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2017-04-26

Republicans may try again to repeal Obamacare, as early as this week

See "Republicans finalize new Obamacare repeal proposal,"
www.politico.com/story/2017/04/25/republicans-obamacare-repeal-237609.
The new repeal version is even worse than the first. It pretends to keep coverage for pre-existing conditions - but states could obtain a waiver of this fake provision, by establishing high-risk pools for expensive patients. These pools have failed in the past because not enough money is appropriated, leaving the patients to pay enormous premium surcharges. Last we heard, the new repeal proposal even makes the waivers automatic, unless the U.S. Health and Human Services rejects them within 60 days.

Waivers can also allow states to let insurance companies delete coverage for "essential health benefits," including:
  • Ambulatory patient services (outpatient care you get without being admitted to a hospital) 
  • Emergency services 
  • Hospitalization (like surgery and overnight stays) 
  • Pregnancy, maternity, and newborn care (both before and after birth) 
  • Mental health and substance use disorder services, including behavioral health treatment (this includes counseling and psychotherapy) 
  • Prescription drugs 
  • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills) 
  • Laboratory services 
  • Preventive and wellness services and chronic disease management 
  • Pediatric services, including oral and vision care (but adult dental and vision coverage aren’t essential health benefits).
[This list from www.healthcare.gov/coverage/what-marketplace-plans-cover/ - note that PrEP coverage could be ended since it is "preventive."]

For more information see Washington Post columnists Eugene Robinson, www.washingtonpost.com/opinions/the-gops-latest-health-care-plan-is-comically-bad/2017/04/20/0627b162-2600-11e7-a1b3-faff0034e2de_story.html.

Our comment: The key problem is the excessive cost of U.S. healthcare. There are huge inefficiencies in its delivery, and real reforms are needed. For example, of course costs will rise without limit when pharmaceutical companies, hospitals, insurance companies, and doctors can charge anything, and government will pay whatever is asked so that millions of Americans are not locked out of care. But the Republicans want to save money only by abandoning the poor and sick - to put that money into tax reduction for the rich, more wars around the world, and the wall.

2017-03-31

ACT UP 30th Anniversary, New York, March 30, 2017

I took these yesterday, March 30. They are in chronological order, earliest ones first.

For info see http://www.facebook.com/events/204115296734664/.

     
 
 
 

Survey: U.S. doctors support single-payer; here is why

A LinkedIn survey of 500 doctors found 48% supporting single payer, vs. 32% opposed - even though they expected to earn less money. The question was, "Would you support a move to single-payer healthcare, like universal Medicare coverage." The article quotes the doctors to detail some of the horrible paperwork, healthcare, and ethical costs of U.S. medical care now. See Insurance is Driving Physicians Mad; Nearly Half Now Say They’d Prefer Single-Payer.

Also, on wait times for new-patient appointments, see Healthcare Dive (an industry newsletter), http://www.healthcaredive.com/news/americans-wait-an-average-24-days-to-get-a-new-patient-appointment/438531/.

2017-03-30

US healthcare kills: Canadians with cystic fibrosis live 49 years average, US Americans 37; whole cause is lack of healthcare

"Compared with patients in the United States who had private insurance coverage, patients in Canada had a similar risk of early death. Compared with patients who had public insurance like Medicaid, Canadians with cystic fibrosis had a 44 percent lower risk of early death. And compared with Americans who were uninsured, Canadians had a 77 percent lower risk of early death." New York Times, http://www.nytimes.com/2017/03/20/upshot/why-cystic-fibrosis-patients-in-canada-outlive-those-in-the-us.html.

The original research was published March 14, 2017, in Annals of Internal Medicine, http://annals.org/aim/article/2609289/survival-comparison-patients-cystic-fibrosis-canada-united-states-population-based (extended abstract available, but full  text behind paywall).

Comment: Deathcare

This study shows one way to quantify loss of life caused by excluding the poor (and some others) from healthcare. Dozens or hundreds of other studies could be done.

That access to healthcare saves lives seems obvious. But at least one conservative used selected data to argue that Obamacare does not save many lives, https://www.nytimes.com/2017/03/29/opinion/is-obamacare-a-lifesaver.html - published well after the two articles linked above (which it does not mention).

Another big fight will be the Trump/Republican budget, proposing huge cuts to almost all Federal activities except war - including medical research. (In science, NASA is to be spared - but focused on Mars, apparently to distract attention from Earth, which some consider more important.)

2017-03-24

Trumpcare fails as Trump and Republicans cancel vote; Obamacare remains for now

by John S. James

Congressional Republicans cancelled a vote on the bill to repeal Obamacare, after it became clear that the replacement they proposed could not get enough votes to win.

The bill that failed was almost unanimously opposed by doctors' and other medical organizations - and then made worse to get votes of right-wing Republicans, upsetting moderate Republicans who otherwise would have voted for it. To reduce premiums, the final bill would have allowed health-insurance companies to offer policies without maternity care, emergency care, treatment for mental health or substance abuse disorders, prescription drugs, lab tests, rehabilitation, and four other "essential benefits" required by Obamacare. Many moderate Republicans could not vote for that.

For more news see GOP health-care bill: House Republican leaders abruptly pull their rewrite of the nation’s health-care law. You can also search for news on this (or any other recent news) at news.google.com.

Comment: What's Next

What's driving the problem is the excessive cost of U.S. health care - currently one sixth of the entire U.S. gross domestic product. The U.S. spends far more on healthcare per person than any other country in the world, but is currently #42 in life expectancy at birth (according to the CIA's list,
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html).

All the cost-reduction proposals we heard in the huge national debate leading up to the failed Trumpcare bill were either to deny healthcare to the poor, or to sell much-worse policies to the middle class. None dealt with the fundamental reason that U.S. healthcare costs so much.

The reason is that U.S. healthcare is dominated by corporations and individuals that are all about making money, whatever their mission statements may say. Almost all incentives in the system are to charge higher prices. Greed and fear work tolerably well for organizing a stock market; they don't work well for medicine.

For example, drug companies have huge biases toward developing only the most expensive therapies. New antibiotics are not a focus even though resistant infections kill many thousands of people each year in the U.S. alone. Why? Because antibiotics cure too quickly; the companies want drugs that need to be taken for years, ideally for life, so that more money can be extracted.

Combining unscrupulous, predatory, what-the-market-will-bear pricing, with the traditional ideology that human life is priceless, causes market prices to rise toward infinity (especially when there is no competition, due either to patent laws, or to regulatory logjams for generics) - not just drug prices but most prices throughout the complex, non-transparent medical system. Quite commonly one person's medical bills can be half a million dollars or more. Since almost nobody can pay that out of pocket (and they would have to pay extra-high prices if they did, since they don't have the negotiating power than insurance companies do), the idea is that almost everyone will be insured. There is little "market discipline" in this system; insurance companies usually pay if high-status doctors say it's needed. So prices go up and up while profiteers pocket the cash.

The real business model of health insurance is to find excuses not to pay for care - and also to get rid of expensive patients, one way or another (for example, automatic premium payments can go away automatically and silently at the end of the year). Despite their complaints about not being able to make money, health-insurance companies have been remarkably successful in recent years; see Gripes About Obamacare Aside, Health Insurers Are in a Profit Spiral.

And since the poor could not possibly pay the insurance premiums, co-pays, and deductibles, government pays for their care through Medicaid. This is what Republican want to get rid of - let the poor suffer and die without access to medical care. Or they can go to an emergency room when necessary to postpone death - which is not comprehensive medical care, and costs a median of $1,233 per visit (as of three years ago), according to a study by the National Institutes of Health,
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584078/.

And more and more of the middle class can't pay for effective insurance either, as costs go up and up. So both political parties propose various subsidies to help them, but ultimately not enough.

The result in an extremely expensive system that burdens the middle class, the poor, and the taxpayers. It has become unsustainable.

But mainstream politicians have avoided the real causes of excessive costs and prices, since talking about this would threaten profiteers who fund their campaigns. So others must take the initiative to get these problems addressed.

If Republicans or Democrats want to help improve Obamacare, they can start by talking with healthcare professionals and finding proposals that working doctors and other health professionals can support. No more schemes that are almost unanimously opposed by the medical community, please.