The World’s Greatest Deliberative Body? Or Maybe A Few Heroes…

So there was room for heroism in the Senate early this morning, after all. And it came down to someone who is used to being a hero, John McCain.

Two days after the 80-year-old Senator from Arizona went to the Capitol after being hospitalized for brain cancer, the former Republican presidential candidate was very presidential, and a Profile in Courage: He voted with his heart, for his state. For his country.

McCain, the one-time prisoner of war, defied being a prisoner of politics.  He joined heroines, Lisa Murkowski and Susan Collins, other Republican Senators,  in voting against a so-called GOP “skinny repeal” — a watered down version of other big Republican plans to overturn Obamacare.  After all the drama, the ups and downs, build-ups, and Trumpian tweets, the seven-year GOP effort to get rid of Obamacare collapsed in the weight of the will of Americans wanting decent healthcare, plain and simple. McCain, Murkowski and Collins carried their torch, along with the Democrats.

Even though the legislation was dubbed a lightweight, it still could have been lethal to Obamacare, eliminating the individual and employer mandates, for instance, and raising the possibility 16 million more Americans without health insurance.

Earlier yesterday, McCain stood with colleagues who seemed to go ahead with voting for the bill even though – – a bit of craziness here – they thought it was not right and hoped a better piece of legislation would come out of a House-Senate conference.

Pretty dicey.  McCain, who this week lambasted nonsensical politics and loudmouth know-nothings, did what he had to do. He fought for what he believed in.

Now Democrats and Republicans should work together to make Obamacare better than ever, for all of us. — Joe Cantlupe



A Different Kind of Courage

In a dramatic moment, Sen. John McCain today came back from surgery and the war hero lectured his colleagues about playing politics. Then he, er, kind of played politics.

With his vote today, (and Vice President Pence breaking a 50-50 tie) the Republicans were able to set the stage for debate on whatever legislation they may want in their largely unfocused but determined effort to erase Obamacare, despite the potential of having millions of people losing their health insurance as a result.

McCain, indeed, is a heroic man, and he has not indicated whether he would support the GOP bills in a future vote. But the real GOP heroes on this day were Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, who voted their conscience and against their colleagues for even continuing the process.

While President Trump grumped about their votes, Illinois Sen. Dick Durbin, the Senate’s No. 2 Democrat called their collective actions acts of political courage, according to the Associated Press. Collins and Murkowski have expressed concerns about deep Medicaid cuts in the GOP bill and have called for bipartisan legislation, according to AP.

Of all the reactions today, the American Federation of Teachers, which represents 1.6 million employees, had one of the most significant – and telling – comments about the healthcare bill: what McCain receives, and deserves, in healthcare, and questions surrounding millions of other Americans. “Sen. John McCain is an American war hero who will get, and should get, the best healthcare our country can provide, ” the AFT said. “The debate about healthcare should be about ensuring all Americans have that same standard of care. That doesn’t start by repealing Obamacare.”

“As a result, we are deeply disappointed by the motion to proceed on a bill that would take away healthcare from at least 22 million people, hurt the vulnerable an others with pre-existing conditions.” – Joe Cantlupe




So What Are The Senate’s Aspirations for the People?

Will the Senate be a chamber of heroism today…or not?

Let’s turn back the clock a bit, first. There was a piece of legislation, observed the President several years ago, that would “set in motion reforms that generations of Americans have fought for and marched for and hungered to see.”

“Today, we are affirming that essential truth every generation is called to rediscover for itself that we are not a nation that scales back its aspirations,” President Barack Obama said in March, 2010, as he and supporters celebrated the passage of the Affordable Care Act.

Are we a nation that turns back its aspirations, or is this what this GOP led Senate (and House for that matter) wants to do?

Today, Sen. Mitch McConnell may try to cobble together enough procedural votes as a first tally whether it would have enough members to actually then vote on healthcare reform bills. President Trump desperately wants that, but so many lawmakers are pretty lukewarm, at best. There is even confusion among Republicans about exactly what they may be voting on. Republicans want to repeal. Or repeal and replace Obamacare with the Better Care Reconciliation Act (BCRA). Or repeal and just let it stay that way until they find something better. Or… you see what I mean.

There is a dramatic build-up to be sure, as Republican Sen. John McCain of Arizona is expected to return from his recent brain tumor diagnosis for a vote, saying last night he wants to continue work on important matters, including healthcare. The Republicans are counting the numbers to determine whether they move forward, or if they can. Getting 50 votes may be tough. Previously, three women Senators have courageously been vocal critics of the legislation. In the meantime, the Congressional Budget Office has said millions of people could lose healthcare if BCRA is approved, or if Congress lets Obamacare go without replacing it. A ticklish situation.

And here, as the Republicans gather, the idea of not really knowing what they are voting on not only seems bizarre but is certainly contrary to their oath. As the MaddowBlog noted, “This isn’t how legislating in the United States is supposed to work on any issue, but it’s especially indefensible when dealing with life or death policymaking.”

A friend of mine, as he was throwing out the trash yesterday, said: “Why can’t Republicans and Democrats come together, do whatever is needed to fix Obamacare. Does Trump even know what he’s talking about?”

When you think of the eloquence of Obama, contrast that with Trump, railing in front of families who have had trouble getting coverage because of Obamacare. Trump criticized GOP Senators who oppose the bill, adding with flourish: “Obamacare is death. That’s the one that’s death.”

“Americans desperately need relief,” the White House said in a statement earlier yesterday. “Congress needs to step up and do their job, by repealing and replacing Obamacare. The legislation working its way through Congress right now provides the choice and control people want, the affordability they need, and the quality they deserve in healthcare?”

Not much elaboration to the word “want.” Simply, Americans don’t like the bills that Congress is moving forward to replace Obamacare. A Monmouth University poll said that only 27 percent of Americans approve the Senate health care reform bill introduced last week while 56 percent disapprove. In an understatement, the university pollster said: “There are signs that Republicans may be losing confidence in how this issue is being handled by their party’s leadership…the Congress as a whole as well as its partisan leadership receive generally negative reviews.”

Among those opponents to the Senate bills to repeal or repeal and replace Obamacare, is the American Medical Association. In a July 21 letter to McConnell and Minority Leader Chuck Schumer of New York, James L. Madara, MD, CEO an Executive Vice President of the AMA, said the Senate legislation lacking in these areas:

  • Efforts to ensure that those currently covered do not become uninsured
  • Preservation of key insurance market reforms and efforts to stabilize and strengthen the individual insurance market, “ensuring that low and moderate income families are able to secure affordable and meaningful coverage”
  • Provision (for) adequate funding for Medicaid and other safety net programs.

“Unfortunately neither the proposed ‘Better Care Reconciliation Act” (BCRA) nor the “Obamacare Repeal Reconciliation Act” (ORRA) adequately addresses these key concerns,” wrote Madara. “Each bill results in millions more Americans without health insurance, weakened markets, less access to affordable coverage and care, and the undermining of funding for state Medicaid payments.”

I think about my friend mulling the Congressional action. Why can’t the Republicans and Democrats work out an agreement?

“Republicans in the Senate could work together with Democrats to find at last a short-term bipartisan solution. Democrats have indicated a willingness to work with them, wrote Tim Jost, an emeritus professor at the Washington and Lee University School of Law who blogs for Health Affairs. “There is wide public support for bipartisan reform. And there are short term fixes that could be adopted on a bipartisan basis.”

“It is time to set aside partisanship, to fix immediate problems in insurance markets, and to begin a national debate on what we want our health care system to look like going forward.”

Does the Senate have the courage to do that? – Joe Cantlupe

IT Needed In Fight Against Antibiotic Resistance

Antibiotics are certainly powerful in fighting infections. But now hospital organizations are finding that they need to battle the impact of antibiotics, too, stemming from patient and prescribing overuse. For hospital leaders, innovative IT systems are becoming critically important to accomplish that task.

Overprescribing antimicrobials have led to antibiotic resistance. At least 700,000 people die each year from antibiotic resistant infections, and that number may reach 10 million each year by 2050.

That’s stunning.

Something called antimicrobial stewardship – a way in which hospitals keep an eye on such prescribing – is what some health systems are trying to do to cut down on antimicrobial infections. That means ordering, dispensing, administering and monitoring antimicrobial stewardship practices. It also means working with patients, educating them about the appropriate use of medications.

IT technology is a key element in helping physicians access timely clinical information about antibiotics at the point of care. In that way, they can figure out the antimicrobial puzzle. While many hospitals are improving their IT system to carry out the task, not enough are using antimicrobial stewardship programs so they can reach their potential in helping patients.

“Many stewardship programs in hospitals today only provide feedback on antibiotic prescriptions, one or more days after the patient has already been started on an antibiotic,” says Brandon Palermo, MD, MPH, executive director and chief medical officer, for ILÚM Health Solutions in HIStalk. “But it’s important to use technology to engage and guide clinicians in real time from the beginning with an antibiotic ordered and to continue tracking pathway adherence as additional microbiology data becomes available and it’s important to be able to support this within their existing workflows.”

ILÚM Health Solutions says it provides an array of tools and services that help hospitals and health systems improve outcomes for conditions like sepsis and pneumonia while implementing key components of their antimicrobial stewardship initiatives. The company offers a technology-powered program that helps hospitals improve their infection disease outcome and supports antimicrobial stewardship programs. It is part of Merck’s Healthcare Services and Solutions group and operates independently from Merck’s pharmaceutical products business.

The ILÚM system works by leveraging data within existing hospital IT systems to promote “optimal decision-making and appropriate use of antimicrobials” through its clinical decision support (CDS) system and Command Center, an electronic dashboard, according to the company.  These solutions “enable case monitoring and prioritization – on an individual and aggregate level based on disease state – and promote early recognition of infectious diseases, appropriate interventions, and adherence to evidence-based clinical pathways,” the company says.

Technology needs to effectively connect everyone on the stewardship team – doctors, nurses, quality managers, pharmacists and healthcare executives, Palermo says. In addition, he says hospitals and clinicians need help accessing important data that are often buried within complex systems.

Hospitals are now required to establish antimicrobial stewardship programs as an organizational priority, under a Joint Commission requirement that became effective Jan. 1, 2017, Palermo says. Palermo wrote in Becker’s Hospital Review that antibiotic stewardship programs can save hospitals a bundle, too. He referred to a University of Maryland study that showed one institution saved $17 million in seven years by implementing such a program.

“Technology needs to give us antibiotic foresight, not just hindsight,” he says in HIStalk. “A root cause of antibiotic resistance is the systemic overuse and inappropriate use of antibiotics. While many factors account for this, a key issue is the lack of timely clinical information at the point of care.”

The Battle Against Sepsis

One hospital that has worked feverishly on this issue is East Jefferson General Hospital, 424-bed general medical and surgical hospital in Metairie, La., which reported a pilot study last December at the Institute of Health Improvement’s Quality Forum Institute of Health Improvement’s Quality Forum. East Jefferson General Hospital partnered with ILÚM as part of a hospital-wide initiative targeting sepsis quality improvement, which included “multi-disciplinary departmental collaboration and sponsorship from administration and medical leadership,” said Raymond DeCorte, chief medical officer for EJGH.

“This innovative solution has helped us to identify patients with sepsis faster, care for them better and reduce the use of critical hospital resources,” he says.  Antibiotic resistant bacteria are often the root cause of infections that trigger sepsis, according to the Mayo Clinic.

Sepsis is a potentially life-threatening complication of an infection, resulting in 750,000 deaths in the U.S. every year and is a major cost driver of health systems. Studies show that hospitals spend an average of $34,000 for each patient with sepsis.

The clinical decision support system helped physicians improve sepsis recognition and adherence to evidence-based care, leading to significantly improved outcomes and reduced resource utilization.

Among patients with all sepsis types, a reduction in hospital length of stay – 7.11 to 6.81 days -was observed. Among patients with severe sepsis, significantly fewer patients developed hospital-onset shock in the study group compared to the control group, 19 percent vs. 35 percent. All cause mortality rates decreased from 23.2 percent to 7.9 percent.

Palermo says automated outcomes reporting is configured to hospital-specific initiatives that track quality program performance.

“We know that following evidence-based pathways for sepsis can save lives, but it’s not that simple,” he told HIStalk. “These pathways call for interventions where time is critical, and early recognition of sepsis is a challenge that continues to vex health systems. I can tell you from my own experience as a practicing physician that this can be a huge hurdle.

“Our collaborations with partner hospitals launch with two parallel tracks – benchmarking and integration,” Palermo added in the interview with HIStalk. “We assist with benchmarking to establish baselines and identify target areas for quality improvement. Our plan is to build out disease modules for various types of infections using a value and data driven approach. We plan to expand to hospitals and health systems across the country and continue to bring key industry players together.”

IT helps us to determine appropriate use of antimicrobials and to execute against stewardship priorities by analyzing and reporting data that reinforce the impact of the program, wrote Debra A. Goff, PharmD, FCCP, a clinical associate professor and infectious diseases specialist at the Ohio State University Wexner Medical Center.

“It can also help prioritize patients in real time by providing actionable intelligence,” Goff adds. “You can also drill down to look at individual prescribing habits, individual drugs and who may be driving those prescriptions within the hospital.” — Joe Cantlupe



Latest CBO Score Today on GOP Measure to Replace Obamacare: 15 Million More Without Insurance Next Year

A GOP Senate replacement bill for Obamacare, if enacted, would result in 15 million more people without health insurance next year, and 22 million by 2026, according to a Congressional Budget Office report released today.

The latest score followed an analysis released yesterday of a proposed repeal of the Affordable Care Act without a replacement. That  would have resulted in 32 million more people without health insurance in 2026.

In its report today, the CBO says of the replacement proposal: “In 2018, 15 million more people would be uninsured under this legislation than under current law. The increase in the number of uninsured people relative to the number under current law would reach 19 million in 2020 and 22 million in 2026.”

By the CBO’s estimation, about 82 percent of all Americans under age 65 would be insured in 2026, compared with 90 percent under current law.

The numbers generally don’t seem to be in President Trump’s favor as he continually presses  Congress to overturn his predecessor’s signature legislation.

The data has a bit of good news: Federal deficits, under the measure, would be reduced by $420 billion over the next decade, the CBO says.

— Joe Cantlupe

Let Them Eat Cake?

Over lunch yesterday, President Trump insisted Republican Senators should forgo vacation, and stay in the Capitol and work on a bill to replace Obamacare.

“People are hurting, and inaction is not an option,” Trump said in a statement. “We must repeal and replace this disaster. The Senate should not leave for summer recess until it has passed a plan to give our people great healthcare.”

Maybe the food sparked his resolve to have a replacement plan instead of just getting rid of Obamacare as he vowed earlier in the week.

As it is, some Republicans just don’t have a taste for it.

The numbers keep getting worse, no matter which way you slice it.

The Congressional Budget Office said, in a report released this evening, that repealing part of the Affordable Care Act legislation without a replacement option would result in 32 million more people uninsured, compared to current law, while doubling premiums in 2026.

Not only that, about half of the nation’s population would live in areas having no insurer participating in the non-group market in 2020 “because of downward pressure on enrollment and upward pressure on premiums,” the CBO said.  That would only increase to three-quarters of the population by 2026.

Those staggering numbers are offset in one governmental respect: the legislation would decrease deficits by $473 billion over the 2017-2026 period.

But the populace pays a price. Under the CBO estimate, those currently uninsured would increase by 17 million in 2018, compared to existing law, and then increase to 27 million in 2020.

That would happen after the elimination of the Affordable Care Act’s expansion of eligibility for Medicaid, and the removal of subsidies for insurance purchased through the marketplaces established by the existing law, the CBO said.

The CBO isn’t exactly certain of its estimates, noting “the ways in which individuals, employers, states, insurers, doctors, hospitals and other affected parties would respond to the changes made by this legislation are all difficult to predict.”

The CBO score comes amid an already wild political week that saw a major GOP Senate health bill intended to repeal the Affordable Care Act collapse and reports of Sen. John McCain’s illness. ( McCain has aggressive brain cancer, glioblastoma. He had surgery to remove a blood clot over his left eye last week, McCain’s office said.)  In the meantime, Senate Majority Leader Mitch McConnell wanted to vote on repealing Obamacare.

Trump, meanwhile, has flip-flopped, saying, on one hand, that he would let Obamacare die, and then insisting the GOP should work through their recess, and improve their own healthcare plan.

“Obamacare was a big lie,” Trump said. “You can keep your doctor -lie. You can keep your plan – lie.”

He calls Obamacare an “absolute disaster,” in part, because of so many insurance premium increases.

The latest CBO score is “nearly identical to estimates the CBO” made based on a bill that Obama had vetoed, according to The Washington Post.

In the meantime, Trump says, “I’m ready to act. I have pen in hand. I’ll sign the legislation into law, and then we can celebrate for the American people.”


— Joe Cantlupe


Seven Years And Nothing to Show

There are “serious problems” with Obamacare, says Sen. Jerry Moran, Republican of Kansas.

And Sen. Mike Lee, Republican of Utah, obviously hasn’t been crazy about the law either.

But both Senators, in statements tonight, signaled a crushing blow to Senate Majority Leader Mitch McConnell’s effort for the chamber to consider the Republicans’ bill designed to replace the very measure Moran and Lee don’t like: Obamacare, or the Affordable Care Act.  McConnell carried the GOP torch, especially for President Trump, a major loser in what is tantamount to a Republican fiasco.

In effect, Moran and Lee didn’t see the GOP’s Better Care Reconciliation Act of 2017 as a suitable replacement for Obamacare. So the Republicans’ seven-year effort to get rid of the healthcare legislation has essentially failed, with McConnell unable to get enough votes among the Republicans’ 52-person majority in the Senate to do the job.

“There are serious problems with Obamacare, and my goal remains what it has been for a long time: to repeal and replace it,” said Moran in a statement. But he said the Republicans’ closed door meetings that resulted in the BCRA  did not effectively  “address healthcare’s rising costs” and was ill conceived.

“For the same reasons I could not support the previous version of this bill, I cannot support this one,” he added. “We should not put our stamp of approval on bad policy.”

Some of the issues that were of major concern to the public, including protections for pre-existing conditions, “increased access and lower overall costs” must now be looked at with a “fresh start,” Moran said.

Moran and Lee said they would be opposing any move to proceed, which McConnell had sought. The Senate Majority Leader delayed a vote because Sen. John McCain of Arizona is recovering from surgery.

“After conferring with trusted experts regarding the latest version of the Consumer Freedom Amendment, I have decided I cannot support the current version of the Better Care Reconciliation Act,” Sen. Lee said in a  statement.

“In addition to not repealing all of the Obamacare taxes, it doesn’t go far enough in lowering premiums for middle-class families; nor does it create enough free space from the most costly Obamacare regulations,” Lee said. — Joe Cantlupe


No Easy Pieces

How ironic a serious health issue involving one of its own is delaying a healthcare vote in the Senate.

The pending vote is over the Better Care Reconciliation Act of 2017 (BCRA), also misnamed because it doesn’t provide better care, many analysts say. So many are railing against it, as the replacement for Obamacare. Doctors. Insurers. Governors. Academics. Polls are showing how much people detest it. And maybe the symbolism of Sen. John McCain’s blood clot surgery that has delayed the Senate vote on the BCRA is a great reminder of how fragile healthcare is, and the need for care for everyone.

Senate Majority Leader Mitch McConnell  is desperately counting the votes he needs.

As McConnell looks at his deck of 52 GOP Senators, he certainly would count on McCain. McConnell wants as many as he can get because all the 48 Democrats are against it. At least two Republicans are opposed, with as many as eight undecided.

The bill is harmful, many agree. Not only are there proposed billions of dollars in cuts in Medicaid that would hurt the neediest, but the Congressional Budget Office noted in a previous version of the measure that at least 22 million people would lose their insurance coverage by 2026. An earlier approved House bill would impact 23 million people. While the CBO is expected to issue its latest score this week, many believe the next report will offer another failing grade, with the impact on the elderly substantial.

One of the GOP senators who is against the bill, Sen Susan Collins of Maine, has said the “deep cuts to Medicaid” should scuttle the measure.

When you think of healthcare,  you think of patients, that we all are at some time or another. And then you think of the doctors taking care of them.

What to do they think of the GOP bill?

A bad diagnosis says the American Medical Association, which represents physicians. While the AMA applauds additional funding to address the opioid epidemic, “those suffering from substance-use disorder have other health care needs that are not likely to be addressed if they lose coverage through a rollback of the-Medicaid expansion,” the AMA said in a statement.

So it’s about the numbers, all those millions who may lose coverage, and if Mitch McConnell loses another vote that could doom his chances. McCain has said he would support, at least, a motion to proceed.

Throughout his life, John McCain has shown exemplary courage, a true American hero. As he ponders his illness, I am sure he will think further about others, less fortunate, struggling with healthcare and paying the bills.

In a statement, McCain acknowledged several days he ago he wasn’t crazy about the revised Senate bill, and that he would file amendments. “We still lack consensus on how to repeal and replace the failed policies of Obamacare, a law that is imploding in the state of Arizona as premiums skyrocket and insurers flee the marketplace,” McCain said.

He noted, “if we are not able to reach a consensus, the Senate should return to regular order, hold hearings and receive input from senators of both parties, and produce a bill that finally provides Americans with access to affordable and quality health care.”

That sounds like an idea. Another one: fix Obamacare, which has done a lot of good for people.

Not many more Senators are needed to defeat the BCRA.

“Only one more Republican vote is needed to continue our nation’s painfully slow but necessary march toward guaranteeing every American health insurance,” wrote EJ Dionne in The Washington Post.

In  Profiles In Courage, President John F.  Kennedy wrote about the various pressures of political office, juggling how to be liked, the yearning for re-election and the “pressure of the constituency and interest groups.”  Kennedy wrote the book as a Senator, recovering from back surgery.

“In a democracy, every citizen, regardless of interest in politics, ‘hold office,’ every one of us is in a position of responsibility and in the final analysis, the kind of government we get depends upon how we fulfill those responsibilities,” Kennedy wrote.

“We, the people, are the boss, and we will get the kind of political leadership, be it good or bad, that we demand and deserve.”

This is the Trump era. It is a time we need heroes more than ever, such as Senators who think carefully about their votes and what it means for everyone.

And then, we, the people, have our say.

—  Joe Cantlupe


Another Cup of Joe, Please?

Ok, it’s 7 o’clock tonight and I’m at this vegetarian restaurant with our son Max and we’re drinking lots of water, great stuff. Feeling good. H2O.  On the way out, Max says, hitting me like a splash of hot java: “If you drink lots of coffee, it can extend your life.” I love coffee, but I’m kind of a fake coffee drinker. I will fill maybe two cups and keep them on my desk the whole day, sipping through steaming hot until lukewarm, and not finishing them. Also, I can’t stand the coffee too strong.  I’ll put skim milk in and I rarely have coffee late, unless we are having dinner with friends or family, or I really need to be totally jazzed for work.

So that’s my routine.  I guess I’m not much of a coffee drinker. When it comes to coffee, that may not be the healthiest.

What Max was talking about were reports from two studies published today that says those extra cups of Joe can lead to a longer life expectancy.

One of the studies that showed the benefits of coffee drinking examined the drinking habits of more than a half million people in 10 European countries. The other study also said coffee helps people of many different races live longer, according to CNN.

“People who drank two to four cups a day had an 18% lower risk of death compared with people who did not drink coffee,” CNN said about one of the study’s findings, published in the Annals of Internal Medicine.

The study made me think of all the times in the old days reading into the wee hours backed by gallons of coffee.

Or as a little kid sitting with my Italian-American relatives as they spent hours debating everything over seriously strong coffee.

And yum, they had amazing pie and cake…that the coffee washed down. Oh, that’s another story.

Before I sat down to write this, I prepared some coffee, and I’m eagerly drinking it right now. Am I going to be up all night and regret it in the morning?

— Joe Cantlupe