Basically, CBO finds GOP’s HealthCare Bill Mean to Older Folks

By the time the Senate deals with the House’s American Healthcare Act, President Trump will likely already turn 71. His birthday is June 14.

That older chap will be covered, but if the healthcare bill becomes law, an estimated 23 million more people than now will lose their health insurance, the latest Congressional Budget Office report released yesterday shows.

“People age 50 to 64 would be particularly hit hard, especially those with lower incomes,”  AARP notes in a blog.

The huge CBO takeaway nugget, it says:  A 64-year-old earning $26,500 a year would face insurance costs that would increase $14,400 in 2026.

And remember those promises that Trump made about covering people with pre-existing conditions?

Well, that was a pre-existing statement that apparently wasn’t meant to stick.

“People with pre-existing conditions may not even be able to purchase health insurance because the prices would be prohibitively high,” the AARP notes.

Obviously, the Senate will be making many changes to the healthcare bill. A big question rests with the pre-existing conditions.  And maybe there are some second thoughts in the House? Freedom Caucus Chairman Mark Meadows, R-NC, became emotional and revealed his surprise about the pre-existing condition issue noted by the CBO. He mentioned his  own family’s battles with cancer, according to the Independent Journal Review

“Listen, I lost my sister to breast cancer,” Meadows is quoted as saying.  “I lost my dad to lung cancer. If anybody is sensitive to pre-existing conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.”

Among the other problematic issues,  the AARP says: Possible instability in individual insurance markets and the potential difficulties for less healthy people in states that receive waivers to allow insurers to eliminate coverage for essential benefits.

Quoting the CBO report: in states receiving the waivers, “less healthy people would face extremely high premiums,” the AARP says.

“The CBO analysis found that premiums would go up to unaffordable levels by inflicting an age tax and removing current protections for people with common conditions including diabetes and weight gain,” said Nancy LeaMond, AARP Executive Vice President in a statement.

“Putting a greater financial burden on older Americans is not the way to solve the problems in our health care system,” she said.

The huge number that doesn’t get much attention, but wow: The CBO report noted that by 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law.

When you turn 71, Mr. President, think of other older people, including septuagenarians like yourself. Those people who may count on the government for healthcare, but may not get it.

–  Joe Cantlupe

 

 

What Are The Right Numbers? Researchers Look For Data To Support (or Rebuff?) Urgent Care- ED Study

Analysis

An at least temporarily pulled study that shows the low costs of urgent care centers compared to free-standing emergency departments in Texas shed light on the infighting that can exist in the seemingly staid world of academic papers.

The conflict over the paper for the Annals of Emergency Medicine,  the journal of the official publication of the American College of Emergency Physicians, exposes the much lamented “silos” in healthcare, and interest groups trying to demonstrate the advantages of either urgent care centers or emergency departments and their impacts on patients.

Or do they?  Or does the situation show that researchers and physicians are addressing far different scenarios in a search for truth that the journal editors just feel uncomfortable about, at this point, and don’t believe is fully documented?

Those are the among the issues that are likely to be explored in the days, weeks, or months ahead in the wake of the Journal of Emergency Medicine’s decision to pull from its website the study that determined that, for instance, a patient can be charged as much as 10 times more in a free-standing emergency room than in an urgent care center for the same diagnosis.

Some emergency department officials complained about flaws of the findings, raising questions about the data. The top author, however, has said the criticism was unfounded and appeared to be political.  HealthDataBuzz revealed the removal from the website on May 8.

The complaints in question about the study centered on data about reimbursement rates paid to doctors, journal editor-in-chief  Michael  Callaham told the Houston Chronicle. Lead author Vivian Ho, a health economist at Rice University’s Baker Institute,  had said officials of the journal had complained mostly about data in an appendix in the study that was later corrected.  Retraction Watch also has reported on the controversy.

Blue Cross Blue Shield of Texas Says the Controversial Study is Right On

Recently, the paper by Ho and colleagues gained a big boost for its accuracy from Blue Cross Blue Shield of Texas, whose researchers also participated in the study.

“This important study highlights the unnecessary increase in cost associated with the use of freestanding emergency rooms, particularly at a time when healthcare costs continue to rise,” BCBS’s Chris Callahan, senior director, media and public relations, said in a statement.  “The facts remain, freestanding emergency rooms charge up to 10 times more than urgent care centers with more than 75% overlap in diagnoses.”

The statement said that the BCBS “firmly supports the work done” by Ho and other authors from Texas academic institutions in the paper.

On the surface, the BCBS statement — similar to one given and first reported by the Houston Chronicle —  appears to be a strong backing of the study. Game over. A home run. Get the study back in the journal and published, no?

Not Ready Yet

But…hold on.

The BCBS statement was immediately criticized, as a top official representing free-standing emergency departments accused Blue Cross Blue Shield of engaging in a scheme against emergency medicine doctors, the Chronicle reported.

Meanwhile, in  email exchanges with HealthDataBuzz within the past two weeks, Callaham, the journal editor, professor emeritus of emergency medicine at the University of California-San Francisco,  said that although BCBS told the press it validated the findings, it had yet to send him information “attesting to the completeness of the data.”

The journal’s editor said he wanted BCBS  to share the data or at “least provide an important third party assessment of it.”

However, Blue Cross Blue Shield of Texas said it would communicate with Ho, not the editor.  “The communication channel has been between the journal and Dr. Ho,” the BCBS spokesman said. “As lead author, it’s probably best to keep that as the primary channel.”

That disappointed Callaham, the journal editor.  Callaham said he would have liked a “specific executive to be responsible for the completeness of the data, not an anonymous” quote to the press from BCBS.

“There should be an identified individual who stands behind the data and vouches that it is accurate and complete,” Callaham said.

The data. There’s the rub.

In the meantime, Ho is planning a follow-up response, and both sides are hoping to work toward a resolution, though judging from the statements and feelings of the parties involved, it may not be an easy task.

Whatever decision is reached can be a boon for care for patients, the ultimate priority, when they figure out the numbers.

— Joe Cantlupe

 

 

Our Failing To Understand Addiction

Part 2 The Opioid Crisis

Americans are mostly good-hearted people and rush to make food or visit their neighbors who return from a hospital stay.

But what about when someone returns home from a drug-rehabilitation stint after an opioid abuse incident?

Any balloons around the mailboxes? Any proposed get-togethers to celebrate?

Don’t count on it, says Leslie R. Dye, MD, FACMT, Editor-in-Chief, Point of Care Content for Elsevier and President of the Medical Toxicology Foundation.

“Much of the public and medical community still does not realize that addiction is a disease and not a moral failing,” she says. “Addiction is not a casserole disease. When someone has cancer the neighbors bring casseroles; when someone goes to treatment for addiction, the family is often ashamed and shamed.”

“If we try to treat hypertension by telling people that they’re bad people and need medication, how effective would that be? An addict also needs medication, even if it is going to regular 12 step meetings.”

“The fact that addiction is a disease does not excuse the problem. Those with the disease have the responsibility to treat it,” Dye says.”

Opioid involved deaths have continued to increase and overdose deaths have quadrupled since 1999. In Part 1 Dye discussed many factors surrounding the national epidemic of opioid and heroin abuse,  including over-treatment of pain, the explosive marketing of pharmaceuticals, and uneven regulations. Dye continues her conversation with HealthDataBuzz about the wide-ranging problem. She focuses on attitudes in the opioid crisis, which has riveted the nation’s attention but the discussion often has not often focused on our day-to-day human perception about the issue.

“Attitudes must change if we are to overcome and treat the opioid epidemic,” says Dye, also past president of the American College of Medical Toxicology

“There is a difference between ‘calling something’ a chronic disease and having evidence to support that it is,” she said. “Addiction is a chronic, relapsing, progressive and often fatal disease. There is medical evidence to support that. Until we recognize and accept that, the solution will be elusive,” she says

That ignorance also extends to the doctor’s office as well, she adds.

“One of the big issues now is that doctors are advised to be very careful when prescribing opioids. Therefore, a person with the addiction will turn to street drugs. They are also cheaper,” she says.

A year ago, the Centers for Disease Prevention and Control issued new guidelines recommending that doctors first prescribe non-opioid medications or non-drug treatments for pain, such as physical therapy, the Boston Globe reported.

“The policy-makers seem to think that we can apply a simple solution, and that creates a lot of adverse and unintended consequences,” said Bob Twillman, director of the American Academy of Pain Management,  according to ClinicPainAdvisor.

Sometimes the medical community feels caught in the middle. When doctors don’t prescribe opioids they are seeking, some patients with addictions may lash out, or turn to the streets for heroin. Derivatives of fentanyl are also becoming an increasing concern; they are more deadly and cheaper than prescription drugs, Dye says.

There’s still a way for physicians to take steps that can improve prescribing patterns and concerns, Dye says.

“Perhaps by affecting prescribing habits, we can decrease the initial trigger for addiction, but the disease model suggests that even short- term use can uncover the disease,” Dye says. “We definitely need to consider alternatives to opioids for pain.”

The many tentacles of the abuses of opioids and impacts are well documented. Questions also surround the ramifications of the key medications for opioid addiction. “There are really no good alternative antidotes for the treatment of acute overdose,” she says. First responders to opioid emergency cases administer Narcan, and the antidote also is sent home with addicts and their families.

“I have heard physicians complain that, by administering Narcan or sending it home with patients, we are ‘enabling’ addicts. That’s nonsense”, she says. “Should we withhold inhalers to those with emphysema if they continue to smoke? Should we withhold insulin from a patient because they don’t follow the appropriate diet?”

“Unfortunately, many in healthcare could be called people who “enable.” Yet there is power to that, in a positive way. “I always saythe EM (mergency medicine) could be called “enabling medicine.’”

Training and Education Needed

The American Society of Addiction Medicine is trying to train more physicians to treat addiction, which is much-needed, as well as others in the medical workforce, Dye says. “We also need to improve access to and availability of treatment.

At the White House, Congress and elsewhere, opioid abuse is a continual focus, although some are concerned it may be out-of-focus.

President Trump’s  budget was criticized for putting more people at risk. His budget calls for $500 million increase from the 2016 funding levels for opioid abuse prevention efforts, and to expand treatment. “But the budget never provides specifics as to how much the administration would like to see invested in mental health or where the money it calls to fight opioid addiction CDC block grants would come from,” says Modern Healthcare.

Trump has signed an executive order creating a high-level opioids commission led by New Jersey Gov. Chris Christie, prioritizing treatment, yet the panel includes Attorney General Jeff Sessions, who maintains a strict tough-on-crime approach.

“I don’t want to get political, nor do I think this epidemic is about politics,” Dye says. “However, I fear that it will get politicized.”

Dye says the country has no choice but to confront the opioid issue, with education a vital element.

“I do think that this epidemic MUST be addressed head-on,” Dye says. “I don’t think we need any more evidence that the problem exists. What we do need is a focus on prevention and treatment. Education and experience (from addicts and those who treat them) need to be provided to parents and children, even as young as grade school.”

She adds: “I think that the more children are educated, they will not only be better equipped to address their own problems but more importantly, may be able to more effectively help a peer. Scare tactics don’t generally work, especially when employed by parents.”

Dye wrote to the White House and offered to help in any way to address the problem. So far there’s been no answer. No matter what, Dye continues to deliver a message that the nation can work together to meet the tyranny of opioid abuse, starting with attitude readjustments, a day at a time.

.– Joe Cantlupe

 

 

Some Urgent Care Centers Getting Headaches Over Insurer Requirements

As some urgent care centers try to open up new businesses or expand, some operators say are being shut out by insurers who may not want to have any new urgent care centers in an area because of perceived over-saturation.

Urgent care centers thrive on treating a patient’s cough or checking out that bruised elbow or twisted ankle.  But insurers keeping them out of certain networks appear to be giving them a big headache, some urgent care operators tell me in a story I wrote for athenainsight.

The story notes: “A lot of urgent care providers are facing a narrowing of networks,” says Laurel Stoimenoff, CEO of the Urgent Care Association of America, which represents 2,700 urgent care centers in the U.S. and abroad.

Those rules hamstring “the entrepreneur who wants to build an urgent care center right now,” Stoimenoff says. “You may have spent a million dollars on the place, even before applying for a contract. Then you apply to one of the major payers and they say, ‘sorry, we’re not accepting more urgent care clients. We have enough of them in our network.'”

In a follow-up email exchange with Stoimenoff, she said payers add more requirements on urgent care centers that they might not otherwise impose on primary care physician offices. That may effectively shut out an avenue for urgent care centers, although the insurers may not actually say they are narrowing their networks, she says.

That is a confusing situation, she says. “(Urgent care centers)  practice acute primary care so we are perplexed as to why UCCs are being held to standards in excess of (primary care physicians),” Stoimenoff says.

Some contractual language written into urgent care center contracts also are problematic, she adds.  Stoimenoff gives the following scenario:

Say a patient goes to an urgent care center and it is determined that patient has pneumonia. A follow-up would seem to make sense, but contracted language with the insurer prohibits follow-up care “as the insurer (would try) to ensure that the urgent care is only providing care for singular episodic visits,” Stoimenoff says.

That could create logistical problems for patients. “A patient may be 2,000 miles from home and/or without a primary care doctor,” Stoimenoff says. “Who then is to follow that patient who has a condition that medical best practice would say needs follow up?” she asks.

Urgent care centers are also limited in prevention practices. Stoimenoff offers this scenario as an example: Someone works in an area that is  “high risk for tetanus,”  and wants a tetanus vaccine from an urgent care center because that person didn’t have one for a decade or more. The urgent care center would have to tell the patient: “We couldn’t give you one and get paid by the payer in most cases because they consider it ‘wellness’ versus ‘episodic illness or injury,” says Stoimenoff.

Baffling, no?

Such scenarios — i.e. real life – seem to go against the idea of having an open marketplace for the full spectrum of a patient’s needs. That is a crucial part of the conversation as the government again moves in some possibly new direction in healthcare.

Franz Ritucci, MD, President of the American Academy of Urgent Care Medicine, agreed with Stoimenoff’s assessments, saying some urgent care centers “are having difficulty contracting with insurance carriers,” he told me for the athenainsight story.

Despite obstacles, urgent care centers believe they are finding their rightful place in helping patients, according to Stoimenoff.

The “issue of receiving the right care in the right place at the right time is likely to finally get attention as we move into value-based care models and there are financial incentives to do the right thing,” Stoimenoff says. “There are numerous studies that support the fact that many patients being seen in emergency departments do not need to be there.”

Change may rest on patient education and advocacy along with physician discussion.

Healthcare is tough: there’s no question it’s scary when someone faces a 3 a.m. sharp pain and doesn’t even think twice about going to the emergency department. It’s another issue for the patient who has a cough and sniffles, then maybe it’s  time for urgent care instead of an overcrowded, expensive emergency department.

One person at a time, it becomes a national issue about cost and quality of care.

“If there is an opportunity to save what is undoubtedly in the billions (of dollars) we should all be open to problem-solving,” Stoimenoff says.

— Joe Cantlupe

 

 

 

Golfing in Bedminster, Russia on His Mind

I can picture a good president – no, not this one – playing golf in beautiful Bedminster, N.J.

The president may be tooling around the golf course, something he holds very dear, and feels incredibly thankful for the past 100 plus days on the job.

He may think about what he said on that first day in office, how not enough people were sharing the wealth of this great land and how the establishment “protected itself, not the citizens of our country.”

As he may go from tee to tee and even bogey a few holes in that lush green carpet as he gets angry about poverty, racial inequities, and hopes for better health and well-being of the country.

That’s the picture of a good president.

Not our president. He went on the golf course, and he was indeed angry not about injustice against our citizenry, but about then FBI Director James B. Comey and the continued investigation into Russian connections involving the election.

Our president was terribly upset about perceived injustice against himself.

He’s going to feel worse. Truth wins.

— Joe Cantlupe

More to the Story: Annals of Emergency Medicine Halts Urgent Care Study Publication Over Data in Controversial Decision

HealthDataBuzz Investigative Analysis

A recent study that examined the cost of hospital-based and freestanding emergency departments compared to urgent care centers in Texas had some intriguing findings: The prices for patients who were treated at emergency departments instead of urgent care centers paid as much as 10 times higher for similar diagnoses.

This morning, The Washington Post ran a front-page story that said: “Free-standing emergency departments offer convenience, but they may drive up costs.” The article quoted one of the study authors.

Yet the study’s findings are controversial and so is the behind-the-scenes maneuvering involving the study itself, Health Data Buzz has learned.  At the center is the publisher of the manuscript, the Annals of Emergency Medicine, which pulled the study for further review following “serious concerns” over data in the article, even after it was the focus of stories in Texas publications.

The dispute apparently began after emergency department physicians complained about the study although those in the urgent care community certainly have applauded the article fact-finding and conclusions.  The  Annals of Emergency Medicine (AEM) is the official journal of the American College of Emergency Physicians, the Texas-based organization whose more than 31,000 members run emergency departments, not urgent care centers.

The unfolding review process has been so intense the editor-in-chief said he has never had such an experience before involving a manuscript, while the top author says she has never felt so mistreated in the handling of the study.

Recently, the AEM halted publication of the study, Dr. Michael L. Callaham, editor-in-chief of the Annals of Emergency Medicine, confirmed in an email exchange. Callaham is founding chair and professor emeritus of emergency medicine at the University of California-San Francisco Medical Center at Parnassus.

Callaham said the journal’s concerns were about accuracy and interpretation of the study, which led to complaints from emergency department physicians. Those complaints come after the study was made available to the press.  “I had never had a similarly difficult and prolonged assessment experience with a research paper in my decades of editing,” he said.  That editorial review is still ongoing, Callaham added.

While the journal has begun an inquiry into the study, questions also have been raised by the principal co-author, Vivian Ho, PhD, director of the Center for Health and Biosciences at Rice University’s Baker Institute for Public Policy, about the AEM actions.

During a journal editors’ review of the study, an issue involving data transcription errors was uncovered, but that has been used by AEM officials to wrongly cast doubt on the entire document, she said. “In my entire 20-plus years as a professor, I have never been mistreated like this,” Ho said.

Emergency department physicians have indeed complained about the study, Ho said. But she suggested that they objected to the study’s findings because they were favorable to urgent care centers. While some minor tabulation errors were made, Ho said the study findings should stand, once corrected.

Researchers from multiple state institutions, including Rice University, Baylor College of Medicine, University of Texas Health Science at Houston, the Michael E. DeBakey VA Medical Center and the Blue Cross Blue Shield of Texas, were involved in authorship of the study.

The study researchers examined over 16 million claims submitted between 2012 and 2015 by Blue Cross Blue Shield of Texas. They reviewed how often patients visited freestanding and hospital-based emergency departments and urgent care centers in Texas metropolitan areas.

The dispute underlies the economics of urgent care centers and emergency departments, whether freestanding or hospital-based. Patients routinely go to urgent care centers for relatively mild injuries and illnesses, but sometimes go to emergency departments for similar concerns, although they are more costly and are designed to handle more serious patient needs.

At certain points, their business models collide, which was an important element of the Texas study, and just another interesting element in the sometimes chaotic nature of healthcare politics and pricing.

Study Gets Media Attention

Like many studies, advance copies of the Texas study were received by the media, which treated it as big news, which it is.

The Dallas Morning News, ran a major story March 27:
Patients in Texas who felt sticker shock after a visit to an emergency room often could have saved thousands if they had gone to urgent care, a new study says. Whether back problems, bronchitis or abdominal pain, patients paid $1,000 or more for treatments that would have cost them under $200 in a less expensive facility.

The Washington Post’s story today quoted Ho as having “found a big overlap in the types of conditions for which people seek care: Three-quarters of the 20 most common diagnoses at freestanding ERs were the same as at urgent-care centers.”

In the study that was initially made available to the press, researchers said they compared prices for the top 20 diagnoses and procedures. Texans use hospital-based emergency departments (EDs) and urgent care centers much more than freestanding EDS, but freestanding ED utilization increased 236% between 2012 and 2015, the study said. It added: The average price per visit was lower for freestanding EDs versus hospital-based EDS in 2012 ($1,431 versus $1,842) but prices in 2015 were comparable, ($2,199  versus $2,259.) Prices for urgent care centers  “were only $164 and $168 in 2012 and 2015,” according to the study. “Out of pocket liability for consumers for all these facilities increased slightly from 2012 to 2015,” it added.

In addition, the study said “there was a 75% overlap in the 20 most common diagnoses at freestanding EDs versus urgent care centers and 60% overlap for hospital-based EDs and urgent care centers. However, prices for patients with the same diagnosis were on average almost 10 times higher at freestanding and hospital-based EDs relative to urgent care centers.”

The Journal’s Controversial Change of Heart

Weeks after stories appeared in the Texas media, Callaham and editor journals halted further publication of the study online, pending further reviews. Initially, when asked about it, Callaham would say only that the journal’s initial reviews “raised some issues that needed clarification and the authors themselves later found and reported to us a tabular error.”
When asked for elaboration, Callaham said the paper was published electronically following a number of revisions. At that time, “a number of emergency physicians not directly associated with Annals expressed concern about data accuracy and integrity,” he said.

Callaham noted most of the physicians were members of the ACEP. At that point, the paper was removed from public access, Callaham said. He mentioned there were “new concerns” from “credible expert sources and were of a serious nature,” he noted.
Ho disputes the findings, saying concerns raised “about the integrity of the data analyzed in this study are unfounded.” The “article had undergone peer review, was accepted for publication,” she said. Despite the relatively minor transcription error, “the main results of the paper remain unchanged and are still correct,” she said.

Specifically, the problems unfolded after Dr. Paul Kivela, the incoming president of the American College of Emergency Physicians, citing the transcription errors, then argued that the entire manuscript was unreliable and convinced the editor-in-chief to “pull the article from the internet until an independent third-party can examine the data,” Ho said.

“We are still in the midst of disputing Dr. Kivela’s accusations,” Ho said.

Ho said  the ACEP “controls the journal, and they are receiving complaints from emergency physicians, particularly those who could earn a substantial share of their income from the freestanding ER model.”

Callaham said only he and senior editors decided about the status of the study. They relied on guidelines recommended by the World Association of Medical Editors, the International Committee of Medical Journal Editors and the Council of Publication Ethics (COPE). The COPE algorithms were particularly important, he said.

“All the prepublication discussions and revisions were handled entirely within our traditional peer review process by Annals editors only, although we did engage a larger number of reviewers than is routine,” Callaham said.

He added: “All decisions about this manuscript to date have been made entirely by myself and the senior editors of the journal and will continue to be so as we work through the COPE algorithm. As soon as we have the remaining materials we are waiting, we will proceed so that uncertainty for all parties can be ended as soon as possible.”

“As soon as we have the remaining materials we are waiting, we will proceed so that uncertainty for all parties can be ended as soon as possible,” Callaham added.
It is uncertain what the inevitable repercussions of the study will be: whether it will eventually be reworked or changed substantially or withdrawn.

“That is exactly what we need to determine, whether there are remaining issues that could change the conclusions of the paper, and how to correct them if that is the case,” Callaham said. “Obviously we do not want to publish erroneous information no matter what, but we also do not wish to interfere with the dissemination of accurate and useful research.”

Despite the constant flow of newspaper or media headlines of the study’s findings, the journal itself will still be reviewing how the manuscript got to where it is, and that may take awhile.

“Resolving all these issues needs to be done carefully and will take time; when this is done to the journal’s satisfaction or if it becomes apparent it cannot be done, we will issue a final decision and implement it,” Callaham concluded.

“Resolving all these issues needs to be done carefully and will take time; when this is done to the journal’s satisfaction or if it becomes apparent it cannot be done, we will issue a final decision and implement it,” Callaham concluded.

— By Joe Cantlupe

Editorial: House of Horrors And HealthCare Reform: Trump 1, America 0

So President Trump goes to the Rose Garden and lets his new GOP House pals run around outside the White House and soak in a victory of Trumpcare health bill passage. Wow. What a pathetic victory. They remind me of a baseball team soaking themselves in champagne after a 162-game season and then go on to lose a one-game playoff.  Coming up next is the Senate. Hopefully, the voices of pained patients and facts will have the upper-hand in the upper house.  Comm’n, moderate Republicans in the Senate, there are still a few of you left.  Just think of all the people with pre-existing conditions, whose lives could be damaged by Trump and his cronies. All for a teeny victory that can be held in a little hand.

Ok, America lost in the House, which voted to take away healthcare from the aging and the poor. The Republicans slapped high-fives in the White House backyard. Even the losing Democrats were childish.  They are singing “Na na hey hey Goodbye.”  They referred to predictions that Republicans would lose elections after yesterday’s vote.

Gee, Congress this is serious. And it’s not about you.

A hex on the House, I say the heck with you.  Send In the Clowns Oh, yeah, they are there, in Congress.

And then there’s Trump, like his hero Andrew Jackson, running a victory lap, but meaningful?  Jackson won the Battle of New Orleans weeks after the War of 1812 was over. Great for symbolism at the time. That’s what Trump is all about. Symbolism. Show.

For Trump, though, the reality war is just beginning in healthcare reform. People are going to face up to his nonsense and despicable one-liners, or statements that have no thoughts behind them. And the lies. Oh yeah. The pre-existing conditions, coverage for everyone. Sure, Donald, sure.

And this is a 70-year-old man who didn’t show us his, er, clean-bill-of-health,  or the taxes either.

Of course, the Republicans rushed through the legislation to get that little “victory.” And it is little, despite the headlines today. Isn’t Ryan supposed to be the wonk who loves counting pennies and spreadsheets?  Sure. But why wait for the fiscal experts at the Congressional Budget Office to review it? Nah. Remember the first time the Republicans tried: The CBO put a big F grade on that one: 24 million more Americans would lose health insurance, adding to those millions already who don’t have it.  I guess the GOP didn’t want to hear the bad news again.

Lots of people detested this bill that passed the House.  Check out Twitter and see all those comments from people who say #IAmAPreexistingCondition. But what do Trump and the gang care?  Polls were already showing people wanted changes to Obamacare and don’t throw it in the trash.  The Republicans said they were waiting seven long years to see Obamacare in the Dumpster. So what if many untruths are attached?

When you live by the lie, what difference does it make?

“Mr. Trump, in particular, has been spreading misinformation and lies about health care, arguing that the legislation would lower costs while guaranteeing that people with pre-existing health conditions could get affordable health insurance,” the New York Times said in an editorial.

As the bill goes to the Senate, many are  watching, chomping at the bit,

The AARP is one.  It represents 38 million people.

AARP Executive Vice President Nancy LeaMond said the organization is “deeply disappointed” that the House passed a “deeply flawed bill.”

She said the bill puts at risk 25 million “older adults with pre-existing conditions, such as cancer and diabetes, who would likely find health care  unaffordable or unavailable to them.”  LeaMond also pointed to the “age tax on us as we age, harming millions of American families with health insurance, forcing many to lose coverage or pay thousands of dollars more for health care.”

“We promised to hold members of Congress accountable for their vote on this bill,” she said.

— Joe Cantlupe