THE PROGNOSIS

Is there a way to do Medicare-for-all without wiping out the country's private insurance system? Sen. Kamala Harris (D-Calif.) says there is.

Here's her solution: Let people keep private plans, but have the government help pay for it. Harris aims to reach universal health coverage by expanding Medicare to everyone, but through private plans that are paid by the government to administer medical benefits. Harris released her proposal yesterday, adding to the proliferating pile of health policy proposals from the Democratic candidates, who are preparing for their second debate tonight and Wednesday.

The 2020 presidential candidate has finally clarified where she stands on the perplexing issue, after months of confusing statements about whether or not she'd eliminate commercial health insurance. In the past, Harris signed onto the sweeping Medicare-for-all bill envisioned by her rival, Sen. Bernie Sanders (I-Vt.), who wants the federal government to directly cover the health expenses of all Americans.

But what Harris is proposing now isn’t quite Medicare-for-all. It’s more like Medicare Advantage-for-all, a popular alternative version of Medicare that currently covers about 1 in 3 seniors. In Medicare Advantage, private plans bid for the rights to sponsor Medicare plans, in contrast to traditional Medicare, in which doctors and hospitals directly bill the federal government.

The program is basically Republicans’ favorite flavor of Medicare, because it so heavily involves the private sector. So using Medicare Advantage as a starting point for health reform could be smart politics for Harris, especially if she eventually finds herself in the general election. Expanding coverage via private means is a more comfortable idea for many Americans.

It certainly is for Tom Scully, former administrator of the Centers for Medicare and Medicaid Services under GOP President George W. Bush, who called the idea a “brilliant masterstroke.”

“There’s a hell of a big difference between Medicare-for-all and Medicare Advantage-for-all,” Scully told me. “I think [Harris] was brilliant to figure that out.”

In her plan, laid out via a Medium post, Harris wants to give people the option of either enrolling in traditional Medicare or buying a Medicare Advantage-type plan while tacking on more benefits, such as mental health care. She’d let people immediately start buying into traditional Medicare and over a 10-year period would phase in privately run Medicare plans to cover newborns, the uninsured and, eventually, everyone who currently has workplace or Obamacare coverage.

The approach allows Harris to embrace the most popular parts of Medicare-for-all — its generous set of medical benefits — while dodging its most controversial aspect of eliminating private health coverage. Harris had wavered on that question for months, on two separate occasions appearing to advocate banning private plans and each time walking back those remarks.

“Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services,” Harris wrote. “If they want to play by our rules, they can be in the system. If not, they have to get out.”

The New York Times's Sarah Kliff: 

Vox's Matthew Yglesias: 

Bloomberg News's Jennifer Epstein: 

Andy Slavitt, who headed CMS under President Barack Obama, called her plan “an effort to balance idealism and pragmatism.”

“The use of Medicare Advantage is a clever approach to getting there,” he told me.

Indeed, Harris’s plan could be viewed as a middle ground between the dramatic health insurance overhaul suggested by Sanders and the incremental approach of a government-financed “public option” backed by former vice president Joe Biden.

If you’re watching the debate, stay tuned for potential clashes between Biden and Harris on the subject when they share the stage Wednesday night. Harris’s rivals were already jumping all over her yesterday, slamming her for trying to have the best of both worlds and charging that it would instead lead to the worst of both worlds.

“This new, have-it-every-which-way approach pushes the extremely challenging implementation of the Medicare for All part of this plan ten years into the future, meaning it would not occur on the watch of even a two-term administration,” said Biden spokeswoman Kate Bedingfield.

“The result? A Bernie Sanders-lite Medicare for All and a refusal to be straight with the American middle class, who would have a large tax increase forced on them with this plan,” she added.

Via CNN's Phil Mattingly: 

Sanders campaign manager Faiz Shakir told Politico that Harris's plan “introduces more corporate greed and more profiteering within Medicare.”

He tweeted this:

Politico's Dan Diamond: 

And the health-care industry, which has formally banded together to fight Medicare-for-all-like proposals, appears no more open to Harris’s proposal than to what Sanders or Biden have suggested.

The Partnership for America’s Health Care Future, a coalition that includes the major trade groups for health insurers, hospitals and other players, released a statement calling it a “one-size-fits-all government-run system.”

“No matter how candidates try to thread the needle, Medicare for all, Medicare ‘buy-in’ and the ‘public option’ would all lead to the same harmful consequences — including unaffordable tax increases, the elimination of consumer choice, threats to patients’ access to their doctors and treatments and a diminished quality of care,” Lauren Crawford Shaver, the group’s executive director, said in a statement.

Today the coalition is launching a six-figure ad campaign that includes digital ads in Detroit and Washington, and this national television ad:

Harris’s proposal is too new for there to be polling data on it. But a new survey from the Kaiser Family Foundation underscores how Americans seem to prefer step-by-step approaches to getting everyone covered versus a system-wide transformation that might cost them their own coverage.

Nearly two-third of respondents said they favor a public option that would compete with private plans and be available to all Americans. Just over half of respondents said they favor a national Medicare-for-all plan, slightly down from 56 percent who expressed support in April.

AHH, OOF and OUCH

AAH: A new proposed rule from the Trump administration would mandate that hospitals disclose discounted prices for services and treatments that they negotiate with insurance companies, our Post colleague Yasmeen Abutaleb reports, in the latest move by Trump officials pushing for transparency in the industry.

The new proposal follows the executive order the president signed last month to provide Americans with more information about health-care costs – the administration has argued “forcing hospitals to post their prices will allow consumers to make more informed choices about where to get care and in turn help lower their health-care costs,” Yasmeen writes, adding insurers and providers worry disclosing such prices could impact competition.

“Under the proposed rule, which is open for a 60-day comment period, CMS would require hospitals to publicize the amount they charge for a set of ‘shoppable services,’ which the agency defines as services that patients can schedule in advance, such as an MRI or a hip or knee replacement,” she reports. “Hospitals also will have to post the prices they have negotiated with insurers, which are typically far less than the prices that hospitals say they charge.”

If they don’t disclose these discounted prices, providers could pay a up to a $300-a-day penalty, the Wall Street Journal’s Stephanie Armour reports.  The price information would have to be “displayed in a machine-readable format so it could be processed by a computer, and listed by common billing or accounting codes to create a framework for comparing standard charges among hospitals.”

“The Trump administration . . . is trying to create a more competitive marketplace where providers are competing for patients on the basis of cost and quality,” Centers for Medicare and Medicaid Services Administrator Seema Verma said on a call with reporters. “This is a direct result of President Trump’s executive order on price transparency.”

OOF: A federal judge blocked New Hampshire from implementing the new rules in the state, the latest roadblock for the Trump administration’s efforts to implement work requirements for Americans covered by Medicaid.

U. S. District Judge James E. Boasberg, the judge who twice rejected similar requirements in Kentucky and ruled Arkansas must stop administering its work requirements, said in his decision that the federal government did not consider how many people could lose Medicaid coverage as a result of the rules, our Post colleague Amy Goldstein reports. He ruled once again that federal health officials had been “arbitrary and capricious” when they approved the state plans.

The judge also said New Hampshire’s rules were set to be “more exacting,” requiring a wider range of low-income residents to abide by the rules and requiring 100 hours a month, 20 hours more than the other two states.

“[T]he agency has still not contended with the possibility that the project would cause a substantial number of persons to lose their health-care coverage. That omission is particularly startling in light of information before the Secretary about the initial effects of Arkansas’s markedly similar project — namely, that more than 80% of persons subject to the requirements had reported no compliance information for the initial months, and nearly 16,900 people had lost coverage,” Boasberg, of the U.S. District Court for the District of Columbia, wrote in his 35-page ruling. “In short, we have all seen this movie before,” he added.

OUCH: Former Chicago mayor Chicago Rahm Emanuel penned an open letter to candidates for the Democratic 2020 nomination ahead of the presidential debates in Michigan this week. His advice: Don’t repeat mistakes he said were made during the debates last month in Miami.

He pointed to the candidates who shot up their hands during the second night of debates when asked if they believed undocumented immigrants should be covered by government health insurance plans.

“This time, don’t fall into the traps that had many of us shaking our heads during the debates in Miami. Before our party promises health care coverage to undocumented immigrants — a position not even Ted Kennedy took — let’s help the more than 30 million Americans who are a single illness away from financial ruin,” he wrote in a post on Medium.

He took a subtle jab at Democrats who have been touting support for Medicare-for-all, suggesting instead that the party vow to shore up and build on the ACA while highlighting what the Trump administration has done to undermine government health care.

“Finally, make sure all Americans are aware that Trump’s only real idea on health care is Medicare cuts for all,” he wrote. “No president has ever proposed to slash the program as drastically as this one. Rather than championing ideas that threaten to upend existing coverage, Democrats should promise to build on the success of the Affordable Care Act by allowing anyone over the age of 55 to buy into Medicare. That would both extend insurance to more Americans and strengthen Medicare.”

INDUSTRY RX

— Drug manufacturing giant Pfizer has agreed to merge its off-patent drug business with drug company Mylan, creating a new unnamed company that will be one of the world’s largest sellers of lower-priced medicines in an increasingly competitive market, the Wall Street Journal’s Jared S. Hopkins reports.

The deal arrives amid increased pressure on generic drugmakers — and as both firms have seen sales decline as competition increases for their top products, such as Pfizer’s Viagra and Mylan’s EpiPen allergy treatment.

“For Pfizer, hiving off Upjohn would further efforts to double down on fast-growing patent-protected prescription drugs and vaccines,” Jared writes. “[Pfizer Chief Executive Albert Bourla] has expressed confidence the company will bring to market in the coming years several new products with blockbuster sales, accelerating growth.”

—As suicide rates climb, survivors of suicide attempts have recently been joining a suicide prevention movement that had largely been driven by family and friends of people who have died.

Suicide rates have increased 33 percent since 1999, with 130 Americans dying by suicide every day, our Washington Post colleague William Wan reports. It’s the 10th leading cause of death in the country. As those numbers climb, survivors are trying to get federal and state lawmakers to do something about it.  

“Clinicians who once hid their own attempts for fear of having their objectivity and work questioned have started revealing their history to peers,” William writes. “Researchers trying to understand suicide, who previously focused on post-mortem data and environmental factors, are starting to embrace the relatively new idea of reaching out to people who experienced it directly. And advocates are harnessing those voices to raise awareness of suicide as a public health issue and win sorely needed funding and attention.”

William spoke with Gregg Loomis, a 61-year-old insurance salesman from New York, who recently spoke with officials in Washington about his suicide attempts.

“I don’t say, ‘I’m bipolar.’ I say, ‘I have an illness,’ because that’s what it is, like cancer or any other illness,” Loomis said during meeting with a staff member for Rep. Nita M. Lowey (D-N.Y.). “The stigma around suicide is huge. We say someone ‘committed suicide’ because it used to be considered a crime and sin. Churches wouldn’t even let people who did it be buried in their cemeteries.”

— And here are a few more good reads: 

TRUMP TEMPERATURE
The administration failed to include its analysis of how many schoolchildren would be affected by food stamp changes in its formal proposal, according to a lawmaker who was briefed on the figures.
NBC News
Another year has passed without the Drug Enforcement Administration approving new applications, despite its stated willingness to do so.
Stat
HEALTH ON THE HILL
Democrats have promised bold action to make prescription drugs cheaper. Here are their biggest ideas — and the network of advisers helping formulate them.
Stat
If it followed the path of traditional Medicare, it would end up paying for a lot of coverage that has little medical value.
New York Times
Accompanying Americans seeking affordable medicine, the Democratic candidate lambasted US pharmaceutical giants
The Guardian
MEDICAL MISSIVES
Victoria Gray, 34, of Forest, Miss., has sickle cell disease. She is the first patient ever to be publicly identified as being involved in a study testing the use of CRISPR for a genetic disease.
NPR
Social Issues
Too often, advocates say, family courts don’t believe mothers’ claims of abuse.
Samantha Schmidt
Kelly Catlin was a silver medalist and Stanford graduate student. At 23, she took her own life.
Kent Babb
DAYBOOK

Today

  • The Senate Homeland Security and Governmental Affairs Committee holds a hearing migration at the United States southern border and what is required to improve conditions.
  • Georgetown University Center for Children and Families Annual Child Health Policy Conference 2019 begins.

Coming Up

  • CMS Administrator Seema Verma and Sen. Mike Braun (R-Ind.) speak on Medicare-for-all at an event hosted by the Heritage Foundation on Wednesday.
SUGAR RUSH

Democratic presidential hopeful Bernie Sanders (I-Vt.) joined diabetes patients as they drove across the U.S. border over the weekend to buy insulin in Canada: