We are only three months into the new year and the 2020 campaign for the Democratic presidential nomination seems to be in full swing, just waiting now for former Vice President Joe Biden to join the race. What is amazing about presidential campaigns is that we get to hear big ideas expressed and candidates emerge taking a different approach and sketching out programs that have not seemed in the past to have enough political support to be possible.
So far, most of the candidates have embraced Medicare for All in theory though they are differing in whether to support single payer health insurance which eliminates private insurance or opt for a public option to the Affordable Care Act. Other proposals being touted would make Medicare a choice on the exchanges for the Affordable Care Act. All of these ideas are focused on providing universal health care that is more accessible and affordable than the current system.
Outrage over high drug prices and out of network costs is growing. Just last week, CBS News had a story about how some hospitals have out of network emergency rooms housed in their facilities and patients end up paying hundreds or thousands of dollars if that emergency room was not in their insurance plan. That sort of arrangement would never exist under any of the universal health care plans.
It’s amazing that the candidates are also coming up with other ideas that no one dared speak of such as term limits for the Supreme Court, or expanding the number of justices, eliminating the Electoral College, a universal income for all Americans, a national holiday on election day and getting rid on gerrymandering.
To me, all of this is a reminder of the beauty of a real democracy. Our system of government has been corrupted for so many years by big money controlling it and partisans trying to suppress voters and by growing inequality that it was inevitable that grassroots activism and an national political campaign would usher in an urgent call for some of the greatest reforms in decades.
A large new Apple watch study of over 400,000 persons who are using the watch which has sensors which can do an EKG has shown success in identifying irregular heartbeats and atrial fibrillation. While the watch sometimes produces “false positives” that identify heart activity that is not irregular, most of the cases have helped people to follow up and get checked by a doctor. 34% of the people who were identified by the watch as having irregular heart activity had atrial fibrillation when tested. Medical personnel say that percentage is good, given that a-fib is not a continuous heart activity but something that comes and goes over a period of time.
A media report noted the following:
“The study reportedly enrolled 419,297 people who had one of the earlier watches and an iPhone. Most were young people, but nearly 25,000 were aged 65 or older—the age group at the highest risk of the condition. The watches monitored for irregular heart rhythms and, if one was detected, notified the users and prompted them to set up a telemedicine consultation with a doctor involved with the study. The notified users were then able to get a separate ECG patch, which they were asked to use for a week to record their hearts’ electrical rhythms for comparison with watch data.”
Apple and other companies are seeking to develop wearable products that can get personal health information which can promote more patient engagement and empowerment. Apple has a health app on its IPHONE that allows patients to monitor exercise and other personal health data during the day.
On Tuesday, top representatives of pharmaceutical companies are coming before Congress and they will be challenged about their high drug prices. The New York Times has editorialized on the need to confront them about the high prices such as the rapid escalation in the price of insulin which has been on the market for a century. Certainly, they can’t cite research and development costs to drive up the price to $1500 per vial.
As the Times noted in today’s editorial, “A vial of insulin that cost less than $200 a decade ago now sells for closer to $1,500. Actimmune, a drug that treats malignant osteoporosis and sells for less than $350 for a one-month supply in Britain, costs $26,000 for a one-month supply in the United States. And the prices of many drugs — that treat cancers, high blood pressure, allergies and more — have risen so much that average consumers are rationing them, at grave peril. Not even experts seem to know how those prices are set or why they keep rising.”
The drug companies have traditionally justified their high prices by citing these research and development costs. Now, though, they seem to believe they should be entitled to charge what they determine the cost of averted health care costs, such as hospitalizations or even the value of extended health and life. That’s what their exorbitant prices represent. Imagine if Jonas Salk believed that. He didn’t. Congress has to return to promoting and protecting the public health of all Americans and ensuring costs are affordable certainly for basic drugs like insulin.
The day of reckoning is coming with Big Pharma as members of both parties in Congress are introducing bills that would increase competition and even use international pricing as a factor in determining prices here. Other bills even promote the government producing key drugs. With all the talk about some liberal Democrats pushing democratic socialism, this is one area where most people wouldn’t mind a little more government control.
New and revived aging in place/community villages in the Albany suburbs of Bethlehem and Clifton Park have formed in recent months and other groups are meeting in the Schenectady suburb of Niskayuna as well as northern Columbia County to plan villages. A steering committee has also been meeting in the City of Albany to consider how and where a potential village or villages would operate in city neighborhoods. There is already a NNORC (Neighborhood Naturally Occurring Retirement Community) that has been operating for many years by Jewish Family Services in a part of the city.
Senior Services of Albany is also sponsoring Livingston Village in a renovated middle school turned into apartments. Community Caregivers based in Guilderland, a suburb of Albany, has been providing village type services for over two decades and it is partnering to provide those services with Bethlehem Neighbors which recently was revived with a new Executive Committee after a dormant period. Community Caregivers is also working with the Albany steering committee to consider partnering with a possible village there.
The Albany Guardian Society has played a key role in the development and support for villages, holding bi-monthly meetings for groups in the eastern part of the state. Now, the Guardian Society has contracted with the New York State Office for the Aging (NYSOFA) to hire staff and run a Villages Technical Assistance Center (VTAC). Last year, the Guardian Society was the conduit for small village seed grants to four communities that came from NYSOFA.
The national Village to Village Network has grown to over 200 grassroots communities seeking to develop services and social supports to enable older persons to remain living independently. A national conference is held every year and local groups are gaining expertise and skills in how to help residents with transportation, home repair services, friendly visiting, health education and social activities.
The 2020 race for the Democratic nomination is likely to have more than a dozen significant candidates though maybe only half that number will be serious contenders. Many are enthusiastically embracing a single payer Medicare for All plan as they seek to court the party’s more liberal voters. Senator Bernie Sanders made the issue a priority in his 2016 campaign and if he runs again he will be leading the battle again though there are others who want to share the issue.
However, as the campaign is already beginning to unfold some candidates are being forced to spell out what their plan would entail and whether they would support the single payer idea and get rid of private insurance. Some more moderate Democrats may not be willing to go there with Senator Sherrod Brown of Ohio saying it is bad politics. He is saying that improving the Affordable Care Act by providing a public option and lowering the Medicare age to 55 or lower to begin with are better starting points. He and others are noting the ferocious opposition to the Affordable Care Act that, in part, cost the Democrats control of Congress in 2010 and anticipate a full onslaught not only by private insurance companies but by doctors and other providers.
So, it will be interesting to see where the current frontrunner in the polls, former Vice President Joseph Biden, comes down if he decides to run. He takes a more pragmatic approach on many issues and he may opt not to fully embrace Medicare for All. Others like former New York City Mayor Michael Bloomberg who sees himself as a centrist has rejected Medicare for All as too expensive and impractical. Elizabeth Warren, Kamala Harris and Kirsten Gillibrand are closer to the Bernie Sanders position.
Older voters who already have Medicare are concerned about maintaining it and giving the government the power to negotiate the price of prescription drugs in Medicare Part D. Many seniors are also very politically active supporting the single payer plan.
Recent polling shows support for Medicare for All but that support drops significantly when respondents are told that private insurance would not be part of it. For Democrats supporting Medicare for All they will have a lot of educating to do with the public in order to convince them to support such a bold change in the status quo. Health care has always been a political quagmire for those seeking to change it.
I was saddened by the recent death of Harris Wofford, the Senator from Pennsylvania and former aide to Martin Luther King and JFK who I became friends with when I was Director of the New York State Office for the Aging. He worked with Sargent Shriver getting the Peace Corps going and he came to meet me when he was working for the Experience Wave to promote civic engagement and voluntarism for older persons. He was a remarkable man who played a key role not only in the founding of the Peace Corps but also VISTA, Americorps and the Senior Corps which includes the RSVP program (Retired Senior and Volunteer Program) and the Foster Grandparents program.
His 92 years included time as a child when he toured India with his grandmother and saw Gandhi and studied and promoted his non-violent philosophy. He became an advisor to Martin Luther King and was credited with getting Presidential candidate John F. Kennedy to to call Coretta Scott King while Martin Luther King was in jail in 1960. He wrote of his experiences with these two icons in his book, Of Kennedys and Kings.
Writing in the Washington Post after Wofford’s death, columnist Michael Gerson said, “Wofford’s theory of social change is compelling. It speaks to the individual. No life lived in service to others is empty. Service is a good way to launch young people into responsible adulthood. A good way for seniors to share undiminished wisdom and skills A good way for anyone to give purpose to their freedom and direction to their gifts.”
Harris Wofford was a good and great man who was a role model of how to impact society and public life in a positive, civil and unifying way.
The House Government Oversight Committee, now chaired by Congressman Elijah Cummings of Maryland has written letters to a dozen major drug companies asking for information about their drug pricing policies. Democrats are vowing to make lowering drug prices a major goal in the House.
“For years, drug companies have been aggressively increasing prices on existing drugs and setting higher launch prices for new drugs while recording windfall profits,” Cummings said in a statement. “The goals of this investigation are to determine why drug companies are increasing prices so dramatically, how drug companies are using the proceeds, and what steps can be taken to reduce prescription drug prices.”
Meanwhile, Democrats in the House are considering a number of actions to address high drug prices for all consumers as well as ways to lower prices through Medicare and using other government powers. These options include:
-cap out of pocket costs
-negotiate Medicare drug prices
-more generic drugs to market
-use foreign pricing as reference for US prices
-rebuild patent system
-have the government produce some drugs
-import drugs from Canada
The Trump Administration has also made reducing drug prices a priority and Donald Trump suggested that foreign prices could be used as a basis for pricing in this country. He also wants to promote changes in Medicare pricing and approve more generic drugs.