Opinion | David J. Shulkin: Privatizing the V.A. Will Hurt Veterans – The New York Times

“It seems that these successes within the department have intensified the ambitions of people who want to put V.A. health care in the hands of the private sector. I believe differences in philosophy deserve robust debate, and solutions should be determined based on the merits of the arguments. The advocates within the administration for privatizing V.A. health services, however, reject this approach. They saw me as an obstacle to privatization who had to be removed. That is because I am convinced that privatization is a political issue aimed at rewarding select people and companies with profits, even if it undermines care for veterans.

Until the past few months, veteran issues were dealt with in a largely bipartisan way. (My 100-0 Senate confirmation was perhaps the best evidence that the V.A. has been the exception to Washington’s political polarization). Unfortunately, the department has become entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.”


How a Bad Law and a Big Mistake Drove My Mentally Ill Son Away – by Norman Ornstein – NYT

“Ever since the school shooting in Parkland, Fla., law enforcement and other officials have been calling for changes in the Baker Act, a Florida law that allows involuntary commitment for 72 hours of people who are an imminent danger to themselves or others. If the Baker Act had been easier to deploy, they think, Nikolas Cruz, the accused shooter, would have been taken and treated before his horrible act.

However this law may be reformed, it will never be able to get people with serious mental illness the treatment they need.

I know something about the Baker Act. About halfway through my son Matthew’s decade-long struggle with serious mental illness, my wife and I invoked the Baker Act against him.”

Here is the top comment, I recommended:

A Mom

Albany, NY, area 15 hours ago

Dear Prof. Ornstein, I am so sorry for your loss. I am writing this as I sit in the hospital next to the bed of my 25-year-old daughter, who suffers from mental illness. They are kicking her out (sending her home) after an emergency psych evaluation. You are correct the system is broken. In just a few months she will no longer have my health insurance. The job she has doesn’t provide anything like what she needs. And I am terrified for her. You are correct, 90 days isn’t enough time. She’s only had a week of intensive inpatient care. Once. She managed to flit from one provider to another, none of whom has had her long enough to find out who she is let alone what her problems are. None of them ever asked her family about her history. This time it’s just an evaluation and home we go. Take your meds. Make a safety plan. We need comprehensive care, not nickels and dimes. And it sure won’t happen under this administration. Best wishes for your own healing.

Tom Brokaw: You Can Find the Entire World Inside Your Hospital – The New York Times

“President Trump is vowing to return to two of his favorite goals in 2018: a crackdown on immigration and the dissolution of the Affordable Care Act.

When congressional Republicans passed the sweeping tax bill in December, they eliminated the A.C.A.’s health care mandate. But President Trump wants to knock out the entire program.As I have learned in the past four years, immigration and health care in America have an organic relationship that may escape the president and his supporters if they experience health care only from the outside looking in.”

Everyone Wants to Reduce Drug Prices. So Why Can’t We Do It? – by Jay Hancock – NYT


“Those comments matched Mr. Trump’s characterization in January of drug companies as “getting away with murder.” That same day, a dozen Republican senators, including Ted Cruz of Texas, John McCain of Arizona and Mike Lee of Utah, voted for the old liberal idea of letting Americans buy cheaper drugs from Canada.”

“The pharmaceutical and health products industries spent $145 million on lobbying for the first half of 2017, according to the Center for Responsive Politics.

Drug makers gave $4.5 million to congressional campaigns in that period, including six-figure donations to House Speaker Paul Ryan; Representative Greg Walden, a Republican of Oregon who heads the House Energy and Commerce Committee; and Senator Orrin Hatch, Republican of Utah and chairman of the Senate Finance Committee, a Kaiser Health News analysis found.

The drug lobby has spent $28 million so far this year to air six ads depicting heroic researchers about 4,600 times on national TV, according to iSpot.tv, an ad tracker.”

“Drug makers say that high prices reflect heavy investment in innovation and drug development. They reject the notion that the industry wields too much influence in Washington. The top 10 publicly traded United States drug companies made $67.8 billion after taxes last year, regulatory filings show.”

Reform is a disaster, since big money seems to rule. Here are the top comments, which I endorsed.

Mickey D

NYC 1 day ago

I have been working in this area, drug pricing and patenting, for almost my entire professional life. All that time the Bayh Dole act has contained a price limiting section. The majority of big drugs are developed with some federal funding for all or part of their inventions. No administration, Republican or Democratic, has ever had the nerve to assert these rights against expensive drugs and their manufacturers. Instead, government agencies, especially the NIH which usually grants these funds, throws up its hands and says they have no expertise in setting fair prices. Well the statute says they have that responsibility and all they have to set up is what all agencies have similarly done, whether they deal in transportation, agriculture, safety, or even emergencies. They hire some economists and get to work.

But the pharmaceutical companies have clearly bought them all off with lobbying and promises of funding for new prestige enhancing articles.

My prediction, after forty years at this, is that nothing is going to happen. My personal failure, including congressional testimony, media interviews, op ed pieces, published letters to the Times, and the like, is nothing compared to our social failure which condemns us to decades and more of suffering because big money has stolen our democracy and our access to reasonably priced pharmaceuticals.

NYT Pick


is a trusted commenter Massachusetts 1 day ago

I spent the better part of my career producing communications materials for agencies whose clients were drug companies. I used to buy into the “‘research and innovation argument” but soon realized how much waste went into marketing, and even into clinical decisionmaking that favored quick-hit profits from developing “me too” drugs over finding novel compounds.

I just finished Ross Douthat’s piece on the problems facing America other than healthcare, and let me just repeat what said there, which is: MONEY is our biggest problem. Money in politics, bought and paid for politicians, Citizens United, lobbyists who write legislation to free up politicos for–what else?–fundraising.

Drugs cost a bundle because they pay an army of industry flacks to preserve the status quo, fight price regulations, ensure politicians get rewarded for votes, and make America subsidize the lower prices the rest of the industrialized world demands to add a product to their government-run formularies.

“If there ever was a time to strike while it’s hot, it’s now,” said “Dr. Sarpatwari.

No, I have a better time: when we as a nation decide to roll back Citizens United and enact term limits.

Complacency Could Kill Health Care – by Paul Krugman – NYT

“I haven’t yet read Hillary Clinton’s “What Happened,” but it seems pretty clear to me what did, in fact, happen in 2016.

These days, America starts from a baseline of extreme tribalism: 47 or 48 percent of the electorate will vote for any Republican, no matter how terrible, and against any Democrat, no matter how good. This means, in turn, that small things — journalists acting like mean kids in high school, ganging up on candidates they consider uncool, events that suggest fresh scandal even when there’s nothing there — can tip the balance in favor of even the worst candidate imaginable.

And, crucially, last year far too many people were complacent; they assumed that Trump couldn’t possibly become president, so they felt free to engage in trivial pursuits. Then they woke up to find that the inconceivable had happened.Is something similar about to go down with health care?Republican attempts to destroy Obamacare have repeatedly failed, and for very good reason. Their attacks on the Affordable Care Act were always based on lies, and they have never come up with a decent alternative.

The simple fact is that all the major elements of the A.C.A. — prohibiting discrimination by insurers based on medical history, requiring that people buy insurance even if they’re currently healthy, premium subsidies and Medicaid expansion that make insurance affordable even for those with lower incomes — are there because they’re necessary. Yet every plan Republicans have offered would do away with or undermine those key elements, causing tens of millions of Americans to lose health insurance, with the heaviest burden falling on the most vulnerable.”

Please note that Lindsay Grahm is one of the four Senators behind this horrible bill.

I am ambivalent about its passage. Its passage would hurt millions of people, but would also give the Democrats the big item they need to take both houses of congress. As an environmentalist, I have to support a democratic party sweep of both houses.

Susan Collins and Lisa Murkowski- the Health Vote Heroines – by Gail Collins – NYT

“And he underestimated two Senate Republicans, Susan Collins and Lisa Murkowski. John McCain’s “no” vote was the high point of the drama, but Collins and Murkowski were the fierce, consistent forces of resistance that gave McCain his opportunity.
My favorite moment came when Trump dispatched Interior Secretary Ryan Zinke to warn Murkowski that if she continued to vote against the bill, her home state of Alaska would lose stuff it wanted from the federal government.”

No Insurance- but for 3 Days- Health Care Is Within Reach – by Nicholas Kristof – NYT


The patients swamped the county fairground here for a three-day health extravaganza of free care organized by Remote Area Medical, an aid group that holds these events across the country. This one involved about 1,400 volunteers serving 2,300 men and women who needed care of every kind.Some patients camped out for three days at the fairground gate before the clinic opened to make sure they would be treated.

Three Legs Good, No Legs Bad – by Paul Krugman – NYT

“Will 50 Republican senators be willing to inflict grievous harm on their constituents in the name of party loyalty? I have no idea.

But this seems like a good moment to review why Republicans can’t come up with a non-disastrous alternative to Obamacare. It’s not because they’re stupid (although they have become stunningly anti-intellectual). It’s because you can’t change any major element of the Affordable Care Act without destroying the whole thing.

Suppose you want to make health coverage available to everyone, including people with pre-existing conditions. Most of the health economists I know would love to see single-payer — Medicare for all. Realistically, however, that’s too heavy a lift for the time being.”

“Does anyone remember the “reformicons”? A couple of years back there was much talk about a new generation of Republicans who would, it was claimed, move their party off its cruel and mindless agenda of tax cuts for the rich and pain for the poor, bringing back the intellectual seriousness that supposedly used to characterize the conservative movement.

But the rise of the reformicons never happened. What we got instead was the (further) rise of the decepticons — not the evil robots from the movies, but conservatives who keep scaling new heights of dishonesty in their attempt to sell their reverse-Robin Hood agenda.”

Good piece, mostly review. Here are some top comments I support:

Michael Hutchinson NY 9 hours ago

The GOP plans to take meager insurance away from millions of Americans. OK, but let’s face it, the flip side of this ghastly idea is the assumption that the insurance industry must be preserved, and the naïve idea that capitalism and the Laws of Supply and Demand will fix everything. Just ask Rand Paul.

But the Laws of Supply and Demand don’t operate in healthcare as they do elsewhere, Dr. Paul, even if you allow purchase across state lines. This is because the insurance industry (Supply) has a financial incentive not to provide healthcare (Demand), and why it uses a massive bureaucracy, placing a huge financial burden on US industry.

Ironically, government-funded Medicare has a tiny overhead, is still run by doctors, and is popular (just ask any senior, even Republicans). Making Medicare generally available would be a massive boost for US industry – $500 billion per year – and a massive boost in standards.

The unseemly spectacle of a group of portly white male senators, each receiving contributions (bribes?) from the insurance industry, each with unparalleled access to healthcare, prattling about the wonders of the free market, reminds me of Sinclair Lewis’s observation that you’ll never get a man to understand something (Medicare for All) if his income (bribe) depends upon him not understanding it.

American healthcare is a disgrace, an unforced error not worthy of a great nation, and there is no capitalist solution.


Reply 1158Recommended

NYT Pick
Sha Redwood City 8 hours ago

Obamacare has had this much success despite Republicans doing whatever they could during the past eight years to break it. Imagine they had a tiny bit of decency, caring more about their constituents than their political gain, and worked with Democrats to improve the law. Millions more would have been insured mow with lower premiums.

Reply 1042 Recommended

Dear Paul Ryan: Listen to Your Constituents – by Nicholas Kristof – NYT

“I visited the three Planned Parenthood clinics in your congressional district in Wisconsin and spoke to women and men arriving full of anxieties. They feared unwanted pregnancy, gonorrhea, breast cancer, and they can’t understand why you’re trying to close clinics that keep them healthy.They’re having trouble reaching you, so I thought I’d help. Speaker Ryan, please listen to your own constituents.”

Strong op-ed.

Here is a comment I support:


NYC 2 days ago

Did you know that more than half the babies delivered in this country are born to mothers on Medicaid? Do you realize that in many places Planned Parenthood is the ONLY comprehensive women’s health clinic?

If you really cared about women and children, you’d support PP’s efforts to be sure that every child is born into a healthy, supportive and welcoming family.

(And by the way, MOST healthcare providers are “private.” Maybe instead of accepting Medicare, Medicaid and insurance plans YOUR doctor should be out soliciting donations.)

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