Tagged Elections

Must-Reads Of The Week From Brianna Labuskes

Happy Friday! The gloves came off and the knives came out at the debate this week, so let’s jump right into the fray.

Sen. Elizabeth Warren (D-Mass.) came out swinging on Wednesday night in an all-around livelier debate than most we’ve seen this primary season. When it came to health care, few were safe from Warren’s jabs — South Bend, Indiana, Mayor Pete Buttigieg’s plan was deemed “paper-thin,” Minnesota Sen. Amy Klobuchar’s was so short it could fit on a Post-it note. Even Vermont Sen. Bernie Sanders (whose plan Warren supports) was criticized as not being realistic or a team player.

Warren wasn’t the only one on the attack. Former Vice President Joe Biden hit at new-comer and billionaire Mike Bloomberg for once upon a time labeling the Affordable Care Act “a disgrace.” But Biden left out some context in that particular attack — such as the fact that Bloomberg was commenting that the law wasn’t enough to fix the deeply flawed health system.

Meanwhile, Midwestern Nice was put to the test as tensions between Buttigieg and Klobuchar boiled over. “You voted to confirm the head of Customs and Border Protection under Trump, who was one of the architects of the family-separation policy,” Buttigieg pointed out. At one point, Klobuchar shot out: “Are you trying to say that I’m dumb? Or are you mocking me here, Pete?”

The Washington Post: A Guide to the Most Biting Brawls of the Contentious Las Vegas Presidential Debate

The Washington Post: Fact-Checking the Ninth Democratic Debate

Buttigieg also tried to get Sanders to take some responsibility for his supporters’ social media behavior. The issue was top of mind this week after a powerful culinary union in Nevada condemned the “vicious attacks” its members were receiving following the union’s criticism of Sanders’ “Medicare for All” plan.

The Wall Street Journal: Democratic Debate in Nevada: The Moments That Mattered

The incident between the union and Sanders’ supporters is the tip of the iceberg of a larger Medicare for All civil war roiling organized labor. On one side, you have liberal unions who argue a government-run plan would free them up to refocus and allow them to concentrate on other important matters. The other side of the coin says there’s no way the health care provided under such a system would be as good as the hard-earned plans they have now.

Politico: Labor’s Civil War Over ‘Medicare For All’ Threatens Its 2020 Clout

I was overly optimistic last week in everyone’s desire to adopt an official name for the coronavirus outbreak. Sorry scientists, “COVID-19” does not seem to have taken off, and, at least colloquially, you might be stuck with “coronavirus.” But no matter what it’s called, it is still demanding the world’s attention. Here’s a look at some of the more noteworthy and interesting stories from the week:

— The number of cases in China keeps dropping, in a sign that the outbreak might be stabilizing, at least in the epicenter. But that doesn’t mean anyone should be optimistic (heaven forbid!), because it’s likely cases outside China are on the cusp of blooming into a pandemic.

The New York Times: Coronavirus Epidemic Keeps Growing, But Spread in China Slows

— The Washington Post peels back the curtain on a fight between the State Department and the CDC over whether infected cruise ship passengers should be flown back to America without telling the other people on the plane. Guess who won …

The Washington Post: Diamond Princess: State Department Flew Coronavirus-Infected Americans to the US Against CDC Advice

— Who in our cast of characters holds the responsibility of steering the world through this crisis? (All I keep thinking is: “Responders…Assemble!” Anyone else? Or only your resident Marvel geek here?)

Stat: The Responders: Who Is Leading the Charge in the Coronavirus Outbreak

— Why is a hospital in Omaha, Nebraska, making news? Because in the early 2000s a group of doctors and scientists came up with the idea of creating a biocontainment unit there. Not everyone was on board at the time, calling it “overkill.” But nearly two decades of epidemics have proved the skeptics wrong.

The Associated Press: Why Treat People Exposed to Virus in Omaha? Why Not?

The New York Times: First Ebola, Now Coronavirus. Why an Omaha Hospital Gets the Toughest Cases.

— Are computers better at spotting an outbreak before humans’ puny minds can? Well, they’re quicker, certainly, but they lack our finesse. AI is more like an overly anxious car alarm, and disease fighters are still needed to come in and tease out the complexities of the situation.

The Associated Press: Can AI Flag Disease Outbreaks Faster Than Humans? Not Quite

— More men than women are falling victim to the coronavirus, and that might have something to do with smoking rates.

The New York Times: Why the Coronavirus Seems to Hit Men Harder Than Women

— The prejudice that tagged along with this outbreak is nothing new. Experts warn that there’s a long history of this kind of reaction, and that if we don’t heed warnings about the consequences of such behavior we’ll just be repeating mistakes of the past again.

Undark: Coronavirus Spurs Prejudice. History Suggests That’s No Surprise.

— The vast majority of coronavirus cases are mild. But in 2% of cases, it’s brutally lethal. So what’s happening?

The Washington Post: How the New Coronavirus Can Kill People or Sicken Them

— Is COVID-19 here to stay or will it disappear like its coronavirus brethren?

Los Angeles Times: SARS Killed Hundreds and Then Disappeared. Could This Coronavirus Die Out?

— And, something I had not considered, but with the Olympics coming up, experts say the world needs to have a better grip on the virus before countries should think about attending.

The Associated Press: Virologist: Tokyo Olympics Probably Couldn’t Be Held Now

As the Trump administration pushes to increase patients’ access to their electronic health records, tech companies wait hungrily in the wings for the data to slip out from under the protection of HIPAA. Supporters of the administration’s moves say that Big Tech will be mindful of their own brands and reputations and treat the potential of (lucrative, sweeping) health data responsibly. Critics are a little less sure about that rose-colored-glasses view of an industry mired in data-privacy scandals.

Politico: Trump’s Next Health Care Move: Giving Silicon Valley Your Medical Data

Covered California enrollment numbers gave health law supporters something to be smug about this week: Thanks to a state-level individual mandate and more subsidies, the marketplace saw a 41% jump in new sign-ups. Covered California officials were pretty much, like, “See what can be done when you support this model?”

Sacramento Bee: Covered California Health Insurance Sign-Ups Rise in 2020

Speaking of California, Gov. Gavin Newsom made a big statement by devoting the entirety of his State of the State address to the homelessness crisis. “Let’s call it what it is. It’s a disgrace,” he said. A main focus for Newsom was the intersection of mental health and homelessness, and what the state can be doing to better help those who need it.

Los Angeles Times: California Homelessness Crisis ‘A Disgrace,’ Newsom Says in State of the State

In the miscellaneous file for the week:

— Pharma used to rule the roost on Capitol Hill. But those days are looking more and more like a thing of the past. The WSJ dissects the once-ironclad relationship between the industry and Republicans, and what went wrong for the drugmakers.

The Wall Street Journal: How the Drug Lobby Lost Its Mojo in Washington

— These days we’re used to courts demanding scientific evidence, to jurors being presented with experts in the field when having to make a decision about the medical ramifications of something like a pesticide or other chemical. But that wasn’t always the case. Undark looks back on when that changed, and the family that’s cited so often in court cases their name has become a verb.

Undark: For Science in the Courts, the Daubert Name Looms Large

— Ever wonder why things are priced to the 99 cents? That’s because of the way people perceive numbers and the greater likelihood you’ll buy something priced at $4.99 versus $5.00. When it comes to pennies, that might seem inconsequential. But it turns out the same kind of thinking can be applied to age — and, thus, decisions about where the cutoff should be on procedures like open-heart surgery.

Stat: How Psychology of a $4.99 Price Tag May Affect Doctors’ Decisions

— Everyone went into the opioid lawsuits with high hopes, buzzing about the possibility of the reckoning (and settlement) being akin to that of Big Tobacco’s in the 1990s. But the reality is likely to be a letdown.

The New York Times: Payout From a National Opioids Settlement Won’t Be As Big As Hoped

And that’s it from me! Have a great weekend.

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KHN’s ‘What The Health?’: The Labor Pains Of ‘Medicare For All’

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

Labor unions are divided over whether to endorse a Democratic candidate for president in 2020 — and, if so, whom to choose. Some unions are firmly behind the “Medicare for All” plans being pushed by Sens. Bernie Sanders and Elizabeth Warren. But the influential Culinary Workers Union in Nevada declined to endorse any candidate, with members worried about what might replace the generous benefits they won by bargaining away wage increases.

Meanwhile, a federal appeals court panel unanimously ruled that the Trump administration violated Medicaid law when it approved work requirements for beneficiaries in Arkansas. The ruling puts similar requirements in doubt in several other states.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Jennifer Haberkorn of the Los Angeles Times and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

  • Health care remains a top issue for voters, but candidates, eager to set themselves apart from the pack, are failing to point out the major policy differences they have with President Donald Trump. For example, at the Las Vegas debate Wednesday, no one mentioned the abortion case coming to the Supreme Court in March or the appeals court case that could invalidate the entire Affordable Care Act.
  • The Trump administration has approved Medicaid work requirements in more than a half-dozen states, with at least eight more pending. All of those state plan approvals are put in doubt by the appeals court opinion that such requirements violate the Medicaid statute.
  • Enrollment in Covered California, the state’s ACA exchange, grew by almost half a million from 2019 to 2020, the state just announced. California did many things other states did not, including extending premium subsidies higher up the income scale, reinstating the penalty for not having coverage that was zeroed out by Congress, and spending millions of dollars on outreach.
  • COVID-19, the novel coronavirus that originated in China, is complicating public health efforts way beyond that nation. U.S. firms are worried about shortages of drugs and drug ingredients that are made in China, and misinformation is spreading even more rapidly than the illness.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: CNN.com’s “Nation’s Largest Teachers Unions Call to End Active Shooter Drills Over Fears They’re Traumatizing Students,” by Leah Asmelash

Alice Miranda Ollstein: The Washington Post’s “Trust and Consequences,” by Hannah Dreier

Rebecca Adams: The New York Times’ “The Health System We’d Have if Economists Ran Things,” by Austin Frakt

Jennifer Haberkorn: Kaiser Health News’ “Ink Rx? Welcome To The Camouflaged World Of Paramedical Tattoos,” by Cara Anthony

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

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Scalpels Out: Democrats Make Slashing Attacks On Health Care Plans

Top contenders for the Democratic presidential nomination torched one another’s proposals to reform the health care system Wednesday, as the contest to unify behind a single candidate to defeat President Donald Trump took a bitterly divisive turn.

Minutes after Tom Perez, the chairman of the Democratic National Committee, warmed up the debate audience in Las Vegas by describing the party as a spirited but unified family, most of the candidates abruptly shifted into attack mode — and not just against Mike Bloomberg, the billionaire businessman and former New York City mayor making his first, belated appearance in the ninth debate.

Fighting to regain momentum after weak performances in the Iowa caucuses and New Hampshire primary, Sen. Elizabeth Warren of Massachusetts dispatched with her opponents’ plans in brutally rapid succession.

Pete Buttigieg, the former South Bend, Ind., mayor, has offered “not a plan” but “a PowerPoint” that she claimed would leave millions uninsured, she said. Sen. Amy Klobuchar of Minnesota has a proposal that is “like a Post-It note: Insert plan here,” she quipped. And Sen. Bernie Sanders of Vermont, whose “Medicare for All” plan she initially adopted as her own, “has a good start,” but his campaign cannot stop attacking those who question how it would work, she said.

“Health care is a crisis in this country,” Warren concluded. “My approach to this is, we need as much help for as many people as quickly as possible.”

It wasn’t the only tense moment.

Sanders Angers The Culinary Workers Union

How Sanders’ Medicare for All proposal would affect unions in particular isn’t a new question. But despite strong support for the proposal from some national unions, it emerged as a flashpoint in the run-up to Nevada’s caucus on Saturday, turning the state’s prominent Culinary Workers Union against Sanders, the current frontrunner, in the 11th hour.

The union did not endorse a candidate but warned members that Sanders’ proposal could eliminate the health care coverage they have gained through years of collective bargaining, replacing it with a system that is untested and unknown.  The union then put out a statement last week saying its members had been “viciously attacked” by Sanders’ supporters over the organization’s opposition . Sanders responded by saying that, though there were some bad actors on social media, it was “not thinkable” that his supporters would attack union workers.

“Let me be very clear for my good friends in the Culinary Workers union, a great union: I will never sign a bill that will reduce the health care benefits they have,” Sanders said. “We will only expand it for them, for every union in America and for the working class.”

Klobuchar defended the “hard-working” culinary workers “who have health care plans that have been negotiated over time, sweat, and blood,” she said. “And that is the truth for so many Americans right now.”

Last summer Sanders tweaked his proposal to try to alleviate concerns from unions. Under a Medicare for All system, he said, the National Labor Relations Board would supervise unions in renegotiating contracts with employers, so that they could acquire “wrap-around services and other coverage not duplicative of the benefits established under Medicare-for-all.”

The idea, Sanders’ aides said then, was so that any savings a switch to single-payer achieved could still be passed on to workers, as increased benefits or wages.

But members of the Culinary Workers Union — and some other groups — still worry about losing the coverage they have, in exchange for something unknown.

Would that happen? Technically, yes, the health plan Nevada’s culinary workers get through their union would no longer exist. Under Medicare for All, private health plans could not sell coverage that duplicates what the government program offers.

But it’s worth noting that, in this world, culinary workers would still have generous health insurance. Sanders’ envisioned health plan is robust – he says it would cover virtually all practicing physicians and medically necessary services, with virtually no cost-sharing.

Of course, that would also depend on whether a President Sanders could muster support for his plan among skeptical members of Congress.

$100 Billion In Profits

Sanders brought up one favorite talking point twice Wednesday — his claim that the health care industry makes $100 billion a year in profits. We previously checked this claim and rated it True. The number comes from adding the net revenues in 2018 from 10 pharmaceutical companies and 10 health insurance companies. We recalculated the numbers, and they added up. Experts said it was even likely that the figure was an underestimate. 

Big Pharma Is Giving Money To Buttigieg And Others 

In another biting moment, Sanders charged that drug companies are donating to Buttigieg and other campaigns as the pharmaceutical industry profits off the current system.

We previously checked Sanders’ claim that Buttigieg was a “favorite of the health care industry” and rated it Half True. This is in part because it is actually Sanders who has received the most donations of any Democratic candidate from the entire health care sector, which includes pharmaceutical companies, health insurance industry, hospitals/nursing homes and health professionals.

But, while checking this claim we also found that Buttigieg has received donations from employees and executives of pharmaceutical and health insurance companies such as AbbVie, Aetna, Anthem, Eli Lilly and Co., Merck & Co. and Pfizer. We did not check into donations for other candidates from pharmaceutical executives. 

Do People ‘Love’ Their Insurance?

You don’t start out by saying, I have 160 million people, I’m going to take away the insurance plan that they love,” Bloomberg said just minutes into the debate, pointing out the shortcomings of Sanders’ Medicare for All plan.

It is true that Sanders’ signature health proposal would eliminate private health insurance, replacing it with a single public plan that covers everybody. That would include the roughly 160 million Americans who get employer-sponsored insurance

But Bloomberg’s argument here — that those people “love” their plans — is complicated.

When we previously checked a similar claim — that 160 million people “like their health insurance” — we rated it Half-True. Cursory polling suggests people with that coverage are mostly satisfied. 

But most isn’t all. And, experts pointed out to us then, once Americans try to use that coverage, many find it lacking. In a Kaiser Family Foundation/ L.A. Times poll, for instance, 40% of people with employer-sponsored insurance still reported having trouble paying for medical bills, premiums or out-of-pocket costs. In that same poll, about half said they skipped or delayed health care because — even with coverage — they couldn’t afford it. (Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.)

And More About Warren’s Attach On  Klobuchar’s Health Plan

“Amy, I looked online at your (health care) plan. It’s two paragraphs.” Warren said.

This is highly misleading.

Warren’s campaign told PolitiFact that she was referring specifically to Klobuchar’s plan for “universal health care.” It pointed to the two paragraphs at the end of this Klobuchar campaign web page, which come under the heading “Propose legislation to get us to universal health care.” 

But that ignores most of Klobuchar’s health care plan, which she outlines in quite a bit of detail on four different web pages — a main health care policy page, a more detailed sub-page, a sub-page on prescription drugs and a sub-page on mental health.

We did a word count on the text from those four web pages, and it exceeded 6,000 words — and a lot more than two paragraphs.

PolitiFact’s Louis Jacobson contributed. 

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Obamacare A Disgrace? Biden Highlights Bloomberg’s Negative Remarks About The Affordable Care Act.

Sparring over health care during the Nevada Democratic presidential primary debate, former Vice President Joe Biden took issue with former New York City Mayor Michael Bloomberg’s record on the Affordable Care Act.

“From the moment we passed that signature legislation, Mike called it a disgrace,” Biden said, a claim he repeated another time during the debate. 

Bloomberg sought to refute that charge, arguing that he defended the law and believed it should be expanded.

It was a heated moment. Both candidates are trying to tie themselves to former President Barack Obama, who spearheaded the 2010 legislation. So we decided to dig in.

We reached out to both campaigns for comment. We didn’t hear back from Bloomberg’s campaign. The Biden campaign sent a CNN article, which cited a speech Bloomberg gave at the Dartmouth Presidential Lecture in July 2010 — just a few months after the health care legislation was passed in March. In the speech, Bloomberg called the Affordable Care Act “a disgrace.” We found a video of the speech on YouTube. 

The remarks 

In the video, Bloomberg was unsparing. 

“We passed a health care bill that does absolutely nothing to fix the big health care problems in this country. It is just a disgrace,” he said. “The president, in all fairness, started out by pointing out what the big problems were, but then turned it over to Congress, which didn’t pay any attention to any of those big problems and just created another program that’s going to cost a lot of money.”

Those aren’t standalone remarks. As recently as 2014, Bloomberg called the law “really dysfunctional” during a talk he gave at the annual meeting of SIFMA, one of the financial industry’s trade groups. 

Both times, Bloomberg was still a registered Independent — he didn’t become a Democrat until 2018.

It’s also worth noting that Bloomberg wasn’t espousing a minority view. The ACA’s approval rating was underwater until 2017, according to polling by the Kaiser Family Foundation. (KHN is an editorially independent program of the Foundation.)

Bloomberg’s response

On the debate stage, Bloomberg sought distance from those remarks, saying he is a “fan of Obamacare.”

“I wrote something supporting it either in the New York Post or the Daily News,” he said.

The op-ed he appears to be referring to — published March 27, 2017, in the New York Post — does indeed talk about the ACA. But it comes years after Bloomberg’s mayorship ended. And while words like “disgrace” don’t appear, calling the piece a “defense” of the law isn’t entirely fair.

In it, Bloomberg noted some key shortcomings — for instance, the health law left 30 million people uninsured. He also argued in support of some ideas more popular with Republicans, such as high-risk insurance pools, as a way to bring down costs.

“It’s regrettable that none of these ideas was seriously considered in the rush to repeal ObamaCare,” Bloomberg wrote at the time.

It is worth noting that Bloomberg’s current health care plan would build on the ACA, largely by increasing subsidies for people buying private insurance on the exchanges, and by installing a Medicare-like public option. (That plan is quite similar to what’s been touted by Biden himself, as well as by candidates like former South Bend, Ind., Mayor Pete Buttigieg.)

Our ruling

Biden said that Bloomberg called the ACA “a disgrace.”

Evidence supports that. And it’s not the only time Bloomberg took issue with the law — even if it is a core component of his current proposal for health reform. 

We rate this claim True.

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Sanders’ Claim That Buttigieg Is ‘Favorite Of The Health Care Industry’ Is Broad And Needs Context

As Pete Buttigieg gained momentum in the Democratic presidential primary race ― finishing second in the New Hampshire primary and a front runner in the Iowa caucuses ― he has increasingly been on the receiving end of shade from his rivals.

The campaign of Sen. Bernie Sanders (I-Vt.), for instance, distributed talking points that zeroed in on fundraising, saying “Pete Buttigieg is a favorite candidate of Wall Street and the health care industry.”

The former mayor of South Bend, Indiana, already faced criticism over his “billionaire donors,” which famously manifested during the Dec. 19 Democratic debate. It was then that Sen. Elizabeth Warren (D-Mass.) described a Buttigieg fundraiser as held in “a wine cave full of crystals.”

Sanders’ comments led us to wonder if Buttigieg really is the sweetheart of the health care industry. We asked the Sanders campaign for its evidence. Staffers pointed us to data from the Center for Responsive Politics, a nonprofit group that operates the website OpenSecrets.org and tracks money from individuals and political action committees donated to political candidates and members of Congress. The center analyzes Federal Election Commission data and sorts contributions by categories based on the economic sector from which they come.

A Deep Dive Into The Numbers

The Sanders campaign used OpenSecrets data it obtained in December 2019. But the OpenSecrets website has since been updated with fourth-quarter filings, so we couldn’t confirm the figures the campaign cited.

Instead, Doug Weber, a senior CRP researcher, pointed to the 2020 presidential race section of OpenSecrets, saying it contains the most accurate data for presidential campaign contributions. It also highlights industry contribution trends focused only on the presidential giving ― in other words, excluding contributions made to Senate campaign accounts.

We asked Weber if Sanders’ talking point about Buttigieg is true. That “depends on what you mean by ‘health care industry,’” Weber wrote in an email. OpenSecrets defines its health sector by contributions from PACs and individuals working in various health industries, he said, and “for our data, that’s our broadest definition of health care.”

Based on this sweeping categorization, Sanders is ahead of Buttigieg in health sector donations. The Vermont senator received $2,910,894, while the former South Bend mayor trailed closely behind with $2,713,038.

However, when you break down this data by industries within the health sector, Buttigieg comes out ahead of Sanders in contributions from pharmaceutical companies and also for health services/HMOs ― which includes groups like large insurance companies.

But even this point is nuanced. Former Vice President Joe Biden has received the most money of any Democratic candidate from the pharmaceuticals and health products sector if contributions from his leadership political action committee are included. Leadership PACs are committees unaffiliated with campaigns that can still receive contributions and financially support candidates.

In the health care industry categories of hospitals/nursing homes and health professionals, Sanders has received the most in dollar contributions.

When asked to clarify how the Sanders campaign is defining the health care industry, a staffer responded that “Bernie Sanders issued a pledge to not accept money from top officials of the insurance and pharmaceutical industries (as distinct from rank-and-file workers in those industries, which the aggregate data you cite deals with). He asked other candidates to do the same. Pete Buttigieg has refused to take that pledge, and has instead raised money from those top officials…These clear, demonstrable and verifiable facts makes very clear precisely what we are referring to.”

The Sanders campaign sent us a list of pharmaceutical and health insurance executives that have contributed to Buttigieg, including employees and executives from AbbVie, Aetna, Anthem, Eli Lilly and Co., Merck & Co. and Pfizer. We checked that list against the Federal Election Commission database to ensure its accuracy. In addition, the Sanders’ campaign shared an October 2019 article from Sludge, an investigative journalism outlet focused on money in politics, which estimated Buttigieg’s third-quarter health care industry donations approached $97,000.

We also checked in with the Buttigieg campaign for a response, which replied that “more than 800,000 Americans” have donated to its candidate. The campaign’s emailed statement noted that Buttigieg’s “Medicare for All Who Want It” plan draws industry attacks because the health system “will have to provide more affordable coverage and better care or they will lose customers as people enroll in the public option.”

What Does It All Mean?

It seems the Sanders’ claim is “imprecise,” said Robert Maguire, research director at the nonprofit group Citizens for Responsibility and Ethics in Washington (CREW).

“Given that the health industry itself is vast, what I assume the Sanders’ campaign … meant to say was that the more corporate aspects of the health industry ― like the pharmaceutical industry and the health insurance industry ― were funding Buttigieg disproportionately to others,” he added.

Michael Beckel, research director of Issue One, a nonprofit organization focused on transparency and enforcement of campaign finance laws, said the key to understanding this claim is that the Sanders campaign is characterizing money from the health insurance and pharmaceutical industry differently than campaign contributions from individuals, such as nurses and other health professionals.

“Rank-and-file employees in one industry don’t always express the same political preferences as executives in that industry,” Beckel wrote in an email. “Even as he’s railed against the pharmaceutical industry and insurance industry, Sen. Sanders has welcomed support from labor unions representing nurses.”

Michael Malbin, a political science professor at the University at Albany-State University of New York, also took issue with the idea that an individual giving the maximum amount of money to a campaign could sway the candidate’s policies.

“Every time election season rolls around, there are stories about individuals employed in one industry favoring one candidate over another, and it could be for whatever reason,” said Malbin. “But, you cannot make the inference from industry coding … that they are giving just for a certain economic interest. Let alone that it’s remotely enough money to drive a presidential campaign. … It’s a $2,800 maximum, for crying out loud.”

The actual composition of donors in the health category can’t be known without analyzing OpenSecrets’ full data set ― which we could not do since it’s not publicly available.

OpenSecrets does, however, analyze the percentage of small donor donations (less than $200) and large contributions for each presidential candidate. And 56% of Sanders’ contributions are from small donors, while 45% of Buttigieg’s campaign contributions come from that same group.

Our Ruling

Sanders’ use of the phrase “health care industry” in this instance is too broad to support the point he is trying to make.

According to recently updated OpenSecrets data, Sanders has received more donations from the health sector than any other 2020 presidential candidate.

However, when the broad “health sector” category is narrowed down to pharmaceutical and health insurance companies, which are two targets of Sanders’ campaign, Buttigieg is shown to have received more donations than Sanders. He has also received donations from top pharmaceutical executives ― offering evidence to support Sanders’ claim. But in specifying donations from the pharmaceutical/health products sector, Biden tops Buttigieg when factoring in contributions to Biden’s leadership PAC.

Context is also important. It’s likely a large number of Sanders’ health care contributions are from nurses and doctors as individuals. There’s no way to identify whether this support was related to the candidate’s health policies or motivated by other reasons.

Sanders’ claim has some truth to it but is imprecise. For this reason, we rate the claim Half True.

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Sanders’ Rift With Culinary Workers Reveals A Labor Union Civil War Over ‘Medicare For All’

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Would ‘Medicare For All’ Cost More Than U.S. Budget? Biden Says So. Math Says No.

During the Feb. 7 Democratic presidential debate, former Vice President Joe Biden once again questioned the price tag of “Medicare for All,” the single-payer health care proposal championed by one of his key rivals, Sen. Bernie Sanders of Vermont.

Biden argued that the plan was fiscally irresponsible and would require raising middle-class taxes. Specifically, he claimed, the plan “would cost more than the entire federal budget that we spend now.”

Medicare for All’s price — and whether it’s worth it — is a subject of fierce discussion among Democratic presidential candidates. But we had never heard this figure before. It caught our attention, so we decided to dig in.

Biden’s campaign directed us to the 2018 federal budget, which totaled $4.1 trillion. It compared that amount with the estimated cost of Sanders’ single-payer proposal: between $30 trillion and $40 trillion over a decade. The math, they said, shows Medicare for All would cost more than the national budget.

But it turns out, based on the numbers and interviews with independent experts, Biden’s comparison of Medicare for All’s price to total federal spending misses the mark because the calculation is flawed.

The Numbers

Sanders has said publicly that economists estimate Medicare for All would cost somewhere between $30 trillion and $40 trillion over 10 years. Research by the nonpartisan Urban Institute, a Washington, D.C., think tank, puts the figure in the $32 trillion to $34 trillion range.

We pointed out to Biden’s campaign that comparing 10-year spending estimates to one-year budgets is like comparing apples to oranges. The campaign suggested that if you take 10 times the current federal budget, you get a figure smaller than the estimated cost of Medicare for All over that 10-year window.

That calculation would lead you to multiply $4.1 trillion by 10 to get $41.1 trillion. That result is close to the high mark Sanders set for his program’s cost but well above the $34 trillion that Urban researchers projected.

Still, that’s not the correct way to formulate a comparison, experts say. “That’s not good math,” said Marc Goldwein, the senior vice president and senior policy director at the Committee for a Responsible Federal Budget. “That’s taking a 2018 number and multiplying it by 10, whereas the $34 trillion is a 10-year number that assumes a lot of growth.”

What you would need to do is add up the Congressional Budget Office’s projected budget outlays from 2020 to 2029, and compare the sum to the Medicare for All spending figure.

So we spoke to Linda Blumberg, an institute fellow at Urban’s Health Policy Center, who arrived at the $34 trillion estimate. She ran the CBO’s numbers: The next 10 years of on-budget outlay, the government office projects, add up to $44.8 trillion.

To be clear, $34 trillion (34 followed by 12 zeros) is no small sum. It accounts for about 75% of that nearly $45 trillion budget estimate and would represent a bigger single increase to the federal budget than we’ve ever experienced, Blumberg said.

That raises one point on which Biden may have some ground. Goldwein argued that you would indeed need significant tax increases to finance the Sanders proposal.

But its price tag still would be less than the projected budget.

“If he said [Medicare for All] was as big as the current federal budget, that would be incorrect,” Blumberg said.

Goldwein looked at the numbers another way: Including interest, he found, the federal budget would consume about $55 trillion between now and 2030. Again, that’s more than what Medicare for All would cost during the same period.

Big picture: No matter how you slice Biden’s math, his numbers are off.

“If what he said was Medicare for All will cost as much as the entire rest of the budget, that would be fair,” Goldwein said. But that’s not the same thing.

Our Ruling

Biden argued that Medicare for All “would cost more than the entire federal budget that we spend now.”

This relies on faulty math. Medicare for All would certainly represent a substantial increase to the federal budget. But it would neither match nor dwarf current federal spending overall. We rate this claim False.

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KHN’s ‘What The Health?’: Live from D.C. With Rep. Donna Shalala

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President Donald Trump’s proposed budget for the fiscal year that begins in October proposes big cuts to popular programs, including Medicaid and the National Institutes of Health. Although those cuts are unlikely to be enacted by Congress, both Republicans and Democrats are likely to use the budget blueprint as a campaign issue.

Meanwhile, several House committees this week relaunched work on legislation to address “surprise” medical bills — unexpected charges from out-of-network providers. And Congress is still trying to come to a bipartisan agreement on how to address drug prices.

Rep. Donna Shalala (D-Fla.) was the special guest for this week’s podcast, taped before a live audience at the Kaiser Family Foundation headquarters in Washington, D.C. Also joining host Julie Rovner of Kaiser Health News were Paige Winfield Cunningham of The Washington Post, Rebecca Adams of CQ Roll Call and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

  • One surprise in the president’s budget is a proposal to move tobacco regulation out from under the Food and Drug Administration’s purview. That comes despite a law Congress passed several years ago that specifically named the FDA as the regulator for tobacco.
  • Last year, it seemed clear that Congress and the White House were determined to find a way to protect consumers from surprise medical bills. But heavy lobbying on the issue and deep fissures in pinpointing the best remedy have slowed that effort. Shalala said she thinks Congress will produce a bill this year that will be balanced so that insurers and medical providers have to compromise.
  • Shalala said that in the 21 town meetings she has held in South Florida, no one has asked about efforts to end surprise bills. Most of the health questions focus on high drug prices and out-of-pocket costs. High out-of-pocket costs have been driven by the large number of people shifted into high-deductible insurance plans.
  • Shalala also said she doesn’t expect a plan to import drugs from Canada, endorsed by the Trump administration and some states, to go forward. Drugmakers sell Canada enough medicine to cover the population there, and not consumers in Florida, she added.

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Newsom Touts California’s ‘Public Option.’ Wait — What Public Option?

Several Democratic presidential hopefuls are pitching a federal “public option” as a way to expand health coverage and make it more affordable.

The details of their proposals vary, but the general idea is to create a government-sponsored plan that could compete with private insurance.

“We have a public option, just so folks know,” California Gov. Gavin Newsom claimed last month as he unveiled his proposed 2020-21 state budget. “It’s called Covered California.”

Hmm, really?

California does not have a public option in the way most people understand the term. According to Newsom’s definition, offering a public option simply means ensuring that consumers have choices and affordable coverage, and that health plans are held accountable, things Covered California already does, his office said.

That’s a stretch, say some health care and political experts.

Covered California “is manifestly not a public option,” said Thad Kousser, chair of the political science department at the University of California-San Diego.

Kousser theorized that Newsom may be co-opting the term to make it seem like the state is making progress toward his goal of creating a single-payer system.

But if Newsom wants to flout the term, the state should “create a public option that doesn’t involve insurance companies, and Covered California is a market to buy insurance from insurance companies,” Kousser said.

Covered California is the state-run exchange, created under the Affordable Care Act, where some individuals, families and small businesses can purchase insurance.

A public option is considered less sweeping than single-payer, a system in which health care is paid for by a single public authority. As a candidate, Newsom, a Democrat, campaigned for the creation of a single-payer program.

But that isn’t likely to happen anytime soon, for a variety of reasons. For one, the Trump administration has said it would reject any state plans to use federal dollars to implement single-payer.

At the national level, Democratic presidential candidates including former Vice President Joe Biden and former South Bend, Indiana, Mayor Pete Buttigieg have pitched public-option plans that would allow, but not require, people to buy into government-run plans similar to Medicare.

The idea is to boost competition by allowing people to choose between private plans and a government-run plan — and reduce costs.

Only one state, Washington, is implementing its own version of a public option, but other states are considering it.

Cascade Care, a hybrid system in which the state will contract with an insurer to administer a public-option plan, will debut in 2021. The state will attempt to control costs by setting payment rates at 160% of what Medicare would pay for the same service. Colorado is proposing a similar idea.

This version is different from the presidential candidates’ proposals because an insurance company will be responsible for running the public-option plan — not the government. But, ultimately, Washington will give its residents a new health insurance option, and that’s not the case in California, said Billy Wynne, chairman of the Wynne Health Group, which recently launched the Public Option Institute, a group analyzing the implementation of public-option programs.

But in California’s defense, he said, what constitutes a public option “is in the eye of the beholder.”

Peter Lee, executive director of Covered California, is also calling the exchange a public option. He argues that public-option plans assume different forms, just like single-payer or Medicare for All proposals.

On the exchange, “plans don’t compete on their own terms; they compete on our terms,” Lee said.  So, “is a public option only a government plan, or is it a public program that sets the rules of how private plans compete?”

Linda Blumberg, a health policy fellow at the Urban Institute, hazards an answer: While Covered California actively negotiates with health plans to keep premiums down, it “doesn’t quite have the spirit of a public option” because it doesn’t bear the financial risk that insurance companies do.

Newsom’s Healthy California for All Commission, which is debating how to get every Californian covered — with an emphasis on single-payer — gathered in Sacramento last month for its inaugural meeting. The commissioners briefly discussed the possibility of implementing a public option as a steppingstone to achieving universal coverage.

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But the concept didn’t get much love, and some commissioners suggested that instead of creating a public option, the state should strengthen existing public programs. One commissioner said the idea of a public option had already fizzled.

“Whatever happened to Vanilla Ice, and whatever happened to Tiny Tim and Miss Vicki? Whatever happened to public option?” asked Dr. Robert Ross, president of the California Endowment, a foundation that focuses on expanding health care access among Californians. “It just kind of went away.”

The closest thing to a functioning public option in California, under the traditional definition, may be the L.A. Care Health Plan, a public, nonprofit insurer equally available to Los Angeles County residents with Medi-Cal, the state’s Medicaid program for low-income residents, and to those who earn too much to qualify for Medi-Cal.

John Baackes, the plan’s CEO, said L.A. Care functions like the public-option plan described in the U.S. House version of the Affordable Care Act, before it was axed in the Senate. “Their definition of the public option was a public entity that did not have shareholders that would compete with commercial insurers in the individual market,” Baackes said.

L.A. Care, created to serve Medi-Cal patients, later opened to individuals and families who purchase their own insurance through Covered California or the open market.

For some time, Baackes said, the plan was the lowest-priced option in the Los Angeles area.

“Our enrollment skyrocketed because this is a very price-sensitive market, but in 2020, we were underbid by competition,” Baackes said. “To me, that’s exactly what the public option was supposed to do: put pressure in the marketplace. So I’m saying if you want to see how it works, look here.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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In Fierce Debate, Democratic Candidates Expand Health Agenda Arguments

Democratic presidential candidates faced off on the debate stage for the eighth time this campaign season. Meeting in Manchester, N.H., they returned to now familiar health care themes — “Medicare for All” versus a public option, the cost of prescription drugs and other key areas they say are ripe for change.

Once again, candidates sparred over the cost of the single-payer health reform bill promoted by Vermont  Sen. Bernie Sanders. Former Vice President Joe Biden argued it would necessarily raise taxes, pointing to its estimated $32 trillion price-tag (a number supported by independent economist estimates). Sanders noted that over the next decade, the nation is projected to end up spending more than $50 trillion on health care. (That’s also borne out by evidence.)

Sen. Elizabeth Warren of Massachusetts and Sen. Amy Klobuchar of Minnesota also dove into issues related to abortion rights. Warren touted the statistic that three out of four Americans believe that Roe v. Wade should be the law. This is pretty accurate — a recent Kaiser Family Foundation poll found that 69% of Americans do not want Roe v. Wade overturned. And Klobuchar again talked about how there is overwhelming support for Planned Parenthood. We previously checked this claim.

The candidates also discussed the opioid epidemic and the shortage of substance abuse treatment beds — in New Hampshire and nationwide.

Here are some highlights and related fact checks:

You sent out a tweet just a few years ago you said ‘henceforth, forewith you are for Medicare for all for the ages.’

Sen. Amy Klobuchar, Feb. 7, 2020

The truth is I have been consistent throughout in my position on health care for every American.

Former South Bend Mayor Pete Buttigieg, Feb. 7, 2020

Klobuchar and Buttigieg, the former mayor of South Bend, Ind., sparred over his record of support for Medicare for All, the single-payer health care bill Sanders backs. Klobuchar noted that Buttigieg previously tweeted in favor of the bill and has since changed his position. Buttigieg said he has been consistent on supporting an approach that would bring health care to all Americans.

Klobuchar’s point — that Buttigieg has at least expressed support for the specific bill, and no longer does — is supported by evidence.

The tweet was posted on Feb. 18, 2018. Buttigieg wrote, “I, Pete Buttigieg, politician, do henceforth and forthwith declare, most affirmatively and indubitably, unto the ages, that I do favor Medicare for All, as I do favor any measure that would help get all Americans covered.”

Since then, Buttigieg has narrowed his stance — backing “Medicare for all who want it,” a plan he argues would also achieve universal coverage, by letting people opt into a public health plan, and offering more generous subsidies for those who purchase private insurance. (Proponents of single-payer are skeptical it would succeed.)

To be fair, even Buttigieg’s 2018 statement includes an important qualifier — he’s not tied to the plan. He favors Medicare for All, he says, as he does “any measure that would help get all Americans covered.” If you agree that his current plan would also achieve universal health care, there’s an argument that he has been consistent.

—Shefali Luthra

It would cost more than the entire federal budget that we spend now.

Former Vice President Joe Biden, Feb. 7, 2020

This is in reference to Medicare for All. We contacted Biden’s campaign, who directed us to the 2018 federal budget — $4.1 trillion — compared to the estimated $32 trillion price tag of Sanders’ single-payer proposal. But there’s a problem: That latter number is an estimate of the cost for 10 years. So putting one year of the budget against a decade of health spending is comparing apples and oranges.

And converting one year’s budget to a decade-long forecast is an economically complex proposition — it’s not so simple as just multiplying by 10.

We also ran this claim by an independent expert, who crunched the $32 trillion estimate. Linda Blumberg, an institute fellow at the Urban Institute, told us Biden’s comparison is “an exaggeration” and “overstatement.”

Certainly, she said, Medicare for All would be “a bigger increase to the federal budget than we’ve ever experienced” — more than a 70% increase, compared to the CBO’s 10-year budget estimate.

“This is an enormous increase, but it wouldn’t double” the budget, she said.

—Shefali Luthra

The health care industry makes $100 billion in profit.

Sen. Bernie Sanders, Feb. 7, 2020

This is a favorite talking point from Sanders. We double-checked the math during the last debate. It holds up — and is probably an underestimate.

The figure is derived by adding the “net revenues” as reported by the companies for 10 pharmaceutical companies and 10 companies that work in health insurance. Multiple independent economists reviewed the methodology with, and affirmed that it’s sound. In fact, the total “net revenue” — or profit — is actually around $101 billion.

The talking point doesn’t include health care’s biggest earners, though: hospitals and health systems. When you factor them in, experts previously told us, the level of profit in our system will grow significantly larger.

—Shefali Luthra

30,000 Americans a year die waiting for health care because of the cost.

Sen. Bernie Sanders, Feb. 7, 2020

The way Sanders uses this number is problematic and oversimplifies the research. When we previously fact-checked this claim, we rated it Half True.

It appears that the number comes from Physicians for a National Health Program, which cited the Oregon Health Insurance Experiment, a study that assigned by lottery some participants to Medicaid and the others remained without insurance. A year into the experiment, researchers found that the death rate differed by 0.13 percentage points between those who were on Medicaid and those who were not — though this difference was not statistically significant. If you extrapolate this number to the number of Americans who are uninsured — about 27 million — then you do get close to a figure of about 30,000 people.

However, experts said that since the difference was not statistically significant it shouldn’t be extrapolated so broadly, and it’s possible that Sanders’ number is too high. Other research does show that there is a connection between being uninsured and higher likelihood of mortality. Thousands of Americans die waiting for health care every year, but this number relies on imprecise math.

—Victoria Knight

36 million Americans last year couldn’t afford to fill a prescription, including those with insurance.

Sen. Elizabeth Warren, Feb. 7, 2020

This is true. If anything, it falls a little short.

The data comes from an estimate by the  Commonwealth Fund, a health care research and advocacy group. Researchers found that in 2018, 37 million non-elderly Americans — about 1 in 5 people — skipped a prescription because they couldn’t afford it. Some of those people had coverage. Others were “underinsured.” That means they had insurance, but it wasn’t enough to safeguard them from large medical bills.

Other data suggests it’s potentially even worse. A November poll from West Health and Gallup estimated that 58 million Americans experienced what they called “medication insecurity” in the past 12 months.

—Shefali Luthra

How about we start with what a president can do —  I love saying this — all by herself? On day one I will defend the Affordable Care Act and use march-in orders to reduce the costs of commonly used prescription drugs like insulin and HIV/AIDS drugs and EpiPens.

Sen. Elizabeth Warren, Feb. 7, 2020

On the campaign trail, Warren has often mentioned that she would use the power of the executive office to reduce prescription drug prices for drugs such as HIV medication and EpiPens. We checked it, and it is true that the president has these executive powers.

Warren has in her “Medicare for All” transition plan a pledge that she would use two legal mechanisms to achieve this goal — “compulsory licensing” and march-in rights. Compulsory licensing means the government will take over a patent if a drug’s prices are too high and create competition. There is precedent for this approach, it was done in the 1960s for cheap generic drugs and in 2001 for Ciprofloxacin during the anthrax scare. Experts said this likely couldn’t be applied to all drugs but could work for insulin and EpiPens.

March-in rights are when the government “marches in” during a public health crisis because a drug isn’t available. But, it only works for drugs in which the government holds all of the patents, such as Truvada, the HIV prevention drug. However, this mechanism has never been employed and it’s unclear whether high prescription drug prices would qualify as a public health concern. Officials at the National Institutes of Health would also have to approve this measure, and it would face significant backlash from the pharmaceutical industry.

Warren is right that the laws are in place for her to reduce prescription drug prices without the power of Congress, but it’s likely it would be difficult.

—Victoria Knight

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