THE PROGNOSIS

Sen. Amy Klobuchar is refusing to hop on the Medicare-for-all train. That makes her the only major Democratic presidential contender to stray significantly from an ambitious and sweeping plan to overhaul the country’s health insurance system that her primary opponents have embraced.

The Minnesota Democrat’s emergence as the race’s centrist candidate has increasingly highlighted the idealism-vs.-pragmatism debate that’s also dividing Democrats inside Congress. Even as progressives push for a Sen. Bernie Sanders-style bill to replace private health coverage with a government-run system, Democratic House leaders have tried to keep the focus on improving existing health-care programs.

That’s the approach preferred by Klobuchar, who said Monday in a CNN town hall that she favors offering more people a Medicaid-type plan – something Democrats tried to include in the Affordable Care Act but ultimately gave up on over GOP objections that it would give the government an oversized role in the nation's health-care system.

“That is a way to provide a public alternative that’s real … so that we can bring down the rates,” Klobuchar said. “And then we can look at other options, but we have to start somewhere. And I think we could do that much more immediately.”

CNN senior Washington correspondent Jeff Zeleny:

Washington Post reporter Paul Kane:

All the other senators officially seeking the Democratic presidential nomination — Kamala Harris of California, Cory Booker of New Jersey, Elizabeth Warren of Massachusetts, Kirsten Gillibrand of New York and, most recently, Sanders of Vermont — have co-sponsored Medicare-for-all as envisioned in a bill introduced by Sanders in 2017. Rep. Tulsi Gabbard of Hawaii, also a 2020 contender, has signed on to a similar bill in the House.

There haven't yet been any public clashes between the candidates, even though Klobuchar's entrance into the race -- and a potential bid by Sen. Sherrod Brown (D-Ohio) -- has crystallized some health-care fault lines, as New York Times's Alexander Burns notes.

"In one camp were a pair of blunt-speaking Midwesterners, Senators Amy Klobuchar of Minnesota and Sherrod Brown of Ohio — both beloved by many liberals, yet both dismissive of fellow Democrats’ promises to create a vast new apparatus of government-backed health care," Alexander writes.  "They endorsed incremental policy changes, like lowering the age of eligibility for Medicare."

As progressive activists have privately noted to me, the idea of a solely government-run health-care system doesn’t poll well with voters -- that is, if what it might entail is explained to them. Starbucks CEO Howard Schultz, who is contemplating an independent 2020 bid, has included Medicare-for-all among a list of policies he’s blasted the Democrats for supporting, suggesting they’re creating a pathway for President Trump to win a second term by running too far to the political left.

“I’ve spoken about how the far right and the far left are holding our government hostage by engaging in revenge politics and preventing sensible solutions to big challenges, such as health care and immigration,” Schultz wrote Monday in a Medium post.

Schultz has gone after Harris for advocating that private health insurance be abolished, calling the idea “un-American.” Republicans have adopted a similar tone, accusing Harris and her colleagues of supporting socialist policies.

Harris insisted yesterday that Medicare-for-all isn’t about “socialism” but about “providing health care to all people.”

“It’s about understanding that access to affordable health care should not be a privilege; it should be a right,” Harris told NBC’s Kasie Hunt. “It’s about understanding that in a democracy, and the way we have constructed our democracy, we at least in concept have said that your access to public education, public health or public safety should not be a function of how much money you have.”

But Schultz might be right that voters skeptical of Trump yet not ready to support more liberal candidates are looking for a third way, my Post colleague Eugene Scott writes. It might be Klobuchar — not the billionaire — who can fill those shoes.

“[Klobuchar’s] stances appear to be rooted in acknowledging a Democratic electorate interested in big ideas but recognizing that some proposals might be too radical to win over independents who backed Trump in 2016,” Eugene writes.

The Medicaid idea referenced by Klobuchar is from a bill sponsored by Sen. Brian Schatz (D-Hawaii), who reintroduced his measure just last week. It would allow states to start selling a government-backed Medicaid plan on their individual insurance marketplaces, which people could purchase with the help of Obamacare premium subsidies.

Because the plans would be available to higher-income people, they could come with copays and deductibles, but premiums would be capped at 9.5 percent of a family’s income. Klobuchar suggested this incremental approach -- versus a total Medicare-for-all-style overhaul -- would be the fastest and most realistic way of achieving universal coverage

“What we need is to expand coverage so that people can have a choice for a public option, and that’s a start, all right?” she told a questioner at the town hall. “You could do it many ways, but you could also do it with Medicaid, something I don’t think we’re talking about enough as a potential solution.”

NBC News's Andrea Mitchell: 

Bloomberg News's Sahil Kapur: 

Justice Democrats spokesman Waleed Shahid:

AHH, OOF and OUCH

AHH: The role of the U.S. Customs and Border Patrol agency has shifted from national security to humanitarian relief, in part because of the deaths of two Guatemalan children who crossed into the United States in December, our Post colleague Maria Sacchetti reports. After the deaths of Jakelin Caal, 7, and Felipe Gómez Alonzo, 8, Homeland Security Secretary Kirstjen Nielsen vowed “extraordinary protective measures,” and federal officials say medical staff presence has increased at the border.

The measures include medical teams from the Coast Guard, the Department of Health and Human Services, as well as private contractors who triage and examine migrant children. The U.S. military is also helping to evaluate and treat migrants. Border agents, including hundreds who are paramedics, monitor remote areas, Maria writes.

But the need remains great. “A Mexican man detained by U.S. Customs and Border Protection died this week at a medical facility, however,” Maria writes. “And advocacy groups warn that the remote areas where families are crossing, and the agency’s crowded detention facilities, still pose serious risks — especially for young children.”

Children coming into the United States pose a separate risk. “[T]he American Academy of Pediatrics said it has urged CBP Commissioner Kevin McAleenan to hire medics trained in pediatrics, or at least accept volunteer pediatricians, because children require more specialized care,” Maria adds.

See our rundown of the issue in yesterday's Health 202.

OOF: New research reveals the Food and Drug Administration, doctors and drugmakers mishandled the dispersal of the powerful opioid fentanyl, which led to thousands of ineligible patients gaining access to the painkiller.

The paper, published in JAMA, found that although pharmacists, drugmakers, prescribers and the FDA agreed to special measures meant to monitor use, the drug was prescribed inappropriately, our Post colleague Lenny Bernstein reports. The report also found the FDA and drug companies took no action, even after they realized this was happening. Based on five years of insurance claims data, the research found between 34.6 percent and 55.4 percent of patients shouldn’t have received the drugs.

Under a “risk evaluation and mitigation strategy” created by the FDA, “drug companies, doctors, pharmacists and patients themselves received special instruction on the use of the drugs and signed up to be part of the small, closed group allowed to prescribe, dispense and take them,” Lenny writes. “But the report contends that those safeguards didn’t work.”

OUCH: Here’s the latest warning coming down from the FDA: Steer clear of so-called “young blood.”

The treatments,  which involve plasma infusions from young donors, are being marketed as a treatment or cure for conditions such as Parkinson’s and Alzheimer's. But federal health regulators say there’s no proof the treatments work, our Post colleague Laurie McGinley reports.

“There is no proven clinical benefit of infusion of plasma from young donors to cure, mitigate, treat, or prevent these conditions, and there are risks associated with the use of any plasma product,” FDA Commissioner Scott Gottlieb and Peter Marks, director of the agency’s Center for Biologics Evaluation and Research, said in a statement.

“Simply put, we’re concerned that some patients are being preyed upon by unscrupulous actors touting treatments of plasma from young donors as cures and remedies,” they wrote.

Clinics offering young-donor plasma infusions have been popping up, promising the “young blood” as a rejuvenating “anti-aging” therapy, but the FDA statement did not cite any specific companies.

Hours after the FDA issued its statement, Ambrosia, a company that charged people thousands for these infusions, announced it would stop treating patients, NBC News’s Shamard Charles reports. The company “had been charging $8,000 for one liter of blood and $12,000 for two as part of a clinical trial. The blood was donated by 16- to 25-year-olds to consumers ages 35 and older.”

HEALTH ON THE HILL

— Rep. Pramila Jayapal (D-Wash.) seems to be unfazed by reports that Republican lawmakers are looking forward to hearings on her proposed Medicare-for-all bill in order to highlight proposals they're convinced will be unpopular with Americans. To this point, she tweeted yesterday:  

The Health 202 wrote last week that the Washington Democrat is planning to release a sweeping Medicare-for-all plan around the end of the month and is looking for more support from her party for the plan.

“It’s a 150-page bill … it’s not an eight-page resolution,” Jayapal told Paige about the measure, insisting she’s confident she’ll have 100 cosponsors by a planned Feb. 26 release. “Now we’re actually putting detail into it, and so we feel confident we will continue to add cosponsors even after introduction.”

STATE SCAN

— The Supreme Court on Tuesday declined to review a federal court’s decision to strike down a Maryland law aiming to prohibit generic drug manufacturers from “price gouging” consumers.

The law sought to stop drugmakers from hiking generic drug prices in a way the state determined was “unconscionable.” Health-care advocates and Maryland’s Democratic attorney general, Brian Frosh, championed the 2017 law as a “groundbreaking attempt to rein in skyrocketing prescription costs,” the Baltimore Sun’s Jeff Barker reports. In April, a federal appeals court ruled the law violated the commerce clause of the Constitution, prompting an appeal from Frosh.

“The problem is Maryland cannot protect itself from price gouging, and it leaves vulnerable people throughout our state subject to monstrous price increases by generic drug manufacturers,” Frosh said about the Supreme Court’s decision not to take up his appeal.

INDUSTRY RX

— If you have a snow day today or are otherwise looking for something to keep you busy for a half hour, here’s our pitch: Over the weekend, Hasan Minhaj’s Netflix show, "The Patriot Act," tackled the convoluted issue of the drug-pricing chain. And a clip of your Health 202 author Paige appears just before the 20-minute mark, so don’t miss it!

— And here are a few more good reads: 

TRUMP TEMPERATURE
The moonshot aimed to transform cancer research, putting more than a billion dollars into getting 10 years of cancer research squeezed into five.
Politico
On one side of the debate, Bernie Sanders promises a single-payer revolution. On the other, Amy Klobuchar and Sherrod Brown are calling for incremental change.
New York Times
Economic Policy
The program would cost $70 billion a year, or about $700 billion over 10 years, according to an analysis provided to Warren’s office.
Jeff Stein
Here, her thoughts on gun control, immigration, women's rights, and more.
ELLE.com
OPIOID OPTICS
While nearby states have pushed to legalize recreational pot, some people in New Hampshire are resisting. After opioids, they wonder why anyone would expand access to drugs.
New York Times
Transportation
Though it is a top-10 state for drug overdoses, a new report said Maryland has seen the same level of fatal car crashes for a decade.
Ashley Halsey III
MEDICAL MISSIVES
The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.
ProPublica
Courts & Law
It was the first time the 85-year-old justice had attended an oral argument since her December cancer surgery.
Robert Barnes and Mark Berman
As Zuckerberg San Francisco General Hospital promises better billing practices, more patients come forward to share their stories.
Vox
DAYBOOK

Coming Up

  • Johns Hopkins Bloomberg School of Public Health is scheduled to host a guest lecture on the health risks of incarceration on Friday.
  • The Senate Finance Committee is scheduled to hold a hearing on drug pricing on Feb. 26. 
  • The Senate Health, Education, Labor and Pensions Committee is scheduled to hold a hearing on vaccines on March 5. 
SUGAR RUSH

Sen. Bernie Sanders (I-Vt.) kicks off a 2020 presidential campaign amid a crowded Democratic field:

Trump wishes Sanders 'well' in his 2020 run: