Nation’s Largest Organization of Nurses Joins Liberal Writers In Protesting Hillary Clinton’s Attacks On Bernie Sanders

National Nurses Union Medicare For All

Hillary Clinton’s sharp move towards the right has many liberals questioning how much further right she will move in the general election, and if elected president. Her recent attacks on Bernie Sanders for his advocacy of a single payer health plan, which as I have noted she once supported, has resulted in considerable criticism from the left and a major nurses organization.

Jonathan Cohn, Senior National Correspondent at The Huffington Post asked, Why is she talking like a Republican? He also pointed out, “This is why Hillary Clinton makes so many progressives queasy.” Jim Newell at Slate wrote, Hillary Is Already Triangulating Against Liberals: Her new attack on Bernie Sanders’ single-payer health care plan shows her indifference to progressive voters. He pointed out that “she is a Clinton, and this is what they do.”

National Nurses United, which previously endorsed Bernie Sanders for president, has issued a press release to respond to Clinton’s attacks on Sanders over his support for a single payer plan:

National Nurses United, the largest U.S. organization of nurses, condemned the Hillary Clinton campaign today for its attack on Sen. Bernie Sanders’ proposal for healthcare for all, including its slanted use of data on the economics of Medicare for all.

“Any politician that refuses to finance guaranteed health care has abandoned my patients, and I will never abandon my patients. That’s why we support improved Medicare for all, and that’s why I support Bernie Sanders,” said NNU Co-President Jean Ross, RN.

“While the Affordable Care Act corrected some of the worst injustices in our insurance, profit-based healthcare system, the work of healthcare reform is far from done,” said Ross. “Today, 33 million Americans remain uninsured. Tens of millions more remain underinsured, facing bankruptcy due to unpayable medical bills or the choice of getting the care they need or paying for food or housing for their families.”

“The only fix for our broken system once and for all is the prescription Bernie Sanders has so eloquently presented – joining the rest of the world by expanding and updating Medicare to cover everyone,” Ross said.

NNU also criticized Clinton for citing a rightwing report first published in the Wall Street Journal on the inflated cost of $15 trillion to implement a Medicare for all system. The Journal report claimed as its source research by University of Massachusetts Amherst economics professor Gerald Friedman.

But Friedman himself has criticized the Journal report, noting in a Huffington Post column that the “economic benefits from Senator Sanders’ proposal would create dynamic gains by freeing American businesses to compete without the burden of an inefficient and wasteful health insurance system.”

Those include a “productivity boost coming from a more efficient health care system and a healthier population, [that] would raise economic output and provide billions of dollars in additional tax revenues to offset some of the additional federal spending,” said Friedman.

Friedman estimates nearly $10 trillion in savings while still reducing national health care spending by over $5 trillion. “With these net savings, the additional $14.7 trillion in federal spending brings savings to the private sector (and state and local governments) of over $19.7 trillion,” Friedman wrote.

Clinton is “ignoring the enormous savings that would come by assuring people could get proper care where and when they need it,” Ross added.

For example, a report out just last week noted $6.4 billion in lost wages and productivity in low income communities through premature deaths due to colon cancer, according to researchers at the Centers for Disease Control and Prevention.

“Dismissing the yearning of millions of Americans for a more humane healthcare system not based on ability to pay, and relying on a disputed data is disgraceful,” said Ross. “It’s a reminder again why nurses across the U.S. have been rallying and campaigning for a candidate who will never stop fighting for guaranteed healthcare for all.”

I further discussed Clinton’s fallacious attacks on Sanders here.

By attacking Sanders from the right on health care and economic policy, along with reminding the left how hawkish she is in her recent speech at the Council on Foreign Relations, Clinton risks seeing progressive voters refuse to vote for her.

Conor Lynch at Salon warns that Hillary Clinton is playing a dangerous game: How her anti-Bernie talking points could cost her — and America — big time. He began, “Hillary Clinton is starting to remind progressives why the name Clinton brings up such a mixed bag of emotions, and why it’s so hard to believe Clinton’s pivot to the left this campaign season.”He concluded:

But Clinton is making it harder for progressives to support her. With a history of hawkish foreign policy and Wall Street backing, she truly is the lesser to two evils. (A neoliberal is better than a fascist, after all [referring to Donald Trump]) But many on the left tend to vote with their conscience, and going after single-payer healthcare and hurling dishonest attacks on Sanders will only alienate progressives further.

Her problem is also not likely to be limited to progressive voters. When Clinton campaigns as a Republican-lite, many potential Democratic voters are not going to see very much reason to turn out to vote, risking the same fate for Democrats as they suffered in 2014.

Please Share

Clinton Attacks Sanders On Progressive Agenda Including Single Payer Health Care


Hillary Clinton distorted the meaning of single payer health plans in the second Democratic debate and is continuing to attack Sanders’ progressive agenda on the campaign trail. Politico reports, “Three days after the fairly cordial second Democratic debate, Clinton’s campaign is mounting an attack against Sen. Bernie Sanders for proposals to raise taxes on the middle class that were part of the national single-payer health care bills he introduced in Congress.”

As Jonathan Cohn, Senior National Correspondent at The Huffington Post asks, Why is she talking like a Republican? He also points out, “This is why Hillary Clinton makes so many progressives queasy.”

Sanders’ campaign responded:

“On Medicare for all, the middle class would be far better off because it would save taxpayers money,” Sanders spokesman Michael Briggs said in response to Clinton’s latest line of attack. “More people would get better care at less cost. Didn’t she used to be for that? We wouldn’t throw money away on costly premiums for profit-making private insurance companies. Pharmaceutical companies would no longer be able to rip off Americans with the most expensive prescription drugs in the world. Didn’t she used to be for that?”

“Secretary Clinton has singled out Senator Gillibrand and praised her [family leave] legislation which, it turns out, Secretary Clinton now refuses to support because of the way it’s paid for,” Briggs added, noting it requires a small tax hike on the middle class. “No wonder people have their doubts about her.”

His campaign web site has further information:

What’s the Truth About the Clinton Campaign False Attacks?

The truth is that a single-payer plan will save American families money and provide universal health care.

Under the legislation offered by Sen. Sanders in 2013, families with taxable income under $250,000 a year (individuals under $200,000) would pay a tax of 2.2 percent of taxable income.

That means a family with a taxable income of $100,000 a year would pay $2,200 a year – but would be relieved of paying any private health insurance premiums and any copayments or deductibles.

A family making $50,000 would pay $1,100 a year.

The page also notes that, “The Clinton campaign received more contributions from the pharmaceutical industry than any other – Republican or Democrat – through the first six months of the campaign.”

Clinton’s attack sounds like a  repetition of attacks on Sanders in The Wall Street Journal in September. Physicians For A National Health Program responded:

In a front-page Wall Street Journal article a few days ago, the projection was made that a single-payer national health insurance program (NHI), as part of the presidential campaign of Senator Bernie Sanders (I-VT), would cost $15 trillion over ten years. Accurate though that figure is, this under-researched article conveys disingenuous misinformation to a broad readership that might be inclined to dismiss such a program as too expensive to even consider.

This article is irresponsible in what it doesn’t say— what the savings would be of reining in our current wasteful, overly bureaucratic profit-driven medical industrial complex, and the benefits that NHI would bring to our entire population compared to what we have now or have ever had.

Thanks to a landmark study in 2013 by Gerald Friedman, Professor and Chairman of the Department of Economics at the University of Massachusetts, we have a solid financial analysis of the costs and benefits of a single-payer national health plan. With NHI, $592 billion would be saved annually by cutting the administrative waste of some 1,300 private health insurers ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). These savings would be enough to cover all of the 44 million uninsured (at the time of his study) and upgrade benefits for all other Americans, even including dental and long-term care. A single-payer public financing system would be established, similar to traditional (not privatized) Medicare, coupled with a private delivery system. Instead of having to pay the increasing costs of private health insurance, so often with unaffordable deductibles and other cost-sharing, patients would present their NHI cards at the point of service without cost-sharing or other out-of-pocket costs. Care would be based on medical need, not ability to pay…

There is far more on this in the full post. Common Dreams adds:

Sanders’ embrace of a single-payer system—also widely backed by the American public—earned him the endorsement of the National Nurses United (NNU), the nation’s largest organization of nurses. NNU Executive Director RoseAnn DeMoro said in August that his ” issues align with nurses from top to bottom,” including his “insist[ance] that healthcare for everyone is a right not a privilege.”

Clinton Flip Flop

There is added irony in that this is yet another flip-flop from Hillary Clinton. She has flip-flopped on some selective economic issues to try to attract progressive support, and she has flip-flopped on gun control.  As I recently posted, some of her statements on gun legislation were  like the views from Sanders which she attacks. At other times she has taken a more conservative viewpoint.  As Martin O’Malley pointed out during the second debate, she has held at least three views, portraying herself  “as Annie Oakley and saying we don’t need those regulations.” Clinton has also supported a single payer plan in the past. This is from Clinton in 1994, both supporting single payer and showing no objection to a general tax to fund it (emphasis mine):

..I believe, and I may be to totally off base on this, but I believe that by the year 2000 we will have a single payer system. I don’t think it’s — I don’t even think it’s a close call politically.

I think the momentum for a single payer system will sweep the country. And regardless of the referendum outcome in California, it will be such a huge popular issue in the sense of populist issue that even if it’s not successful the first time, it will eventually be. So for those who think that building on the existing public-private system with an employer mandate is radical, I think they are extremely short-sighted, but that is their choice.

There are many ways to compromise health care reform, and I don’t think that the President could have been clearer in every public statement he has made that he has one bottom line. It is universal coverage by a date certain. And he has basically told the Congress, you know, you’ve got different ways of getting there. Come to us, and let’s look at it. There are only three ways to get to universal coverage. You know, a lot of people stand up and applaud universal coverage, and they sit down, and you say, “Well, how are you going to get there?”, and they don’t want to confront that there are only three ways.

You either have a general tax — the single payer approach that replaces existing private investment — or you have an employer mandate, or you have an individual mandate. And there isn’t any other way to get to universal coverage. The market cannot deliver universal coverage in the foreseeable future, and any compromise that people try to suggest that would permit the market  to have a few years to try to deliver universal coverage without a mandate that would take effect to actually finish the job will guarantee a single payer heath care system.

Or maybe we are just dealing with ignorance of the topic as opposed to flip-flopping.  Physicians For A National Health Program pointed out her confusion on Medicare for All as a model for single payer plans displayed in an interview in The New York Times in 2008:

Q: Last question. You talked earlier in the interview about how your plan maintains the private insurance system. But in October, at the forum of the Kaiser Family Foundation, you were asked whether your plan to make government insurance, a Medicare-type plan, available to all was a backdoor route to a single payer system, and you said, “What are we afraid of? Let’s see where the competition leads us.” So is it okay with you if the market ultimately dictates that the U.S. system sort of morphs into a single-payer system? And if so, doesn’t that arm the Republicans with exactly what you were talking about, this claim that it’s socialized medicine?

MRS. CLINTON: No, because I think what we would be offering would be a Medicare-like system, which is something people are familiar with, and you know whether we would call it Medicare 2.0 or whatever we would call it. And we’d see whether people want that or not. And where it morphs to, I think this whole system will morph. I mean, look at where Medicare started and where it is today. In large measure, some of the problems we have are because of the way it evolved. But I think from my perspective, having this Medicare-like alternative really does answer the desires of people. And there’s a significant minority who want quote a single-payer system. It at least gives them the feeling it’s not for profit, they’re not paying somebody a billion dollars for raising their premiums 200 percent and all the rest of the problems that we face with the for-profit system. You get the costs of overhead and administration down as much as possible. I believe in choice. Let Americans choose and what better way to determine that than letting the market have some competition and you know see where it does lead to.

Q: And if the choice is a single-payer system, that’s fine by you?

MRS. CLINTON: You know, I think that would be highly unlikely. I think that, you know, there’s too many bells and whistles that Americans want that would not be available in kind of a bare-bones Medicare-like system but I think it’s important to have that competition.


By Don McCanne, MD

Competition between a bare-bones Medicare-like plan versus private bells-and-whistles insurance? What kind of framing is that!?

In her proposal, is she really advocating for a public Medicare-like option that provides only bare-bones coverage? That’s certainly not the model that single payer advocates propose.

Is she suggesting that the private insurance industry will be able to provide us with an insurance product that includes all of the bells and whistles at a premium that is affordable? If such a plan were to be offered it would have a very small market limited to only the wealthiest of us. Insurers typically shun small markets.

On this issue, at least, it looks like Clinton has been moving to the right over the years.

I could understand a politician not pursuing a single payer plan because of the political obstacles in getting it passed. It is a totally different thing when Hillary Clinton repeats right wing talking points to attack Sanders for desiring a single payer plan, especially when she once had a far more liberal view on the subject.

Update: Nation’s Largest Organization of Nurses Joins Liberal Writers In Protesting Hillary Clinton’s Attacks On Bernie Sanders

Please Share

Bernie Sanders Fights Back Against Conservative Attacks From Wall Street Journal & Clinton Camp

Sanders Responds WSJ

I imagine it is a good thing that both conservatives and the Clinton campaign now see Bernie Sanders as a threat, with both attacking him from the right.

The Wall Street Journal ran a scare story earlier this week entitled, Price Tag of Bernie Sanders’s Proposals: $18 Trillion:

He proposes $1 trillion to repair roads, bridges and airports. His college-affordability program would cost $750 billion over a decade. Smaller programs would provide youth jobs and prevent cuts to private pension plans. He would raise an additional $1.2 trillion in Social Security taxes in order to increase benefits and pay those already promised for 50 years. That would bolster the program but fall short of the 75 years of solvency that is typically what policy makers aim to achieve.

Mr. Sanders says he also would propose an expansion of federal support for child care and preschool, though he hasn’t said how much those programs would cost, and they aren’t included in this total.

His most expensive proposal, by far, is his plan to extend Medicare, the federal health program for seniors, to all Americans.

Sanders has responded, pointing out how a single payer plan would be more cost effective:

“That is not the reality. We will be responding to The Wall Street Journal on that,” Sanders told MSNBC’s Andrea Mitchell of the overall estimate.

“I think most of the expense that they put in there, the expenditures have to do with the single-payer healthcare system,” he continued. “They significantly exaggerated the cost of that, and they forgot to tell the American people in that article that that means eliminating the costs that you incur with private health insurance.”

Paul Waldman has also defended Sanders in a post entitled, No, Bernie Sanders is not going to bankrupt America to the tune of $18 trillion:

…while Sanders does want to spend significant amounts of money, almost all of it is on things we’re already paying for; he just wants to change how we pay for them. In some ways it’s by spreading out a cost currently borne by a limited number of people to all taxpayers. His plan for free public college would do this: right now, it’s paid for by students and their families, while under Sanders’ plan we’d all pay for it in the same way we all pay for parks or the military or food safety.

But the bulk of what Sanders wants to do is in the first category: to have us pay through taxes for things we’re already paying for in other ways. Depending on your perspective on government, you may think that’s a bad idea. But we shouldn’t treat his proposals as though they’re going to cost us $18 trillion on top of what we’re already paying.

He next discussed single payer systems, leading to this key point:

There’s something else to keep in mind: every single-payer system in the world, and there are many of them of varying flavors, is cheaper than the American health care system. Every single one. So whatever you might say about Sanders’ advocacy for a single-payer system, you can’t say it represents some kind of profligate, free-spending idea that would cost us all terrible amounts of money.

He next discussed spending on infrastructure, and then how much less we would have to spend under Republican tax plans which primarily provide tax cuts to the wealthy:

The conservatives who are acting appalled at the number the Journal came up with are also the same people who never seem to care what a tax cut costs, because they think cutting taxes is a moral and practical good, in the same way that liberals think providing people with health coverage is a moral and practical good. For instance, Jeb Bush recently proposed a tax cut plan whose 10-year cost could be as high as $3.4 trillion. That’s a lot of money that the government wouldn’t be able to spend on the things it’s doing right now, although the campaign argues that we’d get much of that money back in increased revenues because of the spectacular growth the tax cuts would create. If you remember the claims that George W. Bush’s tax cuts would create stunning growth and prosperity for all, you might be just a bit skeptical of the Jeb campaign’s similar assertions. But in any case, we can’t evaluate the value of Jeb’s plan just by saying that $3.4 trillion is a big number. If you knew that the average family in the middle of the income distribution would get less than $1,000 from Jeb’s plan, while the average family in the top one percent would get a tax cut of over $80,000, then you’d have a better sense of whether it’s a good or bad idea.

Sanders not only defended himself against this attack from the right on economics. He has also defended himself against attacks from a Clinton Super PAC in a recent fund raising email.

Attacks from the right from the Clinton camp might become increasingly common. Many liberals have been certain that Clinton’s move to the left was insincere, and that she would move to the right for the general election and if elected. We never guessed she would move towards the right so soon. As I noted last week, Clinton’s support has been falling among liberals, with Clinton now returning to calling herself a centrist to contrast herself with Sanders. Jonathan Allen picked up on this shift more recently writing, While everyone else was talking about her authenticity, Hillary Clinton changed her position.

The revelation that Hillary Clinton is planning to be more spontaneous and authentic brought a booming collective laugh from Republicans, some Democrats, and opinion writers last week. The group guffaw drowned out a related shift in her positioning that is far more important: Now she wants to be known as a moderate.

“You know, I get accused of being kind of moderate and center,” Clinton said in Ohio September 10, according to CNN. “I plead guilty.”

That’s a tire-squealing turn from the first five months of her campaign, when Clinton emphasized her progressive credentials. She built a policy platform significantly to the left of where many Democrats expected her to stand — in favor of new regulations of the financial services industry, “ending the era of mass incarceration,” and reforming campaign finance laws, to name a few items on her agenda. The focus on populism was described as a newfound affinity for the left, a return to liberal roots, an effort to crowd out the competition, a general election strategy based on energizing Democrats, or some combination thereof. The truth is that Clinton’s record is pretty liberal, except when it comes to national defense and trade.

Now she’s pivoting back toward the centrist label that defined her husband’s campaigns and presidency. The obvious reason for Clinton to switch tacks now is that her initial strategy didn’t work: On the strength of backing from liberals, Vermont Sen. Bernie Sanders has surged to leads in New Hampshire and Iowa. That’s a good reason for her to shake things up a bit, but it’s only part of a story that is more about drawing a contrast with Sanders, sending a signal to her supporters that she’s ready to really fight for the nomination, and making sure that she’s comfortable in the political skin she’s wearing for the rest of the campaign.

Allen caught the general direction of the shift, but missed how conservative her record actually is. Beyond national defense and trade which he mentioned, she has also been rather conservative on civil liberties, the environment, and social/cultural issues. While her views on economics might technically be labeled as liberal, she is far to the right of where Democrats influenced by the views of people such as Elizabeth Warren are now at.

After looking at more wonkish policy matters, Allen hit the key matter with the subtitle: The shift is partly about portraying Sanders as too extreme

By portraying herself as a moderate, Clinton is subtly saying that Sanders is too extreme — that he’s one of the people standing on the sidelines shouting rather than trying to “get something done.” The inference voters are supposed to draw is that would make it harder for Sanders to win the presidency and even harder for him to govern.

Running as a moderate (or to be honest, a conservative) might be more “authentic” for Clinton, but in joining the right wing in calling Sanders too extreme, Clinton is missing the direction much of the country is moving in. As I have pointed out many times before, Bernie Sanders Is The Future Of The Democratic Party. As I’ve also pointed out previously, Sanders’ Views Are Becoming More Mainstream Than Clinton’s Conservative Views.

Please Share

A Bigger Computer Fiasco For The Obama Administration Than

The fiasco with the initial opening of the exchanges at has become a well-known IT glitch from the Obama administration, but that might not turn out to be their biggest mistake regarding computers and health care. As it primarily involves physicians and hospitals, as opposed to the general public, far fewer people are aware with the ongoing problems regarding implementation of Meaningful Use Stage 2 requirements for electronic medical records.

The original stimulus package after Barack Obama took office included a program to provide funds to medical practices to be used for conversion to electronic medical records. In order to qualify for the incentive payments, physicians and hospitals have to follow a set of Meaningful Use requirements which have increased requirements for each stage. Initially there would be incentive payments (which turned out to be far less than the costs of conversion to electronic medical records), and subsequently there are penalties for failing to comply. The first stage was successful in terms of getting large numbers of doctors to adopt electronic medical records, but it is more questionable as to whether this is really resulting in the desired cost savings.

Stage 2 was initially required by October 2014. This would have greatly increased the use of electronic medical records, possibly resulting in more medical cost savings, but the requirements were unrealistic. The law originally required that physicians comply with the requirements of Stage 2 for a 90 day period in 2014, which essentially meant that we could wait until October 1 to implement them. When it was apparent that most physicians could not comply with this, the government postponed this until January 2015.

It was quickly apparent that this was no solution, partially as the new requirements required a full twelve months of compliance with the Stage 2 rules. By requiring compliance by this January, this only gave an additional three months. The same problems which prevented compliance with the rules by October 2014 are still present this January.

The biggest obstacle is that the rules require communication between systems which do not exist in the present software. Before making such requirements, the government should have set up a secure system for communication between computer systems rather than hoping that each individual vendor would offer a solution. Another problem is that the requirements include factors which are outside of a medical office’s control. For example, a medical office could set up a patient portal as required in order for patients to assess medical information. However, there are requirements not only to establish this, but for five percent of patients to utilize it. Many physicians, such as those with primarily elderly patients are especially concerned that not enough will even be interested in using such computerized tools. Fortunately this requirement was at least reduced from ten percent in the original regulations to five percent.

Compliance with the rules is further complicated by it being all or nothing. A medical office might follow 90 percent of the rules but will get zero incentive money and pay the full penalties for non-compliance. There are some exclusions and some flexibility in some areas, but this still creates far too great a burden on physician practices.

When the government first changed the rules last fall delaying the requirements for Stage 2 until January, some members of Congress did realize that this was not long enough to have any impact. There was a bipartisan bill introduced to reduce the requirements for a 90 day period in 2015, essentially giving physicians until October instead of January. This was not introduced until shortly before Congress went on recess prior to the election, and died before the end of the last session. Earlier this month Renee Ellmers (R-N.C.) and Ron Kind (D- Wis.) introduced The Flexibility in Health IT Reporting (Flex-IT) Act of 2015 to restore the 90 day requirement. The bill also has the support of organizations including the American Academy of Family Physicians, American Hospital Association, American Medical Association, College of Healthcare Information Management Executives and Medical Group Management Association.

Even this only postpones the problem and we don’t know if the technology will be any better this fall than it is now. A recent survey of physicians found that 55 percent do not plan to attest to Stage 2, despite the financial penalties.

This failure in the implementation of computerized medical records could be a far worse fiasco than the initial roll out of the exchanges under the Affordable Care Act. The manner in which the Obama administration quickly fixed that problem turned out to be a tremendous success, and this problem is also fixable. A real fix will take more than just postponing requirements.

The government must rethink the logic behind the requirements. Most industries have computerized on their own without being forced to by the government. Some government assistance in conversion to electronic medical records would be helpful, such as establishing standards for communication between systems. Physicians must also be given flexibility to determine for ourselves which aspects of computerization are really of value for caring for our patients and which are not, rather than being forced to follow a long set of rules and only receive credit for 100 percent compliance, or being dependent on factors beyond our control.

Please Share

PolitiFact Lie of The Year: Exaggerations about Ebola

Conservatives used Ebola as one means of spreading fear, helping them in the 2014 midterm elections. PoltiFact has now made exaggerations about Ebola their 2014 Lie of the Year. This includes both conservative hysteria which greatly exaggerated the threat faced in a developed nation such as the United States and many of the right wing conspiracy theories. I have already discussed many of these false claims, often in the context of debunking right wing attempts to restrict civil liberties while ignoring the science. From PoltiFact:

Thomas Eric Duncan left Monrovia, Liberia, on Sept. 19, for Dallas. Eleven days later, doctors diagnosed Duncan with Ebola.

Eight days after that, he was dead.

Duncan’s case is just one of two Ebola-related fatalities in the United States, and since Duncan traveled to Dallas, more Americans — at least nine, and likely many more — have died from the flu.

Yet fear of the disease stretched to every corner of America this fall, stoked by exaggerated claims from politicians and pundits. They said Ebola was easy to catch, that illegal immigrants may be carrying the virus across the southern border, that it was all part of a government or corporate conspiracy.

The claims — all wrong — distorted the debate about a serious public health issue. Together, they earn our Lie of the Year for 2014…

Fox News analyst George Will claimed Ebola could be spread into the general population through a sneeze or a cough, saying the conventional wisdom that Ebola spreads only through direct contact with bodily fluids was wrong.

“The problem is the original assumption, said with great certitude if not certainty, was that you need to have direct contact, meaning with bodily fluids from someone, because it’s not airborne,” Will said. “There are doctors who are saying that in a sneeze or some cough, some of the airborne particles can be infectious.” False.

U.S. Sen. Rand Paul, R-Ky., described Ebola as “incredibly contagious,” “very transmissible” and “easy to catch.” Mostly False.

Internet conspirators claimed President Obama intended to detain people who had signs of illness. Pants on Fire. Bloggers also said the outbreak was started in a bioweapons lab funded by George Soros and Bill Gates. Pants on Fire.

A Georgia congressman claimed there were reports of people carrying diseases including Ebola across the southern border. Pants on Fire. Sen. John McCain, R-Ariz., said Americans were told the country would be Ebola-free. False.

When combined, the claims edged the nation toward panic. Governors fought Washington over the federal response. The Centers for Disease Control and Prevention stumbled to explain details about transmission of the virus and its own prevention measures. American universities turned away people from Africa, whether they were near the outbreak or not.

The post went on to discuss the actual medical facts.

Not surprisingly the misinformation came from many of the usual subjects such as Fox and Republicans such as John McCain and Rand Paul. Their conspiracies theories also involved the usual subjects of right wing attacks like Barack Obama and George Soros.

At least one good thing did come about from the Ebola hysteria. Republicans, with the help of the NRA, had blocked the appointment of Vivek Murthy for Surgeon General for months. The Ebola outbreak placed increased attention on this vacancy and he was finally confirmed by the Senate today.

Please Share

Health Care Policy Briefs: Early Retirement, The Two Americas, Sabotaging Obamacare, Marijuana Not A Gateway Drug, And The Pentagon’s Plan For The Zombie Apocalypse


Five  health care policy items today:

Goldman issued a report on how availability of health insurance allows people the option of retiring early (or as Republicans would put it, become takers) as opposed to waiting until they qualify for Medicare. The found that “the annual probability of retirement–i.e., what share of workers of a given age will retire within the next year–is on average between 2% and 8% higher when retiree health insurance is available.” Early retirement is seen more between the ages of 60 to 64, than in those who are age 55-59.

With Republicans blocking Medicaid expansion in twenty-four states, The Commonwealth Club looked at the healthcare differences in the two Americas:

The Commonwealth Fund’s recently released Scorecard on State Health System Performance, 2014, finds big differences between states on measures of health care access, quality, costs, and outcomes. What’s more, its authors warn that these differences could very well widen in the future. Many of the lowest-performing states are choosing not to expand their Medicaid programs under the Affordable Care Act (ACA). Some also are discouraging eligible uninsured citizens from purchasing subsidized coverage through new ACA marketplaces, though some uninsured are signing up nonetheless.

The fact that so many low-performing states are spurning the ACA’s benefits, while high-performing states are rushing to embrace them, raises profound questions for the future of our country. What would it mean if different parts of the United States find themselves on radically different health care trajectories, with some enjoying progressively better health and health care and others falling further and further behind? In other words, what would it mean if the two health care Americas grow further and further apart over time?

This is unexplored territory for health care researchers and policymakers, but we know enough to point to some possibilities.

To begin with, we know that when people have health coverage they live longer, healthier lives. Widening gaps in rates of insurance coverage between low- and high-performing states will almost certainly lead to growing differences in life expectancy and health status. This is worrisome and regrettable, but probably only part of the story.

An equally important—but much less explored—question is whether differing health care trajectories also will lead to differing economic and social trajectories. All else equal (of course, it never precisely is), will regions with poorer health care and health status suffer economically and socially as well? Will they have less productive workforces, less productive economies, and, as result, lower quality of life overall? Will they become less attractive places to live, work, and do business?

Several lines of evidence suggest that diverging regional health care systems could lead to diverging general welfare. First, untreated physical and mental health problems increase workers’ time off from work, reduce performance while at work, and lower rates of employment. In the early 20th century, infections such as yellow fever, malaria, and hookworm greatly hindered the economy of the American South. In his memoir, Jimmy Carter recalls that, while growing up in rural Georgia, “almost everyone was afflicted from time to time with hookworm,” a parasite that causes anemia, malaise, and fatigue. Eventually, public health measures and improved living conditions brought this and other health problems under control, contributing to a burst of economic growth.

A century later, chronic illness is the equivalent of the infectious illness that once disproportionately taxed the economy of the American South. In the United States, annual productivity losses from diabetes and depression alone exceed $100 billion nationally. And we know this burden can be lightened through good primary and preventive care that will be less available in regions with large uninsured populations.

Second, health insurance boosts economies by protecting people against catastrophic out-of-pocket health care expenses. These costs can lead to bankruptcy, which raises the cost of borrowing for the rest of society as lenders take into account the risk that they will not be repaid. Those avoiding bankruptcy often incur substantial medical debt, with far-reaching consequences. A 2012 Commonwealth Fund survey found that 61 percent of uninsured adults ages 19 to 64 reported problems paying their medical bills or said they were paying off medical debt over time. Among these individuals, more than half said they received a lower credit rating as a result of unpaid medical bills, 43 percent used all of their savings to pay their bills, and 29 percent delayed education or career plans. The 2006 Massachusetts health reform, which has led to nearly universal health coverage, has also led to fewer personal bankruptcies and bills past due and improved credit scores, particularly for those with limited access to credit before the reform…

The report continued to discuss further differences resulting from differing access to health insurance.

Besides blocking Medicaid expansion, conservatives are reducing the number of insured with misinformation campaigns and campaigns to outright dissuade people from obtaining coverage in the exchanges. This has led many uninsured people to fail to obtain coverage through the exchanges to based upon misconceptions spread by conservatives, such as that the cost would be much higher than it actually is. Jonathan Cohn wrote:

About half of the people who McKinsey surveyed did not end up buying insuranceeither because they shopped and found nothing they liked, or because they didn’t shop at all. When asked to explain these decisions, the majority of these people said they thought coverage would cost too much. But two-thirds of these people said they didn’t know they could get financial assistance. In other words, they assumed they would have to pay the sticker price for coverage, even though federal tax credits would have lowered the price by hundreds or thousands of dollars a year.

With a little education and outreach, many of these people will discover that insurance costs less than they thought. When next year’s open enrollment period begins, they are more likely to get coverage. But the idea was to help more of those people this year. And if the administration deserves some blame for this shortfall, its adversaries deserve more. Republicans and their allies did their best to taint the lawand, where possible, to undermine efforts to promote it. Without such obstruction, even more uninsured people would probably be getting coverage right now. As Sprung quipped in his post, “Those who deliberately spread disinformation about the ACA and actively encouraged the uninsured to remain in that blessed state of freedom can be really proud of themselves.”

Or as I put it in a recent post: Fox Lied, People Die.

The National Bureau of Economic Research looked at the effects of legalization of medical marijuana on drug use:

21 states and the District of Columbia currently have laws that permit marijuana use for medical purposes, often termed medical marijuana laws (MMLs). We tested the effects of MMLs adopted in seven states between 2004 and 2011 on adolescent and adult marijuana, alcohol, and hard drug use. We employed a restricted-access version of the National Survey on Drug Use and Health (NSDUH) micro-level data with geographic identifiers. For those 21 and older, we found that MMLs led to a relative increase in the probability of marijuana use of 16 percent, an increase in marijuana use frequency of 12-17 percent, and an increase in the probability of marijuana abuse/dependence of 15-27 percent. For those 12-20 years old, we found a relative increase in marijuana use initiation of 5-6 percent. Among those aged 21 or above, MMLs increased the frequency of binge drinking by 6-9 percent, but MMLs did not affect drinking behavior among those 12-20 years old. MMLs had no discernible impact on hard drug use in either age group. Taken together, MML implementation increases marijuana use mainly among those over 21, where there is also a spillover effect of increased binge drinking, but there is no evidence of spillovers to other substance use.

If marijuana turns out not to be a gateway drug, this would be another reason to reevaluate current marijuana laws. Further discussion at Vox.

The Pentagon has contingency plans for any emergency, including the Zombie Apocalypse. It isn’t as ridiculous as it sounds as it is actually a model plan using a fictional situation, as reported by Foreign Policy:

“This plan fulfills fictional contingency planning guidance tasking for U.S. Strategic Command to develop a comprehensive [plan] to undertake military operations to preserve ‘non-zombie’ humans from the threats posed by a zombie horde,” CONOP 8888’s plan summary reads. “Because zombies pose a threat to all non-zombie human life, [Strategic Command] will be prepared to preserve the sanctity of human life and conduct operations in support of any human population — including traditional adversaries.”

CONOP 8888, otherwise known as “Counter-Zombie Dominance” and dated April 30, 2011, is no laughing matter, and yet of course it is. As its authors note in the document’s “disclaimer section,” “this plan was not actually designed as a joke.”

Military planners assigned to the U.S. Strategic Command in Omaha, Nebraska during 2009 and 2010 looked for a creative way to devise a planning document to protect citizens in the event of an attack of any kind. The officers used zombies as their muse. “Planners … realized that training examples for plans must accommodate the political fallout that occurs if the general public mistakenly believes that a fictional training scenario is actually a real plan,” the authors wrote, adding: “Rather than risk such an outcome by teaching our augmentees using the fictional ‘Tunisia’ or ‘Nigeria’ scenarios used at [Joint Combined Warfighting School], we elected to use a completely-impossible scenario that could never be mistaken for a real plan.”

But do they have plans in case of a Dalek invasion?

Please Share

Insurance Companies Plan To Increase Policies Offered On Exchanges Following 2014 Success, And Other Health Care News

The first year of enrollment for insurance under the exchanges is largely for first getting our feet wet, with more people projected to sign up in the future. It certainly exposed problems in the computer system and allowed for them to be fixed (although further testing before October was clearly needed). Insurance companies got to see whether this was a profitable market they would want to enter. In the past one or two insurance companies dominated in most areas on the individual market. One of the benefits of selling coverage through the exchanges was the hope that multiple companies would now begin to offer coverage.

Even conservatives who oppose the Affordable Care Act should agree with the benefits of having more companies offer insurance, including the likelihood of competition leading to lower prices. Actually exchanges, along with mandates, were originally supported by Republicans until they opposed the plan when supported by Barack Obama.

So far we are receiving good news following the initial IT problems. The Affordable Care Act now looks like a good policy which just got off to a rocky start. Enrollment is estimated at 7.5 million, exceeding predictions made even before they were adjusted downward with the early computer problems, with more healthy young people signing up at the last minute. Politico reports that insurance companies are happy with what they are seeing and want to get in:

Health insurers got their first taste of Obamacare this year. And they want seconds.

Insurers saw disaster in the fall when Obamacare’s rollout flopped and was a mess. But a strong March enrollment surge, along with indications that younger and healthier people had begun signing up, has changed their attitude. Around the country, insurers are considering expanding their stake in the Obamacare exchanges next year, bringing their business to more states and counties. Some health plans that skipped the new marketplaces altogether this year are ready to dive in next year.

At least two major national insurers intend to expand their offerings, although a handful of big players like Aetna, Humana and Cigna, are keeping their cards close for now. None of the big-name insurers have signaled plans to shrink their presence or bail altogether after the first rocky year. And a slew of smaller health plans are already making moves to join more states or get into the Obamacare business for the first time.

“[W]e see 2014 as just the beginning for exchanges,” said Tyler Mason, a spokesman for UnitedHealth Group, one of the nations’ largest insurers. “As the economics, sustainability and dynamics of exchanges continue to become clearer, we believe exchanges have the potential to be a growth market with much to offer UnitedHealthcare and other insurers and consumers.”

Nurturing this growth and health plan participation will be one of the first tasks of Sylvia Mathews Burwell, assuming she is confirmed to succeed Kathleen Sebelius as secretary of Health and Human Services.

The article reviewed plans by many of the larger insurance companies and also noted that several smaller companies now want to start selling insurance. Being able to offer their plans on the same computer site as the larger companies will allow small companies to compete for sales more easily than in the past, further increasing choice for consumers.

It is not only insurance companies which see the Affordable Care Act as succeeding. The latest Reuters/Ipsos poll shows the number of people who prefer Democrats over Republicans on health care has increased:

Americans increasingly think Democrats have a better plan for healthcare than Republicans, according to a Reuters/Ipsos poll conducted after the White House announced that more people than expected had signed up for the “Obamacare” health plan.

Nearly one-third of respondents in the online survey released on Tuesday said they prefer Democrats’ plan, policy or approach to healthcare, compared to just 18 percent for Republicans. This marks both an uptick in support for Democrats and a slide for Republicans since a similar poll in February.

Not surprisingly, Gallup has found a greater decrease in the uninsured in states which have embraced the Affordable Care Act, such as by setting up their own exchanges and taking advantage of the expanded Medicaid program.

Having Gallup survey the number of uninsured is of value as the Census Bureau is changing how it is surveying the uninsured, with Gallup providing a second set of numbers for comparison. Many Republicans see a conspiracy to make Obamacare look good. Actually this looks like a change to get more accurate results, which might actually show a greater number of uninsured. The changes also started with 2013 so we will still be able to compare the year prior to the exchanges to subsequent years. Sarah Kliff explained further at Vox.

Cross posted at The Moderate Voice

Please Share

Fact Checking Valuable, But Not Always Right


The Moderate Voice has a post yesterday on the increase in fact-checking in journalism. Fact-checking is preferable to the standard media practice of quoting both sides as if they are equally valid, generally with an implied assumption that the truth is somewhere in the middle. This leads to erroneous reporting when one side is intentionally using misinformation and lying far more than the other. However labeling something fact checking doesn’t necessarily mean it is immune from journalistic problems. Paul Krugman pointed out one problem:

“The people at PolitiFact are terrified of being considered partisan if they acknowledge the clear fact that there’s a lot more lying on one side of the political divide than on the other,” Krugman wrote in 2011.

“So they’ve bent over backwards to appear ‘balanced’ — and in the process made themselves useless and irrelevant.”

As Krugman pointed out, there are fact checkers which label an equal number of statements from Democrats and Republicans as being wrong in order to give the appearance of being impartial. That typically means that outrageous lies from Republicans are called lies but to provide a sense of balance,  statements from Democrats which are generally true but in which there is an exception are also called lies.

The entire idea of calling something true or a lie is often a poor way to handle complex issues which are stated by politicians in brief statements. Sometimes politicians are trying to be truthful, but boiling down a complex issue into a brief statement, or commercial, will result in exceptions where the statement is false. Often it is preferable to look at what is true in what is being said and where it isn’t entirely true and explain the issue rather than just calling it truth or a lie.

While Republicans have been hit far more with big lies on health care, Democrats have been harmed by the problems in how some fact checkers declare something either true or a lie (being a lie if not 100% true in every case). There have been two big examples of this. The first is Democrats saying that the Medicare proposals in the Ryan budget would destroy Medicare. Technically this is untrue as Ryan would replace Medicare with something named Medicare. On the other hand, it is true because the Republican proposals would change Medicare into something fundamentally different with far less protection for seniors. Rather than just calling it a lie, fact checkers would have done more good by explaining why Democrats consider these changes to be destroying Medicare.

The other is the greatly exaggerated “lie of the year” when Obama said people could keep their own doctor under the Affordable Care Act. This was an absurd statement on one level because every year insurance companies and doctors make decisions which can affect this which the government has no  power over. On the other hand, Obama was right in the context where he was speaking, even if worded poorly. Republicans were lying when they claimed that Obamacare would make people join some sort of government run program which would tell them which doctors they can see. The Affordable Care Act actually makes it more likely that people could have insurance which would allow them to keep their doctor than had been the case in the past and does nothing to force people to lose their doctor. People have a better chance of keeping their doctor when protected from losing their insurance. Frequently people are forced to change doctors because of employers changing insurance plans. Employees have a better chance of keeping their own doctor when provided more choice in plans, as under the Affordable Care Act.  Where Obama got it wrong was that the same forces already present which lead to people having to change doctors, while diminished, would still exist. It would be far better to explain this complex issue, where Obama was mostly right, than to just declare it a lie because it is not true one hundred percent of the time.

Cross posted at The Moderate Voice

Please Share

Obama Administration Announces Increase In Payments To Medicare Advantage Plans

Presumably in response to Republican scare stories about Medicare cuts to Medicare Advantage plans and insurance company lobbying, CMS has announced an increase in payments of  0.4% in 2015, in place of the expected 1.9% rate cut as of February. This negates a distorted Republican attack that Obama is cutting payments to Medicare.

The proposed cuts were to what is essentially corporate welfare for insurance companies running  Medicare Advantage plans. The plans increased payment compared to what it costs to care for similar patients in the government Medicare plan. Republicans have included the same cuts which were previously proposed by the Obama administration in their proposed budgets despite faux attacks against Democrats for cutting Medicare.

Update: Full Text of Press Release from CMS

CMS Ensures Higher Value and Quality for Medicare Health and Drug Plans

Rate Announcement Details Plan Payments and Other Program Updates for 2015

Today, the Centers for Medicare & Medicaid Services (CMS) issued the 2015 rate announcement and final call letter for Medicare Advantage and prescription drug benefit (Part D) programs. The announcement sets a stable path for Medicare Advantage and implements a number of policies that ensure beneficiaries will continue to have access to a wide array of high quality, high value, and low cost options while making certain that plans are providing value to Medicare and taxpayers.

Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has increased by 38 percent to an all-time high of more than 15 million beneficiaries. Today, nearly 30 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan. Furthermore, enrollees are benefiting from greater quality as over half of enrollees are now in plans with 4 or more stars, a significant increase from 37 percent of enrollees in such plans in 2013.

 “The policies announced today will provide improved benefits in Medicare Advantage and the Prescription Drug Plans while keeping costs low for Medicare beneficiaries,” said Jonathan Blum, CMS principal deputy administrator. “We believe that plans will continue their strong participation in the Medicare Advantage program in 2015 and beneficiaries will continue to have access to a wide array of high quality and affordable Medicare health and drug plans.”

After careful consideration of public comments, key changes and updates finalized in the Rate Announcement and final Call Letter include:

Lower Out-of-Pocket Drug Spending: Beneficiaries in the Part D prescription drug coverage gap, or “donut hole,” will benefit from greater savings on prescription drugs. As a result of the Affordable Care Act, in 2015, enrollees who reach the donut hole will receive coverage and discounts of 55 percent on covered brand name drugs and 35 percent on covered generic drugs, an increase from 52.5 percent and 28 percent, respectively, in 2014. The Affordable Care Act’s Coverage Gap Discount Program has provided discounts to more than 7.9 million Medicare beneficiaries, saving $9.9 billion on prescription drugs, or an average of $1,265 per beneficiary.

Greater Protection for Beneficiaries: CMS intends to again use its authority, provided by the health care law, to protect Medicare Advantage enrollees from significant increases in costs or cuts in benefits, and, for the 2015 contract year, finalizing the permissible amount of increase in total beneficiary cost to $32 per member per month (down from $34 per member per month for the 2014 contract year). CMS also continues to require plans to refine their offerings so that beneficiaries can easily identify the differences between their options.

Increased Protections for Beneficiaries Affected by Changes in Medicare Advantage Plan Networks: The final Call Letter strengthens tools used to ensure compliance with established provider access requirements and establishes best practices for Medicare Advantage Organizations to follow when they make significant changes to their provider networks.

Payments to Medicare Advantage Plans:

  • CMS estimates that the overall net change to plan payments between 2014 and 2015 to be +0.4 percent, compared to the estimated overall net change to plan payments of -1.9 percent for the proposals in the Advance Notice   Individual plan payments will vary by plan based on, but not limited to, its location and star rating.
  • Before the Affordable Care Act, Medicare Advantage plans were paid more than 10 percent compared to traditional Medicare, costing the program more than $1,000 per person each year, while quality and health outcomes were similar to those enrolled in traditional Medicare. The changes underway reduce excessive payments to Medicare Advantage plans, while incentivizing quality improvements by basing part of Medicare Advantage payment on plan quality performance.
  • To provide for continued stability in the Medicare Advantage program, CMS will implement a new phase-in schedule for the Part C risk adjustment model introduced in 2014. In addition, to improve payment accuracy, CMS has refined its risk adjustment methodology to account for the impact of the influx of baby boomers. In addition, for 2015, CMS will not finalize the proposal to exclude diagnoses from enrollee risk assessments.

Other policies that are not being finalized as proposed include:

Delayed implementation of new Part D Risk Adjustment Model.

Not implementing some proposed changes to the Star Ratings.

Not implementing the proposal to require additional coverage in the gap for generic and brand drugs in Enhanced Alternative plans.

To view a fact sheet on the 2015 Rate Announcement and final Call Letter, please visit:

The 2015 Rate Announcement and final Call Letter may be viewed later today through: and selecting “Announcements and Documents.”

Update II: The mainstream media is starting to pick up the news. Here are reports from AP and from The Hill.

Cross posted at The Moderate Voice
Please Share

Republicans Had To Hide Support For Fix To Affordable Care Act To Limit Attacks From The Right

The “doc fix”  has become a strange legislative tradition as Congress regularly votes to stop the automatic  cuts in physician payment called for under the flawed Sustainable Growth Rate formula. As I discussed in March, this time there were a couple of new twists which were known, but in addition it turns out that another item hidden in the bill reveals a lot about the Republican Party.

First I’ll recap what we had already known. The “doc fix” proposed to block the cuts which would have taken effect in April was for one year and included multiple other measures, including a delay in implementing change to ICD-10 diagnosis codes until at least October 2015. Physician groups actually opposed this bill because a permanent fix was also under consideration and it was feared that passing yet another temporary fix would lead to abandonment of the permanent fix (which does now appear dead).

The “doc fix” regularly passes with bipartisan support because Congress is not going to risk the backlash which would be created if many Medicare patients could no longer find physicians willing to accept them. This time the House passed the “doc fix” on a voice vote, which allows individual members to avoid being held accountable for the vote.

Over the weekend we learned why House Republicans wanted to pass this on a voice vote. Another item in the bill made some changes in the Affordable Care Act which was desired by small business and which Democrats were willing to make:

At the prodding of business organizations, House Republicans quietly secured a recent change in President Barack Obama’s health law to expand coverage choices, a striking, one-of-a-kind departure from dozens of high-decibel attempts to repeal or dismember it.

Democrats describe the change involving small-business coverage options as a straightforward improvement of the type they are eager to make, and Obama signed it into law. Republicans are loath to agree, given the strong sentiment among the rank and file that the only fix the law deserves is a burial.

“Maybe you say it helps (Obamacare), but it really helps the small businessman,” said Rep. Phil Roe, R-Tenn., one of several physician-lawmakers among Republicans and an advocate of repeal.

No member of the House GOP leadership has publicly hailed the fix, which was tucked, at Republicans’ request, into legislation preventing a cut in payments to doctors who treat Medicare patients.

It is unclear how many members of the House rank and file knew of it because the legislation was passed by a highly unusual voice vote without debate.

This shows how dysfunctional Congress has become. Normally both parties would see it as a victory for the system that they passed a measure to make requested changes in the Affordable Care Act. However, Republicans felt compelled to hide this vote because it contradicts their public policy of only supporting repeal (having voted for repeal over fifty times). Since this became public, the Republicans have faced criticism from the right, probably making it even harder for them to vote on improvements in the Affordable Care Act in the future.

The fix which passed allows small businesses to offer policies with higher deductibles. This allows for lower premiums, and the higher deductibles are often handled separately with Medical Savings Accounts. There are also added protections in new insurance policies under the Affordable Care Act such as annual limits on out of pocket expenses and the elimination of annual and lifetime caps on coverage which help offset the problems created by higher deductibles.

If Republicans should attack the Affordable Care Act based upon including high deductible plans, keep in mind that this is exactly the type of plan which Republicans frequently advocate, and that the Republicans voted to increase the allowable deductible levels in response to requests from small business.  Democrats had no objection to the change as the limit on deductions was originally placed in the bill because it was supported by Republican Senator Olympia Snowe. In response to this addition, Snowe voted for the Affordable Care Act when in the Senate Finance Committee but ultimately voted against the bill on the Senate floor, along with every other Republican Senator.

Cross posted at The Moderate Voice

Please Share