Another Bad CBO Report Card for Latest GOP Healthcare Bill

While Republican Senators try to put together their latest, flailing plan to overhaul Obamacare, the Congressional Budget Office today released some quick calculating of its own:

Not good.

The CBO says the result of the Graham-Cassidy bill would be that insurance coverage for “high-cost medical events would be reduced by millions” of people.  (The deficit would be reduced by $133 billion under the bill with in a 10-year period, the agency says).


The reason, says the CBO:

  • Enrollment in Medicaid “would be substantially lower because of large reductions in federal funding.”
  • Enrollment in nongroup coverage “would be lower because of reductions in subsidies for it.”
  • Enrollment in  “all types of health insurance would be lower because penalties for not having insurance would be repealed.” Those losses would be “partly offset by enrollment in new programs established by states using the block grants and by somewhat higher enrollment in employment-based insurance,” the CBO says.

Because of the quick turnaround, the CBO said it didn’t have time yet to estimate the exact numbers. — Joe Cantlupe

McCain: Statesmanship Over Friendship; (Trump: Chuck Schumer sold him a “bill of goods. Sad.” )

The last time Sen. John McCain, R-Ariz, was in the healthcare debate spotlight came in a tense vote last July to repeal and replace Obamacare. Then, he strolled in the Senate chamber, and put his “thumbs down.”

Yesterday, in another heroic move, he virtually killed the latest last gasp of the GOP to overcome Obamacare, saying he “cannot in good conscience” vote for the Sen. Lindsey Graham, R-SC, and Bill Cassidy, R-LA, proposal, which had been roundly criticized. At last count, GOP leaders were “one senator away from defeat,” The Washington Post said.

McCain said he would vote against the wishes of his good buddies.

In a string of tweets this morning, President Trump  denounced McCain’s action, saying he let his best friend “LG down.” Trump also said that Democratic NY Sen. Chuck Schumer “sold John McCain a bill of goods. Sad.”  (Editorial Note: Gee, what happened to Trump’s pals, “Chuck and Nancy?” …oh, another story)…

“John McCain never had any intention of voting” for the bill, Trump said, adding that the Arizona governor supported it. “He campaigned on Repeal & Replace,” Trump said. “Let Arizona down!”

Trump cited Arizona as having a ” 116% increase in Obamacare premiums last year.” The President is predicting that Sen. Rand Paul “may find a way to get there for the good of the Party!”  (Interestingly, like McCain, Paul has signaled he would vote against the healthcare plan, too)

“I take no pleasure in announcing my opposition,” he said in a statement.” Far from it. The bill’s authors are my dear friends, and I think the world of them. I know they are acting consistently with their beliefs and sense of what is best for the country. So am I.”

“I hope that in the months ahead, we can join with colleagues on both sides of the aisle to arrive at a compromise solution that is acceptable to most of us, and serves the interests of Americans as best we can.” –

– Joe Cantlupe



Annals of Emergency Medicine “Pulls Back the Curtain” on Controversial Urgent Care Study Reposted Today

Five months after the Annals of Emergency Medicine withdrew a controversial academic paper touting the pricing merits of urgent care centers compared to competing free-standing emergency departments in Texas, the AEM today  reposted the study online – its findings almost exactly the way it was the first time, which caused a firestorm in the ED world.

The authors of the study, under pressure to review their initial paper, had fixed some minor technical errors even before the paper was pulled, they said. But their conclusions were virtually similar: free-standing EDs and hospital-based EDs in Texas are overpriced, compared to urgent care centers. It showed a potentially ineffective use of emergency facilities, they said, which is becoming an increasing financial burden in healthcare.

“The main results of the paper are the same,” says lead author, Vivian Ho, the Baker Institute Chair in Health Economics, the Department of Economics, at Rice University. Before the paper was initially withdrawn following publication in May. “We had some median prices in the (paper’s) appendix that were incorrect because I transposed them incorrectly,” Ho says.

In a highly unusual move – citing the controversy involved – the editor in chief, Michael Callaham, MD, wrote that the journal was “pulling back the curtain” and not only published the final article but several editorials and “the background arguments and discussions that took place between the author and their critics.”

When the paper was first published it caused an uproar among emergency department physicians, and AEM said they sought further review, focusing on what they termed serious concerns over data in the study, which was gaining widespread media attention, and showed that patients who were treated at emergency departments instead of urgent care centers paid as much as 10 times higher for similar diagnosis. The Annals of Emergency Medicine is the official journal of the American College of Emergency Physicians.

Since HealthDataBuzzs revealed the AEM decision last spring to remove the paper from the website with the intent of either trying to salvage or scrap the paper,  the organization tapped into many academics and others to review its findings. In the meantime, there was much consternation: the AEM editor Callaham saying he had never been involved in such a situation, and Ho saying she was never so mistreated in the handling of a study.

While some criticized the study, other academics were aghast that the paper would be summarily pulled, based on criticisms from those with self interests. Top emergency department officials criticized the Ho paper as bearing “no relation to what was occurring in the field,” and there were flaws in median prices that investigators used in the study. In response, Ho said the allegations were “baseless and misleading.” As many critics focused on “transcription errors in the tables” of a study appendix, she noted they had no bearing on the article findings. “Honest errors are a part of science and publishing and require publication of a correction when they are detected,” she said.

The Annals of Emergency Medicine today published continued rebuttals to the paper, and Callaham discussed the maze of issues involved in an unusual editorial process  that not only suggested there was information in the paper signifying that it should be published, but there was room for other comments as well.  He declared that some in the media were “sensationalizing certain aspects of the findings, including conclusions that were not the focus of data analysis and were not casually proven.”

With all the back-and-forth, “we chose instead to escalate the level of review and share the results with our readers,” Callaham wrote. The “unusually extensive review” including the work of four peer reviewers, one regular editor and four expert editorial specialists, he says.  Callaham is founding chair and professor emeritus at UCSF Medical Center at Parnassus.

“After digesting all the assessments and arguments, we concluded the article had some original and important data to report (on a topic with a paucity of such information) and believed it should be published,” Callaham wrote. “But because the concerns were also important and could not be conclusively resolved, they should be published too.”

“Additionally,” Callaham wrote, “some of the conclusions in this article are not based on the actual analysis and results, which have been quite misunderstood by the lay press.” That’s why, he said, the journal was not following its usual practice of only presenting the final article and maybe one editorial.

He noted there was an “unusually broad range of potential conflict of interest declarations for the various parties” in the dispute, Callaham says.

Blue Cross Blue Shield of Texas researchers played a key role in the paper, and told Callaham’s team that they “firmly support the work done by non-biased researchers led by (Dr. Ho) and “stand by the accuracy of the data.”

Callaham added: “We sent several letters by FedEx to national officers of Blue Cross Blue Shield inquiring whether they would be willing to have the data reviewed for validity and completeness by an impartial third party, but they did not respond in any way.”

“This raises serious questions about conclusions based on such “black box” data, ” Callaham, referring to a possible conflict of interest and the lack of clinical data. Callaham said there was an “unusually broad range of potential conflict of interest declarations for the various parties to this dispute.”

After the paper was first published, Paul D. Kivela, MD, MBA, FACEP, President-Elect of the American College of Emergency Physicians, charged in a letter to the AEM that the Ho report included data that was “somewhat problematic and incomplete.”

William P. Jacquis, MD, FACEP, Vice-President of the American College of Emergency Board Liaison to the Annals of Emergency Medicine, added: “Comparing the prices between urgent care centers and freestanding EDs is an ‘apples to oranges’ comparison of contracted rates versus charges, which makes the findings flawed.”

Ho and her colleagues said the complaints were much-a-do about nothing; an academic political controversy, with many concerned about their self-interests.

“We welcome the input of other researchers, but Annals’ decision to withdraw our article is suppressing the possibility for an objective, well-informed, public debate about the validity of our findings,” Ho wrote.

In the end, with the journal publishing the story today, the AEM is essentially giving its support, if not to the paper, the overall discussion. At one point, there was so much back-and-forth among academics; Ho said she thought, “this needs to stop.”

The paper come at a crucial time as urgent care centers are trying to create a niche market, and free-standing emergency departments, which are not attached to hospitals are among the fastest growing trends in healthcare, according to the New England Journal of Medicine Catalyst. Urgent care centers are marketing themselves expanded and weekend hours, which are often not available in routine physicians.

Despite the controversy and unsettled fate of the study, Ho says it focuses the importance of “wasteful spending” in healthcare and the “rising costs of premiums.”

“I think the firestorm around the paper is really great and brought the attention of high prices at freestanding emergency departments,” Ho says.  —  Joe Cantlupe

Through the Looking Glass at FDA

What is the vision at the Food and Drug Administration?

I take a look at the contradictory world of the FDA  – especially as it relates to the ophthalmology industry -in a piece for MillennialEye.

Progress:”Through the political maelstrom and bureaucratic twists and turns, there is progress, according to Carl Tubbs, MD, an ophthalmologist with InSight Vision Group in Denver, a member of the American Glaucoma Society and president of the American National Standards Institute.

“We have seen a willingness from the FDA to move standard development forward in a more direct path,” he says. “The process has included the presence of more consistently involved FDA members in the standards process so that our team is more familiar with ongoing issues and we do not need to readdress them, and what I perceive is better inter-departmental communication within the FDA itself.”


The FDA is moving along with the approval process, but it is still understaffed and occasionally stumbles in bureautic obstacles.

“The (FDA)  is a vision of two worlds: the focus of major regulatory reform that aims to hasten the approval process for high-quality drugs and devices, but also a federal agency significantly understaffed and bogged down in bureaucratic uncertainty,” the article states

It adds: “The FDA has taken steps in recent years to improve its review and evaluation of drugs and devices, recently becoming more efficient, for instance, than the European Medicines Agency (EMA), its counterpart agency in Europe. FDA officials also say they are now working closer than ever with private industry to develop product innovations and move products quicker to market”.  — Joe Cantlupe

For Skin Cancer Patients, A Needed Online Meeting Place

Skin cancer isn’t talked about much until something seems to go wrong, like someone asking: what is that mole that I didn’t see before? And we’ve moved from a sun worshipping society to a more skeptical and smart sun worshipping society, like thinking it is silly and dangerous putting aluminum foil on a board near your face to reflect the sun (yeah, people once did that), or running outside and hitting those tennis balls on the spur of the moment without thinking twice about sunscreen.

Some Baby Boomers, for instance, may not have thought about sun damage in their youth before reams of scientific information showed how bad it could be.

Years ago, “most people worshipping in the sun, who were tanning all the time (as kids) until adulthood never thought about the long term diagnosis,” says Marcia Kavulich, director of Health Union Community Development. “The diagnosis usually came as a shock.” Health Union is an organization that has developed online communities for patients with various illnesses, with skin cancer a new focus.

As many people head to the beaches these summer, there are some important considerations and data shock: “skin cancer is the most commonly diagnosed cancer in the U.S., and most cases are preventable,” says the Centers for Disease Control and Prevention.

Nearly 5 million people are treated for “all skin cancers combined, with an annual cost estimated at $8.1 billion,” the CDC says. About 9,000 people die annually from melanoma.

The CDC adds: “The number of Americans who have had skin cancer at some point in the last three decades is estimated to be higher than the number for all other cancers combined, and skin cancer incidents have continued to increase in recent years.”

Yet, we as a society don’t really give it much notice…until…

And patients who have skin cancer, too often feel they don’t have the resources to help them navigate their needs, about the scientific ins-and-outs of sun and care, as well as something else: their worries, says Anna McClafferty, SVP Health Union Insights.

That’s where Health Union’s newest online community,, has been extraordinarily effective in steering the conversation for skin cancer patients, its officials say.

“Many people tend to not give much thought to skin cancer, until they or someone they know are diagnosed with it,” said Judy Cloud, a patient advocate for Cloud has received treatment for skin cancer. “Unfortunately, there typically hasn’t been as much information readily available about skin cancer as other types of cancers, nor are support groups prevalent,” she said in a statement.

In a recent survey of 900 patients, Health Union found that many patients who have or had skin cancer are extremely worried about their cancer reoccurring, and they become “hyper vigilant,” ever looking for changes in their skin. Whatever they find increases their stress levels, says McClafferty.

Although skin cancer may return, many patients have a great chance for recovery and are receiving much support from family and friends, Yet the stress seems ever present: one out of three skin cancer patients – 33 percent — report their condition negatively affects their mood and emotions, according to Health Union

While it’s important that people take care of their skin, it’s equally important they do not become overstressed, which can lead to other ailments, says McClafferty. “Compared to other cancers, skin cancer is very treatable,” she adds. That’s one of the great things about the new online community, to help with patients who can reach out for support among advocates, other patients and experts in the field. Patients can ask questions about different types of skin cancer, treatments and prognosis. “They can have a greater understanding of their condition, chances for reoccurrence, and about wearing protective sunscreen,” McClafferty says.

“The results of this survey give us a better idea of the journey for people living with skin cancer, says Tm Armand, president and co-founder of Health Union in a statement. “People come to because they are the uncertainty of their future and are looking for support and reassurance. We are excited to be able to provide this much needed resource.”

Skin cancer can be detected early if people see “signs such as reddish patches of skin, or changes in moles that include looking for variations that involve asymmetry, border, color, diameter, and edges—called the ABCDEs,” according to Health Union. Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common types of skin cancer. More than half of BCC and SCC survey respondents had reddish patches of skin, and more than two-thirds of melanoma patients had a mole meeting the ABCDEs of skin cancer, the organization says.

According to Health Union’s survey respondents, 57 percent had BCC, 46 percent had melanoma, 44 percent had SCC and 10 percent had another type of skin cancer.

Cloud, the patient advocate, said she was thrilled about

“It’s a place people go for information and support and also be able to share their experience. No one should fight this alone and with no one has to,” Cloud says.

In 2014, there was a Surgeon General’s Call to Action to prevent skin cancer, calling on “partners in prevention from various sectors across the nation to address skin cancer as a major public health problem.”

A team approach – what is all about – is the kind of thing the nation’s top doctor wants. — Joe Cantlupe


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