Trump’s choice for HHS secretary ignites debate

By Shannon Firth
MedPage Today, Jan. 5, 2016

WASHINGTON — When President-elect Trump chose Rep. Tom Price (R-Ga.) to be Secretary of Health and Human Services, he poked an already buzzing hornet’s nest.

Like the rest of the country, doctors, nurses, and medical students have very divided opinions about the government’s role in healthcare. Price’s nomination amplifies that division.

The American Medical Association (AMA) voiced immediate support for Price, while the American Medical Students Association (AMSA), Physicians for a National Health Program (PNHP), and National Nurses United (NNU) roundly condemned the nominee. Most other physician and nurse organizations voiced something between concern and resignation.

MedPage Today spoke with the leadership of several physician and nursing groups to understand their concerns and in some cases highlight areas of agreement.

Line In the Sand

On Nov. 29, the AMA backed Price, a member of the association’s House of Delegates, in a press statement: “Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs,” wrote Patrice Harris, MD, a psychiatrist from Atlanta and chair of the AMA Board of Trustees.

That statement infuriated many physicians, including AMA members and nonmembers alike.

For example, the Clinician Action Network, led by Manik Chhabra, MD, Navin Vij, MD, and Jane Zhu, MD, MPP, posted a letter that has since gathered 5,000 signatures from clinicians across the country: “We believe that in issuing this statement of support for Dr. Price, the AMA has reneged on a fundamental pledge that we as physicians have taken — to protect and advance care for our patients.”

The letter criticized Price’s record and presumed agenda, such as “the dismantling of Medicaid” and “proposals to reduce funding” for the Children’s Health Insurance Program. The group also worried that essential benefits such as opioid use disorder treatment, prenatal care, and access to contraception would be threatened.

Harris explained that the AMA’s support should not be viewed as a blanket endorsement for every one of Price’s positions. She also recalled the “flurry of objections” that targeted another physician nominee, C. Everett Koop, MD, who served as surgeon general under President Ronald Reagan. Koop is now remembered for his efforts to prevent tobacco use and to promote safe sex for AIDS prevention.

Initially, many physicians were alarmed by Koop’s anti-abortion stance, Harris noted. But “Dr. Koop’s one-time opponents later cited him as a role model for how the U.S. surgeon general can help the nation face serious health care challenges.”

Some Docs Enthusiastic

Others, like Jane Orient, MD, executive director of the Association of American Physicians and Surgeons, who practices in Tucson, Ariz., offered unqualified support for Price’s nomination.

Orient said she shares Price’s views on reproductive rights and does not believe taxpayers should pay for another person’s abortion or birth control, which she said “is quite reasonably priced.”

She said she considers Price’s critics’ concerns for health equity “laughable.”

“Instead of trying to have the optimal medical care for everybody and [giving] people the right to choose their own medical care and the right to control of their own money, they want to take these resources out of the hands of people making decisions for themselves and put it in the hands of bureaucrats who have this whole formula to decide what they think is equitable. And they don’t think it’s equitable for people to spend their own money for their own medical care,” Orient said.

“Tom Price has been in favor of allowing people to do this, even if they’re on Medicare,” she said, referring to Price’s support for Medicare privatization.

Red Flags for Others

While PNHP has been critical of the Affordable Care Act, wholesale repeal is not the solution the group has in mind — that is, unless the ACA were replaced with a single-payer system, Robert Zarr, MD, a pediatrician based here and a past PNHP president, said in a phone interview with MedPage Today.

Instead, Zarr anticipates an acceleration of healthcare privatization: “We’ll see it go a lot faster now that we have a House and a Senate and a White House presumably agreeing on this one premise — which is ‘private is good, public is bad.'”

“People who have HIV, who have advanced kidney disease … people who are living in devastated communities economically … If access to healthcare is made harder and harder, then they’re going to have a shorter lifespan, and they’re going to suffer more before they die.”

Many nurses also oppose Price’s nomination, Deborah Burger, RN, of Santa Rosa, Calif., and co-president of National Nurses United, the largest nurses union in the country, told MedPage Today in a phone interview.

If the ACA is repealed, one of the first steps in that repeal will likely involve a reversal of the tax increases that fund subsidies that help people afford their premiums.

And the revenue for Republicans’ proposed block grants for Medicaid won’t be there, she continued.

Seeking Common Ground

Other nurses like Pamela Cipriano, PhD, RN, president of the American Nurses Association, also criticized Price’s record on diversity and inclusion, as well as his opposition to gay marriage.

As more people declare their gender identity and sexual identity, they have been ostracized and stigmatized by clinicians, said Cipriano: “The healthcare community really needs to step up to make sure that these [LGBTQ] individuals … are being adequately cared for, and if there’s an inherent bias in the leaders of our Health and Human Services [Department], that doesn’t bode well for the healthcare community really embracing their needs.”

Price will very likely be confirmed, said Cipriano. She hopes that he will listen to nursing groups. In addition to supporting continued federal funding for nursing education, Cipriano hopes Price will set partisanship aside and embrace the “triple aim” — improving access, quality, and affordability of healthcare — and continue to advance value-based payment.

The American Congress of Obstetricians and Gynecologists (ACOG), in a letter to Price concerning his opposition to federal funding for abortion and for Planned Parenthood, sounded a warning: “Planned Parenthood clinics provide critical preventative healthcare services to women and men. Abortion is healthcare. ACOG remains committed to protecting each of these critical aspects of women’s health.”

The group also acknowledged areas where Price’s views aligned with its own: Medicare physician payment reform, repeal of the Independent Payment Advisory Board, and medical liability reform.

“Your consistent efforts to find common ground and work together on shared goals are laudable, and your commitment to accomplishments, rather than talking points, is unfortunately all too rare in Washington. We hope that you will use your new role as an opportunity to expand on these collaborative practices,” ACOG wrote.

Laura Wooster, MPH, executive vice president of public policy for the American Osteopathic Association, also sounded a cautious tone in a phone call with MedPage Today. “Other than stating our priorities, it seems premature to really start getting vocal,” she said, explaining that the group doesn’t normally endorse or oppose nominees.

She noted, though, that many of the group’s members have echoed one of Price’s talking points, the “administrative burden” that government involvement in healthcare can sometimes bring.

Senate Opposition Brewing?

Even though confirmation seems assured, Price still must face grilling and probable opposition from Senate Democrats.

On Thursday, Democrats in Congress called for an ethics probe into Price’s financial holdings and investments. Price traded $300,000 worth of shares in health-related companies while in the House, according to The Wall Street Journal.

“There’s enough evidence here that cries out for an investigation. Whether the law was actually broken, whether there [were] quid pro quos or inside information is the better way to put it — we don’t know,” said Senate Minority Leader Chuck Schumer (D-N.Y.) at a news conference, as reported by CNN.

MedPage Today will continue to follow that story.

Shannon Firth is Washington correspondent for MedPage Today.

http://www.medpagetoday.com…

Republicans hide their true intentions behind euphemisms about “saving” it. The truth is that Medicare doesn’t need saving.

By Nancy Altman
The Huffington Post, Dec. 30, 2016

New Year’s is a time for resolutions. Consistent with this tradition, powerful Republicans have made clear that they are resolving, in the New Year, to dismantle Medicare, ending it as we know it.

Speaker of the House Paul Ryan has said that destroying Medicare is part of the Republican plan to repeal Obamacare, another Republican resolution for 2017. And Representative Tom Price, powerful chairman of the House Budget Committee, Ryan ally, and likely next Secretary of Health and Human Services, has explained that the Republicans will enact Medicare legislation in the first six to eight months of 2017, since it is probably too big a task to include it in the planned January repeal of Obamacare.

These Republicans are people who carry through on their New Year’s resolutions. In discussing the goal of destroying Medicare in the New Year, Ryan explained, “With a unified Republican government, we can actually get things done.”

These Republicans never say, straightforwardly, that their plan is the repeal and replacement of Medicare. Because of Medicare’s overwhelming popularity, Republicans hide their true intentions behind euphemisms about “saving” it. But no one should be fooled. Their idea of saving Medicare is to destroy it, just as, during the Vietnam war, a U.S. military officer explained, “It became necessary to destroy the town to save it.”

The truth is that Medicare doesn’t need saving. There is no question that, as the wealthiest nation in the world at the wealthiest moment in our history, the United States can afford not just today’s Medicare, but a greatly expanded Medicare. In 1965, when Medicare was enacted, the nation’s Gross Domestic Product was, in real terms, a quarter of what it is today ($4.1 trillion in 1965 versus $16.7 trillion today.) Moreover, Medicare covers the most expensive part of the population – seniors and people with disabilities. Covering the rest of us is easier and cheaper.

Indeed, other industrialized countries spend a small fraction of what the United States spends on health care with better outcomes, despite older populations. Japan, for example, has a much older population than we do, and theirs is aging more rapidly than ours. In 2010, seniors represented 23 percent of the Japanese population, but just 13 percent of the U.S. population. In 2050, American seniors will compose just under 21 percent of the population ― less than Japan’s percentage of seniors today! Yet, the United States today spends three times more per capita than Japan on health care. Despite the additional spending, our health outcomes are worse. Indeed, Japan’s average life expectancy is more than four years longer than that of Americans!

The Republican plan to destroy Medicare will make American costs and health outcomes worse. Despite Medicare covering the most expensive part of the population, it is much more efficient than the rest of the American health care system. Japan and other industrialized countries have what amounts to Medicare for all. No other nation has the crazy patchwork system we have, which includes employer-sponsored private insurance, means-tested insurance, and individual private insurance, in addition to government-run Medicare.

Ryan proposes to make the patchwork system even more of a hodgepodge, with less coverage and higher costs. He wants to end Medicare as we know it and, instead, simply give seniors and people with disabilities fixed cash stipends to fend for themselves, unprotected, on the private market. But before the enactment of Medicare, many seniors and people with disabilities couldn’t get health insurance at any price. And those that managed to find an insurance company willing to cover them paid much higher prices than other Americans.

So why do the Republicans want to destroy Medicare and make our health care system less efficient and more expensive, with less coverage and poorer outcomes? Ideology, pure and simple. Republicans believe that the private sector is always superior to the government. But there are some things the government does better than the private sector. And Medicare is one of them.

Insurance is most inexpensive when everyone is covered under the same plan as the result of mandatory coverage. Only the federal government has the power and the ability to cover everyone, spreading the risk and responsibility as broadly as possible. Indeed, we should be expanding Medicare, not destroying it.

But, driven by ideology, Ryan and his fellow Republicans want to end Medicare as we know it. Ryan proposes to raise the initial age of eligibility for Medicare from its current age 65 to age 67, and to simply give everyone now under the age of 55 cash to buy insurance on their own, eliminating the efficiency of a single, large risk pool.

While those now on Medicare may think that they will be spared, they are wrong. Republicans always say, about their efforts to end Social Security and Medicare, that those aged 55 and over will not be affected, because those politicians recognize that seniors are most concerned about the programs and they vote. This assurance, of course, is insulting, because it assumes seniors are only concerned about themselves and not their children and grandchildren.

Moreover, the blatant assurance is not even true. Many Republican Social Security proposals cut current beneficiaries’ cost of living proposals. And, in the case of Medicare, the impact on current beneficiaries is likely to be even more substantial. If Ryan and his fellow Republicans have their way, Medicare will become increasingly expensive per enrollee, covering an aging and shrinking group, with high medical costs. As the group shrinks, they will have less and less political clout. Everyone not on traditional Medicare, will, by that time, be forced to fend for themselves with private insurance companies. It is extremely foreseeable that at some point, someone will propose treating this very old, small, and expensive population like everyone else. And then their Medicare will be gone, as well.

If we want a health care system in this country that provides everyone with access to the best medical care possible at the lowest possible cost, the way to achieve that is not to end Medicare, but to expand it. That, indeed, was the idea of the program’s founders. They saw Medicare as simply a first step, to be followed soon after by expanding it to include all children, and then more and more of the population, until the United States had Medicare for All.

We should follow that wise plan. As a next step, we should lower the initial age of Medicare eligibility, when people can first claim Social Security retirement benefits, from age 65 to 62. We certainly should not raise the age to 67 and then end the program as we know it, as the Republicans resolve to do. Unfortunately, they are now in control of all branches of government, and so have the political power to do what they want.

To stop them, I urge everyone who is old or hopes to be old someday to make your own Medicare resolution for 2017. Tell your elected leaders: Hands off Medicare except to expand it. And ask your friends to join you. Mobilize and make your voices heard. Then, as a resolution for 2018, we can all resolve to elect leaders who listen to us and have the good sense to expand, not destroy, Medicare.

Nancy Altman is founding co-director of Social Security Works.

http://www.huffingtonpost.com…

As Democrats focus on Obamacare and Medicare, there’s a “quieter war” on Medicaid brewing

By Deirdre Fulton
Common Dreams, Dec. 29, 2016

Medicaid, the nation’s healthcare program for the poor and disabled, is on the chopping block under President-elect Donald Trump and a Republican-controlled Congress—and it will take “intense focus by progressives” to ensure it doesn’t meet a dire fate.

In fact, former National Economic Council director Gene B. Sperling wrote Sunday in a New York Times op-ed, “if Democrats focus too much of their attention on Medicare, they may inadvertently assist the quieter war on Medicaid—one that could deny health benefits to millions of children, seniors, working families, and people with disabilities.”

As Democrats prepare for battles over the two programs, “the Republican effort to dismantle Medicaid is more certain,” Sperling warned—a prediction echoed this week by multiple news outlets.

“Neither Mr. Trump nor Senate Republicans may have the stomach to fully own the political risks of Medicare privatization,” he continued. “But not only have Speaker Paul D. Ryan and Tom Price, Mr. Trump’s choice for secretary of health and human services, made proposals to deeply cut Medicaid through arbitrary block grants or ‘per capita caps,’ during the campaign, Mr. Trump has also proposed block grants.”

Just this month, Vice President-elect Mike Pence told ABC: “With regard to Medicaid…there’s a real opportunity, there’s a real opportunity as we repeal and replace Obamacare to do exactly what the president-elect also said on the campaign, and that is block granting Medicaid back to the states.”

Block-granting can mean funding cuts, The Hill explained:

Block grants would mean limiting federal Medicaid funds to a set amount given to the states, rather than the current federal commitment, which is more open-ended.

Indeed, Sperling pointed to 2012 study (pdf) from the Kaiser Family Foundation, which found that a Medicaid block-grant proposal from Speaker Ryan “would lead to 14 million to 21 million Americans losing their Medicaid coverage by the 10th year, and that is on top of the 13 million who would lose Medicaid or children’s insurance program coverage under an [Affordable Care Act, or Obamacare] repeal.”

A separate Center for Rural Affairs report (pdf), also from 2012, found that “changes in Medicaid are likely to have a disproportionate effect on rural areas.”

Pence’s tenure as governor of Indiana could provide more clues about where the critical safety net program is headed. As governor, Pence implemented a policy requiring poor Medicaid recipients to make monthly payments for their insurance, or else lose benefits.

“That idea could soon be going national,” The Hill wrote, noting that “Trump’s nominee to run the Centers for Medicare and Medicaid Services, Seema Verma, helped Pence develop the changes to Medicaid in Indiana.”

While negotiating this arrangement, one federal official told NPR this week, Verma was “very committed to a particular ideology. That ideology is very much focused on personal responsibility.”

In a statement following Verma’s nomination, Physicians for a National Health Program president Robert Zarr said Verma’s “actions in Indiana signal that she will inflict cruel and unusual punishment on America’s most vulnerable citizens.”

As Common Dreams reported, leading Democrats are planning nationwide rallies for January 15 to gird against this gutting of the U.S. healthcare system.

Deidre Fulton is a staff writer at Common Dreams.

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

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