From Health and Fitness

‘Medicare For All’ Emerges As Early Divide In First Democratic Debate

During Wednesday night’s Democratic presidential primary debate — the first in a two-night event viewed as the de facto launch of the primary season — health policies,  ranging from “Medicare for All” to efforts to curb skyrocketing drug prices, were among the key issues the 10 hopeful candidates onstage used to help differentiate themselves from the pack.

Health care dominated early, with Sens. Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums.

But the candidates broke ranks on the details and not all of their claims stayed strictly within the lines.

Only two candidates — New York City Mayor Bill De Blasio and Warren — raised their hands in favor of banishing private insurance in favor a government-sponsored Medicare for All approach.

Klobuchar, a single-payer skeptic, expressed concern about “kicking off half of America off their health insurance in four years.” (That’s correct: In 2017, a majority of Americans had private coverage, with 49% getting that insurance through work, according to the Kaiser Family Foundation.)

Former Texas Rep. Beto O’Rourke, who also supports maintaining a private insurance system, outlined his own universal health care plan, based on a so-called “Medicare for America” bill in Congress.

The single-payer talk set off other discussion about the role of health insurance and the cost of care. We fact-checked some of the biggest claims.

Warren: “The insurance companies last year alone sucked $23 billion in profits out of the health care system. $23 billion. And that doesn’t count the money that was paid to executives, the money that was spent lobbying Washington.”

We contacted Warren’s campaign, who directed us to a report from the National Association of Insurance Commissioners, a nonpartisan group of industry regulators. It supports her assessment.

The report says that in 2018, health insurers posted $23.4 billion in net earnings, or profits, compared with $16.1 billion a year prior.

This came up in the context of Warren’s support for eliminating private insurance under a Medicare for All system. However, the financing and price tag of such a system is unclear.

Booker: “The overhead for insurers that they charge is 15%, while Medicare’s overhead is only at 2%.”

This is a flawed comparison. Booker said administrative overhead eats up much more for private carriers than it does for Medicare, the government insurance program for seniors and the disabled. But Medicare piggybacks off the Social Security Administration, which covers costs of enrollment, payments and keeping track of patients.

Also, Medicare relies on private providers for some of its programs, and overhead charges there are higher. Medicare’s overhead is less than that of private carriers, but exact figures are elusive.

The insurance companies’ trade group, America’s Health Insurance Plans (AHIP), reported in 2018 that 18.1% of private health care premiums went to non-health care services. That includes taxes of 4.7% and profits of 2.3%. The Medicare trustees reported that in 2018, total expenses were $740.6 billion, with administrative expenses of $9.9 billion. That comes to 1.3%, less than Booker said.

Warren: “I spent a big chunk of my life studying why families go broke, and one of the number one reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance.”

Is the No. 1 reason people go broke the cost of health care? We’ve rated similar statements  Half True — partially accurate but lacking important context.

A 2005 study Warren co-authored and a 2009 paper both found that health care expenses were a leading cause of personal bankruptcy. But these claims have come under dispute, in particular from academics who suggest that people may overstate the role medical bills play in their financial problems. Other research suggests a far narrower impact, though that in turn has been criticized for focusing only on adult hospitalizations.

That said, research from the Consumer Finance Protection Bureau found that medical bills are a leading cause of personal debt — in 2014, the CFPB found that nearly 20% of credit reports included a medical debt tradeline.

But Rep.Tulsi Gabbard (Hawaii) drew on examples of universal health coverage in other countries to explain why she still supported some private insurance options.

Gabbard: “If you look at other countries in the world who have universal health care, every one of them has some form of a role of private insurance.”

This is correct. Virtually every country with universal health care includes a role for private insurance. Some allow it to cover services not addressed by the national plan. Others allow it as a means to get care faster. Others heavily regulate it as a principal source of coverage.

For instance, Canada, the model for the principal Medicare For All bill, allows private insurance to address prescription drug coverage, private rooms in hospitals and vision and dental care. (It is not allowed to compete with the government plan.) In England, about 10% of people — mostly wealthier people — elect for private coverage, which can yield faster access to care. Countries such as the Netherlands and Switzerland heavily regulate private coverage.

Beyond Medicare for All, candidates also touched on strategies to bring down drug prices as well as other issues.

Klobuchar: “2,500 drug prices have gone up in double digits since (Donald Trump) took office.”

This is accurate, according to according to a report from Pharmacy Benefits Consultants, an industry group, which listed a number of pharmaceutical products experiencing price increases as high as 1,468% .

And the numbers are even less flattering than Klobuchar would suggest.

An analysis by the Associated Press found that, between January and July 2018, more than 4,400 branded prescription drugs experienced price increases. Meanwhile, data compiled by Rx Savings Solutions found that the list price of more than 3,000 drugs went up this year.

O’Rourke: “In Texas, the single largest provider of mental health care is the county jail system.”

This is correct.

Texas jails are the largest mental health care systems in the state, according to a report from the University of Texas at Austin. The Harris County jail, which includes a 108-bed unit, identifies itself as the largest mental health care facility in Texas.

This is not a Texas-specific issue. According to a 2011 NPR report, it is more common to see Americans getting mental health care in jails and prisons than hospitals or other dedicated treatment facilities.

Election day is 496 days away.

Senate Panel Makes Surprisingly Fast Work Of ‘Surprise Medical Bills’ Package

It may seem as if the Senate, or at least certain key senators, have decided on a way forward to fix the nation’s “surprise medical bill” problem. But make no mistake: The door is still open to try another solution.

Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns. The 196-page bill touches nearly every aspect of the health care industry, from lowering the price of prescription drugs and creating a national database of health care costs, to increasing vaccine rates and preventing youth tobacco use.

One thing the bill specifically does not deal with: the insurance market and the Affordable Care Act, which could be why the massive package was voted out of the committee in just over two hours with little debate. The Lower Health Care Costs Act of 2019, sponsored by HELP Committee Chairman Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), the top Democrat on the panel, sailed through with a bipartisan 20-3 vote.

“You don’t have to preach the whole Bible in one sermon,” said Alexander as he described his panel’s action. “We picked out one important thing: reducing health care costs.”

Still, just because the first hurdle has been cleared doesn’t mean there’s room for speculation about what could happen between now and when it reaches the Senate floor. Alexander said he’s hoping the bill will be voted on before the Senate leaves Aug. 2 for a monthlong recess.

The smooth hearing capped a busy few weeks, as senators debated the mechanism that would be used to stop surprise medical bills — the unexpected and often costly charges patients face when they get care from a doctor or hospital not in their insurance network.

An earlier draft of the bill outlined three options to solve disputes between payers and providers. There was an in-network guarantee, where all of the health care providers at a hospital — whether the anesthesiologist or lab — must accept in-network insurance rates.

Another option, often referred to as baseball-style arbitration, would have the health plan and the doctor — if they couldn’t reach an agreement on reimbursement — present to an independent arbitrator their best offers for how much a patient’s out-of-network care should cost. The arbitrator would choose between the two.

But another approach — benchmarking — ultimately made it into the formal draft. Here’s how it works: When patients are seen by doctors who aren’t in their network, the insurer would pay the providers the “median in-network rate,” meaning the rate would be similar to what the plan pays other doctors in the area for the same procedure.

At the markup hearing Wednesday, Alexander said he initially preferred one of the other approaches, the in-network guarantee, but changed his mind when the Congressional Budget Office said benchmarking would save more money.

A group of senators on the panel led by Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Lisa Murkowski (R-Alaska) voted for the chairman’s choice, even though they had advocated for arbitration. Cassidy made clear he continues to have reservations.

“This is entirely for the insurance companies,” he said of benchmarking. “I’m surprised that my colleagues on the other side of the aisle running for president are OK with this.”

Neither of the two Democratic senators on the committee running for president, Sens. Elizabeth Warren (Mass.) and Bernie Sanders (Vermont), were present but both voted no by proxy.

But it is also not an entirely settled issue.

Cassidy and Alexander indicated that the door was still open to including independent arbitration before the package gets to the floor.

“We’re going to keep working on that the next three or four weeks. There are clearly opportunities to improve the bill and move in the direction Sen. Cassidy wants to go,” Alexander told reporters after the hearing.

At the markup hearing Wednesday, the committee took a step toward Cassidy’s preferred vision for fixing surprise bills. It passed an amendment from Cassidy that would require insurance companies to post accurate lists of who is in-network, so patients have a better chance of avoiding surprise bills.

“This bill is not as good as it should be,” Cassidy said. “And I thank the chairman because he has offered to work between now and floor consideration on the surprise bills.”

The only other amendment approved by the panel, offered by Sen. Tammy Baldwin (D-Wis.), would require drug companies to report price increases.

And despite Alexander saying early on that he didn’t want to talk about the individual insurance market or the ACA, some Democrats couldn’t let the opportunity pass without mentioning Republican efforts to undermine it.

“Repairing the train can only get you so far if you are pulling up the track at the same time — and that’s unfortunately exactly what this administration is doing,” Murray said in her opening statement. “The biggest threat to families’ health care continues to be sabotage from President Trump.”

California Rolls Out Program On Background Checks For Ammunition Purchases, While Gun Advocates Stock Up, File Lawsuit

Background checks can help authorities discover guns that aren’t registered with the state, gun safety advocates say, adding that the program could have prevented last week’s fatal shooting of rookie Sacramento police officer Tara O’Sullivan. Meanwhile, gun owner groups complain about the new ID requirement. News on gun violence is from Missouri, as well.

Football Players Dominate Research On CTE, But One Woman Wonders If Victims Of Domestic Violence Wouldn’t Show Same Symptoms

As many as 31 million women might have had a traumatic brain injury and 21 million might have had multiple mild ones. Yet there’s little research on the lasting effects in women. In other public health news: worker safety, burnout, genetic testing, wildfires, heart attacks, menstrual products and anger.

Link Between Common Class Of Drugs, Increase In Dementia Risk Deepened With Wide-Ranging Study

The researchers looked at anticholinergic drugs that work by blocking a chemical called acetylcholine, which acts as a neurotransmitter and is involved in many nervous system functions including muscle movements, heart rate, the widening of blood vessels, respiratory functions and muscle contractions in the stomach during digestion. Previous research has found a link between the drugs and dementia, but a new study strengthens those findings.

San Francisco Becomes First City In Nation To Ban Sale Of E-Cigarettes, Possibly Leading The Way For Others

“This is a decisive step to help prevent another generation of San Francisco children from becoming addicted to nicotine,” said City Attorney Dennis Herrera in a statement, following the vote. The city is the headquarters for Juul, one of the leading brands of e-cigarettes. The company is working on a ballot initiative to get the issue out in front of voters in November.

False, Misleading Information On Cancer ‘Cures’ Thrives On YouTube, Ensnaring Patients At Their Most Vulnerable Time

“People with a new cancer diagnosis are often feeling vulnerable and scared,” said Renee DiResta, a researcher who studies disinformation. Facing the horrors of such a diagnosis and treatment, some people start searching for information and community online. But even as tech giants like YouTube and Facebook try to crack down on false health information shared on their platforms, it’s nearly impossible to get it all. In other health and technology news: robocalls, securing data and digital chronic disease management.

‘An Arm And A Leg’: Why Are Drug Prices So Random? Meet Mr. PBM


Can’t see the audio player? Click here to listen.


Surely, an old-time, generic drug can’t cost $720 — for a three-month supply?

After a close call with an outrageous Rx tab, host Dan Weissmann tackles the health care cost puzzle he’s been avoiding: figuring out prescription drug prices.

Here’s what he found: Your insurance company is probably in cahoots with a pharmacy benefit manager — and the negotiations that go on between them are trade secrets. No wonder it’s so hard to know what you’ll pay at the drugstore counter!

On Episode 4 of “An Arm and a Leg,” meet the behind-the-scenes negotiator that helps decide how much you pay at the pharmacy counter.


Season 2 is a co-production of Kaiser Health News and Public Road Productions.

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Early Abortion Bans: Which States Have Passed Them?

This year has brought an unprecedented wave of new state laws that allow abortions to be performed only early in pregnancy — if at all.

Most of the new laws — known as early abortion bans — explicitly outlaw abortion when performed after a certain point early in the pregnancy. The laws vary, with some forbidding abortion after six weeks of pregnancy, and some after eight weeks. Alabama’s law is the most extreme: It aims to outlaw abortion at any point, except if the woman’s health is at serious risk. So far in 2019, nine U.S. states have passed laws of this type, and more states are considering similar legislation.

None of the laws passed this year are actually in effect, either because they have a future enactment date or because judges have put them on hold in response to lawsuits, or both.

These new bans are a direct challenge to the precedent set by the 1973 U.S. Supreme Court ruling Roe v. Wade, which affirmed that a woman has a right to seek an abortion up until the point that the fetus could be “viable” outside of the uterus. Viability must be determined on an individual basis but is generally between 24 and 28 weeks of pregnancy.

“We want to stop abortion of unborn children. And the only way we can do that is to go back and revisit the Roe decision,” Eric Johnston, the president of the Alabama Pro-Life Coalition, told NPR’s Ari Shapiro. Johnston helped write the Alabama law that outlaws almost all abortions.

“This law is, in effect, a vehicle to do that.”

A few states already have existing laws that outlaw abortion earlier in pregnancy than the standard set by Roe, banning the procedure as early as 18 or 20 weeks. When challenged, bans on abortion at this stage of pregnancy have consistently been struck down in court, according to the Guttmacher Institute. But not all of those laws have been challenged in court, so they remain on the books. There is no state law currently in effect that bans abortion before 20 weeks.

Three states — New York, Vermont and Illinois — have moved in the other direction. All three states passed laws this year that affirm the legal right to an abortion in each state, even if the Supreme Court overturns Roe v. Wade. Illinois is the most recent example, with its governor signing a bill on June 12 that states that “every individual has a fundamental right to make autonomous decisions about one’s own reproductive health.”

These early abortion bans differ from another common type of state regulation known as a TRAP law — for Targeted Regulation of Abortion Providers. TRAP laws place particular restrictions on the doctors or health clinics that provide abortions, and the Supreme Court has allowed some of these laws to go into effect, while striking down others.

Here are some details on the newest bans, by state.

*Important note: Supporters of reproductive rights have filed multiple lawsuits against this type of law. None of these early abortion bans are currently in effect or are being enforced.

Alabama – No abortion at any point in pregnancy. Allows exceptions if the woman’s life is threatened. No exceptions for rape or incest.

Arkansas – No abortion after 18 weeks. Allows exceptions for rape, incest or medical emergencies.

Georgia – No abortion after 6 weeks. Allows exceptions if the woman’s life is endangered, if the pregnancy is deemed “medically futile” and in cases of rape or incest if the woman files a police report.

Kentucky – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Louisiana – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered or if the pregnancy is deemed “medically futile.”

Mississippi – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Missouri – No abortion after 8 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Ohio – No abortion after 6 weeks. No exceptions for rape or incest. Allows exceptions if the woman’s life is endangered.

Utah – No abortion after 18 weeks. Allows exceptions for rape or incest if the doctor performing the abortion verifies that the incident was reported to law enforcement. Allows exceptions if the woman’s life is endangered.

NPR’s Carrie Feibel, Sarah McCammon and Carmel Wroth contributed to this report.

This story was originally published by KHN’s partner NPR.

San Francisco Set To Ban Sales Of E-Cigarettes

San Francisco’s Board of Supervisors is slated to vote Tuesday to ban the sale and distribution of e-cigarettes in the city. The city is the corporate home of Juul Labs, the biggest producer of e-cigarettes in the country.

The ordinances would make the sale of e-cigarettes illegal in brick-and-mortar stores and online when shipping to San Francisco addresses.

San Francisco Mayor London Breed has 10 days to sign the legislation, which she has said she will do. The law will be enforced seven months from that date, in early 2020.

San Francisco Supervisor Shamann Walton, who co-authored the legislation, sees it as part of a long-term battle against the effects of smoking.

“We spent a few decades fighting big tobacco in the form of cigarettes,” Walton said. “Now we have to do it again in the form of e-cigarettes.”

Under federal law, the minimum age to buy tobacco products is 18.  California and 15 other states, however, have raised that age to 21 or passed measures that will set it to 21 by 2021. Despite this, use of e-cigarettes, or vaping, has skyrocketed among teenagers nationally.

Last year, 1 in 5 high school seniors reported vaping in the past month. That’s almost double the number from the year before. Even eighth graders are vaping in record numbers.

These increases come after years of declines in teenagers smoking traditional cigarettes.

Public health officials are concerned about the rising number of teenagers using e-cigarettes, as nicotine can harm a young person’s developing brain. The Centers for Disease Control and Prevention warns that young people who vape may be more likely to start smoking traditional cigarettes.

Walton said he’s disgusted with the actions of Juul and similar companies, who he said are “putting profits before the health of young people, and people in general.”

Despite the tobacco age limit, Walton noted that vaping devices are commonly confiscated from students in the city’s middle and high schools.

The ordinance is accompanied by another that prevents the manufacture, distribution and sale of e-cigarettes on San Francisco property. The ordinance takes direct aim at Juul Labs, which leases space from the city on San Francisco’s Pier 70. The ordinance is not retroactive, so it would not remove Juul from the company’s current space, but it would prevent other e-cigarette makers from renting city property in the future. In a statement, Juul spokesman Ted Kwong wrote that, regardless, the company does not “manufacture, distribute or sell our product from this space.”

Juul’s vaping device was introduced in 2015. It’s small, sleek and discreet, looking similar to a flash drive. The company now controls 70% of the vaping market.

In a statement, Juul Labs said it shares the city’s goal of keeping e-cigarettes away from young people. The company said it has made it harder for underage buyers to purchase Juul off its website and has shut down Juul accounts on Facebook and Instagram.

But, the company argues that “the prohibition of vapor products for all adults in San Francisco will not effectively address underage use and will leave cigarettes on shelves as the only choice for adult smokers, even though they kill 40,000 Californians every year.”

Walton doesn’t buy that argument, however. He said that’s simply “trading one nicotine addiction for another.” What’s more, he’s concerned that for every adult that might benefit, dozens of young people could become addicted.

San Francisco resident Jay Friedman said the complete e-cigarette ban goes too far. The software engineer smoked a pack of cigarettes a day for 20 years, and smoking e-cigarettes has reduced his regular cigarette habit to two to three a day. He said he feels better physically.

Friedman supported a ban on flavored tobacco that city voters passed last year. “I feel like it was good to get rid of the fruit flavors for kids,” he said, “but this feels like maybe a step too far.”

If e-cigarettes are banned, he said, he would try to quit nicotine altogether. But, “there would be a point in a moment of weakness where I’d just end up buying a pack of smokes again and then it’s just a slippery slope from there.”

Small businesses in San Francisco are concerned the ban will hurt their bottom line.

Miriam Zouzounis and her family own Ted’s Market, a convenience store near downtown San Francisco. She said e-cigarettes are an “anchor” product: They draw people into the store.

“When people come and want to purchase something at the store and we don’t have that exact item that they want, they’re not going to buy the rest of the items that they might on that trip: a drink or a sandwich,” Zouzounis said.

She said sales from e-cigarettes account for at least $200 to $300 a day in sales. As a board member of the Arab American Grocers Association, she said she believes laws like this mostly affect businesses owned by immigrants.

Abbey Chaitin is a 15-year-old lifelong San Francisco resident. She isn’t drawn to using e-cigarettes, she said, because she has seen peers become addicted to them.

“I’ll see them in class fidgeting,” Chaitin said. “They need it to focus, to function.”

And Chaitin predicted that, regardless of a ban, young people will still get their hands on e-cigarettes: “People my age can find a way around that if they really need to,” she said.

Meanwhile, Juul is collecting signatures for a November ballot initiative to override the ban.

This story is part of a partnership that includes KQED, NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

The Values Of Health Care

Julie Rovner, the chief Washington correspondent for Kaiser Health News, joins Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and Alan Weil of Health Affairs at the Aspen IdeasHealth festival to discuss the politics surrounding the national debate on health care. The panel explores the failed effort to repeal and replace the Affordable Care Act, the strong support for coverage guarantees for people with preexisting conditions and for the expansion of Medicaid, and efforts among progressives to move to a “Medicare for All” system. The discussion is available here.