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























‘Why On Earth Would Any Senator Vote for a Bill That Causes 22 Million People to Lose Their Health Insurance?’ Connecticut Senator Murphy asks.

As Senate Majority Leader Mitch McConnell counts the dwindling number of GOP votes for the Republican healthcare bill, the  Congressional Budget Office tallied the potential losses — of insurance coverage for millions of people. Oh, the entire population of 13 states, Sen. Chris Murphy (D-Conn.)  says, calling the measure a “humanitarian disaster.”

Sure, it gets rid of Obamacare and its problems, but the proposed GOP Senate healthcare bill makes everything else worse, Murphy said on the Senate floor last night.

At least 22 more Americans would lose coverage under the Republicans’ Senate bill, with an estimated 49 million uninsured by 2026, the CBO report released yesterday says. That compares to  28 million lacking insurance that year under the current Obamacare.

The House bill said one million more in the U.S. would lose coverage.

Premiums would go through the roof, especially for the poor and elderly. Medicaid takes a huge hit under the Senate bill, the report says. Remember President Trump’s vow to keep it intact  He wanted less meanness, more heart?

“The largest savings would come from reductions in outlays for Medicaid – spending on the program would decline in 2026 by 26 percent in comparison with what CBO projects under current law,” the report says.

Are the Republicans courting disaster for themselves and the populace?  More GOP Senators say they are against or hedging against the bill. The measure is teetering at best. McConnell is the ringleader of the bill. (Interestingly, the  Daily Beast reports that a free government clinic helped save McConnell’s life years ago…..oh that government!)

“This CBO score should be the last straw for Republicans,” Murphy said in a statement. “Why are on earth would any senator vote for a bill that causes 22 million to lose their health care, drives up healthcare premiums, and reduces the quality of care people receive?”

“This bill is a humanitarian disaster and now CBO has confirmed this fact. Republicans should scrap this monstrosity of a bill and sit down with Democrats to craft a better path forward for our country’s health care system,” Murphy said.

Next year alone, 15 more people would be uninsured under the proposed Senate bill than under Obamacare, mostly because the penalty for not having insurance would be eliminated, the CBO says. The number of uninsured would increase to 19 million in 2020, and 22 million in 2026. It would then increase in subsequent years.

The Senate plan would reduce the deficit by $320 billion through 2017, at least $220 billion more than the estimated savings of the House bill, the report says.


 — Joe Cantlupe

A Day in the Life of Healthcare, A Sickening Feeling

At the Florida rehabilitation facility, the musician pounds his piano and sings some really old oldies – and the patients shuffle their feet, clap to the songs, and try to move their wheelchairs to get a better view. The patients are mostly in their 80s.

The music is a bit of a joyful reprieve from the day’s often mind-numbing ritual at the facility.  A few patients walk slowly in the halls. A  few babble incoherently or break the silences by screaming.  Someone is sitting near the nurse’s station, seemingly fighting off a dizzy spell from medications.  A woman demands a visitor roll her wheelchair to her room, only to find it is someone else’s.

There is singing in one room, where a patient is reportedly celebrating a birthday a few years beyond 100.  In contrast, some patients don’t seem to have any visitors. The other day there was a scary moment: someone fell inside her room, startling everyone, as the staff scrambled to help her.

This is a stop from a hospital stay for a patient, often from a chronic condition or a nagging ailment, part of aging. Some have been in and out of the hospital and the rehabilitation center several times over the last few months.  Others may be on their way home, a dream.

I am visiting a family member, who is recovering from an infection and can’t wait to leave after repeat visits to the rehab center.  Blaring from the rooms are the TVs, where healthcare seems to be all the news all the time: the Senate’s once secret, but now almost ready for a vote, healthcare bill.   Today on CNN, chief political correspondent Dana Bash interviews HHS Secretary Tom Price, who dismisses Obamacare and vows the administration is working to ensure people don’t fall through the cracks. Price keeps talking up the GOP plan, and Bash, a solid professional, peppers him with questions, focusing on the gaping inconsistencies of the promise vs. the plan. As Price answers, she has an incredulous look on her face, listening politely to Price’s answers. Like, really?

To me, it’s a blur what he’s saying. I’m astonished by the obfuscation. The untruth.

For some reason, I feel even worse on this day, surrounded by the truth of healthcare, in this rehabilitation center. The Senate GOP’s plan, as the New York Times reports, shifts “money from the poor to the rich,” with substantial cuts in Medicaid, and the potential for more people to lose insurance coverage. Here at this rehabilitation center aren’t the poor, exactly, but I can only imagine the struggle ahead for many of them and their families if this bill is passed. As AARP notes, cuts in Medicaid would eliminate funding for “millions of low-income and vulnerable Americans,” including 17 million senior citizens, and children and adults with disabilities. A so-called “age tax” would allow insurers to “charge older Americans five times more for coverage than everyone else while reducing tax credits that help make insurance more affordable,” AARP said.

“This new Senate bill was crafted in secrecy behind closed doors without a single hearing or open debate – and it shows,” said AARP Executive Vice President Nancy LeMond. “The Senate bill would hit millions of Americans with higher costs and result in less coverage for them.”

AARP isn’t the only one railing against this piece of legislation that sends America into the dark ages of healthcare protections.  It seems most of healthcare is against it.

I walked the corridors of the rehabilitation facility after I stopped listening to the music. I wonder how many of these patients even know who Mitch McConnell is.  The Senate majority leader is said to be working the chamber back doors in hopes of rounding up the necessary votes to pass the bill, a potential close call as seemingly more Senators indicate they just aren’t ready to stomach the plan.

Thinking of those people in the rehab center,  it’s hard not to have a sickening feeling, and wonder why these politicians don’t feel bad about potentially costing so many lives if this bill is passed.  Maybe they should visit the sick and the aged to help them understand the importance of healthcare, compared to political rhetoric.

— Joe Cantlupe

A Bundle of Caution

While many support bundled payments in healthcare – how hospitals and physicians are reimbursed through so-called “episodes of care” — for their impacts on quality and cost of care, there are still many challenges ahead.I explore the status of bundled payments with my colleagues in a piece for athenahealth insight.

As the story notes: “Under the Obama administration, many healthcare organizations looked at bundled payments as the first step toward major payment reform — and assumed that more and more providers would need to gain competency with them.”


“But under the Trump administration, the future of bundled payments is uncertain. Secretary of Health and Human Services Tom Price, M.D., has spoken out against the programs. His department has delayed a proposed expansion of some mandatory bundling initiatives, as well as the implementation of new cardiac and orthopedic bundled-payment models.”

“And even some major advocates of alternative payment models have asked HHS for revisions and delays.”

— Joe Cantlupe