Healthcare Triage News: The Trump Administration Has Many Options to Undermine Obamacare

Healthcare Triage News: The Trump Administration Has Many Options to Undermine Obamacare

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While the Senate and the House haven’t been very effective in passing a repeal of Obamacare, the ACA’s provisions are still at risk. There’s a lot that Donald Trump’s administration can do (or not do) to undermine Obamacare’s provisions and marketplaces.

7 QUESTIONS THAT ANSWER THE ULTIMATE OPPORTUNITY OF LEADERSHIP

7 Questions that Answer the Ultimate Opportunity of Leadership

The easiest thing leaders do is get things done. The hard part is the people.

Leaders are ineffective if all they do is get things done.

The true focus of leadership:

Leaders focus on people while getting things done.

The greatest opportunity of leadership is developing other leaders.

If you don’t get things done, you won’t be a leader very long. But ultimately leaders enable others to get things done. Now the question is, “What things?”

Leaders advance the welfare of others.

You earn the right to lead by advancing the welfare of others. But serving the greater good is only the first level of leadership. The hard part is next.

Leadership expands when the people you serve become leaders who enable others to serve.

The 3 Levels of Leadership:

Level 1: Advance the welfare of others.

Level 2: Influence others to advance the welfare of others.

Level 3: Influence others who influence others to advance the welfare of others.

How to serve those who serve others:

  1. Honor humility. Won’t honoring humility inspire pride? Not if you think of humility as behaviors and practices.
  2. Break isolation. Establish and strengthen connections.
  3. Clarify ‘good’. People must know what ‘good’ is, if they plan to advance it.
  4. Recognize service.
  5. Celebrate openness.
  6. Show enthusiasm, more than criticism, for others.
  7. Address tough issues with candor, empathy, and compassion.

7 Questions that develop leadership in others:

  1. If you were to exemplify humility today, what might you do?
  2. How might you help others establish and strengthen connections today?
  3. How might you advance the welfare of others today?
  4. Who might you recognize today?
  5. How might you be open to the suggestions and ideas of others today?
  6. How might you pass your enthusism on to others today?
  7. How will you acknowledge emotions and deal with tough issues at the same time?

How might leaders focus on people while getting things done at the same time?

Out-of-Pocket Costs, Financial Distress, and Underinsurance in Cancer Care

http://jamanetwork.com/journals/jamaoncology/fullarticle/2648318?utm_source=STAT+Newsletters&utm_campaign=cf53ee7567-MR&utm_medium=email&utm_term=0_8cab1d7961-cf53ee7567-149578673

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The financial burden of cancer treatment is a well-established concern.1,2 Owing to cost sharing, even insured patients face financial burden and are at risk for worsened quality of life3 and increased mortality.4 Underinsured patients (those spending more than 10% of their income on health care costs) are a growing population,5 and are at risk given the looming heath policy and coverage changes on the horizon. In this setting, little is known about what expectations patients have regarding those costs and how those cost expectations might impact decision making.

Methods

After approval from the institutional review board at Duke University Medical Center, we conducted a cross-sectional survey study of financial distress and cost expectations among patients with cancer presenting for anticancer therapy. We enrolled a convenience sample of adult patients at a comprehensive cancer center and at 3 affiliated rural oncology clinics. Patients provided written informed consent and were compensated with $10 for completing the survey. Trained interviewers surveyed patients in person.

We abstracted the electronic health record for cancer diagnosis, stage, type of treatment, and duration of treatment at the time of enrollment. Demographics including race and income were obtained from the patient. Patient out-of-pocket expenses were based on patient’s best estimation of recent, averaged monthly costs. We surveyed patients about whether their actual costs met their expectations, and about how much they were willing to pay out-of-pocket for cancer treatment, not including insurance premiums. Financial distress was measured using a validated measure. We measured median relative cost of care, defined as monthly out-of-pocket costs divided by income. Expected financial burden, willingness to pay, and subjective financial distress were dichotomized to assess the impact of unexpected costs and high financial distress. We used hypothesis testing to examine variables associated with burden and distress. Multivariable logistic regression included specific variables of interest along with select variables found to be statistically significant in bivariate testing. Statistical analyses were performed using SAS software (version 9.4, SAS institute).

Results

Of 349 consecutive patients approached, 300 were eligible and agreed to participate, and 3 withdrew (86% response rate). Of the 300 patients, 157 (52%) were men. Patient characteristics, income, and costs are described in the Table along with unadjusted analyses. Forty-nine (16%) patients reported high or overwhelming financial distress (score >7).

The median relative cost of care was 11%. The relative cost of care for patients with high or overwhelming distress was 31% vs 10% for those with no, low, or average financial distress. One hundred eighteen (39%) participants endorsed higher than expected financial burden from cancer care. In unadjusted analysis, unexpected burden was associated with being younger, unmarried, nonwhite, unemployed/not retired, having lower household income, higher costs, colorectal/breast cancer diagnosis, lower quality of life and higher financial distress (Table). In adjusted analysis, experiencing higher than expected financial burden was associated with high or overwhelming financial distress (OR, 4.78; 95% CI, 2.02-11.32; P < .01) and with decreased willingness to pay for cancer care (OR, 0.48; 95% CI, 0.25-0.95; P = .03).

Discussion

More than one-third of insured cancer patients receiving anticancer therapy faced out-of-pocket costs that were greater than expected, and patients with the most distress were underinsured, paying almost one-third of their income in health care-related costs. Patients at risk for unexpected costs had less household income and faced higher out-of-pocket costs.

Facing unexpected treatment costs was associated with lower willingness to pay for care, even when adjusting for financial burden. This suggests that unpreparedness for treatment-related expenses may impact future cost-conscious decision making. Interventions to improve patient health care cost literacy might impact decision making. Indeed, the Institute of Medicine has listed cancer cost-related health literacy as a high priority for future research, and this priority has been included in the Center for Medicare and Medicaid’s Oncology Care Model.6 Future studies should test interventions for cost mitigation through shared decision making.

Kaiser Health Tracking Poll – August 2017: The Politics of ACA Repeal and Replace Efforts

Kaiser Health Tracking Poll – August 2017: The Politics of ACA Repeal and Replace Efforts

 

KEY FINDINGS:
  • The August Kaiser Health Tracking Poll finds that the majority of the public (60 percent) say it is a “good thing” that the Senate did not pass the bill that would have repealed and replaced the ACA. Since then, President Trump has suggested Congress not take on other issues, like tax reform, until it passes a replacement plan for the ACA, but six in ten Americans (62 percent) disagree with this approach, while one-third (34 percent) agree with it.
  • A majority of the public (57 percent) want to see Republicans in Congress work with Democrats to make improvements to the 2010 health care law, while smaller shares say they want to see Republicans in Congress continue working on their own plan to repeal and replace the ACA (21 percent) or move on from health care to work on other priorities (21 percent). However, about half of Republicans and Trump supporters would like to see Republicans in Congress keep working on a plan to repeal the ACA.
  • A large share of Americans (78 percent) think President Trump and his administration should do what they can to make the current health care law work while few (17 percent) say they should do what they can to make the law fail so they can replace it later. About half of Republicans and supporters of President Trump say the Trump administration should do what they can to make the law work (52 percent and 51 percent, respectively) while about four in ten say they should do what they can to make the law fail (40 percent and 39 percent, respectively). Moving forward, a majority of the public (60 percent) says President Trump and Republicans in Congress are responsible for any problems with the ACA.
  • Since Congress began debating repeal and replace legislation, there has been news about instability in the ACA marketplaces. The majority of the public are unaware that health insurance companies choosing not to sell insurance plans in certain marketplaces or health insurance companies charging higher premiums in certain marketplaces only affect those who purchase their own insurance on these marketplaces (67 percent and 80 percent, respectively). In fact, the majority of Americans think that health insurance companies charging higher premiums in certain marketplaces will have a negative impact on them and their family, while fewer (31 percent) say it will have no impact.
  • A majority of the public disapprove of stopping outreach efforts for the ACA marketplaces so fewer people sign up for insurance (80 percent) and disapprove of the Trump administration no longer enforcing the individual mandate (65 percent). While most Republicans and Trump supporters disapprove of stopping outreach efforts, a majority of Republicans (66 percent) and Trump supporters (65 percent) approve of the Trump administration no longer enforcing the individual mandate.
  • The majority of Americans (63 percent) do not think President Trump should use negotiating tactics that could disrupt insurance markets and cause people who buy their own insurance to lose health coverage, while three in ten (31 percent) support using whatever tactics necessary to encourage Democrats to start negotiating on a replacement plan. The majority of Republicans (58 percent) and President Trump supporters (59 percent) support these negotiating tactics while most Democrats, independents, and those who disapprove of President Trump do not (81 percent, 65 percent, 81 percent).
  • This month’s survey continues to find that more of the public holds a favorable view of the ACA than an unfavorable one (52 percent vs. 39 percent). This marks an overall increase in favorability of nine percentage points since the 2016 presidential election as well as an increase of favorability among Democrats, independents, and Republicans.

Gene Editing Spurs Hope for Transplanting Pig Organs Into Humans

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In a striking advance that helps open the door to organ transplants from animals, researchers have created gene-edited piglets cleansed of viruses that might cause disease in humans.

The experiments, reported on Thursday in the journal Science, may make it possible one day to transplant livers, hearts and other organs from pigs into humans, a hope that experts had all but given up.

If pig organs were shown to be safe and effective, “they could be a real game changer,” said Dr. David Klassen, chief medical officer at the United Network for Organ Sharing, a private, nonprofit organization that manages the nation’s transplant system.

There were 33,600 organ transplants last year, and 116,800 patients on waiting lists, according to Dr. Klassen, who was not involved in the new study. “There’s a big gap between organ supply and organ demand,” he said.

Dr. George Church, a geneticist at Harvard who led the experiments, said the first pig-to-human transplants could occur within two years.

The new research combines two great achievements in recent years — gene editing and cloning — and is unfolding quickly. But the work is novel and its course unpredictable, Dr. Klassen noted.

It may be years before enough is known about the safety of pig organ transplants to allow them to be used widely.

The idea of using pigs as organ factories has tantalized investigators for decades. Porcine organs can be the right size for human transplantation, and in theory, similar enough to function in patients.

But the prospect also raises thorny questions about animal exploitation and welfare. Already an estimated 100 million pigs are killed in the United States each year for food.

Scientists pursuing this goal argue that the few thousand pigs grown for their organs would represent just a small fraction of that total, and that they would be used to save human lives. The animals would be anesthetized and killed humanely.

Major religious groups have already weighed in, generally concluding that pig organs are acceptable for lifesaving transplants, noted Dr. Jay Fishman, co-director of the transplant program at Massachusetts General Hospital. Pig heart valves already are routinely transplanted into patients.

(Some leaders in the Jewish and Muslim communities, though, do not endorse pig kidneys for transplant, reasoning that patients with kidney failure can survive with dialysis.)

Scientists began pursuing the idea of pig organs for transplant in the 1990s. But in 1998, Dr. Fishman and his colleagues discovered that hidden in pig DNA were genes for viruses that resembled those causing leukemia in monkeys.

When researchers grew pig cells next to human embryonic kidney cells in the laboratory, these viruses — known as retroviruses — spread to the human cells. Once infected, the human cells were able to infect other human cells.

Fears that pig organs would infect humans with bizarre retroviruses brought the research to a halt. But it was never clear how great this threat really was, and as years have gone by, many experts, including Dr. Fishman, have become less concerned.

Some patients with diabetes have received pig pancreas cells, hidden in a sort of sheath so the immune system will not reject them. And burn patients sometimes get grafts made of pig skin. The pig skin is eventually rejected by the body, but it was never meant to be permanent anyway.

There is no evidence that any of these patients were infected with porcine retroviruses. In any event, said Dr. A. Joseph Tector, a transplant surgeon at the University of Alabama at Birmingham, pig retroviruses are very sensitive to the drugs used to treat H.I.V.

“We don’t know that if we transplant pig organs with the viruses that they will transmit infections, and we don’t know that the infections are dangerous,” Dr. Fishman said. “I think the risk to society is very low.”

Dr. Church and his colleagues thought the retrovirus question could be resolved with Crispr, the new gene-editing technology. They took cells from pigs and snipped the viral DNA from their genomes. Then the scientists cloned the edited cells.

Each pig cell was brought back to its earliest developmental stage and then slipped into an egg, giving it the genetic material to allow the egg to develop into an embryo. The embryos were implanted in sows and grew into piglets that were genetically identical to the pig that supplied the initial cell.

Cloning often fails; most of the embryos and fetuses died before birth, and some piglets died soon after they were born. But Dr. Church and his colleagues ended up with 15 living piglets, the oldest now 4 months old. None have the retroviruses.

Dr. Church founded a company, eGenesis, in hopes of selling the genetically altered pig organs. Eventually, Dr. Church says, the company wants to engineer pigs with organs so compatible with humans that patients will not need to take anti-rejection drugs.

Dr. David Sachs, a professor of surgery at Columbia University, was skeptical that it would be straightforward to make pigs with such compatible organs.

“I am afraid that he may find these goals more difficult to achieve than he expects, but I would be happy to be mistaken,” said Dr. Sachs, who is also studying ways to create pigs suitable for organ donation.

Part of the organ rejection problem is already being solved with gene editing and cloning. It is an issue that emerged in the early 1980s when surgeons put a pig heart into a baboon. To their shock, the baboon died in minutes.

Researchers soon discovered that pig organs are covered with carbohydrate molecules that mark the organs for immediate destruction by human antibodies.

Dr. David Cooper, at the University of Alabama at Birmingham, and his colleagues, including Dr. Tector, have used gene editing and cloning to make pigs without the carbohydrates on the surfaces of their organs.

They successfully transplanted hearts and kidneys from those pigs into monkeys and baboons. So far, the animals have lived more than a year with no problems, Dr. Tector said.

They also gave insulin-producing islet cells from a pig to diabetic monkeys, and the monkeys lived for a year without requiring insulin. In partnership with United Therapeutics, the group has already built a farm for gene-edited pigs.

Dr. Church says he, too, is making pigs whose organs lack the carbohydrates, and he wants to combine the two advances so the organs also do not have retroviruses. The Alabama group, though, does not think pig retroviruses are a major concern.

Surgeons are used to evaluating the risks of infection from transplanted organs, Dr. Tector said. The advantage of the transplant to the desperately ill recipient often outweighs that risk.

To some, the idea of growing pigs to create organs is distasteful. Many patients may prefer a human organ, Dr. Cooper acknowledged, but that is not always possible.

“About 22 people a day die waiting for a transplant,” he said. “If you could help them with a pig organ, wouldn’t that be wonderful?”

Trump to GOP: Get Obamacare repeal bill done

http://www.politico.com/story/2017/08/10/trump-obamacare-repeal-senate-republicans-241494?utm_campaign=KHN%3A%20First%20Edition&utm_source=hs_email&utm_medium=email&utm_content=55194059&_hsenc=p2ANqtz-8_YOjdjRTjA-xM50_ZT5aTfcjL6fylg2px13PHXBu5kUC3p0UiYmzhnVD8O5O7HqNErxB3FYB_-rCA7s1w-oHuLGYjjA&_hsmi=55194059

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President Donald Trump renewed his call for Senate Republicans to take another crack at dismantling Obamacare, saying Thursday it’s a “disgrace” that they failed to pass a repeal bill.

“They lost by one vote,” Trump said from his Bedminster, New Jersey, golf course. “For a thing like that to happen is a disgrace.”

The president has hectored Senate Republicans for days over their collapsed health care effort, most recently singling out Majority Leader Mitch McConnell for criticism.

“I just want him to get repeal and replace done,” Trump told reporters, when asked about his multi-day string of tweets attacking the Kentucky Republican over health care. “It’s almost two years, and all I hear is repeal and replace. And I get there, and I said where’s the bill? I want to sign it.”

McConnell has suggested that the GOP should move on from health care after falling just short of the 50 votes he needed to pass a “skinny” repeal bill, and instead focus on tax reform. And earlier this week, McConnell said Trump has “excessive expectations” about how quickly Congress can pass legislation.

But Trump demanded that Republicans follow through on their agenda, suggesting further failure could cost McConnell his job atop the Senate GOP.

“If he doesn’t get repeal and replace done, and if he doesn’t get taxes done, meaning cuts and reform, and if he doesn’t get a very easy one to get done, infrastructure, he doesn’t get them done, then you can ask me that question,” Trump said.