Vaccine experts call for clarity on UK’s 12-week Covid jab interval

British Society for Immunology calls for a robust programme monitoring the body’s immune response

Experts have called for greater clarity on the monitoring in place to assess the 12-week dosing interval for Covid-19 vaccines, as the row over delayed second doses continues.

The UK’s coronavirus vaccination programme was shifted late last year to prioritise administering the first dose of jabs to as many at-risk people as possible. As a result, the interval between the two doses of the jab was increased to up to 12 weeks.

Related: Doctors call for shorter gap between Pfizer Covid vaccine doses in UK

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Vaccine experts call for clarity on UK’s 12-week Covid jab interval

British Society for Immunology calls for a robust programme monitoring the body’s immune response

Experts have called for greater clarity on the monitoring in place to assess the 12-week dosing interval for Covid-19 vaccines, as the row over delayed second doses continues.

The UK’s coronavirus vaccination programme was shifted late last year to prioritise administering the first dose of jabs to as many at-risk people as possible. As a result, the interval between the two doses of the jab was increased to up to 12 weeks.

Related: Doctors call for shorter gap between Pfizer Covid vaccine doses in UK

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Nearly 6 in 10 Older Americans Don’t Know When or Where They Can Get a COVID-19 Vaccine; Black and Hispanic Adults among the Groups Least Likely to Have Enough Information

Despite Optimism about COVID-19 Vaccines in the Future, Half Say They are Frustrated with the Current Situation and Nearly a Quarter are Angry While older Americans are a high-priority group for getting a COVID-19 vaccine, the latest KFF COVID-19 Vaccine Monitor report finds that, among those who have not yet been vaccinated, most people ages 65 andMore

Get Ready for a Lot of Biden Executive Orders on Health Care

In this column for the JAMA Health Forum, Larry Levitt explores what President-elect Biden might do to advance his health care vision both through legislation and through executive orders and waivers and demonstrations.

Britain could be mass-producing its Covid shot. Shame we junked our industrial base | Aditya Chakrabortty

The dire state of UK manufacturing has left us dependent on other nations. We may soon find out why some call this a ‘national security risk’

Everything now hinges on a vaccine: how many more Britons die, whether the NHS finally breaks, how long the UK stays locked down. All depends on how fast the country can get vaccinated against this plague. Yet we’re in this position in large part because of government failure. When the prime minister imposes lockdowns late and with a sulky grumble; when we haven’t fixed our £22bn test-and-trace system (which, by the way, now bankrolls more outside consultants and contractors than the Treasury has actual civil servants); and when the Dominics and Stanleys are allowed to carry on as if rules are for the little people. If Boris Johnson blunts every political instrument he can lay his pale and meaty hands on, pretty soon a syringe is the only resort.

Vaccines were always going to be how the world limped out of this pandemic; but as Taiwan and New Zealand show, even without inoculation it is possible to drive the number of Covid cases significantly down. Compare their record with the UK – which is on course to hit 100,000 Covid-related deaths before January is out, and where a staggering one in 30 Londoners is today infected. The lecterns from which Johnson and his top advisers gave their press conference this week read “Stay Home. Protect the NHS. Save Lives” – exactly as they did at the start of all this last March, as if to confirm how little progress they have made in almost a year.

Related: For mRNA vaccines, we should stick to the schedule | Angela Rasmussen and Ilan Schwartz

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Sector by sector: are British firms ready for post-Brexit trade?

Analysis: From retail to aviation to pharmaceuticals, we look at what will change from 1 January

After months of tortuous negotiations between the UK and the EU, a Brexit trade deal was agreed at almost the last minute. But how prepared are UK businesses for the significant changes that will come into force on 1 January? Are they happy with the terms of the agreement?

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Evaluating President-Elect Biden’s Healthcare Plan | Part 1

By TAYLOR J. CHRISTENSEN

Without the full support of congress behind him, President-Elect Joe Biden will probably not have an opportunity to sign any major system-altering healthcare legislation. But, if Democrats can gain a majority in the senate–either this election cycle or next—healthcare reform will be high on the agenda. Let’s take a critical look at what Joe Biden would push to accomplish.

For this evaluation, I am relying solely on information that Joe Biden has committed to on his official campaign website. He has many pages talking about a variety healthcare issues, such as the pandemic, gun violence, and the opioid epidemic. But the main page that reviews his plans for the healthcare system as a whole is here. Consider giving it a read through first, because what follows will only be summarizing and evaluating the key big-picture components of his plan.

Joe Biden is not pushing for Medicare for All. He instead wants to keep the Affordable Care Act (i.e., the ACA, or “Obamacare”) and fix the parts of it that are not working so well. To understand the rationale of his proposed changes, we first need to review where we are at now with the ACA.

There are many parts to the ACA, but its main thrust was to increase insurance coverage. What kind of numbers are we working with? Below are some 2019 data, rounded for simplicity. And note that I am excluding the 60,000,000 people who are over age 65 and therefore on Medicare.

The under-age-65 people fall into one of four insurance groups . . .

Employer-sponsored insurance (160,000,000 people) if they are lucky enough to work for an employer that provides benefits.

Medicaid (70,000,000 people) if their income is low enough to qualify.

Private insurance from the “private market” (10,000,000 people) if they make too much money to qualify for Medicaid and do not have an employer that provides benefits.

Uninsured (30,000,000 people) if they do not get insurance from their employer, their income is too high to qualify for Medicaid, and they do not want to pay for insurance from the private market.

Remember, those are from 2019, so they are post-ACA numbers. Prior to the implementation of the ACA, the uninsured number hovered around 45,000,000 people. What did it do to reduce the number of uninsured people? There were many ways, but here are the two biggest ways:

First, it allowed states to liberalize their eligibility criteria for Medicaid. This is known as a “Medicaid expansion,” and it offered federal funds to pay for most of the costs associated with all the new Medicaid enrollees. That accounts for about 12,000,000 of the 70,000,000 people who are currently on Medicaid, some of whom were previously uninsured, and others of whom were previously on private insurance. But Medicaid expansion was ruled optional by the supreme court, so not all states chose to expand their Medicaid programs.

Second, it created a tax (also called a “health insurance mandate”) for anyone who did not have health insurance. This was to push the uninsured who did not qualify for Medicaid to buy insurance. And because everyone was going to be required to buy insurance, the government had to make sure it would be affordable for everyone, so they promised to help cover the cost of insurance premiums for anyone under 400% of the poverty level. Additionally, to prevent insurance companies from taking advantage of the government’s willingness to help pay for people’s insurance premiums, they made a rule that insurers have to charge everyone the same premium without respect to pre-existing conditions (although that premium can be adjusted up or down to a limited extent depending on a person’s age and smoking status).

So, an easy way to summarize the ACA’s second way it was trying to increase insurance coverage is by saying it was attempting to shift uninsured people into that private market. The ACA even created a nice website (healthcare.gov) to make it extra easy for people to shop for insurance plans on the private market by listing them all there side by side in a standardized fashion, and the website went so far as to pull in people’s tax information to calculate their premium subsidy right up front as well.

While Medicaid expansions were predictably effective at lowering the number of uninsured people in the states that chose to do that, the mandate did not work so well–most of the healthy uninsured who did not newly qualify for Medicaid still did not buy insurance.

This was for a variety of reasons. Some people who were not on health insurance when the ACA’s mandate took effect did not even realize they were choosing, by default, to pay that tax, so it had no motivating impact on their insurance status. Other people wanted to buy insurance to avoid paying the tax, but unless they qualified for premium subsidies, they found that private market premiums were unaffordable, so it made more sense for them to just risk continuing to be uninsured and pay the tax.

The summary of the ACA’s effects on the private market, then, is that it created a perfect storm of sick people getting insurance and healthy people not getting insurance, which drove premiums higher and priced out even more people. Then, in 2017, the mandate was eliminated, which further aggravated these issues.

All these factors help explain why we continue to have 30,000,000 people uninsured in spite of the ACA’s efforts.

With all this in mind, the natural solution becomes fairly obvious: To shift the uninsured into the private market, restore and strengthen the mandate and get rid of the 400% poverty level limit on premium subsidies and make them more generous.

And that’s exactly what Joe Biden would do. Except for the reinstating the mandate part, which would probably not be popular nor even possible. I guess he hopes that if his subsidies are generous enough, he will get the healthy people into the market even without a mandate.

How generous is he making the subsidies? Healthcare premiums will be limited to no more than 8.5% of any individual or family’s income, regardless of income. Currently subsidies kick in at around 10%. And not only that, but he is also planning on benchmarking these subsidies based on gold level plans rather than silver (meaning out-of-pocket costs, especially deductibles, will be a lot lower). This will certainly entice at least some of those 30,000,000 people into buying health insurance.

But he has gone further than that. I suspect he feels that insurance companies do not truly competitively price their plans, because he also intends to create a new government-run insurance company that would offer its own plan (known as the “public option”) in the private market alongside all the other private insurers’ plans on healthcare.gov. As the thinking goes, if the public option ends up being way cheaper than all the private plans, private insurers will lose much of their market share and will be forced to offer lower prices.

This private option would also be made available to other groups, such as employees whose employer does not provide health insurance, and it would even be offered for free to low-income uninsured people in states that have not expanded Medicaid.

Now you know the major points of Joe Biden’s healthcare plan, plus the relevant context to show why he chose them. Part 2 of this series will critically evaluate that plan to show what he got right and what he got wrong or missed altogether.

Taylor J. Christensen is an internal medicine physician and health policy researcher who blogs about how to fix the healthcare system at clearthinkingonhealthcare.com.

Government ‘operated illegal buy British policy’ over Covid contracts

Other firms better placed to supply antibody tests, argues case against health secretary Matt Hancock

The government was operating an illegal “buy British” policy when it signed contracts with a small UK firm to supply Covid antibody tests, claim lawyers who have filed a case against the health secretary.

The Good Law Project said there were a number of other companies in a better position to supply antibody tests in June and August, when the Department of Health and Social Care (DHSC) agreed deals worth up to £80m with Abingdon Health without going out to tender.

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Poll: Large Majorities Now Say They Wear Masks Regularly and Can Continue Social Distancing for At Least Six Months if Needed, though Republicans Remain Less Likely to Take Such Precautions

As winter sets in and COVID-19 cases and deaths reach records in most parts of the country, more Americans say they wear masks every time they leave home now (73%) than said so in May (52%), a new KFF Health Tracking Poll finds. A small minority (11%) say they wear masks only some of theMore

KFF Launches New COVID-19 Vaccine Monitor to Track the Public’s Confidence in the Vaccine and Experiences for the Duration of the Pandemic

Republicans and Black Americans are More Likely to Be Hesitant but Even Among These Groups Reasons Vary KFF has launched a new COVID-19 Vaccine Monitor to dive deeply into the public’s views about the vaccine and experiences getting it for as long as the pandemic lasts. First results released today show that Americans’ enthusiasm forMore

KFF COVID-19 Vaccine Monitor: December 2020

This initial survey for the KFF COVID-19 Vaccine Monitor tracks the public’s attitudes and experiences with COVID-19 vaccinations, with a focus on sub-groups of Americans. It explores confidence in vaccines, assesses trust in messengers, and highlights key challenges for vaccination efforts.

Ministers would be wise to play for time before ordering Sizewell C | Nils Pratley

Dashing ahead with a nuclear power station that’s modelled on Hinkley Point C would be reckless

This is the government’s problem as it reopens talks on a proposed nuclear power station at Sizewell C in Suffolk: it is contemplating ordering a replica of Hinkley Point C before the Somerset original has produced a single megawatt of electricity.

That is not a small point. Developer EDF’s pre-Hinkley version of its European pressurised reactor at Flamanville in Normandy is about a decade behind schedule. What’s more, EDF wants UK taxpayers or bill-payers to bear more of the construction risks at Sizewell, a less-than-compelling offer when you remember that Flamanville is also €9bn (£8.2bn) over budget.

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Deal or no deal: how life will look for key industries after Brexit

Companies are praying a trade agreement can be struck, but must prepare for talks to fail. Which will be most affected?

The scene is set for a showdown, and the future of the UK economy is at stake. Will Britain secure a free trade deal with the EU? Or will the prime minister choose to sail into uncharted waters, not only stepping outside the single market and customs union, as the UK will be even under a deal, but adding the tariffs and border checks that come with a no-deal Brexit?

Armed with a determination to end the transition period on 31 December, Boris Johnson is poised to force British businesses to sell their goods and services across the EU without any of the benefits that a deal offers, and with only a few days’ notice. Here we assess the impact on some of the worst-hit industries of securing a deal – albeit a slimmed-down one – compared with the alternative.

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Here’s how to tackle the Covid-19 anti-vaxxers | Will Hanmer-Lloyd

Do not demonise. To optimise the vaccine rollout, all of us must show respect to those who are unsure about inoculations

  • Will Hanmer-Lloyd is a behavioural strategist

The Covid-19 vaccines, which are up to 95% effective, have the potential to save millions of lives in the UK and many more around the world.

Yet creating the vaccines is just the first step. We now need to produce them as quickly as possible, work out the logistics of distribution and administration and – most importantly – ensure as many people as possible take them. And as the history of vaccines shows, that is not as easy as some might assume. You only have to look at the fall in uptake of the measles, mumps and rubella (MMR) vaccine after it was falsely linked with autism.

Related: Vaccine results bring us a step closer to ending Covid, says Oxford scientist

Related: Covid vaccine tracker: when will a coronavirus vaccine be ready?

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Vaccine results bring us a step closer to ending Covid, says Oxford scientist

Latest breakthrough comes as PM says he hopes most at-risk could be immunised by Easter

The world is moving a step closer to ending the coronavirus pandemic, the scientist behind Britain’s first vaccine has declared, as Boris Johnson said he hoped the majority of those most at-risk could be immunised by Easter.

Successful trial results for the Oxford University/AstraZeneca vaccine, suggesting it could protect up to 90% of people, are the third set of promising findings in as many weeks. Before this year, there had never been a vaccine for a coronavirus.

The UK government’s joint committee on vaccination and immunisation has published a list of groups of people who will be prioritised to receive a vaccine for Covid-19. The list is:

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The Guardian view on coronavirus and vaccine scepticism: time to act | Editorial

Plans for mass immunisation against Covid-19 are developing fast, but concerns must be addressed

In the 1960s, academics studying rumours drew inspiration from epidemiology. They noted how such stories spread through communities, “infecting” some individuals while others seemed immune, and how more resistant populations could stop their spread.

Their insights have in turn been taken up by health professionals. Hearsay can be useful, helping to catch disease outbreaks. It can also be deadly. Though vaccine hesitancy is as old as vaccines themselves, it has risen sharply in many countries in recent years. Unfounded scare stories about the safety of immunisation programmes have contributed to growing scepticism and outright refusal, with fatal consequences. In her new book Stuck: How Vaccine Rumours Start – and Why They Don’t Go Away, Prof Heidi Larson notes the paradox: we have better vaccine science, more safety regulations and processes than ever before, yet a doubting public.

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UK in ‘advanced discussions’ to buy Moderna Covid vaccine

Britain decided not to buy US vaccine and earliest it could be supplied to UK is spring 2021

The UK has not acquired the Moderna vaccine but is in “advanced discussions” to ensure British access, officials have said, while cautioning that no one in the UK would be able to be given it until spring next year.

A government spokesman said the company was scaling up its European supply chain but that it would be around four to six months before the vaccine might be available in the UK, a far longer timeframe than the Pfizer-BionTech vaccine, which the chief scientific officer has said could be available by Christmas.

100m doses of the University of Oxford/AstraZeneca vaccine

40m doses of the BioNTech/Pfizer vaccine, reported last week to have 90% effectiveness

60m doses of Novavax vaccine

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In Praise of Unsung Heroes

By KIM BELLARD

Even in this extraordinary year, this has been an extraordinary week.  Last Tuesday we had what many believe to have been the most important Presidential election in recent times, maybe ever.  The week also found the coronavirus pandemic reaching new heights.  That was the week that was.

What struck me, though, is how both our election systems and our healthcare system rely on “ordinary” people to keep them going.  They’ve never been more extraordinary than this year.

The pandemic first impacted voting earlier in the year, during primary season.  Going to the polls suddenly seemed like potentially a life-threatening choice, and working at them practically suicidal.  Dates of primaries were moved, many polling stations were closed, new voting procedures were put into place, and absentee ballots found a new popularity.  And yet people turned out in droves to vote, often standing in line for hours.

President Trump upped the ante by constantly railing against absentee ballots and warning about voter fraud.  Despite this, or perhaps because of it, record numbers of people voted early, in person or by mail.  Several states had surpassed 2016 numbers of voters before Election Day.   Tens of millions more showed up on Election Day.  And, amazingly, Election Day passed with relatively few incidents.

Then the counting started. 

We’re a week in and races in several states have yet to be called, and have lack of agreement from most Republicans about some of the ones that have been called.  We have an apparent President-elect but no concession from the current President or other Republican “leaders.”  Instead, they utter the bromide that we should count the legal votes, not count the illegal votes, and let the judicial process play out.

As is always true, but especially during the pandemic, the election would not have been possible without poll workers.  With older people both being more at risk for COVID-19 and being the majority of the election workforce, it wasn’t initially clear there would be enough workers. 

Calls went out for young people to become poll workers – and they responded.  Organizations like Power the Polls and Poll Hero Project recruited over 650,000 new workers, most of them under 65 and many of them students.

“I just felt that I had to do something,” one student worker told The New York Times.   Another told The Christian Science Monitor:

There are a lot of stereotypes about my generation: We’re lazier, not connecting to the real world. We’re zombies to social media and our phones and stuff.  But this has truly shown me that is just not at all true. There are so many people my age who are just looking for any opportunity to get involved.”

Election Assistance Commission chairman Ben Hovland told Time: “Poll workers are really the unsung heroes of our democracy.” He’s right.

But, of course, once all those votes are cast they have to get counted, and that leads to a second group of unsung heroes of democracy.  Those are the people sitting in those drab offices and warehouse deciding which ballots are valid and ensuring they get properly counted.  They’re set up as bipartisan teams, usually with election observers watching the process. 

In 2020, unfortunately, they’re the ones also risking catching CIVID-19 in the close quarters and getting threats of physical violence, even death threats.  The President and his allies are constantly questioning their motives, challenging their tallies and gathering outside counting spots to protest. They’re demeaning the hard work and long hours the workers have been putting in. 

One nonpartisan poll watcher saw partisan observers harassing election workers, telling WaPo:

That was the most heartbreaking part.  I felt for those workers. I could only imagine what it would feel like, trying to do your job, having these people hover and sneer at you and yell at you and make something so simple, something that’s supposed to be so patriotic, so hard.

Despite all that, the Registrar in Clark County (NV) spoke for all his compatriots, insisting to WaPo: “We’re going to be okay.  We’re going to continue to count. We will not allow anyone to stop us from doing what our duty is.”

“It’s a risky thing to do, but it’s essential work,” one such worker proudly told NYT

Meanwhile, the U.S. is nearing 10 million COVID-19 cases and a quarter of a million deaths, setting new daily records for cases and hospitalizations, both nationally and in a majority of states.  ICU beds are in short supply, as is PPE.  As bad as the spring was in the northeast, the fall is proving to be just as frightening, and the winter threatens to be even worse.

Speaking of unsung heroes, the last count – well over a month ago — for health care worker deaths from COVID-19 topped 1,700 in the U.S. alone. 

Health systems are again resorting to recruiting contract health care workers, often from other states USA Today reports: “Hospitals in nearly every state are recruiting contract nurses to fill shifts,” often paying “crisis rates.”  One emergency room physician added: “Pretty much every nurse who wants a job right now in the United States has a job.”

These are the workers whom President Trump accused of falsely inflating COVID-19 counts in order to get paid more.  It’s not clear if he was including the Walter Reed staff who saved his life when he contracted COVID-19.   

“Trump has insulted our integrity and allowed for more than seven months of chaos and excessive deaths (due) to COVID,” one ER physician told CNBC.  Another lamented that so many still voted for President Trump: “I really thought that our experiences in the trenches would impact people’s voting decisions.” 

The poll workers showed up to work.  The ballot counters showed up to work.  The nurses, medical technicians, aides, doctors, pharmacists, and other healthcare workers showed up for work.  It isn’t always, or even usually, glamorous, and, for most of them, it’s not even particularly well paid. But they do it anyway, despite the risk of COVID, despite the criticisms, despite even the threats,

The least we could do is to be grateful, and not make their jobs even harder.  Let’s make them unsung no more. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

Why a Covid vaccine doesn’t mean the end of face masks yet | David Salisbury

Despite the Pfizer breakthrough, social distancing and remote working won’t disappear overnight

The news this week that the Pfizer/BioNTech vaccine protected more than 90% of recipients is of huge importance. The vaccine efficacy is higher than we had hoped for.

There appear to be no safety concerns, although the final safety data along with other data on manufacturing and the full efficacy results will need to be submitted to the Medicines and Healthcare products Regulatory Agency (MHRA) to review whether it’s safe enough to grant temporary authorisation. This would allow the vaccine to be rolled out before a full product licence is issued.

Related: Speed trumps efficacy in UK’s Covid vaccine rollouts, says adviser

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What Will Shape Joe Biden’s Health Care Agenda?

I’m thrilled to have health futurist Jeff Goldsmith back on THCB, and given Biden was only confirmed as President-elect this morning, his article on what to expect is extremely timely!–Matthew Holt

By  JEFF GOLDSMITH

The Trump administration’s health care journey began with a trillion dollar near miss–the failed Repeal and Replacement of ObamaCare- and ended with a full-on train wreck, the catastrophically mismanaged COVID epidemic that will have claimed 300,000 lives by the time he leaves office. After four years of posturing and lethal incompetence, it will be a relief to see caring and professionalism return to the White House health policy under President-Elect Joe Biden.   

Like Inheriting a Badly Managed World War

Like Barack Obama, Joe Biden will be saddled at the beginning of his regime with a damaged national economy. He will also walk in the door to the immediate need to manage the greatest public health catastrophe in a century as well as its economic consequences–a deep and enduring recession. Biden will be inheriting the equivalent of a badly managed World War we are presently losing.

Public health professionals who were marginalized by Trump will be challenged not only to craft coherent policy to contain and extinguish COVID  but also to sell it to a frightened and polarized general public, many of whom reject the need for basic public safety measures.    

Controlling COVID and rebuilding the critical public health agencies–CDC and FDA–that have damaged by political meddling will consume the lion’s share of the administration’s health policy bandwidth in its first year. It will be pressed to address a huge readiness gap–from critical PPE supplies to the development and deployment of testing and tracing capability to public health co-ordination and messaging–for the next pandemic. Increasing the presently inadequate level of public health funding (less than $100 billion a year in a $21 trillion economy) seems inevitable.

The inability of Congress to produce a fall round of COVID relief will create pressure on Biden to take immediate action to help struggling sectors of the economy, like airlines, restaurants and hospitals, as well as further help for the long term unemployed. Only a little more than half of the 22 million jobs lost in the spring have returned by November. Twenty million Americans were stranded by the July expiration of supplemental unemployment benefits as well as countless millions more “free agents” and contractors not eligible for traditional unemployment that are losing coverage at the end of the year. Mortgage, credit card and consumer loan forbearance are ending, and unless Congress acts, acres of rotten credit will turn rapidly into a banking and bond market crisis which the Federal Reserve cannot fix by itself.   

State governments face FY21 deficits equaling $500 billion over the next two years , against a current annual spending base of about $900 billion.  Further assistance to state and local governments will almost certainly include an additional increase in the federal match for Medicaid (FMAP), beyond the 6.2% temporary increase passed in March). Medicaid enrollment will likely top 80 million by mid 2021, almost one-quarter of the US population. Some states will have upwards of 40% of their population on Medicaid by mid-2021.

States laboring under severe revenue shortfalls will be unable to afford the expanded Medicaid program that was part of ObamaCare without a further increase in the FMAP rate.  President Trump and Senate Republicans blamed the state and local government fiscal crisis on profligate Democratic mismanagement, and blocked aid to them during 2020. But Texas, Florida, Georgia and other red states have the same problems New York and California do. 

Serious Fiscal Limitations Push the Health Policy Agenda Away from Coverage Expansion

Barack Obama entered office with a FY08 federal deficit of $420 billion. Joe Biden enters with a FY20 deficit of $3.1 trillion and a baseline FY21 deficit of $1.8 trillion, before adding the cost of the likely additional trillion dollar-plus stimulus package early next year. It will be passed over the dead bodies of Republican Congressional leadership suddenly recommitted to deficit reduction after racking up $8 trillion in deficit spending during the four years they controlled the federal government.

Coverage Expansion via Medicare and Public Option Unlikely

That deficit will significantly constrain a further expansion of health coverage. Not only will “Medicare for All” be off the table. Severe fiscal pressures will cause the new administration to “slow walk” a public option (which would require federal subsidies to implement) and Medicare expansion to people over age 60. These expansions were going to be  controversial and politically costly because they would be fiercely contested by hospitals and other care providers concerned about the erosion of their commercial insured customer base (the source of perhaps 130% of their bottom lines) as well as the use of Medicare as a de facto price control lever. 

By the time Biden addresses the first two problems–COVID and the economic crisis–he will probably have expended his limited stock of political capital and be weakened enough to be unable to take on the large messy issues of health coverage expansion and cost control. The Affordable Care Act exhausted Obama’s store of political capital, by early 2010. His administration’s failure to turn the economy cost the Democrats control of the House of Representatives and 20 (!) state legislatures in 2010.

What Can Biden Do in Health that Does Not Require Federal Spending?

Thus, the focus of Biden health policy is likely to be on items not requiring fresh spending.

Two major candidates for Biden policy activism: facilitating unionization of health care workers and antitrust enforcement. Labor unions were major Democratic supporters in this election cycle. Moreover, they were extremely active this spring and summer as advocates for the safety of health workers. They ran a very effective orchestrated press campaign to pressure large health systems such as HCA and Providence Health. Union leaders were prominent in health policy working groups for the Biden campaign after the conclusion of the primary season. Aggressively pro-union appointments to the National Labor Relations Board and legislation to facilitate union elections are almost certain to be early Biden initiatives.

Antitrust action to slow down or unwind hospital and health insurance mergers are also likely. The California Attorney General Xavier Becerra’s settlement of his aggressive anti-trust action against Sutter Health not only resulted in a huge financial payment (useful for reducing California’s budget deficit) but also forbade Sutter from “all or nothing” rate negotiations with health insurers. Spreading this approach nationally would significantly damage the financial position of large multi-hospital systems and complicate the forthcoming rate negotiation cycle with health insurers.  

It is also likely that the Biden administration will continue the push begun during Trump for price transparency and disclosure of patient financial responsibility prior to service, further complicating rate negotiations with health insurers. Resolution of the deadlock over surprise billing is also likely.

Finally, Biden is likely to attack the 5% margins generated by Medicare Advantage carriers who now control 37% of all Medicare lives, and are getting a 50% share of each year’s worth of baby boomers enrolling in the program. Only half of boomers are yet enrolled in Medicare, and cutting Medicare Advantage cap rates will be a juicy target for Biden’s OMB in attempting to control the exploding federal deficit. Cutting health insurer profits is not the same as “cutting Medicare”.

Health care’s corporate sector is presently basking in record valuations and a largely favorable regulatory climate from the outgoing Trump administration, even as the care system has reeled from COVID.  Financial pressures from the COVID health economy and continued slack demand for care will certainly challenge the care system, as it faces renewed regulatory and political pressures from the new administration. 

Jeff Goldsmith is the President of Health Futures, Inc

We Need a Digital Identity Framework to Guide the Challenging Transition to Remote Healthcare

By GUS MALEZIS

We don’t often see two Republicans and two Democrats come together to offer solutions to problems. But even at this difficult time in America, I can see bipartisanship in a truly meaningful way. The intensely-challenging issue of digital identity is bringing members of Congress of both parties together.

Most American adults rely on an 84-year-old system of identification — the social security number. But that ID is limited in use, and does not serve us well in healthcare and especially as COVID-19 – beyond the healthcare and safety issues – makes us an ever more digital nation. We are indeed accelerating our national pivot to a digital nation as we, for example,  log on to go to school or work, to buy food, to shop for clothing, or to pay bill and transfer money from a bank account. And, now more so than ever, healthcare is becoming digital, as we seek to navigate a digital world to visit the doctor, to fill a prescription, or to review medical test results. Digital identity presents a major obstacle to a safer and smoothly functioning digital healthcare experience.

As the Coronavirus disrupts our nation, and healthcare delivery turns increasingly digital, on-line fraudsters have not been interrupted; they have simply been given far more opportunity than they might have imagined.

Congressman Bill Foster(D-IL) , has introduced the “Improving Digital Identity Act of 2020,” to make digital identity more secure and data breaches and identity theft less likely. Joining him in sponsoring the bill are another Democrat, John Lagevin (D-RI), and two Republicans — John Katko (R-NY)and Barry Loudermilk (R-GA). These four Congressmen — from far different parts of the American political spectrum — have come together to create a bill that would establish a standard framework for federal agencies to provide digital identity verification, establish a task force on securing digital identities, and create a grant program for states to modernize systems.

This bipartisan effort to protect digital identity can help change for the better millions of lives in the healthcare world. While many of the entities behind this bill are from the financial services world, healthcare needs this bill to become law as much as any sector. Healthcare providers are in desperate need of a more robust, comprehensive digital strategy to address the industry’s unique security, privacy, compliance, and workflow challenges. As important as it is for providers to have a powerful digital ID, it is equally important for patients to have one too, so they can have easy and consolidated access to their health information, and so that doctors can equally see the patient’s complete health picture, regardless if they are treating the patient at the home, the clinic or hospital.

As technology leaders, it is our job to deliver the solutions necessary to meet these complex and growing cybersecurity demands. Having a digital identity framework for all industries, including healthcare represents a giant step forward. With a unified system, we can avoid the security and efficiency gaps of non-cohesive approaches, and we can ensure patient privacy. This is especially important as we plan for the post-pandemic world, which no doubt will only involve more and more remote care – and many other unknowns.

Our goal is to develop a technology solution that works everywhere — in the clinical environment, at home, on any device. After all, healthcare is no longer just in the hospital and the ER – it takes place everywhere, and we need enhanced digital identification that will allow us to access it from anywhere. The technology also has to be simple and easy to use. We cannot afford to further complicate physician workflows and risk exacerbating the national public health problem of physician burnout.

Albert Einstein said, “in the midst of every crisis, lies great opportunity.” With more remote medicine being practiced during the global pandemic, more digital identity failures are exposed. The opportunity — working more remotely and more digitally, with elevated security and privacy during the Covid crisis – is to make vast improvements in healthcare delivery as a whole. That starts with a trusted digital identity framework designed specifically to address and support the unique requirements of healthcare — and its entire ecosystem, including clinicians, patients, external vendors, and non-human entities such as shared mobile and connected medical devices.

We are reaching for these goals, and this legislation will be pivotal. Not only will health care providers benefit from having a trusted digital identity, but indeed all Americans will –  whether they be traversing a healthcare system, depositing a check, or ordering a pizza.  

At this time of stress and pandemic in our country, I am grateful to see four members of Congress come together — two Republicans and two Democrats — in favor of a more secure digital identity for us all.  

Gus Malezis is the President and Chief Executive Officer of Imprivata, a Lexington, Mass.-based healthcare digital identity company.

Pharma may avoid worst-case drug pricing scenario as US elections deadlocked

Pharma may have avoided a worst case scenario amid the political upheavals in the US elections with the threat of tough drug price legislation lowered, with hawkish Democrats unlikely to win overall control of Congress.

With the outcome of the presidential race unclear at the time of writing, Democrats likely to back tough drug pricing legislation may not have won the majority needed to control the Senate, although they look to have maintained control of the lower House of Representatives.

The Democrats need to “flip” two seats in Georgia to win a slim majority in the upper house and analysts said the party doesn’t have the influence it needs to effect radical change on drug pricing in the US.

According to a team of Jefferies analysts led by Peter Welford a Democrat clean sweep would have been “optically concerning” for pharma because of the party’s tougher stance on medicine prices – a vexed issue in the US where many patients pay all or part of prescription costs.

The pharma sector’s “sharp uptick” yesterday was also down to the FDA’s publication of briefing documents from the FDA that suggest Biogen’s Alzheimer’s drug aducanumab could be approvable ahead of an influential meeting of the regulator’s advisers tomorrow.

If Joe Biden is confirmed as president, Jefferies said it is less clear on his top priorities for pharma, although an expansion of the Affordable Care Act – also known as ‘Obamacare’ – could be likely.

A Biden presidency is likely to favour tying drug prices to the lowest price from a basket of developed-world countries for Medicare drugs administered by doctors (part B).

It would also aggressively push this policy for self-administered (part D) Medicare drugs, according to Jefferies.

If Trump remains in the White House he would also pursue this “most favoured nation” policy on drug pricing for part B drugs, and potentially for part D drugs.

Roche is most exposed to this pricing reform, potentially hitting sales of its recently launched drugs Ocrevus for multiple sclerosis, Hemlibra for haemophilia, and Tecentriq for various types of cancer.

These drugs were supposed to replace sales lost as Roche’s older cancer drugs Rituxan, Herceptin and Avastin were hit by biosimilar competition, although the effect may not be as marked in the US where price differences between old and new drugs are less marked.

Biden’s proposals for hikes to US corporation taxes could be more punitive for Roche than for other pharma companies, translating into a 4-5% cut in earnings per share according to Jefferies.

 

 

 

The post Pharma may avoid worst-case drug pricing scenario as US elections deadlocked appeared first on .

Election Issue Spotlight: “Junk” Insurance Makes a Pandemic Even Worse

By ROSEMARIE DAY and NIKO LEHMAN-WHITE

One of the most important responsibilities of the American government is to protect its citizens from harmful industry practices, from lead poisoning to dangerous pharmaceuticals to financial meltdowns. Its record is far from perfect, but government regulators usually act in good faith and in turn earn the trust of those they protect. As we head into Tuesday’s election, it’s important to shine a spotlight on the fact that the Trump administration has betrayed that trust yet again. They have allowed low-quality, unregulated forms of insurance called Short-Term Limited Duration Insurance (STLDI) to prey upon those who lost their jobs during this pandemic. Also known as “junk” insurance, this issue has gotten far less attention than the need to protect people with pre-existing conditions. But the consequences of its inadequate coverage can be just as devastating.

Only 57% of STLDI plans cover mental health care, only 29% cover prescription drugs, and virtually none cover pregnancy. These plans are also allowed to discriminate against the sick, which most do in order to save money. STLDI managed to penetrate the market through a combination of cheap prices, lucrative broker incentives, and deceptive marketing.

Consumers get very little back for their money with these plans. Plans on the Affordable Care Act’s exchanges must spend 80 cents out of every premium dollar collected on care. In 2018, the top five STLDI insurers spent only 43 cents.

Originally envisioned as short-term solutions to gaps caused by unexpected coverage loss, the Trump administration extended their maximum length from three to 12 months and allowed renewals that can essentially extend them to three years, thus drawing consumers away from the individual markets established under Obamacare. This was essentially a kick in the gut for the law, after the current administration was unable to win any legislative or court battles against it.

These last few years, the shortcomings of these plans have been blindsiding consumers, leaving some with hefty bills for $200,000 heart surgeries and $800,000 cancer treatments. But the current pandemic has exposed just how vulnerable consumers are and just how little foresight the Trump administration displayed in allowing these plans to operate freely.

An investigative report by the Economic Studies department at Brookings and the University of Southern California called STLDI brokers, agents and other salespeople posing as consumers. They found that these entities were greatly exaggerating the extent of coverage: only one out of nine provide an accurate description of the plan’s COVID-19 treatment coverage, and half of the others provided information that was demonstrably false. This is extremely concerning. With hospital bills for COVID treatment often reaching into the tens of thousands of dollars, unaware patients will be caught with devastating surprises.

States have a number of effective options to protect consumers from this junk insurance, and many have already taken action. They can limit their duration, require a minimum Medical Loss Ratio, require disclosures, prohibit pre-existing condition discrimination, and outright ban the plans, among other options. But in the absence of federal oversight, residents of many states are left unprotected.

14 million Americans are expected to lose their health coverage during this pandemic and will be unable to switch to a family member’s plan or be eligible for Medicaid. These Americans are vulnerable to these predatory plans. With the election right around the corner, it’s time for all states to protect consumers from being taken advantage of. And it’s time for the people to hold our state and federal governments accountable for our safety and consumer rights.

Rosemarie Day (@Rosemarie_Day1) is the Founder & CEO of Day Health Strategies and author of “Marching Toward Coverage:  How Women Can Lead the Fight for Universal Healthcare” (Beacon Press, 2020). 

Niko Lehman-White is a Consultant with Day Health Strategies.

Careful What You Wish For: How Republican Attorneys General’s Attack on the ACA Could Trigger Medicare for All

By MIKE MAGEE

Cautionary tales are timeless. Take for example Aesop’s Fables, from 620 BC, which included the advisory, “Be careful what you wish for lest it come true.”

Trump and the Republicans who oppose the ACA take heed. You may be inadvertently taking the entire collusive Medical-Industrial Complex down a rabbit hole.

In the opening salvo to the Amy Coney Barrett hearings, House Speaker Nancy Pelosi seemed to be anxious for the fight.  Her view of Trump’s strategy? “The president is rushing to make some kind of a decision because … Nov. 10 is when the arguments begin on the Affordable Care Act…He doesn’t want to crush the virus. He wants to crush the Affordable Care Act.”

With no health plan replacement on the shelf, death star Republicans have been struggling to bury this ever more popular piece of legislation for ten years.

In the process, they’ve alienated not only those who believe health care is a right rather than a privilege, and those who support protections for pre-existing conditions, but also those against deceptive skimpy health insurance, those who believe transgender Americans deserve care guarantees, those who demand access to affordable drugs, those who have their under age 26 adult children covered on their family plan, those opposed to cuts in coverage of contraceptives, and those in favor of federal funding of Planned Parenthood clinics.

As Kaiser Health News Washington correspondent, Julie Rovner, recently wrote, “With the death of Ruth Bader Ginsburg, the ACA’s future is in doubt.” In a case now known as California v. Texas, set for presentation to the Supreme Court in just a few weeks, 21 attorneys general (AGs) led by California are seeking clarity on a challenge by Texas led Republican AGs to declare the ACA unconstitutional based on a weak technicality.

Experts like University of Michigan law professor Nicholas Bagley have sounded the alarm that Barrett’s confirmation could mean the deciding swing vote on the case. He writes, “Among other things, the Affordable Care Act now dangles by a thread.”

But charter members of the Medical-Industrial Complex (MIC) aren’t lining up with Mitch McConnell. America’s Health Insurance Plan (AHIP), the lobbying arm for the big insurance companies, says a Trump win here would cast “a long shadow of uncertainty over ACA-based investments and denies health insurance providers, states, individuals, and other stakeholders of much needed clarity.”

The AARP, with its own proprietary Part D pharmaceutical plan, says a bad decision here “plunges millions of Americans into an abyss of prolonged uncertainty because they do not know if they will lose access to life-sustaining health care coverage and consumer protections.”

The American Hospital Association, the Catholic Health Association of the United States, and the Association of American Medical Colleges issued a joint warning that a Trump/McConnell victory here could  “have serious, perhaps irreparable, consequences for hospitals and the patients they serve.”

Why would charter members of the MIC be spurred to such progressive, public-spirited action against their very own free-market allies, you might ask.

The answer lies in the “What if?” What if Republicans actions in the Supreme Court on November 10th succeed in throwing American health care into full-throttled chaos in the middle of a pandemic now slated to result in 400,00 plus American casualties by February, 2021…and Joe Biden wins control of the executive and legislative branches of government?

Here are two possible scenarios:

1.Biden rolls back the Trump regulatory actions thus far enacted, and the Democratic Congress reinstates the ACA mandate (the technicality that led to the claims of unconstitutionality of the ACA) thus negating the effects of the negative Supreme Court decision. Medicaid extensions in the 12 remaining purple (formerly red) states proceed. At the same time Biden approves extended eligibility to enroll in a voluntary public option.

2. Biden takes a good hard look at the ACA, and at the Republican led legal challenges that will continue unabated with tacit support for the MIC status quo – and says, “Screw it. I’m going Medicare for All.”

Mike Magee MD is a Medical Historian and Journalist at the University of Hartford. He is the author of Code Blue: Inside the Medical Industrial Complex. ((Grove Atlantic/2019)

Will Trump, Congressional Infections Boost Innovations For Covid-19 Survivors?

By MICHAEL MILLENSON

When powerful politicians confront a life-threatening diagnosis, it can change policy priorities. 

In addition to President Trump and a slew of top aides, five U.S. senators and 15 members of the House of Representatives have now tested positive or been presumed positive in tests for Covid-19 as of Oct. 5, according to a running tally by National Public Radio (NPR).

In that light, the recent burst of coronavirus infections could accelerate three significant innovations affecting every Covid-19 survivor.

1) Post-Covid Clinics

Even seemingly mild encounters with the coronavirus can trigger a cascade of lingering health consequences. While “there is no consensus definition of post-acute Covid-19,” noted an Oct. 5 JAMA commentary, symptoms that have been reported include joint pain, chest pain, fatigue, labored breathing and organ dysfunction “involving primarily the heart, lungs and brain.”

A survey by Survivor Corps, a patient support group, and the Indiana University School of Medicine found that Covid “long haulers” often suffer from “painful symptoms…that some physicians are unable or unwilling to help patients manage.” A similar survey by the Body Politic Covid-19 Support Group concluded that Covid long-haulers face “stigma and lack of understanding [that] compromise access to health care and quality of support.”  

“It’s a nightmare,” a coronavirus survivor in her 40s told me. (Like other long-haulers, she asked not to be named.)

The woman recalled going to the emergency room (ER) with tightness in her chest and trouble breathing. If someone barely touched her stomach, she screamed in pain. Her primary care physician eventually recommended she see a cardiologist and a gastroenterologist, but there was neither coordination nor urgency. As she waited a month for the gastroenterologist, “my stomach was bloating like I was pregnant, and it was hard to breathe. No one was listening to me.”

Enter “Post-Covid,” or “Covid-19 Recovery” clinics. The centers aim “to bring together medical professionals across a broad spectrum,” from subspecialists to social workers, according to a recent article in Kaiser Health News. Based on the number of positive tests in the United  States, a half million people could already have long-lasting coronavirus symptoms, one expert said.

One of the first and largest of these clinics was opened by New York’s Mount Sinai Health System in May. A partial list of others includes the Hackensack Meridian Health System in New Jersey, the University of Pennsylvania Health System and University of California-San Francisco.

But while post-Covid centers promise more holistic, coordinated and cost-effective care, innovation doesn’t guarantee adequate insurance reimbursement for financially struggling hospitals.

That’s where political power comes in. With some 20 Congressional Covid-19 survivors (and counting?), as well as the president, there’s an impressive, bipartisan group potentially pushing to make certain Covid long-haulers can access the services they need. 

2) Patient-generated health data

One way long-haulers have tried to fight what they’ve felt was physician indifference is by generating their own data at home.

The woman in her 40s quoted above says she uses a pulse oximeter, a blood pressure monitor and a thermometer, as well using the Apple Watch to monitor heart rate. A Body Politic member in his 30s told me, “I had to literally bring in my own heart rate monitor and demonstrate my elevated heart rate in real time to be taken seriously.” 

Meanwhile, a long-hauler in her 30s, a certified physician assistant, says she’s deployed a variety of devices to avoid what could have been multiple trips to the ER. 

“I have episodes of air hunger now, where I feel like I’m suffocating,” the woman said. When that happens, she checks her blood oxygen level and often finds, “it may feel like you’re not breathing, but you are.”

A recent commentary in the Mayo Clinic Proceedings argued that use of patient-generated data must become routine in primary care.

The authors wrote, “Integration of technology-assisted tools, including symptom-checker apps, Web-based screeners and wearable devices, into health systems’ electronic health records (EHRs) holds promise to make the most of every precious encounter between patients and physicians.”

Covid restrictions accelerated eased payment rules for telehealth visits. A push for mainstreaming of patient-generated health data into the EHR seems inevitable. The political momentum will be aided both by politicians’ personal experience and the encouragement of clout-heavy companies in the self-monitoring space, including Apple, Fitbit (which has agreed to merge with Google) and others.

3) Patients as research partners

When AIDS activist Larry Kramer died in July, Dr. Anthony Fauci recalled how the two had gone from fierce foes to fast friends as Fauci, in the 1980s and now head of the National Institute of Allergy and Infectious Diseases, came to understand the crucial role patients can play in successful research.

That realization throughout the National Institutes of Health (NIH) was reflected in the September NIH Director’s Blog. NIH director Dr. Francis Collins called the long-haulers organized by Body Politic “citizen scientists,” praised their “talent and creativity” and pointedly mentioned the group meeting with the Centers for Disease Control and Prevention (CDC) and the World Health Organization.

Separately, the independent Patient-Centered Outcomes Research Institute (PCORI) has already year pumped out nine separate Covid-related grants. Taken together, the NIH, CDC and PCORI actions constitute a clear signal by the politically attuned scientific elite that the patient-as-partner is central to Covid-19 research related to prevention, treatment and community outreach.

President Trump called what he’d learned about Covid-19 after being infected “the real school.” Meanwhile, the virus has gradually spread through Republican- and Democratic-leaning states alike. If there’s a silver lining, it’s that recent lessons learned could now spur a bipartisan consensus to support innovations addressing the needs of survivors.

Michael Millenson is a frequent THCB Contributor, the author of Demanding Medical Excellence: Doctors and Accountability in the Information Age, President of Health Quality Advisors LLC and an adjunct associate professor of medicine at Northwestern University

This post originally appeared on Forbes here.

A War on Science is a War on Us

By KIM BELLARD

We’re in the midst of a major U.S. election, as well as hearings on a Supreme Court vacancy, so people are thinking about litmus tests and single issue voters – the most typical of which is whether someone is “pro-life” or “pro-choice.”  Well, I’m a single issue person too; my litmus test is whether someone believes in evolution. 

I’m pro-science, and these are scary times.

Within the last week there have been editorials in Scientific American, The New England Journal of Medicine, and Nature – all respected, normally nonpartisan, scientific publications – taking the current Administration to task for its coronavirus response.   Each, in its own way, accuses the Administration of letting politics, not science, drive its response. 

SA urges voters to “think about voting to protect science instead of destroying it.”  They cite, among other examples, Columbia Law School’s Silencing Science Tracker, which “tracks government attempts to restrict or prohibit scientific research, education or discussion, or the publication or use of scientific information, since the November 2016 election.”  Their count is over 450 by now, across a broad range of topics in numerous federal agencies on a variety of topics.   

The SA authors declare:

Science, built on facts and evidence-based analysis, is fundamental to a safe and fair America. Upholding science is not a Democratic or Republican issue.

Similarly, NEJM fears:

Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Jeff Tollefson, in Nature, warns:

As he seeks re-election on 3 November, Trump’s actions in the face of COVID-19 are just one example of the damage he has inflicted on science and its institutions over the past four years, with repercussions for lives and livelihoods. 

“This is not just ineptitude, it’s sabotage,” Jeffrey Shaman, an epidemiologist at Columbia University, told Mr. Tollefson about the Administration’s pandemic efforts.  “He has sabotaged efforts to keep people safe.”  Christine Todd Whitman, former New Jersey Governor and EPA head, added: “I’ve never seen such an orchestrated war on the environment or science.”

The Administration likes to tout the admittedly remarkable progress that pharmaceutical companies have made in therapeutics and vaccines – Operation Warp Speed! — but the constant battles with both the FDA and the CDC (EUAs for everything!) have left the American public skeptical of supposed breakthroughs.  In the wake of President Trump’s recent embrace of monoclonal antibodies, The Washington Post lamented:

This has been the 2020 pattern: Politics has thoroughly contaminated the scientific process. The result has been an epidemic of distrust, which further undermines the nation’s already chaotic and ineffective response to the coronavirus. 

A Pew Research survey found Americans evenly split between those who would definitely/probably get a vaccine as soon as it was available and those who would not – and the percent willing has dropped from 72% in May.  Almost 80% fear the approval process will move too fast; in other words, that the science will be trumped by political concerns. 

“Warp speed really isn’t something I want from my medications, especially not ones for my children,” one physician told Alexandra Feathers in Slate.

A separate survey, from Axios/Ipsos, found that only 8% of Americans now have a “great deal” of faith in the FDA to look out for their best interests; only slightly more than half even had a fair amount of faith.  Trust in the CDC has also fallen

Science is losing. 

As tempting as it is to blame the current Administration for this war on science, it is a symptom of the problem, not the cause.  Some examples:

  • One in four Americans believe the sun rotates around the earth. 
  • Depending on how the question is asked, between a fifth and a third of Americans don’t believe in evolution at all, with another third believing in evolution “directed” by God. 
  • Only three-fourths are Americans believe climate change is happening, with smaller percentages believing any such change is due to human actions. 
  • Anti-vaccination beliefs had been growing steadily even prior to COVID, for well-understood, highly effective vaccines.    
  • American school children continue to rank mediocre in science and math; adult Americans get a gentleman’s “D” for their science knowledge. 
  • Only 73% of Americans think science has, on balance, had a positive impact on society; only 35% have a “great deal” of confidence in scientists to act in the public interest (although 51% had “fair” confidence). 

Politicians can get away with downplaying science because we let them; we let them because some of us don’t know enough, and others among us don’t care enough.  Anti-vaxxers were initially seen as an aberration, too small to worry about, but became a problem.  Now people not getting a COVID vaccine could be the difference between months of pandemic and years of pandemic.

Cultural wars have become wars on science.  Experts agree that wearing a mask and social distancing are the keys to our battle against COVID for the next many months, yet to many wearing a mask is a “personal choice” — even when not wearing one is a risk not just for the person not wearing one but to them people around them. 

We should listen to the science.

It’s easy to get caught up in partisan politics about all this, but that’s wrong.  Science doesn’t care about your politics.  COVID doesn’t ask who you’re going to vote for.  Climate change doesn’t stop if you refuse to believe in it.  As writer Valorie Clark tweeted:

Stop asking candidates if they “believe in” climate change and start asking if they understand it. It’s science, not Santa Claus.

We should stop allowing candidates to tell us there’s a metaphorical Santa Claus and start demanding fact-based decisions. We should stop thinking science is something only scientists care about and start accepting that our lives depend on science, so we better understand how. 

Many might claim they are bad at science, but I think about what mathematician Paul Lockhart wrote many years ago in A Mathematician’s Lament.  If music was taught like math (or science) is, few would enjoy listening to it and even fewer would play it. It’s incumbent on scientists and educators to make science more accessible and understandable for the rest of us. 

We’ve failed the science test so far when it comes to COVID, and it has literally cost us hundreds of thousands of lives.  It’s not the first such test we’ve failed, but we can, should, and must do better – starting now. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

A War on Science is a War on Us

By KIM BELLARD

We’re in the midst of a major U.S. election, as well as hearings on a Supreme Court vacancy, so people are thinking about litmus tests and single issue voters – the most typical of which is whether someone is “pro-life” or “pro-choice.”  Well, I’m a single issue person too; my litmus test is whether someone believes in evolution. 

I’m pro-science, and these are scary times.

Within the last week there have been editorials in Scientific American, The New England Journal of Medicine, and Nature – all respected, normally nonpartisan, scientific publications – taking the current Administration to task for its coronavirus response.   Each, in its own way, accuses the Administration of letting politics, not science, drive its response. 

SA urges voters to “think about voting to protect science instead of destroying it.”  They cite, among other examples, Columbia Law School’s Silencing Science Tracker, which “tracks government attempts to restrict or prohibit scientific research, education or discussion, or the publication or use of scientific information, since the November 2016 election.”  Their count is over 450 by now, across a broad range of topics in numerous federal agencies on a variety of topics.   

The SA authors declare:

Science, built on facts and evidence-based analysis, is fundamental to a safe and fair America. Upholding science is not a Democratic or Republican issue.

Similarly, NEJM fears:

Our current leaders have undercut trust in science and in government,4 causing damage that will certainly outlast them. Instead of relying on expertise, the administration has turned to uninformed “opinion leaders” and charlatans who obscure the truth and facilitate the promulgation of outright lies.

Jeff Tollefson, in Nature, warns:

As he seeks re-election on 3 November, Trump’s actions in the face of COVID-19 are just one example of the damage he has inflicted on science and its institutions over the past four years, with repercussions for lives and livelihoods. 

“This is not just ineptitude, it’s sabotage,” Jeffrey Shaman, an epidemiologist at Columbia University, told Mr. Tollefson about the Administration’s pandemic efforts.  “He has sabotaged efforts to keep people safe.”  Christine Todd Whitman, former New Jersey Governor and EPA head, added: “I’ve never seen such an orchestrated war on the environment or science.”

The Administration likes to tout the admittedly remarkable progress that pharmaceutical companies have made in therapeutics and vaccines – Operation Warp Speed! — but the constant battles with both the FDA and the CDC (EUAs for everything!) have left the American public skeptical of supposed breakthroughs.  In the wake of President Trump’s recent embrace of monoclonal antibodies, The Washington Post lamented:

This has been the 2020 pattern: Politics has thoroughly contaminated the scientific process. The result has been an epidemic of distrust, which further undermines the nation’s already chaotic and ineffective response to the coronavirus. 

A Pew Research survey found Americans evenly split between those who would definitely/probably get a vaccine as soon as it was available and those who would not – and the percent willing has dropped from 72% in May.  Almost 80% fear the approval process will move too fast; in other words, that the science will be trumped by political concerns. 

“Warp speed really isn’t something I want from my medications, especially not ones for my children,” one physician told Alexandra Feathers in Slate.

A separate survey, from Axios/Ipsos, found that only 8% of Americans now have a “great deal” of faith in the FDA to look out for their best interests; only slightly more than half even had a fair amount of faith.  Trust in the CDC has also fallen

Science is losing. 

As tempting as it is to blame the current Administration for this war on science, it is a symptom of the problem, not the cause.  Some examples:

  • One in four Americans believe the sun rotates around the earth. 
  • Depending on how the question is asked, between a fifth and a third of Americans don’t believe in evolution at all, with another third believing in evolution “directed” by God. 
  • Only three-fourths are Americans believe climate change is happening, with smaller percentages believing any such change is due to human actions. 
  • Anti-vaccination beliefs had been growing steadily even prior to COVID, for well-understood, highly effective vaccines.    
  • American school children continue to rank mediocre in science and math; adult Americans get a gentleman’s “D” for their science knowledge. 
  • Only 73% of Americans think science has, on balance, had a positive impact on society; only 35% have a “great deal” of confidence in scientists to act in the public interest (although 51% had “fair” confidence). 

Politicians can get away with downplaying science because we let them; we let them because some of us don’t know enough, and others among us don’t care enough.  Anti-vaxxers were initially seen as an aberration, too small to worry about, but became a problem.  Now people not getting a COVID vaccine could be the difference between months of pandemic and years of pandemic.

Cultural wars have become wars on science.  Experts agree that wearing a mask and social distancing are the keys to our battle against COVID for the next many months, yet to many wearing a mask is a “personal choice” — even when not wearing one is a risk not just for the person not wearing one but to them people around them. 

We should listen to the science.

It’s easy to get caught up in partisan politics about all this, but that’s wrong.  Science doesn’t care about your politics.  COVID doesn’t ask who you’re going to vote for.  Climate change doesn’t stop if you refuse to believe in it.  As writer Valorie Clark tweeted:

Stop asking candidates if they “believe in” climate change and start asking if they understand it. It’s science, not Santa Claus.

We should stop allowing candidates to tell us there’s a metaphorical Santa Claus and start demanding fact-based decisions. We should stop thinking science is something only scientists care about and start accepting that our lives depend on science, so we better understand how. 

Many might claim they are bad at science, but I think about what mathematician Paul Lockhart wrote many years ago in A Mathematician’s Lament.  If music was taught like math (or science) is, few would enjoy listening to it and even fewer would play it. It’s incumbent on scientists and educators to make science more accessible and understandable for the rest of us. 

We’ve failed the science test so far when it comes to COVID, and it has literally cost us hundreds of thousands of lives.  It’s not the first such test we’ve failed, but we can, should, and must do better – starting now. 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

UK doing more than most to help poor get Covid vaccine, study finds

Campaign scoring countries for global access efforts calls for more British transparency

The UK is doing more than most countries to support access to Covid vaccines for the poorest populations in the world, but it is not transparent enough about the deals it is doing at home, according to an international aid organisation launching a tracker.

The One campaign has given countries and pharmaceutical companies scores for the efforts they have made to ensure the poorest get vaccines. In the vaccine access test no country or company scores green, the top rating, classed as aiding global access to vaccines.

Continue reading…

Talking Politics in the Exam Room: A Physician’s Obligation to Discuss the Political Ramifications of Science with Patients

By HAYWARD ZWERLING

I walked into my exam room to see a patient I first met two decades ago. On presentation, his co-morbidities included poorly controlled DM-1, hypertension, hyperlipidemia, and a substance abuse disorder. Over the years our healthcare system has served him well as he has remained free of diabetic complications and now leads a productive life. Watching this transformation has been both professionally rewarding, personally enjoyable, and I look forward to our periodic interactions.

At this visit, he was sporting a MAGA hat. I was confused. How can my patient, who has so clearly benefited from America’s healthcare system, support a politician who has tried to abolish the Affordable Care Act, used the bully pulpit to undermine America’s public health experts, refused to implement healthcare policies which would mitigate COVID-19’s morbidity and mortality, and who minimizes the severity of the coronavirus pandemic every day. Why does he support a politician whose healthcare policies are an immediate threat to his health and longevity?

My brain says, “You are the physician this patient trusts to take care of his medical problems. You must teach him that COVID-19 is a serious risk to his health and explain how the President’s public health policies threatens his health. You must engage in a political conversation.”

It is currently taboo for physicians to discuss politics in the exam room, especially when political opinions are discordant as it risks creating a rift in the patient-physician relationship. Reflexly, I answer myself “Do not engage in a political discussion, you need to deal with his immediate health issues.”

During the visit, we reviewed his medicines and test results and agreed on a treatment plan. At the end of the visit, I told him that it is in his best health interest to wear a mask, socially distant, wash his hands frequently, and defer visiting his favorite bar and gym. I consciously decided not to address his support for the President. 

Back in my office, I reviewed the encounter and immediately had misgivings about my decision to avoid discussing the health ramifications of his political proclivities. I knew he was mistakenly informed about the science of COVID-19, as his primary source of information was Fox News and his peers. I was concerned that this misunderstanding led him to support a politician whose public health policies will adversely impact his health.

Every day physicians teach their patients the scientific truths they must understand to enable them to make informed healthcare decisions. Is it not also a physician’s responsibility to teach their patients the science underlying relevant public health policy and explain that there is a linear connection between political choices, public health policies, and their health and longevity? Would not a more comprehensive understanding of this relationship enable our patients to make more informed political decisions, including the option to choose political leaders who will implement better healthcare policies?

While politics has become hyperpolarized, most patients still believe their physicians tell the truth about science and medicine; thus physicians are in a unique position to educate their patients about the ramifications of science.

By selecting me as his physician, he was implicitly telling me that he had confidence in my judgment. In return, I should have emphasized that the coronavirus is an immediate risk to his health, I should have explained how COVID-19 spreads and how he can reduce his risk. I probably should have breached the “no politics in the exam room” taboo and told him that the President’s refusal to implement public health measures recommended by every public health expert has resulted in the needless death of tens of thousands of Americans and is part of the reason that 1,000 Americans die from COVID-19 every day. I should have explicitly connected the dots and stated that the President’s COVID-19 public health policy is an immediate threat to his health.

The medical profession now understands that social determinants of health are probably the most important driver of a patient’s overall health and these determinants are largely the result of political decisions. Clearly, we have a professional responsibility to teach our patients the science underlying their health issues. Don’t we also have a professional obligation to ensure that our patients understand the health ramifications of their political choices? If that is the case, do we not have a professional obligation to initiate a conversation about the political issues which impact our patients’ health?

If we fail to breach the taboo of “talking politics” in the exam room, are we not shirking our professional responsibilities to our patients and society?

Hayward Zwerling is an endocrinologist with an interest in health information technology, health care policy, woodworking, and politics.

Biden’s Nov 9th speech: “Don’t you force me to pass Medicare 4 All”

By MATTHEW HOLT

The new Supreme Court, in all likelihood including just nominated Justice Amy Coney Barrett, will be hearing the California v Texas suit against the ACA on November 10th, seven days after the election. The lower courts have already ruled the ACA unconstitutional. Some hopeful moderates among my Democratic friends seem to believe that the justices will show cool heads, and not throw out the ACA. But it’s worth remembering that in the NFIB vs. Sebelius decision which confirmed the legitimacy of most of the ACA back in 2011 all the conservative justices with the exception of John Roberts voted to overturn the whole thing. With Ginsburg being replaced by Barrett there’s no reason to suppose that she won’t join Thomas, Alito, Kavanagh & Gorsuch and that Robert’s vote won’t be enough to stop them this time. The betting odds must be that the whole of the ACA will be overturned.

There is nothing the Democrats can realistically do to prevent Barrett filling RBG’s seat on the court, but assuming Biden wins and the Democrats take back the Senate, the incoming Administration can give the Supremes something to think about regarding the ACA. I would not suggest this level of confrontation before the election but, if Biden wins, the gloves must come off.

Assuming he wins and that the Dems win the Senate, this is the speech Biden should give on November 9th. (The TL:DR spoiler is, “Keep the ACA or I’ll extend Medicare to all ages”)

“I’m directing this speech to an extremely select number of people, just the Supreme Court Justices appointed by Republican Presidents. It is obviously no secret that we have political differences on many issues and we find ourselves in the strange situation in which I am the incoming President with an incoming Democratic Senate majority and yet you are considering overturning the signature bill of the administration in which I was Vice-President. You may recall that at the time of its signing I told President Obama that it was a “big f****** deal”  and, although many of my colleagues in the more progressive wing of the Democratic Party have criticized the ACA since its passage, it turns out that I was right. 

I am not referring here to the apoplexy that the ACA created amongst the Republican Party including not only the current and outgoing President but also almost all Republican members of Congress between 2010 and 2018. Instead I’m referring to the ACA’s impact on the nation and its health care system. 

Since 2010 there have been many changes to the way our nation’s health care system operates; almost all of them have their roots in the ACA. 

First, the ACA gave access to health insurance coverage to many people who had great trouble getting it before. That includes young people moving between their parent’s home, college and getting into the workforce; small business owners; freelance workers; the unemployed; people with low incomes; and people with underlying “pre-existing” health conditions. I remind you that due both to the pandemic and changes in our economy, there are many, many more of these people now than there were in 2009. 

Before the ACA these people were either not well served by the private health insurance industry or literally were unable to buy coverage at all. This not only caused extreme personal and financial suffering and in some cases death to the people affected, but also impacted the economy. It restrained innovation and entrepreneurship, and it meant that the participants in the health care system–including very many well meaning clinicians and provider organizations–had to play very inefficient games in order to try to provide those people with much-needed care, which drove up the cost of care to everyone else. Warren Buffet calls that the tapeworm in the US economy.

The ACA changed this in two main ways.

First it created a system of standardized insurance benefits and mandated insurers to provide those benefits to anybody regardless of health status. It also directly subsidized the cost of insurance for people of low to moderate-incomes. Given that median household income is around $63,000 in the US and the current cost of family insurance is around $28,000, these subsidies are essential. Otherwise people who do not have employment-based insurance would not be able to purchase coverage.

Second, the ACA expanded Medicaid coverage for the poor, creating a standardized set of benefits for those earning up to 133% of poverty. Sadly, the conservative majority on the court, joined (in my view to their everlasting shame) by Justices Breyer and Kagan, decided that the federal government did not have the right to force states to expand Medicaid even though the federal government paid 100% of the cost. It turned out that many states with Republican governors chose not to expand Medicaid, even though this meant that many rural hospitals in their states were forced to close. Numerous studies have shown that Medicaid expansion has improved the financial and emotional health of the poor, and other work has shown that the current Administration’s policy of allowing states to restrict access to Medicaid, by using such tricks as work requirements, have been cruel and counterproductive–and that they have not reduced health care costs or increased employment. States that have not expanded Medicaid have left their most vulnerable and poor populations in an extremely difficult state. For example in Texas a single parent with two  children is only eligible for Medicaid if the children are on Medicaid and total household income doesn’t exceed $230 a month, which would barely cover your clerks’ daily lunch bill. Some estimates suggest that nearly three-quarters of a million people in Texas are in the coverage gap between Medicaid and qualifying for the ACA.

However, the ACA was not just about expanding insurance for those who had trouble getting it before. It also closed several loopholes that had confronted many other people who needed to use the health care system. This included closing the donut hole in the drug coverage for seniors provided by the Medicare Modernization Act in 2003. It also did away with maximum coverage benefits which severely compromised the care received by extremely sick people–often children or those with very rare diseases. And, in a great benefit to many, many young Americans from middle class and even wealthy families, the ACA allowed parents to keep their children on their insurance up until the age of 26, when they were usually established in the workforce.

Many of you on the Supreme Court believe that private delivery of insurance and health care services are superior to those delivered by the government. For you the ACA should indeed have been a very welcome piece of legislation. All of the new enrollment coming through the ACA exchanges went through private health insurance companies, and the vast majority of Medicaid expansion is also managed by private health insurers. While federal tax dollars are subsidizing this coverage expansion, it’s worth pointing out that a IRS decision in 1954 confirmed the tax-free status of private health insurance premiums paid by employers which translates to an annual subsidy to private employers that exceeds the cost of the premium subsidies in the ACA. On the night that the ACA was passed a Canadian journalist reported that America had just seen the largest expansion of private health care coverage ever–and he was right.

This coverage expansion was by no means all that the ACA did. It was also the legal and regulatory basis for a substantial modernization of the nation’s health care system. Of course since the 1930s, US health care has largely been based on a fee-for-service payment approach, acknowledged by experts to be both inefficient and inflationary. The ACA created the Center for Medicare and Medicaid Innovation which has been at the forefront of creating programs that encourage improved care at a lower cost by, for instance, bundling payments for joint surgery, cancer and other care. It also created the system of accountable care organizations which encourages doctors and hospitals to work together to more efficiently and effectively manage the health of large populations of Medicare recipients. And while the ACA did not create the Medicare Advantage program, it put in place an environment in which private health insurance companies were able to use government funding within the Medicare program to deliver innovative programs that are improving the quality of care received by our seniors. 

In addition, since the passage of the ACA, and assisted by it and the HITECH Act passed in 2009, there has been a considerable boom in the development of new types of health care technologies, particularly digital technologies. These show amazing promise for delivering 24/7 care to many vulnerable populations. The significant spread of telehealth and remote patient monitoring during the current COVID-19 pandemic was only possible because of the innovation of numerous private companies. They developed those technologies in large part in response to incentives created by the ACA.

Finally, although the cost of health care in the United States is still significantly higher than it is in other countries, since the passage of the Affordable Care Act the rate of increase of health care cost has slowed and up until this year the health care system was barely growing as a share of the overall economy for the first time ever (other than a brief blip in the mid 1990s).

This is just a brief overview of the impact of the Affordable Care Act. It has directly meant access to health care coverage for around 20 to 30 million people and, as health futurist Ian Morrison points out, has tentacles impacting every single part of the health care system. This was not the case when four conservative justices including two currently on the bench (Alito & Thomas) voted to throw out the ACA in 2012. And it has not escaped my attention that the two justices who have replaced Scalia and Kennedy appear to have similar or perhaps even more conservative viewpoints.

If following the arguments you will hear this week, the Supreme Court decides to uphold the lower court hearing and abolish the entire ACA on what is pretty much a technicality, the consequences will be dramatic. And they will be very bad.  

Tens of millions of people will lose their health insurance. Of course they will still require care. The cost of delivering that care will fall upon the nation’s health care providers, and eventually on the taxpayer. That cost will be distributed in an unplanned and chaotic manner –resulting in much actual and financial pain.

In addition, virtually every current organization funding, delivering or involved in care delivery will have to completely reformat the business operations it has spent the last decade putting in place. American health care will be thrown into chaos and the cost in both dollars and human suffering will be extreme. 

Given the extreme impact of throwing out the ACA,  I will appeal to all the justices to maintain the ACA in place.

Unlike the outgoing president, I respect the institutions and separation of powers inherent in the constitution of our nation. But given that I and my colleagues in the Senate have just been elected by a significant majority of Americans, and also given that none of the conservative justices on the court were appointed by a President who won the majority of the vote of his fellow citizens when initially elected, I would recommend that the court consider its actions very carefully. Unlike some in my party, I am not advocating significant constitutional changes such as appointing more justices, but the more the court bends against the arc of history, the more likely it is that such actions may be taken in the future.

However, in regards to the nation’s health care system I am hereby telling you exactly what I will do–should the court return a verdict overturning the ACA.

You are well aware that in the Democratic primary campaign, which was largely settled before the covid-19 pandemic had its full effect, my opponent Senator Sanders was campaigning to create Medicare for All. While I was and am opposed to this policy, it is clear that a significant majority of Democrats and in some polling a majority of Americans were in favor of expanding Medicare For All even before the full effect of the pandemic was realized. 

The world of course is radically different now compared to how things were even at the start of 2020. Not only has our health care system had to deal with the onslaught of the pandemic, but the recession that it caused has placed many more millions of Americans out of work, and some 5 million of those have already lost their health insurance. I pledged in the election campaign both to get the economy moving and also to support those who were victims of the recession, which includes those millions who lost their health insurance. 

In my campaign I pledged to build on the successes of the ACA. As you are well aware, two of the most significant policies I proposed were to create a public option and to reduce the eligibility age for Medicare to 60 years old. If the Supreme Court throws out the ACA, it will be by definition impossible for me to build on the ACA’s infrastructure.

But at a time of a pandemic during a recession I will not stand by and allow tens of millions of Americans to suffer. 

Instead let me tell you what I will do. 

As you know under the current rules of the Senate and from the convoluted passage of the ACA itself, it is virtually impossible to pass significant legislation without 60 votes. In the election that just happened we Democrats have retaken control of the Senate, but only with a slight majority. However, as you also know, the Senate can pass legislation impacting budgets under the process of reconciliation with a simple majority. You will recall that using reconciliation the Republican majority in the Senate tried to repeal the ACA in 2017, and were only prevented from doing so by the deciding vote of my friend the late Senator John McCain.

On the day which I hope never comes that the Supreme Court invalidates the ACA, my colleagues in the House and Senate will immediately introduce legislation amending Title 18 of the 1965 Social Security Act that created Medicare to reduce the age of eligibility not to 60 but to zero. At the same time we will amend title 19 of the 1965 Social Security Act that created Medicaid to reduce its budget to $0 other than to pay the premiums into Medicare for those known as “dual eligibles” and to pay for long term care and other services that Medicare currently doesn’t cover.

You and other conservatives might believe that we will not be able to complete this because of the Byrd Rule for reconciliation which was designed in the 1980s to ensure that reconciliation did not radically change the budget of the federal government. But the Senate Republican majority in the Congress before last essentially already violated these rules by passing a scandalously unfair and unfunded tax cut, and my colleagues in the Senate will be prepared to override the Byrd Rule. This, I point out, is significantly less controversial than overriding the filibuster or changing the number of justices on the Supreme Court.

Conservatives might also believe that Medicare expansion would significantly increase the budget of the federal government. This would be true but is ignoring two salient facts. The first is that the expansion to the federal budget would be something of the order of 2 trillion dollars a year, as the federal government already spends roughly 1.5 trillion of the 3.5 trillion the United States spends on health care. That level of expansion of government is somewhat similar to the deficit spending which just happened under the CARES act and other stimulus money spent during the current pandemic. So it’s not that large a leap for the country to make.

In addition while the expansion of Medicare under reconciliation would not directly abolish private health insurance in the manner that my colleague Senator Sanders has proposed, the fact that Medicare part A is free to Medicare recipients, and that parts B & D are very heavily subsidized, will mean that it is not only those who have lost their insurance or have trouble buying it in the individual market, or those who were previously on Medicaid, who will voluntarily enter the Medicare program. It is extremely likely that the vast majority of employers who are currently providing health insurance for their employees, which to be noted would be voluntary if there is no ACA, will cease to do that. After all their employees could now enter the Medicare program at no extra cost to them. While this will cost the government more, it will save employers and individuals an approximately equal amount and so the net effect on the economy will be limited.

Part of the reason that I am not a proponent of Medicare for all, has been that the change it would cause to employer-based health insurance, and to the finances of our nation’s health care system would be too extreme. It is worth noting that Rand  recently showed that employer-based health insurance paid hospitals and doctors at nearly 250% the rate they receive from Medicare. There will certainly be high transition costs for the health care system from this move but everyone in the health care system already understands how Medicare works. My Administration will to work with providers and care delivery organizations to make sure that they are able to fulfill their mission of providing high-quality care to Americans.

Even though I have been a political centrist my entire life and have never been a proponent of Medicare For All–despite the fact that every other industrialized nation has something pretty similar to it–if you strike down the ACA I will act immediately. I would view the suffering of Americans as being too great not to respond. With no ACA in place there is no available legislative option other than this Medicare expansion.

I am well aware of the ideology of many on the political right in the US including most of the conservative justices on the Supreme Court. I would stress that this type of radical expansion of Medicare is not what I would ordinarily want to see. But if the ACA is abolished in the middle of a pandemic and a massive depression, my first duty to the American people as their President will be to relieve the suffering of as many of them as possible.

As you consider your judgement in the California v Texas case I would ask you not to put me in the position where I would have to take such a radical step.  

But I assure you that if necessary I will have no hesitation in doing so.

Matthew Holt is the publisher of THCB. He has not written a speech for Joe Biden before but would happily lend him this one

Pharmacies in England pause online flu jab bookings as demand soars

Boots, LloydsPharmacy and Well Pharmacy report unprecedented take-up and many chemists run out of stock

Pharmacies across England are struggling to keep up with the demand for the flu vaccine, pausing online bookings and limiting it to those most in need.

The country’s three largest pharmacy chains – Boots, LloydsPharmacy and Well Pharmacy – have all reported unprecedented demand after a government vaccination campaign to reduce the pressure on the NHS during a second wave of Covid-19.

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Voters Are Souring on President Trump’s Handling of Coronavirus, with Implications for November

As the country struggles to get a handle on the coronavirus pandemic and prepares for the 2020 election, this analysis finds that, while voters are increasingly negative in their evaluations of President Trump’s handling of the pandemic, he continues to garner strong support among Republican voters – even those living in areas disproportionately impacted by the virus.

The Guardian view on Brexit bureaucracy: tied up in red tape | Editorial

Businesses already struggling with the fallout from Covid-19 will be forced to deal with a mountain of new bureaucracy in the middle of a deep recession

The government did not quite achieve the Brexit breakthrough it was seeking on Friday, when there was hope that a fast-tracked trade agreement with Japan might be reached. But it seems likely that a deal, essentially replicating one signed by the EU and Japan last year, will be done by the end of the month. Some kind of morale booster for Britain’s battered and bruised businesses would certainly be welcome.

As the clock runs down to the end of the transition period on 31 December, ministers are no longer bothering to offer the false hope of a relatively frictionless trade agreement with the EU. Even a Canada-style free trade deal will mean a vast infrastructure of compliance and checks: permits for lorry drivers to enter Kent, huge customs clearance centres and tracking apps are all in the mix. The government estimates that, from 2021, there will be over 400m extra customs checks a year on goods going to and from the EU.

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Up to 750,000 UK Covid test kits recalled due to safety concerns

Products made by diagnostics firm Randox removed from care homes and individuals

the Up to 750,000 unused coronavirus testing kits manufactured by diagnostics company Randox have been recalled from care homes and individuals due to concerns about safety standards.

At the beginning of the coronavirus crisis, the Department of Health and Social Care (DHSC) is understood to have operated a haphazard policy for obtaining testing kits and it faced criticism for the purchase of millions of kits that turned out to be significantly less effective than originally claimed by pharmaceutical companies.

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UK warns drug firms to stockpile in case of Brexit disruption

Companies should ensure six weeks’ worth of drugs for end of transition period, DHSC says

Pharmaceutical companies should stockpile six weeks’ worth of drugs to guard against disruption at the end of the Brexit transition period, the government has said.

The Department of Health and Social Care (DHSC) has written to medicine suppliers advising them to make boosting their reserves a priority.

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Coronavirus: UK signs deal for 60m doses of potential vaccine

GlaxoSmithKline and Sanofi Pasteur could supply vaccine by early next year if it is successful

The government has signed a deal with the pharmaceutical firms GlaxoSmithKline (GSK) and Sanofi Pasteur for 60m doses of a potential Covid-19 vaccine.

If the vaccine proves successful, the UK could begin to vaccinate priority groups, such as frontline health and social care workers and those at increased risk from coronavirus, as early as the first half of next year, the Department for Business, Energy and Industrial Strategy said.

Related: Coronavirus vaccine tracker: how close are we to a vaccine?

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UK must ensure medicines replenished for Covid-19 second wave

The trade committee urged ministers to develop “parallel supply chains” as a solution

Britain needs to ensure its stockpile of medicines is replenished to deal with a second wave of coronavirus and any shocks to a supply chain dominated by China and India, the trade committee warned in a report released today.

The cross party committee said the pandemic had revealed that 70% of the active ingredients used in pharmaceuticals in the UK are made in China – while India manufactured “virtually all” the paracetamol in British shops.

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By Nearly a 2-1 Margin, Parents Prefer to Wait to Open Schools to Minimize COVID Risk, with Parents of Color Especially Worried Either Way

Most Say Things Will Get Worse Before They Get Better, and Just Over Half Now Say Their Mental Health is Worse Because of Coronavirus Worry and Stress As state and local officials prepare for the new school year amid the COVID-19 pandemic, parents with children who normally attend school overwhelmingly prefer that schools wait toMore

UK government orders halt to Randox Covid-19 tests over safety issues

Care homes and members of public told to immediately stop using firm’s kits

The UK government has instructed care homes and members of the public to immediately stop using coronavirus testing kits produced by a healthcare firm after safety problems were discovered.

Randox was awarded a £133m contract in March to produce the testing kits for England, Wales and Northern Ireland without any other firms being given the opportunity to bid for the work.

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The Trump COVID Legacy: Bad Timing. Lots of Questions. Few Answers.

By MIKE MAGEE, MD

What a strange irony. Trump decides, full-bravado, to challenge China to a trade war just months before China unwittingly hatches a virulent pandemic that collapses our deeply segmented health care system and our economy simultaneously. And rather than cry “Uncle”, our President then fires the WHO just as their experts are heading to China to attempt to unravel the mystery of COVID-19.

With the ongoing, cascading catastrophe of Trump’s mishandling of COVID-19, it is easy to lose sight that the next pandemic (fueled by global warming, global trade, and human and animal migration) is just around the corner. And we haven’t even begun to nail down the origin story of this one.

Unraveling the transmission trail requires international cooperation. As one expert recently noted, “Origin riddles for other new infectious diseases often took years to solve, and the route to answers has involved wrong turns, surprising twists, technological advances, lawsuits, allegations of cover-ups, and high-level politics.”

What we do know is that there are originators, intermediate hosts, and human super-spreaders….and COVID-19 appears to have begun in China.  These are not new insights. We’ve seen this playbook before.

The 2002 Severe Acute Respiratory Syndrome (SARS) rode palm civets to the human hosts.

The 2012 Middle East Respiratory Syndrome (MERS) utilized camals as intermediaries.

The Influenza Pandemic of 2009 traveled through Mexican pigs which had been imported from Europe.

This particular tragedy appears to have begun in Wuhan, China, with the first documented case occurring in December, 2019. The city is the site of the Wuhan Institute of Virology lead by the highly recognized bat virologist Shi-Zheng-Li. 

WHO experts will be meeting with China’s experts to share information that has only been released in bits and pieces.

For example, the original working assumption is that this pandemic began in Wuhan’s open seafood market. In January, 2020, there was a small cluster of pneumonias there, and the market was closed and disinfected. But a later study outlined five early cases, four of which had no ties to the market.

The next thrust, fueled in part by the Trump administration, was the pandemic was the result of an inadvertent or purposeful release of the microbe by Shi. Scientists who have now studied the viral genome have uncovered no telltale marks of lab-based engineering.

The lead theory presently is bat-based transmission through an animal intermediary, possibly feral cats, led to the first human infections.

A hostile US government has not served to enhance information exchange. Quite to the contrary. Enlightened leaders are fully supporting the WHO,  seeking answers to questions as recently detailed by veteran Science writer Jon Cohen:

1.  “Does more epidemiological data exist about the earliest cases than have been made public so far…?”

2. “How aggressively have Chinese researchers looked for SARS-CoV-2 in samples collected before the first known cases in Wuhan?”

3. “Have they looked outside of Wuhan? How far back in time have they probed?” 

4. “Can widespread screens be done of bats and other wild animal species thought to be susceptible to SARS-CoV-2 and common in China, including primates, deer, and rodents?” 

5. “Can widespread screening of susceptible domesticated animals provide clues to COVID-19’s origin?” 

6. “Do stored samples from farmed animals exist?” 

7. “Can widespread screening take place of people in China who might come in contact with bats or other wildlife that harbor SARS-CoV-2?” 

8. “Do government health reports contain any information about possible COVID-19 cases that predate 1 December 2019, the first confirmed case of SARS-CoV-2 in the scientific literature?” 

9. “Are there stored samples from sewage plants in China that can be probed?” 

10. “Did Shi’s team ever work with coronaviruses in that lab, and, if so, why?”

Answers to these questions, and many others that affect the future of our nation, await the results of November’s election.

Mike Magee is a Medical Historian and author of “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/June, 2019).

The 2020 Pandemic Election

The 2020 US election will be vicious, with a nasty pandemonium following a nasty pandemic.

By SAURABH JHA, MD

When the COVID-19 pandemic is dissected in the 2020 presidential election debates, Donald Trump will be at a disadvantage. The coronavirus has killed over 100,000 Americans and maimed thousands more. The caveat is that deaths per capita, rather than total deaths, better measure national failure, and by that metric the US fares better than Belgium, Italy and the United Kingdom. New York City owns a disproportionate share of the deaths, but this hyperconnected megapolis is an outlier whose misfortunes can’t be used to draw conclusions about administrative competence for the country as a whole.

Nevertheless, even after introducing nuance, the numbers aren’t flattering. President Donald Trump may claim that the US dodged the calamity predicted by the epidemiological models, which foretold millions of deaths. To be fair, we don’t know the counterfactual — Jeremiads aren’t verifiable. The paradox of successful mitigation is that we can’t see the future we dodged, precisely because we avoided it.

Reducing the death count logarithmically, rather than merely arithmetically, won’t be celebrated because as bad as the worst case scenario could have been, the situation still looks awfully bad. Many still disbelieve the high death toll predicted by epidemiologists early on, particularly Trump supporters who believe the response to the virus, specifically the economic shutdown, has been criminally disproportionate. One can’t simultaneously believe that COVID-19 is no more dangerous than the seasonal flu and that Trump saved millions from the coronavirus. The constituency that acknowledges the lethality of COVID-19 and credits Trump for decisive action against it is small.

Triangle of Incompetence

Trump’s challenger, former Vice President Joe Biden, will charge that fewer Americans would have died had the Trump administration acted earlier. Trump may be accused of having blood on his hands, but such rhetoric is unnecessary. Biden’s team can simply show a montage of Trump’s bombast where he downplayed COVID-19’s lethality, dismissed doctors’ concerns about the shortage of personal protective equipment or exaggerated how well the US was containing the pandemic. Incidentally, the most iconic picture of the administration’s scornful indifference is the current vice president, Michael Pence, visiting a hospital without a mask, surrounded by health-care workers wearing masks.

Cornered, Trump must defend his delay without disputing its causal link with fatalities, as it’s indubitable that every week the country remained open, the virus spread farther and killed more people. He may disperse the blame. Along with Trump, the governor of New York state and the mayor of New York City underestimated the severity of the disease. As late as the middle of March, the mayor was encouraging New Yorkers to visit their neighborhood bars. The virus feasted on administrative incompetence.

But the triangle of incompetence won’t reduce Trump’s culpability. He’s the captain of the ship. Even though this odd vessel has many first mates, each of whom can ignore their captain in a pandemic, he can’t accuse his first mates of being mutineers making bad decisions when he made the same bad decisions. Trump may say that COVID-19 outfoxed even the experts, who underestimated the seriousness of the virus early on even as they watched as Beijing quarantined Wuhan. Experts eventually corrected themselves when the facts about COVID-19 emerged. Trump may say that he, too, corrected himself.

He may allege that by quibbling incessantly about the effectiveness of masks and travel restrictions, the experts muddied common sense pandemic prescriptions. He may accuse the Centers for Disease Control and Prevention (CDC) of failing ungraciously to spot the severity of the pandemic. The CDC is to global pandemics what the CIA is to global terrorism. Over time, its scope has increased, and now it deals with way more than just bacilli. The CDC has taken on non-infectious pathogens such as chronic disease, smoking and gun control, with gusto. It has become another chronically underfunded, bloated, politicized bureaucracy, with a mission so boundless that it fails at the most salient.

But blaming scientists and institutions will seem unpresidential, even by Trump’s standards, because as flawed as they may be, they’re still American ornaments. Furthermore, he risks losing independent voters who want to see their leaders accept responsibility for their actions. How will Trump straddle the fine line between accepting his responsibility and admitting his incompetence?

Wild Card

Trump’s wild card is China. How astutely he plays his hand will determine how easily he extricates himself from the coronavirus pit. One needn’t cite conspiracy theories about the Communist Party of China (CCP) deliberately setting the virus free to usher in a new economic world order, to acknowledge that China’s behavior was suspicious from the start. Beijing silenced the whistleblowers who tried alerting the world to human-to-human transmission. The Chinese authorities knew much more much earlier than they shared with the world — at worst deceitful, at best opaque.

China’s actions make the origin of the virus, whether the laboratory or the wet food market, irrelevant. That the provenance of the virus was China could be considered unfortunate and of no fault of the CCP. Trump could make his criticism precise: that CCP’s fault isn’t that the virus originated in or spread from China, or the time it took to control the virus, but that they could have warned the international community much earlier about its severity but chose not to. He’ll say that their delay cost lives and wrecked economies.

Trump could turn his nemesis — the lack of timely response — to his advantage. Biden may be flat-footed on China. The Democrats haven’t pursued the China angle because blaming Beijing for America’s woes exculpates Trump. Though no law of conservation of incompetence exists, for a political narrative to succeed, either Trump or China can have blood on hands, not both.

Instead, the Democrats have framed China-bashing as racism. For instance, they have labeled those who allude to the virus’s provenance by calling it the “Chinese virus” or “Wuhan virus” racist — a transmogrification of taxonomy since viruses are often named after their places of origin, like Ebola, named after a river in the Democratic Republic of Congo. Trump unapologetically refers to COVID-19 by its Far Eastern roots, earning the now standard epithet, “racist.” Recently, New York’s Governor Andrew Cuomo called COVID-19 the “European virus,” likely more to troll Trump than signify the virus’ peripatetic nature.

“European virus” sounds debonair but could backfire if the anger against China swells. Anger could rise both nationally and internationally if the global economy doesn’t recover and high unemployment becomes chronic. It’ll be easy making the case that blaming the CCP isn’t blaming the Chinese, or indeed that the Chinese people can’t be blamed for the actions of a government they neither voted in nor can vote out.

Another Schism

Another schism in politics is that Republicans and Democrats disagree on which communist country to court. Formerly, both agreed that the former Soviet Union was the enemy. The elections were a contest of who could flex more muscle against the Soviets. Latterly, the Republicans in general and Trump in particular have become partial to Russia. For the Democrats, Trump’s fondness for Russia isn’t a geopolitical strategy but the natural affinity of a boorish, immoral president for a crooked regime. Russia has transformed from Evil Ming to a habitually lying, chronically drunk, Dickensian recidivist. Vladimir Putin is viewed as Trump’s Fagin.

China shouldn’t be different. The Democrats should call out the CCP for its treatment of Uighur Muslims, exploitation of workers in sweatshops and contribution to climate change. But they don’t, partly because Trump is anti-China but mostly because they’re envious of what the autocratic CCP achieves. Many American academics have ties with China. Chinese buy American bonds and indulge American expertise. In return, America overlooks Beijing’s abuses.

Ironically, a Republican, President Richard Nixon, first courted China. But reversals are common in politics. What one side thinks is often determined by what the other side is thinking. Trump baited China long before the pandemic. He imposed trade tariffs, in line with his protectionist policies. In the midst of a trade war, many manufacturers have since left China. Trump may argue that his policies were prescient and should be extended so that the US relies less on China for its supply chains, that given the pandemic it’d be unwise placing all the eggs in one basket.

Trump will make China public enemy number one. He could demand reparations. Whether Beijing complies is immaterial. The angry rhetoric will soothe those who would have seen lives, jobs and freedoms disappear because of COVID-19.

Biden must decide between joining the anti-CCP chorus and out-Trumping Trump on China, or focusing on America’s own failures. If Biden doesn’t up the ante on China, Trump could accuse him and the Democrats of being Beijing’s apologists. China could be to the Democrats what Russia was to the Republicans — a chronically asphyxiating noose around their necks. Trump’s China pivot depends on the public mood in November. If the people are angry, but not very angry, they may hold the incumbent, not China, responsible for their travails. What’s certain is that this will be the most vicious election ever. A nasty pandemonium will follow a nasty pandemic.

Saurabh Jha is an associate editor of THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner. This post originally appeared on Fair Observer here.

The Lancet’s editor: ‘The UK’s response to coronavirus is the greatest science policy failure for a generation’

Richard Horton does not hold back in his criticism of the UK’s response to the pandemic and the medical establishment’s part in backing fatal government decisions

There is a school of thought that says now is not the time to criticise the government and its scientific advisers about the way they have handled the Covid-19 pandemic. Wait until all the facts are known and the crisis has subsided, goes this thinking, and then we can analyse the performance of those involved. It’s safe to say that Richard Horton, the editor of the influential medical journal the Lancet, is not part of this school.

An outspoken critic of what he sees as the medical science establishment’s acquiescence to government, he has written a book that he calls a “reckoning” for the “missed opportunities and appalling misjudgments” here and abroad that have led to “the avoidable deaths of tens of thousands of citizens”. 

In being shielded, he has learned the true significance of key workers… ‘they are making society work’

Related: UK failures over Covid-19 will increase death toll, says leading doctor

Whitty is in the middle of viral storm… it’s debatable whether he’d increase public confidence by acknowledging he got it wrong

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