Opinion | Democrats Are Credible on Health Care – by Paul Krugman – NYT

“It’s worth remembering what Republicans said would happen before the A.C.A. went online: that it would fail to reduce the number of uninsured, that it would blow a giant hole in the budget, that it would lead to a “death spiral” of rising premiums and declining enrollment.

What actually happened was a dramatic fall in the uninsured, especially in those states that expanded Medicaid. The budget costs of expanding Medicaid and subsidizing other insurance have been significant, but estimates for 2019 suggest that these costs will be around $115 billion — much less than half the revenue lost due to the Trump tax cut.

What about that death spiral? Premiums on the health exchanges established by the A.C.A. initially came in much lower than expected, then rose sharply when the people signing up for those exchanges turned out to be fewer and sicker than insurers had hoped. But the markets have now stabilized, with only modest premium increases for 2019 and insurers returning to the exchanges.

And while the exchanges are covering fewer people than projected, Medicaid is covering more than expected, so that overall gains in coverage have been surprisingly on target. In early 2014, the Congressional Budget Office projected that under the A.C.A., by 2018 there would be 29 million uninsured U.S. residents. The actual number is … 29 million.”


Opinion | Medicaid’s Nickel-and-Dime Routine – The New York Times

“D’ashon, a Texas toddler with severe birth defects, needed 24/7 nursing care to keep his breathing tube clean and to prevent him from pulling it out.

His foster mother asked Superior HealthPlan, the insurance carrier that provides Medicaid services to the state’s 30,000 foster children, for additional nursing hours, according to a Dallas Morning Newsinvestigation. Superior said no, even after D’ashon’s doctors and nurses said that it was a matter of life or death.

Bind his arms with a soft splint to keep him from removing his breathing tube when no nurse was on duty, the company suggested to D’ashon’s foster mother. The insurance carrier finally agreed to provide round-the-clock nursing care — after D’ashon choked while no nurse was on duty and lapsed into a permanent vegetative state.”

Editorial | The Crazy Talk About Bringing Back Asylums – The New York Times

“When President Trump mused that the mass shooting at a high school in Parkland, Fla., in February might have been prevented if the United States had more mental institutions, he revived a not-quite-dormant debate: Should the country bring back asylums?

Psychiatric facilities are unlikely to prevent crimes similar to the Parkland shooting because people are typically not committed until after a serious incident. Still, a string of news articleseditorials and policy forums have noted that plenty of mental health experts agree with the president’s broader point.

The question of whether to open mental institutions tends to divide the people who provide, use and support mental health services — let’s call them the mental health community — into two camps. There are just 14 or so psychiatric beds per every 100,000 people in the United States, a 95 percent decline from the 1950s. One camp says this profound shortage is a chief reason that so many people suffering from mental health conditions have ended up in jail, on the streets or worse. The other argues that large psychiatric institutions are morally repugnant, and that the problem is not the lack of such facilities but how little has been done to fill the void since they were shut down.”

David Lindsay:   Yes, and, here are the two top comments I also recommended:

Rusty Inman
Columbia, South Carolina
Times Pick

I spent two years, in the mid-70’s, as a clinical resident at two different state hospitals in the Deep South.

I remember well residents for whom those institutions were a relatively new “home” and I remember equally well residents for whom those institutions had been “home” for two and three and four decades.

But, no matter how briefly or how long those buildings and grounds had been “home” to them, I remember how devastating the realization was to me—young, green and oh, so idealistic—that few of them were or ever would be capable of managing lives of their own beyond those buildings and grounds. Indeed, for most, that was the reason they were there. They didn’t represent threats to the world beyond, but the world beyond represented real threats to them. I once wrote in my journal that the walls surrounding those institutions weren’t meant to keep my patients in but to keep the world that was/seemed so scary to them out.

That these institutions were “warehouses” is beyond dispute. But one man’s “warehouse” is another’s sanctuary.

A few years later, they boarded up those sanctuaries, tore down those protective walls and told my old patients that they had to find, on their own, new “homes” and new lives. The cruelty of it was beyond imagining—they were to do what they had already proven themselves incapable of doing.

BTW, they were right per those walls: Inside them they were safe, outside them they had no defenses against a world that truly was crazy.

asjohnclt commented June 2

Charlotte, NC
Times Pick

My father was mentally ill back in the 60s and was hospitalized in the state mental health asylum. I was a teenager at the time and my mother and I visited him regularly. His hospitalization was not an ideal solution, but it was a far better one for him and for us than attempting to care for him at home. Today’s situation of basically no mental health institutions is a joke. I personally know of two men who were both brilliant and mentally ill who died on the streets. Our governments’ lack of funding and lack of care for the mentally ill is shameful. We and my father were better off.


The Largest Health Disparity We Don’t Talk About – By DHRUV KHULLAR – NYT

I didn’t think our relationship would last, but neither did I think it would end so soon.My patient had struggled with bipolar disorder his entire life, and his illness dominated our years together. He had, in a fit of hopelessness, tried to take his life with a fistful of pills. He had, in an episode of mania, driven his car into a tree. But the reason I now held his death certificate — his sister and mother in tears by his bed — was more pedestrian: a ruptured plaque in his coronary artery. A heart attack.Americans with depression, bipolar disorder or other serious mental illnesses die 15 to 30 years younger than those without mental illness — a disparity larger than for race, ethnicity, geography or socioeconomic status. It’s a gap, unlike many others, that has been growing, but it receives considerably less academic study or public attention. The extraordinary life expectancy gains of the past half-century have left these patients behind, with the result that Americans with serious mental illness live shorter lives than those in many of the world’s poorest countries.

Opinion | Just Saying Yes to Drug Companies – by Paul Krugman – NYT

“Last week we learned that Novartis, the Swiss drug company, had paid Michael Cohen — Donald Trump’s personal lawyer — $1.2 million for what ended up being a single meeting. Then, on Friday, Trump announced a “plan” to reduce drug prices.

Why the scare quotes? Because the “plan” was mostly free of substance, controlled or otherwise. (O.K., there were a few ideas that experts found interesting, but they were fairly marginal.) During the 2016 campaign Trump promised to use the government’s power, including Medicare’s role in paying for prescription drugs, to bring drug prices down. But none of that was in his speech on Friday.

And if someone tries to convince you that Trump really is getting tough on drug companies, there’s a simple response: If he were, his speech wouldn’t have sent drug stocks soaring.

None of this should come as a surprise. At this point, “Trump Breaks Another of His Populist Promises” is very much a dog-bites-man headline. But there are two substantive questions here. First, should the U.S. government actually do what Trump said he would do, but didn’t? And if so, why haven’t we taken action on drug prices?”

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.