with Paulina Firozi
When I sat down with Schrier last week, she told me how unsurprising the measles outbreak is, shared thoughts on the Rep. Alexadria Ocasio-Cortez (D-N.Y.) mania and said members of Congress sometimes act like “proud roosters.” And much more. Read on:
Health 202: Some of your fellow Democrats want to transition the country to a Medicare-for-all system. Do you agree?
“I worked in the system, I’ve been a patient in the system. I see some of the deficits with Medicare – there still is a 'donut hole,' and you still need to have insurance on top of Medicare. We still don’t have a pay-for mechanism. We also don’t necessarily have the luxury of time to roll out. Look at with what happened with Obamacare. It took five years to roll out, it took another five years for the public to accept it. Because people are really happy for the most part with the [Affordable Care Act], I believe there is an opportunity to just keep it and make it better and not blow up the whole system in order to do it. We have no guarantee Medicare-for-all will work better and cost less, we really just don’t know that.
“People on Medicaid are covered, people with subsidies up to 400 percent of poverty level, they’re doing okay. It’s after that people really are hurting and so we proposed a lot of really smart ideas. One is extending subsidies to 600 percent federal poverty level, the other is capping any family’s cost for premiums at 8 and a half percent of their income. I’ve also sponsored a public option, a Medicaid buy-in for people. It starts when people live in a place where there is only one or no insurance providers and then it can expand Medicaid slowly, organically.”
Health 202: Your home state of Washington just became the first state to approve a public option.
“I’ve been watching, and I think it’s a really smart way to go. I think if they can increase Medicaid reimbursement rates so hospitals stay afloat and doctors can stay in business, I think we can get to a really good place. We may end up going to Medicaid-for-all or Medicare-for-all ultimately, but it’s a way to do it without blowing up the system.”
Health 202: Speaking of Washington state, some cases of measles have been reported there. The state just eliminated personal and philosophical exemptions for refusing vaccines. Where do you stand on vaccine exemptions?
“Our state has said no exemptions for [the measles, mumps, rubella vaccine] unless medical exemptions, which is totally appropriate in this setting, where this is a public health responsibility. I don’t believe there is any religion out there that one, prohibits immunization or two, gives you the right to put your fellow citizens in harm’s way.
Health 202: You just introduced a vaccine education bill, yes?
“As a pediatrician, I have found that the best way to get kids immunized is to have ongoing conversations with families. So what my bill does is it looks for hot spots where there are anti-vaxxers or a lot of discussion, a lot of Facebook posts about anti-vax rhetoric and it specifically targets those areas with a positive information campaign. These can’t be government public service announcements – nobody listens to those, there’s already enough skepticism about the government or about big pharma.
"This should come from other parents, this should come from a 75-year-old doctor who says ‘I want to tell you about the time when I had a child with measles die in my arms. I think it needs to come with the same kind of passionate heartfelt stories that are coming from the other side.”
Health 202: Have you been surprised to see the prevalence of anti-vax sentiment?
“Not at all. Working as a pediatrician, I have these conversations every single day. Two percent of the people who are missing vaccines are flat out no's. There are lots and lots of families out there who just say, 'Gosh, does my child really need this? I heard this rumor about this one: My friend said her child got this and something happened.’ That is why you can’t be condescending or dismissive. It’s really a matter of meeting people where they are and giving them reassurances.”
Health 202: You’re one of 67 House freshmen. Is it ever frustrating to see how much attention AOC gets compared to everyone else?
“I don’t have a real need to be a show horse, so I don’t crave the media attention. I just think it’s really important to be mindful that the reason we got the majority is because of moderates like me who flipped districts. If we want to succeed, we have to think about the middle of the country, and we gotta think about the middle 70 percent and where they want to go. If we really want to govern well, we can’t go far right or far left. I think she has done a phenomenal job of getting people excited, getting young people excited about voting and that is indispensable.”
Health 202: You obviously know a lot about health care, but now you need to know health policy. How has that been going?
“You become a little bit of a policy wonk. But I think what is really different between me and other policy-oriented people is that I have the perspective of a doctor. They look at the economics of it and how many people are covered and I look at it and say 'Wait, hold on a second.' If you have a high deductible, for example, and you have a one-year-old child, and every clinic visit you’re going to pay cash for because you have a high deductible – that policy might work for an adult but it does not work for kids. And so having the first X number of visits – I’d say 5 to 7 visits – not count against your deductible I think is a smart way to go.”
Health 202: Because kids get acute illnesses more often than adults?
“Right. And it could also be that for adults with chronic illnesses – because we want to incentivize primary care so you don’t end up with complications later – there could be a carveout. [Like] if you have diabetes we want you to have an A1C four times a year and we want you to see your doctor four times a year and that part won’t count toward your deductible. I think there are ways we can imagine a system that works better that a doctor brings to the table that other people don’t think of.”
Health 202: In your years as a pediatrician, did you see doctors considering the cost to the patient when prescribing them medications or services?
“I always think about that because I think that’s just a smart way of thinking, and also being a patient you think about which insulin is going to break the bank. I would call pharmacies and just see what medications cost, but other doctors don’t do that. There is definitely a disconnect and I think doctors do need that information so they can be responsible prescribers.”
Health 202: So you would actually research cheaper, similarly effective medications to prescribe your patients?
“On the medications I would prescribe frequently, absolutely. There are pretty egregious examples. Clindamycin, for acne. When I was a kid, my brother used that stuff and it was probably a dollar then.
Now it’s about $20 for the old-fashioned formulation, but if you get in gel form the price goes up to a couple hundred dollars and if you get it in foam form then you’re up even higher than that. It’s insane. If a doctor doesn’t know that he’ll go, ‘Oh, it’s kind of nice to have a foam form because it doesn’t feel sticky on your face or something.’ But does it really make that much difference?”
“Epi-pens…you have the auto-injectors you use for allergies. Every kid with a peanut allergy needs a kit for home, a kit for school, sometimes a kit for the other parent’s house. The price went from $50 to $600 ... so if you need two or three of these kits, you’re looking at almost $2,000 dollars. So, I would write prescriptions and send people to Canada and they would go buy them there for $50. The same injector, the same technology but that price was wildly different. It’s that kind of egregious gaming of the system and gouging of the customer that just needs to be addressed.”
Health 202: What do you think of the Trump administration’s proposal to tie payments for some Medicare drugs to prices in other countries?
“Nobody wants to stifle innovation. Transparency would be a great first step so we know why drugs cost so much. I think the notion of tying what we pay to the global community makes some sense, keeping in mind of course that we do subsidize a lot of medications – for example in Africa so we can combat AIDS in Africa – so those don’t necessarily reflect market prices so you would need to compare to other first world countries.”
Health 202: Democrats and Republicans here in Washington spend a lot more time arguing over health insurance than finding bipartisan ways forward on it. Do you think that can be changed?
“There is just so much partisanship and pride. There is a hesitation to join the other side. We’re all going to have to learn we can’t always get our way. It’s maddening to watch, I understand that they do better in committee when there are no cameras because people can actually have a real conversation and not just grandstand for TV. I would like to see more of that. I think you could achieve transparency with a transcriptionist instead of a camera and then we would see more cooperation, that is my personal feeling as a freshman. It’s like they’re all putting on a show and they’re, yeah, prancing around like proud roosters.”
Health 202: Congressional hearings often don’t seem to be about learning things.
“No, they’re totally not. Listening to the testimonials – definitely learning. But the part with question and answer I think should be directed at each other. We have a roundtable where someone says this idea would be good, what you do think and then you just find a place in the middle. It shouldn’t be that hard.”
“I’m playing softball with a bunch of women Republicans and Democrats. We don’t talk politics, but we’re all good people, we all have families, we should be able to come together.”
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AHH, OOF and OUCH
AHH: President Trump is expected to issue an executive order as early as next week to require the disclosure of prices for drugs and health-care services, the Wall Street Journal's Stephanie Armour reports.
"The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data," Stephanie writes. "The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care, according to two people familiar with the discussions."
Stephanie writes that the White House declined to comment on its plans, while industry groups said they'd be an executive overreach and legal challenges are possible.
"The White House has been working for months on a strategy officials believe will lower health-care costs by giving consumers and employers data for the first time on the discounted and negotiated rates between insurers, hospitals, doctors and other providers," she writes. "Internal administrative disputes over how aggressively to mandate price disclosure have delayed earlier plans to issue an executive order, two people said, and some details of the current order are still being completed."
OOF: The first state trial of the opioid epidemic begins in Oklahoma today. Families that have lost loved ones to opioid overdoses see it as a chance to hold drug companies accountable after years of waiting for recompense, The Post's Lenny Bernstein reports. Yet much has changed since Oklahoma Attorney General Mike Hunter sued three drug companies and their subsidiaries 23 months ago, alleging they are responsible for the opioid scourge.
"The central character in the opioid epidemic, Purdue Pharma, has settled with the state for $270 million and will not be on trial in Judge Thad Balkman’s courtroom," Lenny writes. "On Sunday, a second defendant, Teva Pharmaceuticals, settled out of court for $85 million. The state has dropped all but one accusation against the remaining company — Johnson & Johnson — and is pinning its strategy on a novel use of Oklahoma law."
Oklahoma is near the middle of the pack when it comes to state overdose rates. Its rate of 20.1 per 100,000 residents is far below West Virginia’s rate of 57.8, but much worse than Nebraska’s 8.1. "The state is seeking a penalty in the billions of dollars to 'abate' the crisis, alleging it will take as much as $17.5 billion across the next 20 to 30 years to compensate for the damage," Lenny writes. "Its single charge is that the drug companies created a 'public nuisance,' a violation historically alleged when one party’s activities negatively affect others — a neighborhood crack house or a factory that pollutes a waterway, as examples."
OUCH: Democrats trying to advance Medicare-for-all are meeting hefty opposition from their own neighborhood hospitals, Politico's Adam Cancryn and Rachel Roubein report.
"The multibillion-dollar industry has emerged as the most formidable foe of single-payer health care," Adam and Rachel write. "It’s helped assemble a coalition of health care lobbies that has launched social media campaigns attacking Medicare for All...while fighting narrower Democratic proposals to expand federal health coverage over concerns any change would slash hospital revenue....That’s created a dilemma for Medicare for All champions who cast themselves as crusaders against a broken health care system full of greedy insurers and drug companies, yet remain wary of taking on hospitals that rank as top employers in many congressional districts and are seen by the public as life-saving institutions."
“We’re not cutting out hospitals, we are keeping the existing hospital system,” Medicare-for-all sponsor Rep. Pramila Jayapal (D-Wash.) told Adam and Rachel, adding “they’re very much going to be a partner at that table.”
REPRODUCTIVE WARS
AHH: Louisiana Gov. John Bel Edwards -- a Democrat -- has pledged to sign into law a six-week abortion ban the state legislature is expected to take up today.
"Edwards, a Catholic Army veteran and first-term governor, is a high-profile member of a now-obscure class of politician: the 'pro-life liberal,'" the Post's Reis Thebault writes. "As bills that ban abortions outright or after six weeks of pregnancy churn through statehouses across the country, his cohort has found itself the target of fierce criticism from fellow Democrats."
Many Democrats view Edwards’s support for Louisiana’s “heartbeat” ban as the ultimate betrayal to their party’s cause. "Edwards, elected in 2015, has championed health care expansion and a minimum raise increase in a state that overwhelmingly voted for President Trump a year later," Reis writes. "Yet his views on abortion have thrust him and other antiabortion Democrats into the national spotlight, unlikely intraparty combatants in a debate that has grown increasingly partisan...But if you ask them, they’ll say the Democratic Party has left them behind, not the other way around."
“It’s all about abortion, they just don’t want anyone who opposes abortion in the party,” Kristen Day, executive director of the group Democrats for Life, said in an interview. “They’re kicking people out of the party instead of trying to bring people in.”
— A few more good reads from The Post and beyond:
INDUSTRY RX
STATE SCAN
SUGAR RUSH
