicare. His reform? Send seniors and people with disabilities into the private insurance market armed with nothing but an inadequate amount of cash. Anyone who knew the world before Medicare knows that seniors and people with disabilities were often unable to buy insurance at any price. Those who could were forced to pay exorbitant prices.

That is the world to which the aptly named Price wants to return us. Price, chairman of the Senate Budget Committee and Ryan co-conspirator, reinforced Ryan’s Medicare threat by revealing that the Republicans planned to enact Medicare privatization in the first six to eight months of the Trump administration.

As Secretary of Health and Human Services , Price would be in an even more powerful position to work to end Medicare. Rather than one of 435 members of the House of Representatives, he would, if confirmed, be the Trump administration’s chief Medicare spokesman.

And, as the top Medicare person, he could do even more destruction than pushing legislation that ends Medicare. As Secretary, he could revoke regulations that protect Medicare beneficiaries and could issue regulations that harm them. Moreover, policymakers, researchers and others rely on the Department of Health and Human Services for accurate, reliable data. In this world of alternative “facts,” could anyone trust the data put forward by a Department Secretary who is determined to end Medicare?

Senate Democrats recognize the threat. To deprive Price of all this power over Medicare, they boycotted the Committee vote on his nomination, since the rules require the presence of at least one member of the opposition party. So, what did their Republican counterparts do? They ignored the rules and unanimously voted him out of Committee with no Democrats present.

With the Muslim ban appropriately dominating the national news and with Senate votes coming up on so many nominees who want to undermine the very missions of the agencies they will control, it is easy to feel overwhelmed. Anti-public schools advocate Betsy DeVos was just confirmed as Secretary of Education after an unprecedented tie vote . Racist Senator Jeff Sessions may, in the next few days, be confirmed as Attorney General, and therefore be in charge of our civil rights.

But here is the oddly good news. Sessions’ confirmation vote is scheduled to come before the vote on Price. Outrageous as it will be, if Sessions is confirmed, it will mean that other Cabinet nominees, including Price, can be blocked with just two Republican Senators voting with the Democrats.

I am deeply suspicious that Senators Susan Collins’s and Lisa Murkowski’s votes against Betsy DeVos were not courageous and principled. Rather, I believe that they may have been just the opposite – cowardly and cynical. After all, if they really wanted to block DeVos they could have done it in committee. McConnell may have granted Collins and Murkowski permission to vote against DeVos, knowing their votes were not needed and recognizing that their constituents were strenuously opposed to DeVos’s confirmation.

Collins and Murkowski can prove me wrong by voting against putting Tom Price in charge of Medicare, a program that he himself has proclaimed he wants to end. After all, bad as DeVos is, education is still largely a state and local matter. Not true for Medicare, which is a completely federal program.

If Price is confirmed by all (or all but one) Republican Senator voting for confirmation, it will be clear that Collins and Murkowski acted cynically in voting for DeVos. It will also be clear that the Republican Party wants to destroy Medicare.

Those of us working to expand, not cut Medicare will do everything we can to assure that the American people understand that a vote for Price is a vote to destroy Medicare. We will do all we can to assure that the electorate never forgets who voted for Price, and, in so doing, voted to destroy Medicare.

That may feel like a threat. I prefer to think of it as a promise.

Nancy J. Altman is founding co-director of Social Security Works. Email your Senators today and tell them to oppose Tom Price’s confirmation as Secretary of Health and Human Services.

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