Kamala Harris has already backtracked on her support for Medicare for All, making it hard to have confidence she will fight for such a plan should she be elected.
Wendell Potter recently warned why such tweaks short of Medicare for All will not work:
I spent 20 years as a health insurance executive before leaving my job as a vice president at Cigna. I can tell you firsthand that by focusing on a half-baked measure like a Medicare buy-in, Democrats would hand a huge gift to the private insurance industry while doing less than the bare minimum to help struggling businesses, workers, families and patients.
When the next Congress starts in January, House Democrats should use their new majority introduce, debate and vote on significant legislation that would assure universal coverage, protect taxpayers, and dramatically transform our health care system: Medicare for All.
The Higgins plan to let people aged 50-64 to buy Medicare coverage does nothing to restrict the ability of insurers to profit from our fragmented coverage system. It would allow insurance companies to continue to control prices for almost everyone under 50, while pushing many of their most expensive-to-insure patients out of their risk pool and into Medicare’s — which shifts the cost onto taxpayers…
It’s time for Democrats to stop proposing health care reform that relies on insurance companies to play fair. After two decades in the for-profit health insurance industry, I can assure you they never will. They have no interest in doing anything that might in any way jeopardize profits. Their only interest is delivering profits to their shareholders. From that perspective, the status quo is very profitable. For everyone else, not so much.
Harris should have been prepared for push back on Medicare for All–both from people concerned about such a major change, and from attacks from the insurance industry. She handled this quite poorly. That said, her flip flopping on Medicare for All is hardly my biggest objection to Harris.
The goal this year must not only be to elect candidates to oppose Trump, but to also reform the Democratic Party (which is responsible for the situation in 2016 which enabled Trump to be elected president). Tuesday provides an opportunity for another progressive upset in Michigan, but it will be a challenge due to the presence of both a real progressive (Abdul El-Sayed) and a faux progressive (Shri Thanedar) who will divide the vote against establishment candidate Gretchen Whitmer.
El-Sayed is running on a platform similar to that of Bernie Sanders. Sanders has endorsed El-Sayed, and came to Michigan to campaign for him on Sunday. The previous weekend, Alexandria Ocasio-Cortez, who was responsible for a major upset over the Democratic establishment, came to campaign for El-Sayed. He was also recently endorsed by The Nation and previously received endorsements from groups including Justice Democrats, Our Revolution, The People for Bernie, Our Revolution, the Progressive Caucus of the Michigan Democratic Party, and Democracy for America.
El-Sayed is behind in the polls, but victory might be within reach. Progressives are encouraged by the greater enthusiasm seen for his campaign as compared to his opponents. Progressives are also encouraged by the memories of Bernie Sanders coming back from twenty-points behind just prior to the Michigan Democratic primary in 2016 to upset Hillary Clinton. The polls missed support for a progressive alternative to the Democratic establishment then, and could be doing so again.
The front runner, Gretchen Whitmer, is the daughter of a former president and CEO of Blue Cross Blue Shield of Michigan, and the recipient of their money. She is also the only Democratic candidate who opposes single payer health care. She has also benefited from dark money contributions, which has become an issue in the race. When she twisted the facts to respond to El-Sayed, the Truth Squad at a Michigan newspaper called her claims “mostly inaccurate” as she tried to equate contributions from private individuals with her corporate contributions.
The task of upsetting the establishment candidate is made more difficult by the presence of faux-progressive Shri Thanedar, who is running as a progressive for strategic reasons, and has put $10 million of his own money into the race. Hopefully the efforts of Bernie Sanders, Alexandria Ocasio-Cortez, and several progressive groups will lead to progressives coming out to vote for the true progressive candidate in the race, Abdul El-Sayed.
There has been a lot of talk lately about an anti-establishment fervor in the Democratic Party, largely fueled by both dissatisfaction with the status quo and the manner in which the DNC rigged the rules to block challengers to Hillary Clinton in 2016. Clinton’s inability to beat a candidate as terrible as Donald Trump cast more doubt on the party establishment’s strategy of promoting moderate candidates. Alexandria Ocasio-Cortez’s victory over party insider Joseph Crowley in New York’s 14th congressional district Democratic primary gave additional hope for progressive and true liberal Democrats hoping to beat the party establishment. In Michigan efforts to beat establishment candidate Gretchen Whitmer (who would still be far preferable to GOP front runner Bill Schuette) for the nomination for Governor might be thwarted by two candidates running as progressives in Michigan who are likely to split the vote. However, only one is a true progressive.
While both Abdul El-Sayed and Shri Thanedar are running as Bernie Sanders style progressives, only El-Sayed looks like the real deal. The Intercept has had multiple articles exposing Thanedar as an opportunist. In a new article today, The Intercept shows how they differ on health care, but first recapped the case against Thanedar:
In Michigan, businessperson Shri Thanedar has spent millions of dollars on television ads casting himself as “the most progressive Democrat running for governor,” and promising that he would bring single-payer health care to Michigan.
“Health care is not a privilege; it is our fundamental right. I will bring single-payer health care to Michigan,” Thanedar says in a TV commercial. “Agree? Vote for Shri.”
But there’s reason to be skeptical.
Over the last year, investigations by The Intercept have revealed many facts which cast doubt on Thanedar’s progressive branding. He donated thousands of dollars to Sen. John McCain’s presidential campaign, he was spotted clapping and nodding approvingly at a Marco Rubio presidential rally, and several Michigan political consultants have claimed that Thanedar once consulted them about possibly running as a Republican.
The Intercept interviewed Thanedar and found that “Thanedar’s much touted single-payer health care ‘plan’ appears to be nonexistent.” In contrast, they found that former Detroit Public Health chief Abdul El-Sayed “has a detailed strategy for how to accomplish it.” However, Thanedar is likely to split the progressive vote due to having spent much more on advertising. The Intercept notes:
Last month, he released a plan to establish “Michicare,” which would levy payroll and business taxes to establish state-funded public coverage for all Michigan residents…
But despite having a more well-developed plan, El-Sayed’s middle-class background means he does not have the same resources to advertise his health care plan as does Thanedar, who, not without controversy, made a fortune in the chemical testing industry.
As a result, there’s a real risk that the public might be misled.
The article also notes how this will impact the race against establishment candidate Gretchen Whitmer:
But by coopting a progressive message and splitting the progressive vote, Thanedar has helped Whitmer, an establishment candidate, take a comfortable lead.
Whitmer is the daughter of former Blue Cross Blue Shield CEO Richard Whitmer. She’s the only Democratic candidate in the race who does not back single-payer, saying that it’s not “realistic” in Michigan at this time. BCBS Michigan lobbyists threw a fundraiser for Whitmer earlier this year. And she’s currently taking heat from an unidentified group who have paid for ads attacking her from accepting “big money” from insurance companies.
El-Sayed has been endorsed by Justice Democrats, Our Revolution, The People for Bernie, Our Revolution, the Progressive Caucus of the Michigan Democratic Party, Democracy for America, and after her victory in New York, by Alexandria Ocasio-Cortez. Whitmer has a long list of establishment endorsements. I am not aware of any significant endorsements for Thanedar but the Grosse Pointe Democratic Club has issued an anti-endorsement for Thanedar warning Democrats NOT to vote for him.
There is wide spread consensus that opiates were overused in the past, and their use has been greatly curtailed in recent years. Many people were placed on high doses for chronic pain when this was considered the standard of care, and the pharmaceutical industry did all it could to promote this practice. The problem is many people who are using high doses safely and responsibly are now being targeted by government efforts to decrease opiate use. While it makes sense to limit new prescriptions, and decrease their use in long-time users when possible, the government has been going overboard in intervening in patient care to decrease their use.
Both in January 2016 and January 2017 I encountered cases where Medicare drug plans abruptly reduced the doses of pain medications they would approve, and Medicare is now considering far more draconian cuts as of January 2018. This is largely based upon distorting recommendations from the Centers for Disease Control, with even writers of those guidelines protesting actions by the Medicare plans. Some patients have tried to get around this by paying for part of their prescriptions, but I have recently been informed by local pharmacists that they are now under pressure to stop filling prescriptions for amounts beyond what is approved. This is driving some to the use of cheaper street drugs such as heroin, increasing the risk of overdoses, contrary to the stated goals of regulations to reduce opiate use.
The New York Times has an excellent article on the situation. I have some excerpts below, but recommend reading the full article.
Medicare officials thought they had finally figured out how to do their part to fix the troubling problem of opioids being overprescribed to the old and disabled: In 2016, a staggering one in three of 43.6 million beneficiaries of the federal health insurance program had been prescribed the painkillers.
Medicare, they decided, would now refuse to pay for long-term, high-dose prescriptions; a rule to that effect is expected to be approved on April 2. Some medical experts have praised the regulation as a check on addiction.
But the proposal has also drawn a broad and clamorous blowback from many people who would be directly affected by it, including patients with chronic pain, primary care doctors and experts in pain management and addiction medicine.
Critics say the rule would inject the government into the doctor-patient relationship and could throw patients who lost access to the drugs into withdrawal or even provoke them to buy dangerous street drugs. Although the number of opioid prescriptions has been declining since 2011, they noted, the rate of overdoses attributed to the painkillers and, increasingly, illegal fentanyl and heroin, has escalated.
“The decision to taper opioids should be based on whether the benefits for pain and function outweigh the harm for that patient,” said Dr. Joanna L. Starrels, an opioid researcher and associate professor at Albert Einstein College of Medicine. “That takes a lot of clinical judgment. It’s individualized and nuanced. We can’t codify it with an arbitrary threshold.”
…Dr. Stefan G. Kertesz, who teaches addiction medicine at the University of Alabama at Birmingham, submitted a letter in opposition, signed by 220 professors in academic medicine, experts in addiction treatment and pain management, and patient advocacy groups.
His patients include formerly homeless veterans, many of whom have a constellation of physical and mental health challenges, and struggle with opioid dependence. For them, he said, tapering opioids does not equate with health improvement; on the contrary, he said, some patients contemplate suicide at the prospect of suddenly being plunged into withdrawal.
“A lot of the opioid dose escalation between 2006 and 2011 was terribly ill advised,” Dr. Kertesz said. “But every week I’m trying to mitigate the trauma that results when patients are taken off opioids by clinicians who feel scared. There are superb doctors who taper as part of a consensual process that involves setting up a true care plan. But this isn’t it.”
Some two dozen states and a host of private insurers have already put limits on opioids, and Medicare has been under pressure to do something, too. Last July, a report by the inspector general at the Department of Health and Human Services raised concerns about “extreme use and questionable prescribing” of opioids to Medicare recipients. In November, a report from the Government Accountability Office took Medicare to task, urging greater oversight of opioid prescriptions…
Opponents of the new limit say that doctors are already overwhelmed with time-consuming paperwork and that many will simply throw up their hands and stop prescribing the drugs altogether.
A delay or denial would put chronic pain patients — or those with inflammatory joint diseases, complex shrapnel injuries or sickle cell disease — at risk of precipitous withdrawal and resurgence of pain, doctors said.
The Medicare proposal relies on guidelines from the Centers for Disease Control and Prevention that say doctors should not increase an opioid to a dose that is the equivalent of 90 milligrams of morphine.
But experts say that Medicare misread the recommendations — that the C.D.C.’s 90-milligram red flag is for patients in acute pain who are just starting opioid therapy, not patients with chronic pain who have been taking opioids long-term. The acute pain patient, the guidelines say, should first be offered treatments like acetaminophen or ibuprofen. A short course of a low-dose opioid should be a last resort.
“We didn’t take a specific position on people who were already on high doses,” said Dr. Lewis S. Nelson, the chairman of emergency medicine at Rutgers New Jersey Medical School and University Hospital, who worked on the guidelines.
“We did say that established, high-dose patients might consider dosage reduction to be anxiety-provoking, but that these patients should be offered counseling to re-evaluate,” he added. “There is a difference between a C.D.C. guideline for doctors and a C.M.S. hard stop for insurers and pharmacists.”
Dr. Erin E. Krebs recently released a comprehensive study showing that patients with severe knee pain and back pain who took opioid alternatives did just as well, if not better than, those who took opioids. Nonetheless, she and seven others who worked on the C.D.C. guidelines signed the letter opposing the Medicare rule.
“My concern is that our results could be used to justify aggressive tapering or immediate discontinuation in patients, and that could harm people — even if opioids have no benefit for their pain,” said Dr. Krebs, an associate professor of medicine at the University of Minnesota.
“Even if we walk away from using opioids for back and knee pain, we can’t walk away from patients who have been treated with opioids for years or even decades now,” she added. “We have created a double tragedy for these people.”
In the right situation, I’m all for limited government. Reduce foreign interventionism and the surveillance state. Get government out of the private lives of individuals–including regulation of reproductive rights. Unfortunately, when Republicans talk about limited government it generally turns out to be reducing the safety net or cutting important functions which often represent a very small part of the budget. The Wall Street Journal reports, CDC to Scale Back Work in Dozens of Foreign Countries Amid Funding Worries:
The Centers for Disease Control and Prevention plans to scale back or discontinue its work to prevent infectious-disease epidemics and other health threats in 39 foreign countries because it expects funding for the work to end, the agency told employees.
The CDC currently works in 49 countries as part of an initiative called the global health security agenda, to prevent, detect and respond to dangerous infectious disease threats. It helps expand surveillance for new viruses and drug-resistant bacteria, modernize laboratories to detect dangerous pathogensand train workers who respond to epidemics.
The Washington Post adds:
Global health organizations said critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak. The risks of deadly and costly pandemic threats are higher than ever, especially in low- and middle-income countries with the weakest public health systems, experts say. A rapid response by a country can mean the difference between an isolated outbreak and a global catastrophe. In less than 36 hours, infectious disease and pathogens can travel from a remote village to major cities on any continent to become a global crisis.
On Monday, a coalition of global health organizations representing more than 200 groups and companies sent a letter to U.S. Health and Human Services Secretary Alex Azar asking the administration to reconsider the planned reductions to programs they described as essential to health and national security.
“Not only will CDC be forced to narrow its countries of operations, but the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance, and research,” wrote the coalition, which included the Global Health Security Agenda Consortium and the Global Health Council.
The coalition also warned that complacency after outbreaks have been contained leads to funding cuts, followed by ever more costly outbreaks. The Ebola outbreak cost U.S. taxpayers $5.4 billion in emergency supplemental funding, forced several U.S. cities to spend millions in containment, disrupted global business and required the deployment of the U.S. military to address the threat.
“This is the front line against terrible organisms,” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks. He now heads Resolve to Save Lives, a global initiative to prevent epidemics. Referring to dangerous pathogens, he said: “Like terrorism, you can’t fight it just within our borders. You’ve got to fight epidemic diseases where they emerge.”
…Officials at the CDC, the Department of Health and Human Services and the National Security Council pushed for more funding in the president’s fiscal 2019 budget to be released this month.
It is fitting that Donald Trump, who claimed that “I alone can fix it,” couldn’t make it through his entire first year without breaking the government. Donald Trump has been among the worst presidents ever. However, while the past year under Trump might have been the worst of times, it was not the worst of all possible times. Trump’s first year has been terrible, but we must also be appreciative all those spared from dying in Hillary’s wars over the past year.
Donald Trump and the Republicans have been terrible on many issues, including health care, race, and immigration. As I had previously predicted, Trump has been totally incoherent on foreign policy. He has escalated a potential nuclear crisis in North Korea, but we also must not forget that Hillary Clinton was largely responsible for the situation and peace would have probably have been impossible if she was in the White House. Clinton’s push to overthrow Muammar Qaddafi based upon lies after he surrendered his nuclear weapons, along with her joining with her neocon allies in lying us into the Iraq war, have been cited by both Kim Jong-un and Vladimir Putin as reasons for their nuclear buildup and other foreign policy actions.
Donald Trump’s relations with Russia have been mixed, and evidence has grown of both a history of financial crimes and an attempt at a cover-up over the past year. At least Trump’s financial crimes are under investigation, while Democrats regularly make excuses for the influence peddling of Bill and Hillary Clinton.
The irony is that, after the risk of deterioration of relations with Russia and a return to a Cold War atmosphere was feared by many should Clinton become president, Clinton has managed to create hysteria over Russia without even being elected. While Trump is probably guilty of money laundering and a obstruction of justice, the evidence to date has contradicted conspiracy theories which appear to have been fabricated Clinton and the DNC to blame Clinton’s loss on Russia. With Clinton continuing to promote belligerence towards Russia even out of office, using conspiracy theories to get Democrats to embrace her neoconservative interventionism, it is of considerable concern as to how much greater harm Clinton could be doing in the White House.
Donald Trump has been terrible for civil liberties as president, including his attacks on the press. It must not be forgotten that even before the election Clinton had far right wing views on civil liberties which were not all that different from Trump’s. Donald Trump has ignored the norms of a democratic society, but since the election Clinton has also continued her attack on civil liberties and has attacked the fundamental principles of democracy, including the legitimacy of election results. Both Clinton and Trump have cited fake news, which often means information critical of them, as justification to call for censorship.
While many Republicans have little respect for civil liberties, in the past year we have seen Democrats engage in McCarthyism as part of their anti-Russia hysteria. The Democratic Party as a whole turned out to be worthless when faced with a vote to renew and expand warrantless surveillance as many joined with Republicans. If many Democrats were unwilling to stand up to Donald Trump on a fundamental civil liberties issue, I would expect even fewer to resist calls for increased powers by an authoritarian like Hillary Clinton.
Donald Trump has been a terrible president, but at least his faults are widely recognized, and his falsehoods are regularly exposed. Donald Trump might have authoritarian tendencies, but if so he is a very weak authoritarian. He has brought about serious damage to the entire Republican and conservative brands, likely doing far less damage than Hillary Clinton would have been capable of.