medicare – R&R – Reachout and Rebuild

Frustrations Boil at Pace of Vaccinations at Long-Term Care Facilities

David Posnett — Sun, 17 Jan 2021 20:24:55 +0000

Our local ‘Retirement’ facility

The Trump administration raised hopes of a speedy process for nursing homes and assisted living facilities. Patience is wearing thin.

By Rebecca Robbins

In mid-December, a top Trump administration official floated an enticing possibility: All nursing home residents in the United States could be vaccinated against the coronavirus by Christmas. “It’s really a remarkable, remarkable prospect,” Alex M. Azar II, the secretary of health and human services, declared.

It turned out to be a fantasy.

A month later, vaccinations of some of the country’s most vulnerable citizens are going more slowly than many state officials, industry executives and families expected. Their hopes had been buoyed when government officials said long-term care facilities would be at the front of the line for vaccines.

CVS and Walgreens, which are largely responsible for vaccinating residents and workers in long-term care facilities, are on track to make at least initial vaccination visits to nearly all nursing homes they are working with by Jan. 25. The two pharmacy chains have already given out more than 1.7 million vaccine doses at long-term care facilities.

But the progress is uneven across the country and not nearly as comprehensive for different types of long-term care. For example, thousands of assisted living facilities — for older people who need less care than those in nursing homes — do not yet even have an appointment for their first visit from the pharmacy teams, in large part because states have given such facilities lower priority in their vaccine-distribution plans.

“I’ve had facilities call me, and I’ve had people cry, I’ve had people curse, because this was the first sign of hope that they’ve had in many, many months,” said Betsy Johnson, who leads a group that represents Kentucky’s nursing homes and assisted living facilities.

“It’s just human nature to think, ‘OK, but I was supposed to be first — and I don’t even know when my clinic is going to happen,’” Ms. Johnson said.

In Pennsylvania, teams from CVS or Walgreens are not scheduled to visit some nursing homes until February, and the vast majority of the state’s assisted living facilities have not yet been scheduled for a first visit, said Zach Shamberg, president of the Pennsylvania Health Care Association.

“There’s a great deal of frustration, there’s a great deal of apprehension, as to when or if this vaccine will come,” Mr. Shamberg said.

The pace of the vaccination program has taken on greater urgency as the rapidly spreading virus continues to decimate nursing homes and similar facilities. The virus’s surge since November has killed about 30,000 long-term care staff and residents, raising the total of virus-related deaths in these facilities to at least 136,000, according to a New York Times tracker. Since the pandemic began, long-term care facilities have accounted for just 5 percent of coronavirus cases but 36 percent of virus-related deaths.

Even as the vaccination campaign accelerates, the suffering is unlikely to wane. The coming months could be “the deadliest of the pandemic” for people living and working in long-term care, according to an analysis released on Thursday by the Kaiser Family Foundation.

The Trump administration announced in October that it had teamed up with CVS and Walgreens to lead a federal effort to vaccinate residents and workers at long-term care facilities, among the first eligible groups.

On Friday, CVS said it had given out just over one million doses in more than 12,000 initial visits to long-term care facilities. Nearly 8,000 visits are scheduled for the coming week. Walgreens said it had given out nearly 750,000 doses in nearly 9,000 visits to facilities, mostly nursing homes. The number of visits that Walgreens has scheduled with assisted living facilities “continues to accelerate,” a company spokeswoman, Rebekah Pajak, said.

The vaccinations by CVS and Walgreens were always expected to take several months because of the need to visit tens of thousands of facilities three times. The first two visits are for most residents and staff to get the two doses of the vaccine, with the third visit as a backup for people who missed the first clinic.

The idea that all nursing home residents could get their first doses by Christmas was not a realistic prospect even when Mr. Azar, the health secretary, floated it 12 days before the holiday. By that point, some states had told the Centers for Disease Control and Prevention that they would not activate the federal program to vaccinate their nursing homes until Dec. 28. The logistics would have been challenging even if states had put a priority on getting their first doses to nursing homes.

Michael Pratt, a spokesman for the Health and Human Services Department, said Mr. Azar had been speaking only aspirationally about what states were capable of doing, since they had enough vaccine doses to cover all nursing home residents by Christmas. But that would have required that states place less of a priority on vaccinating high-risk groups like heath care workers.

T.J. Crawford, a spokesman for CVS, said the chain was making first visits to all facilities within four weeks of each state’s activating its vaccination program for nursing homes or assisted living facilities.

“This isn’t a drive-through or stadium vaccination effort,” Mr. Crawford said. “We’re visiting more than 40,000 facilities with an average of less than 100 residents, in some cases going room to room.” He said CVS was “on track and delivering on goals established and communicated early in the process.”

But a growing number of governors and state health officials have voiced frustration with CVS’s and Walgreens’ speed.

In Mississippi, some long-term facilities won’t get their first visit until Feb. 11, the state health officer, Dr. Thomas Dobbs, said this month. “We’re clearly disappointed with the progress in the long-term care program,” he said.

Some states and cities are exploring ways to hasten the inoculations.

Seattle is using its Fire Department to vaccinate nearly 1,000 residents and staff at adult family homes, a type of long-term care, by the end of January. Florida hired an emergency services company, CDR Maguire, to give out doses at 1,900 assisted living facilities that had not been scheduled for visits by CVS and Walgreens teams before Jan. 24.

In Michigan, officials have asked the federal government to let them work with other pharmacies, such as the supermarket chains Meijer and Kroger, to speed up the vaccination effort in long-term care facilities, said Bobby Leddy, a spokesman for Gov. Gretchen Whitmer.

West Virginia is the only state that has not activated the federal program involving CVS and Walgreens, though Walgreens is separately working with West Virginia to vaccinate 32 of its long-term care facilities. Relying mostly on local independent pharmacies, the state said on Dec. 30 that it had wrapped up the first round at its 214 long-term care facilities.

Some of the initially feared problems that could slow down the vaccine rollout in nursing homes have not emerged as serious obstacles, at least so far, according to facility operators and industry researchers.

Despite widespread worries that the vaccines’ side effects — which can include fevers, chills and fatigue — would cause staff to miss work and residents to need more care, that has not happened to any significant degree. And while there was early confusion about how nursing homes should get consent from residents or their families, that process has largely gone smoothly.

But other things are slowing the campaign. A significant number of long-term care workers have balked at receiving the vaccine. The virus’s spread is also delaying the process. People should not be vaccinated while they still have Covid-19 symptoms or are isolating, according to the C.D.C.

Outbreaks and cases of Covid-19 in some long-term care communities have led Walgreens to delay scheduling initial visits or to reschedule them, said Rick Gates, an executive leading the company’s long-term care vaccinations.

CVS has encountered the same issue, though it has not been widespread. The company has left the decision about whether to proceed with visits in such cases to local clinic team leaders and officials at the facilities, Mr. Crawford said.

Another factor is that some states did not quickly activate their programs to vaccinate people at assisted living facilities and similar communities. In some cases, they waited until weeks after they began vaccinations at nursing homes.

But many long-term care facilities include both nursing homes and assisted living. In those cases, pharmacy teams have been able to vaccinate only a subset of residents.

In Prairie du Chien, Wis., for example, a team from Walgreens on Thursday made its first visit to the local nursing home, Prairie Maison, to inject nearly all of its roughly 50 residents with the Moderna vaccine.

But Prairie Maison is part of a larger senior community, which includes about 50 assisted living residents. Because Wisconsin did not activate its vaccination program for assisted living until Friday, those residents weren’t offered the vaccine — even though they are in the same building as the nursing home residents.

“Vaccinating one group and not the other doesn’t make a lot of sense,” said Dr. Mark Grunwald, the chairman of Prairie Maison’s board.

From Kristin Stephens

Assistant Vice President, Media Relations and Public Affairs, GREATER NEW YORK HOSPITAL ASSOCIATION

See prior blog posts relevant to Peconic Landing:

Social Security Under Attack

David Posnett — Fri, 18 Sep 2020 02:04:18 +0000

https://www.americanprogress.org/issues/economy/news/2020/08/12/489401/trumps-plan-defund-social-security/

The Social Security Act was signed into law by President Franklin Delano Roosevelt, a Democrat, on August 14, 1935, to function as a “federal safety net for elderly, unemployed and disadvantaged Americans,” while legislating that it cannot spend more than it receives through payroll taxes.

More than just a retirement program, it provides important life insurance and disability insurance protection as well. Over 64 million people, more than 1 in every 6 U.S. residents, collected Social Security benefits in June 2020.

One-third of all retirees are dependent on Social Security for 90 percent or more of their income, and over 60 percent depend on it for more than half of their income. About 61 million people are enrolled in Medicare.

Social Security and Medicare are both funded entirely through payroll taxes paid into “The Social Security Trust Funds” Every penny paid out must be paid with money coming in now and in the future from payroll taxes. There are no other funding sources.

We know the Republican Party, in its chronic itch to defund entitlement programs, has sought to cut Social Security, even though it operates at a very efficient administrative cost of around 2 percent.

Last month, due to his administration’s disastrous response to COVID-19, Trump signed an executive order delaying some payroll taxes until next year — but would then require payroll taxes to be doubled from January through April 2021 to restore losses.

However, within this executive order, Trump also asks his treasury secretary to “explore avenues, including legislation, to eliminate the obligation to pay the taxes deferred.” He was sounding an early call to scratch the itch and de-fund Social Security, along with Medicare.

And then, out campaigning more recently after his payroll tax delay order, Trump said: “If I win, I may extend and terminate. In other words, I’ll extend it beyond the end of the year and terminate the tax.”

If he were, in fact, to “terminate” the payroll tax, Trump would effectively leave the Social Security system with no ongoing funding at all. That means no Social Security and no Medicare benefits, since all funding of the system will have been terminated.

The Social Security Administration’s chief analyst, Stephen Goss, recently stated that if Trump’s (Republican) plan goes into effect, “we estimate that [the Disability Insurance] Trust Fund asset reserves would become permanently depleted in about the middle of calendar year 2021,” and that “the Social Security Trust Fund would become permanently depleted by the middle of calendar year 2023 with no ability to pay [Old-Age and Survivors Insurance] benefits thereafter.”

What does this mean for us if Trump, with his Republican majority, win?

What else does it mean?

James Ewing

Published as a letter to the editor in the Southampton Press this week.

Changing her mind on Medicare for All

David Posnett — Wed, 22 Jul 2020 17:42:42 +0000

https://thehill.com/opinion/healthcare/507348-how-i-changed-my-mind-on-medicare-for-all

Dr. Li Tso, opinion contributor July 14, 2020

I know most of the arguments against “Medicare for All.” I’ve been making them for most of my professional life as a physician:

1) We don’t need it; our current mix bag of public and private insurance coverage is adequate

2) Disrupting the private insurance industry would result in too many job losses

3) The government cannot be trusted to run a program of this size

4) We don’t have buy-in from a majority of constituents

5) We simply can’t afford it.

I’ve said all of these for 30 years. I now know that I am wrong.

Health care policy can be simplified to answering the basic question of who gets covered and at what cost. Universal coverage was once championed only by the most progressive. Then came COVID-19.

COVID has taught us that every member of our society needs adequate health care. This is not just a progressive talking point, it is the reality of infectious disease: those without proper care run the risk of acquiring and transmitting the disease to the rest of us.

The most marginalized segments of our population such as the homeless, undocumented workers, and the incarcerated still have contact with clerks in coffee shops, police officers, and staff in our emergency rooms. This was made evident when a homeless patient came to my practice’s office for wound care seven times over a two weeks period at the beginning of the pandemic before strict safety protocols were instituted. This patient subsequently tested positive for COVID-19. Fortunately, none of the staff in my practice contracted COVID from this patient. This scenario is just a microcosm of what can go wrong if we do not care for everyone.

Universal coverage is no longer charity or a luxury, it’s now medically necessary as protection for us all.

COVID has also taught us that tying insurance to employers no longer makes sense. It’s a historical accident that we even have this system: The Stabilization Act of 1942 was passed to limit war-time inflation and limited employers’ ability to raise wages, but there was an exemption for “insurance and pension benefits” which could grow “in a reasonable amount” during the freeze.

Suddenly, employers were in the health insurance business as health benefits could be considered compensation but did not count as taxable income.

When Congress rewrote the tax code in 1954, it preserved the tax subsidies for third-party insurance, and by 1964, almost 80 percent of the population had some form of employer-sponsored health insurance.

This system sort of worked until the cost of health coverage became too expensive and companies, especially small companies, reduced or eliminated coverage. Today, Kaiser Permanente estimates that only about 49 percent of Americans get their coverage this way.

COVID made it clear what a weak link this is as sudden massive unemployment can quickly result in public health catastrophe. More than 30 million people lost their jobs — and for many, their health insurance–in just a few months of lockdown. Many of these people run the risk of being suddenly uninsured.

Yes, Medicare for All will cost a lot, and it will cause huge disruptions. But disruption is part of free enterprise and innovation. Why should health care companies be exempt? It makes little sense and is almost un-American. Think electricity replacing whale oil, combustible engine replacing horse and buggy, the invention of the computer, the internet, smartphones, fax machines. Each innovation caused massive job restructuring but they also made our lives better and easier. By some estimates, Amazon has resulted in the elimination of 1.5 million retail jobs. Are health insurance jobs more vital than retail jobs? In the case of Medicare for All, displaced private insurance workers are the very ones the government would need to hire and help implement the new program.

For many years I didn’t trust the government to run a system as large as Medicare for All — not when the DMV can barely handle your license renewal. Consider our newest department, the Department of Homeland Security, which was created in 2002. DHS now has over 240,000 employees and a budget of nearly $50 billion. Bureaucracy exists within any large organization. We now readily accepted this new department after the terrorist attacks of 9/11. Aside from the extremists, no one is calling for the dismantling of major departments due to bureaucracy.

Medicare for All will certainly be expensive. Projections range from 13-47 trillion dollars over 10 years.

Critics claim that this enormous amount would bankrupt our treasury and unfairly pass down this debt to our children and grandchildren. However, other than for a short duration in the 1990s, the U.S. government has run a budget deficit every year since 1970. Our national debt is now over 25 trillion dollars and will surely grow in the future. Economists continue to debate about the meaning and consequence of this large debt.

The United States government has spent more than six trillion dollars to help support the economy during the pandemic with widespread support from both politicians and the public and very muted dissent from the traditional deficit hawks. That’s because it’s clear to politicians that the stimulus is preventing a broader crisis. Deficit spending is considered not only reasonable but a wise use of resources when it provides benefit to a large segment of our population.

The sizable cost of 1 to 4 trillion per year for universal health coverage is justifiable and may even appear to be a bargain considering the amount we have already spent on COVID, and the amount people will continue to spend on the most expensive health care system in the world. We currently are already spending nearly $4 trillion per year on U.S. healthcare. Despite this enormous amount, we still have gaps in coverage and we rank poorly as measured by healthcare access and quality index compared with other developed countries.

COVID has made clear that we need to reframe the way we think about universal health coverage. It would be naïve to think that COVID will be our last novel pathogen or last economic shock. The disruption and cost of permanent universal coverage is indeed high but the cost of not pursuing this policy will likely be much higher.

Li Tso, M.D. is a primary care physician at Mass General Hospital, assistant professor of medicine at Harvard Medical School.

Lee Zeldin’s Record

David Posnett — Thu, 11 Jun 2020 17:00:39 +0000

No matter where you live — Montauk or Manorville, Smithtown or Shirley, Patchogue or Port Jefferson — we all want our communities to thrive. To do that, we need a representative who puts our needs first: safe drinking water and well-paying jobs. Affordable healthcare and prescription drugs. A tax plan that works for working families. And decisions based on science, not donations. Although Zeldin says he’s fighting for us, his voting record says otherwise. Zeldin serves the needs of big business and the powerful few, not the working families in his district.

Check out the issues here. For example healthcare.

NY-01 deserves a representative who puts us first.

Photo Courtesy of Sean P. Mills Photography

VOTES DON’T LIE. FOLLOW US ON SOCIAL.

Facebook: @LeeZeldinRecord | Twitter: @ZeldinRecord

Website: https://www.leezeldinrecord.com/

COVID-19 is here!

David Posnett — Mon, 09 Mar 2020 20:21:29 +0000

We now have a confirmed case admitted at Southampton Hospital. It is time to reassess. Although there is but a single patient confirmed on the South Fork of Long Island, suspicion is running high. (update 3/11: 6 cases in Suffolk county including one in the retirement home PECONIC LANDING). A local physician tells me that patients with potential COVID-19 symptoms are examined in the parking lot, in their cars, by the physician (wearing protective gear). This is in order to avoid transmission to critical medical staff in the office. Healthcare professionals are a known risk group for contacting COVID-19. But physicians on the South Fork are still struggling to get testing for their patients.

Delays in testing

A few days ago I called the Suffolk County Department of Health to inquire about getting COVID-19 tests done on people that had recently returned from international travel to countries with now well-documented outbreaks. These persons also had flu-like symptoms. The county officials thought this did not meet CDC criteria for testing (no high fever and no acute respiratory distress) and they recommended self-isolation. I know first hand how unreliable self-isolation can be! A recent news report confirmed my suspicions when a Missouri patient’s family broke quarantine to attend a school dance!

The problems seem to have been threefold — the Centers for Disease Control did not move quickly enough to manufacture test kits at scale (either because of lack of funding or political will) nor did it open up testing options to other institutions that could have worked to develop tests — and because of the limited availability of tests, the CDC rationed how many tests were performed. Those issues were compounded by the initial release of faulty tests by the CDC in early February.

As former U.S. Food and Drug Administration official Scott Gottlieb wrote on Twitter in early February, “Since CDC and FDA haven’t authorized public health or hospital labs to run the tests, right now #CDC is the only place that can.

Also, the CDC has somewhat arbitrary criteria (?) for placing countries on the list of places that will increase your risk of having contracted COVID-19. Here is a list of countries with documented cases as a percentage of the population size. Level 3 Travel Health Advisory (CDC) applies only to the top 4 on the list. Note that Bahrain with 5.42 documented cases/100,000 inhabitants does not make the list while China with 5.79 does! Neither does Switzerland with 3.96 cases, where many cases have been tourists from its southern neighbor, Italy.

The above graph comes from a local Swiss Newspaper (NZZ) – test your German skills!

By January there was a test available. It was offered worldwide by Roche, Inc. FOR FREE and to any country in the world! The US declined the offer. Read more about these early missteps here.

The above report is from a Zurich Newspaper: note the date on the sample is Jan 29th 2020.

Note also, patients that took the test were billed about $200 (SFR 180) for labor of administering the test. That was their entire cost.

At the time an astute observer commented: “It’s very difficult to understand that countries like the US didn’t seize the opportunity to get the test for free. Perhaps some US companies wanted to make money by developing their own tests?”

Thermo Fisher Scientific corporation provides the COVID-19 test in the US currently. According to the Associated Press, Donald Trump, has listed investments in Thermo Fisher Scientific Corporation (TMO), which moved jobs out of the U.S. in high profile outsourcing deals. Apparently, Donald Trump stands to profit from medical testing of coronavirus that will now take place in the United States.

The response by the administration

The reason that COVID-19 cases are low in the USA is most likely because it has been difficult to get patients tested.

For instance, a recent CDC conference gave us a glimpse into Trump’s view of the coronavirus as a political rather than health issue. Trump said he would rather have the passengers of the Grand Princess, a cruise ship docked in San Francisco with 21 confirmed cases on board, stay on the ship than move to land — all because doing so would raise the number of total Covid-19 cases in the US:

“I would rather because I like the numbers being where they are,” Trump said. “I don’t need to have the numbers double because of one ship that wasn’t our fault.”

It is unclear how many people have been infected by the virus due simply to a delay in testing, but it has become increasingly clear in recent days that there are Americans infected with the virus across the country. It is naive to think that one can suppress the numbers.

Trump fears the fall out on the economy and indirectly on his political chances in November. But his actions are likely to make things worse for himself.

The coronavirus outbreak has U.S. companies starting to shutter offices and send workers home through layoffs, furloughs or directives to telecommute until health risks from the spreading virus recede. Even if that’s helpful to guard against further spread of the disease, it’s triggering widespread uncertainty and the biggest threat to the labor market since the financial crisis almost a dozen years ago.

The evidence is expected to show up through lost consumer spending.
“If workers can’t work … production and income go down,” Georgetown University economist Harry Holzer said. “That becomes a demand problem if workers lose income and stop spending.” When that happens, “odds of recession can go way up.”

Eleven states, including California, Massachusetts and New York, require employers to offer workers paid leave, as does the District of Columbia. But none of these jurisdictions explicitly guarantee the benefit to healthy workers on leave because a virus outbreak sent everybody home.

Fourteen Democratic senators last week wrote to leaders of the Business Roundtable, the Chamber of Commerce and the National Association of Manufacturers to urge their member companies not to penalize workers for going home during the outbreak.
Paid sick days are particularly rare for low-income workers. Ninety-three percent of workers in the top tenth of the income distribution get paid sick leave, compared with only 30 percent of those in the bottom tenth, according to the Economic Policy Institute, a left-leaning think tank.

Our Healthcare system can not handle a pandemic efficiently

Finally, let’s consider our health care system and how it is ill-suited to handle a pandemic: America’s Health System Will Likely Make the Coronavirus Outbreak Worse
Out-of-network costs, high deductibles, and confusing coverage options may keep people from getting tested or receiving care (Abigail Abrams)

Deductibles, networks, and a complicated insurance bureaucracy—that already make it tough for many Americans to afford medical care under normal conditions will likely make the outbreak worse.

First, people must actually choose to get tested—a potentially expensive prospect for millions of Americans. While the government will cover the cost of testing for Medicaid and Medicare patients, and for tests administered at federal, state and local public health labs, it’s unclear how much patients will be charged for testing at academic or commercial facilities, or whether those facilities must be in patients’ insurance networks. Just recently, a Miami man received a $3,270.75 bill after going to the hospital feeling sick following a work trip to China. (He tested positive for the seasonal flu, so did not have the new coronavirus, and was sent home to recover.)

Those who test positive for COVID-19 possibly face an even more financially harrowing path forward. Seeking out appropriate medical care or submitting to quarantines—critical in preventing the virus from spreading further—both come with potentially astronomical price tags in the U.S. Last month, a Pennsylvania man received $3,918 in bills after being released from a mandatory U.S. government quarantine after he and his daughter were evacuated from China. (Both the Miami and Pennsylvania patients saw their bills decrease after journalists reported on them, but they still owe thousands.)

In 2019, 82% of workers with health insurance through their employer had an annual deductible, up from 63% a decade ago, according to a report from the Kaiser Family Foundation. The average deductible for a single person with employer insurance has increased from $533 in 2009 to $1,396 last year. The timing of the new coronavirus at the beginning of the year makes the outlook even worse: because most deductibles reset each January, millions of Americans will be paying thousands out of pocket before their insurance companies pay a cent.

Many patients may simply decide not to go to the doctor, which is “exactly the opposite of what we want to happen in this type of situation.”

Public health experts and Democrats have also criticized the Trump administration’s decision to allow people to sidestep the Affordable Care Act’s rules and buy limited, short-term health insurance coverage. Such “junk plans,” are not required to cover diagnostic tests or vaccines.

A large group of health, law and other experts released a letter this week urging policymakers to “ensure comprehensive and affordable access to testing, including for the uninsured.”

The Trump Administration is considering using a national disaster recovery program to reimburse hospitals and doctors for treating uninsured COVID-19 patients. And even Republicans, who have traditionally opposed health care paid for by the government, are warming to the idea. “You can look at it as socialized medicine,” Florida Rep. Ted Yoho, who has vocally opposed the Affordable Care Act, told HuffPost this week. “But in the face of an outbreak, a pandemic, what’s your options?”

Sanders’ Vaporware

David Posnett — Sun, 08 Mar 2020 00:49:18 +0000

Published as an LTE in the East Hampton Star.

Vaporware
Springs, February 24, 2020

Why doesn’t Bernie Sanders level with voters as to how he plans to pay for his flagship “Medicare for All” plan? The answer is simple: He can’t.

Take a look at Sanders’s official campaign website and take a look at his program for Medicare for All. If as Senator Warren says Pete Buttigieg’s plan is nothing more than a “Post-it,” the Sanders plan is more like a postage stamp. Nowhere does his campaign site include a plan for paying for his pie-in-the-sky program. After spending seven-plus years of foisting this plan on voters, one would think he would be able to explain it to us. He can’t, because it is unworkably expensive.

In short, it is nothing but political vaporware. What is vaporware? When the term was in vogue it described efforts by software companies to promise a non-existent product to deceptively discourage customers from buying an existing competitive product (or discourage competitors from developing one). So what Sanders is doing is deceptively attracting voters to a Medicare for All plan that promises everything but will deliver nothing.

And what’s even worse is that there is proof of his plan’s nonviability from an actual attempt to launch a similar plan. And guess where that plan was tried? Vermont (Bernie’s home state)! In 2011, then-Governor Pete Shumlin euphorically promised a single-payer plan, dubbed Green Mountain Care. Backed by advocates bordering on the “theological,” Green Mountain Care (encouraged by Senator Sanders) promised a system of health care for all that would save money, even though no one knew what it would cost when it passed in 2014.

That belief proved hopelessly naïve. As the Green Mountain plan moved into implementation, it became clear that the plan would double Vermont’s budget, would require raising state income taxes by up to 9.5 percent, and imposing an 11.5-percent payroll tax on employers.

The Green Mountain Plan crashed in flames in 2014, after the governor realized that the only economically viable plan would offer Vermonters less protection than they already had.

So there is every reason for Senator Sanders to avoid discussing how his Medicare for All plan would be financed (other than in the broadest of generalities, like “taxes would go up.” (Yes, but how much?) There is an equally obvious reason why he fails to even mention the failed Vermont plan, and a mysterious absence of any explanation of how his plan would correct the deficiencies of the Vermont plan he touted at the time.

Given Senator Sanders’s evasions, it is incumbent upon voters (and his competitors) to put his feet to the fire and force him to explain in detail, with data, how his plan would be paid for and why it would behoove 150 million Americans to vote for a candidate who would deprive them of their existing health care for an unknown product. Until he comes clean, it’s vaporware, and voters should beware of being duped. Taking him on faith could not be more dangerous.

Sincerely, BRUCE COLBATH

Exposing Lee Zeldin’s Record on Healthcare

David Posnett — Thu, 05 Mar 2020 17:15:21 +0000

Remember the Graham Cassidy bill?

By Perry Gershon

Representative Lee Zeldin (R-NY1) is a master at telling half-truths. He goes to great lengths to tell his constituents that he supports healthcare coverage for people with pre-existing conditions and lowering prescription drug prices, but his voting record says differently. Zeldin voted against coverage for pre-existing conditions, and just recently shot down a bill for prescription drug coverage reform and prescription drug coverage reform. He even has the audacity to take credit for programs he voted against. A quick look at his record, however, is quite revealing.

Lee Zeldin voted to repeal the Affordable Care Act (ACA). He has cast several such votes in his three terms in office, most recently May 2017 (and he openly urges the courts to overturn the ACA now). The federal requirement to provide coverage for people with pre-existing conditions comes directly from the ACA, so Zeldin’s opposition to coverage for pre-existing conditions is right there in his votes! Zeldin and Trump claim to offer ACA-replacement legislation that provides for pre-existing condition coverage, but these bills do not protect consumers, especially those with pre-existing conditions. They provide no requirement that these individuals will not be penalized in pricing and availability of coverage.

When Congress, in December 2019, passed its bill to make prescription drugs more affordable, Lee Zeldin voted against the bill (HR-3). His position on this critical issue is again demonstrated by his vote. The only effective way to control the cost of prescription drugs is to let Medicare, the largest consumer, negotiate drug prices directly with the manufacturers. It’s no surprise that Zeldin continues to prohibit Medicare from negotiating because much of his campaign contributions come from drug makers and their affiliates. This isn’t me saying this, it’s right there in his campaign finance reports that he is legally obligated to file with the Federal Election Commission. Given Zeldin’s benefactors, it’s no wonder he opposes true prescription price reforms.

Zeldin takes credit for funding medical research at Stony Brook. His most recent February “newsletter” stated that he secured $3 million of new NIH grants to Stony Brook for medical research, and he cites a bi-partisan letter he signed requesting a budget increase specifically for NIH research. What Zeldin does not tell you is that when the actual budget came to a vote on July 25, 2019, he voted against it. His own voting record proves that Zeldin did not vote to increase NIH appropriations or increased funding for Stony Brook.

But Zeldin’s biggest deception of all is that he is has listened and knows what his constituents need for their healthcare. Again, the facts belie that. Zeldin’s last public town hall was in April 2017, before his vote to repeal the ACA. He has not held one since then. He has no idea what his constituents want or need!

Town halls are meant to be open to ALL constituents who want to attend. There should be no prescreening of questions or questioners (to exclude critics) or else it is not really a true town hall. I know this from first-hand experience.

I have held five open town halls since last September and I will hold five more before the end of June. I take questions from Democrats, Republicans – whoever attends and wants to ask a question. As a matter of fact, I take each and every question asked of me and I give truthful fact-based answers. There is no pre-screening and no spin at my town halls.

People on Long Island deserve a representative who will listen to them when they speak out about healthcare. I want to see universal healthcare for everyone – and I believe we can do it with the ACA supercharged with a public option. We need to allow Medicare to negotiate drug prices to achieve true pricing reforms. This November, we have a chance to give NY-1 a representative who will fight for us in Washington and tell us the truth here at home.

Originally published in the Village Times Herald

Curb Drug Costs: Makes Sense For All

David Posnett — Thu, 23 Jan 2020 15:31:21 +0000

By Mike Anthony, on page A10 of the Southampton Press:

http://digital.olivesoftware.com/Olive/ODN/SouthamptonEast/

Makes Sense For All

Dr. David Posnett’s informative letter about House of Representative bill HR3 [“Choosing Sides,” Letters, January 9], see prior post herein, details key elements of Congress’s promise to establish a consumer- and patient-friendly drug price negotiation system. Dr. Posnett aptly captures the gist of the matter in several paragraphs.

My prime takeaway: If the Veterans Administration can negotiate drug prices, why not the Centers for Medicare and Medicaid Services? High-quality and lower-cost drugs makes sense for all of us.

As Dr. Posnett points out, Congressman Lee Zeldin repeats the canard that “these policies would siphon $1 trillion from biopharmaceutical innovators over the next 10 years.” A cynic might ask: Why don’t the drug companies use some of their robust advertising budget and redirect it to research?

The thing is, you don’t have to be a cynic to think that way. Dr. Marcia Angell reveals how drug companies have strayed from their mission in “The Truth About the Drug Companies: How They Deceive Us and What to Do About It.” Here’s an excerpt from the publisher:

“As Dr. Angell powerfully demonstrates, claims that high drug prices are necessary to fund research and development are unfounded. The truth is that drug companies funnel the bulk of their resources into the marketing of products of dubious benefit.”

Any doubt about that? Just ask Purdue Pharma, the company that pleaded guilty to criminal charges of misbranding Oxycontin by claiming that it was less addictive compared to other opioids. Purdue was fined $634 million.

Yes, drug efficacy and safety are as important as pricing — and HR3 covers that as well.

NPR reports that several overseas generic drug manufacturers abuse safety protocols. In India, about 25 percent of inspected drug manufacturing plants violated drug integrity rules; in China, 32 percent of their plants violated these rules.

To guarantee the safe manufacture of drugs, HR 3 provides $920 million to improve regulatory oversight of medical products and to protect public health. And, most important to the East End community, HR3 provides $7.5 billion in funding for states, counties, cities and towns to fight the opioid epidemic.

Contact Congressman Zeldin and ask him to reconsider his opposition to HR3: https://zeldin.house.gov/contact/offices

Mike Anthony

Westhampton

Trump: I will “Negotiate Like Crazy”

David Posnett — Tue, 14 Jan 2020 15:29:19 +0000

https://www.27east.com/east-hampton-press/choosing-sides-1666846/

Choosing Sides

Donald Trump has repeatedly proposed to allow Medicare to “negotiate like crazy” on prescription drugs. Now, he is backtracking. Was this all showmanship? He probably realizes that skyrocketing drug prices will be an issue in 2020.

Here is where we stand.

HR3 is the House bill that recently passed, 230-192, with unanimous Democratic support. This bill requires the Centers for Medicare & Medicaid Services (CMS) to negotiate prices for certain drugs; current law prohibits the CMS from doing so. CMS must negotiate maximum prices for insulin products and expensive brand-name drugs that do not have generic competition.

In addition, the negotiated maximum price may not exceed 120 percent of the average price in Australia, Canada, France, Germany, Japan and the United Kingdom. This is meant to stop drug companies from ripping off Americans, while charging other countries less for the same drugs. Drug manufacturers that fail to comply are subject to penalties.

The bill also reduces annual out-of-pocket costs for patients to $2,000. Also, the Congressional Budget Office claims that HR3 would lower health insurance costs for employers and increase federal revenue by about $45 billion a year, because employer insurance premiums would decline, and those savings would manifest in increased taxable wages.

Sounds reasonable, right? Of course, pharma disapproves, and its arguments have become the Republican rallying cry: HR3 would stifle innovation and new drug development.

It’s exactly the ageless claim I have been hearing for over 40 years from the pharma industry — a claim meant to stifle price controls. I say this having worked with pharma companies in drug development as an outside collaborator and consultant: Note that every other first-world country has price controls, and their pharma industries do quite well. Note also that much of the “innovation” in this country comes from government-funded research grants (tax dollars). Pharma often gets a freebee when they pick up a promising project and help carry it to fruition (I’m thinking of anti-HIV drugs, for example).

U.S. Representative Lee Zeldin voted against HR3 and is one of the standard-bearers of the pharma party line. He’s covering himself politically by expressing support for a watered-down Senate bill, which has little chance of passage, even in the Senate.

Although one HR3 opposition group calls itself Voters for Cures, it is clear who they really are: They complain that “these drastic policies would siphon $1 trillion from biopharmaceutical innovators over the next 10 years.” And Lee Zeldin is on board, writing: “House Democrats’ legislation stifles medical innovation.”

One trillion dollars for big pharma? That’s your money.

By opposing HR3, Lee Zeldin has voted for the drug companies, against drug price controls and against the interest of his constituents.

David N. Posnett, M.D., East Hampton

Medicare-for-all-who-want-it

David Posnett — Mon, 11 Nov 2019 17:12:19 +0000

Adapted from John Hooker in response to Wendell Potter’s statement:

“There’s now a chorus of voices, led by Senators Sanders and Warren, that are saying, ‘enough’. An entire generation has grown up hearing the stale health insurance industry talking points (that I helped craft decades ago). And they aren’t fooled! Politicians who keep defending the insurance industry will go down with them when the health care system finally collapses.”

I will repeat myself until I’m unable to write any more. THIS IS NOT THE RIGHT STRATEGY FOR SUCCESS. Wendell Potter is right factually but is playing the role of an activist (and selling books).

If you want to change something, choose Medicare for all who want it (MFAWWI) – also known as the public option. This will do the work without being bombarded with slogans like “socialism” etc. Remember, not so long ago, even some Democrats did not support Obamacare in 2010. They were too afraid of the public reaction when Republicans began bombarding the country with their fraudulent slogans.

We have reached, a “McCarthyism” situation in this country where the number of people becoming irrational is increasing. This is very dangerous. If we do not reform, we will screw up this country for good.

Introducing the government option or MFAWWI will do the dirty work of putting the insurance companies gradually out of work. It will bring the price of pharmaceuticals down because the increasing size of MFAWWI will put pressure on pharmaceutical pricing. It will force re-structuring through market forces and do this at a more manageable pace for society so that it can adapt to this huge change.

There is too much now to disentangle in one fell swoop — particularly while half of the opposing stakeholders will be bombarding a well-meaning single-payer system.

Time to be realistic. The only way to get the whole country to move in a direction of this magnitude (re-structuring one-sixth of the economy) is to have a huge majority convinced that that is what we have to do — like a war effort! We aren’t there yet.

Same for climate change!! Which is even bigger an issue.