THE PROGNOSIS

President Trump is hardly using a new argument when he denounces Medicare-for-all as “socialism.” The country’s doctors actually wrote that playbook nearly 100 years ago. 

There's a long history in this country of politicians using the charged term to try to stave off various kinds of government-sponsored health care, including the kinds we have today. 

Trump frequently tries to draw a distinction between Medicare and the plans 2020 Democrats are advancing, which he laments would put the government in control of peoples’ personal medical decisions and ruin the current system. “Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare,” Trump recently said during a speech outside Orlando. 

“These Democratic policy proposals … may go by different names, whether it’s single-payer or the so-called public option, but they’re all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism," he said. 

From Seema Verma, administrator of the Centers for Medicare and Medicaid Services:

But here’s the catch: The American Medical Association used to call Medicare “socialism” too. 

And the idea that government-sponsored health insurance is “socialism” has resurfaced again and again in the decades-long debate over how to get more Americans covered. Until the 2010 Affordable Care Act, the AMA and Republican lawmakers used the charged label to to oppose nearly every insurance expansion attempted by Congress and the White House since the 1930s. 

Consider these points, made by health policy expert David Blumenthal in his 2009 book “The Heart of Power: Health and Politics in the Oval Office": 

  • As President Franklin Delano Roosevelt explored a national health program in 1938, the AMA issued a statement expressing its opposition to any form of government-sponsored health insurance. In the end, FDR avoided serious confrontation with the AMA and it went nowhere.
  • When President Harry S. Truman called on Congress in 1945 to pass five reforms, including national health insurance and disability insurance to protect workers, he said Americans “will not be frightened off from health insurance because some people have misnamed it ‘socialized medicine.’ I repeat — what I am recommending is not socialized medicine.”

But “cries of socialized medicine … were heard from the Republican side of the Senate,” the New York Times reported the next day.

  • The AMA organized a massive public relations campaign against national health insurance. One of its telegrams asking for donations said this: “Obviously this is the beginning of the final showdown on the collectivist issue. Not one day dare be lost … do not underestimate the crisis … fight for personal freedom and professional independence.”
     
  • In a 1946 Senate hearing on a bill to create a national medical and hospitalization program, Sen. James Murray (D-Mont.) asked that critics refrain from calling it “socialistic.”

“I think it is very socialistic,” responded Sen. Robert Taft (R-Ohio). “It is, to my mind, the most socialistic measure that this Congress has ever had before it, seriously.”

  • The AMA mobilized against government insurance in 1949, hiring a public relations firm that assigned 37 assistants to the campaign against Truman’s proposal. The firm produced a pamphlet of questions and answers entitled “The Voluntary Way is the American Way,” which included a made-up quote from Lenin:

“Q: Would socialized medicine lead to socialization of other phases of American life?

A: Lenin thought so. He declared: Socialized medicine is the keystone to the arch of the Socialist State.”

  • President Lyndon B. Johnson only avoided the AMA boycotting Medicare in the 1960s by ensuring the bill included generous compensation for both doctors and hospitals.
     
  • As Congress was working to pass Medicare, Ronald Reagan made a recording for the AMA in 1961 warning it would open the door to other federal programs “that will invade every area of freedom as we have known it in this country until we wake to find that we have socialism.”

It’s not surprising doctors have historically opposed public health insurance, because it typically pays them less than private plans. And invoking the term “socialism” as communism spread in the mid-20th century was strategic from a public relations standpoint. Forty percent of Americans told Gallup in 1942 that socialism is a “bad thing,” compared with 25 percent who said it was good.

“Summoning up socialism and communism as a threat was a useful tool to relate these health-care changes to all the other things Americans feared,” Blumenthal told me. “It’s easy to forget the extent to which the Soviet Union was the number one enemy and number one fear.”

But the characterization is not entirely fair. Medicare-for-all would dramatically overhaul the United States health-care system, eliminating private plans and giving the government control over how much health providers would be paid. Yet the approach, at least as envisioned by its author, Sen. Bernie Sanders (I-Vt.), would still keep the means of production — namely, doctors and hospitals — private. In that sense, Medicare-for-all isn’t socialism.

Polls indicate socialism is even less popular now (although it’s lately seen some uptick in support among young people). Fifty-one percent of Americans recently told the Gallup poll that socialism is “a bad thing,” while 43 percent said it’s a “good thing.” Just 6 percent said they have no opinion, compared to 34 percent with no opinion in the 1940s.

The AMA has softened its position on the government’s role in health care in the days since Medicare and Medicaid were being created. It notably supported Obamacare, which provided created federally subsidized private plan marketplaces.

For a time, the association belonged to an industry coalition fighting Medicare-for-all and other public plan options but left over the summer. It's now exploring whether it might change its position to back the idea of adding a public option to the private marketplaces as competition to further drive down prices.

AMA President Patrice Harris recently told reporters the organization’s evolution is consistent with its historical approach. 

“I think with what AMA has felt for many years is that we need a plurality, there is no one system, which is why we do oppose a single-payer system,” Harris said. “We believe in plurality, freedom of choice for patient and physician. We do not believe that a one-size-fits-all approach is the way to go.”

AHH, OOF and OUCH

AHH: Trump tweeted that he is set to meet with members of the vaping industry as his administration readies a ban on flavored e-cigarettes.

The Health 202 wrote this week about the highly anticipated crackdown on vaping, and concern from health-care advocates that the administration may walk back the approach the president outlined in September. 

So far, the promised ban has been delayed amid a lobbying blitz, the Wall Street Journal’s Thomas M. Burton and Alex Leary report. “Public-health advocates, including doctors who specialize in treating lung diseases, voiced concern about what may be in the background of the president’s tweet. In particular, the worry is about who attends any meeting with Mr. Trump,” they write.

Albert Rizzo, chief medical officer of the American Lung Association told the Wall Street Journal his group has not been contacted by the White House, but he indicated concern that the “mention of jobs in the tweet could be a signal that any administration action might somehow leave vape shops free to sell flavors that appeal to children. Dr. Rizzo said he is adamant any ban should preclude sale of flavors like menthol and mint.” 

Matthew L. Myers, the president of the Campaign for Tobacco-Free Kids, said there was concern the administration would back away from the pledge to eliminate flavors including mint and menthol, which are particularly popular with youth. “With every additional comment from the White House, there is concern that for inaccurate political purposes, they’re backing off what they said,” Myers said.

Trump's tweet did not indicate when the meeting would happen.

— Former FDA chief Scott Gottlieb is suggesting that all vaping products from Juul Labs be pulled from the market entirely.

“It’s very clear that Juul can’t keep their products out of the hands of kids,” Gottlieb said, according to CNBC’s Jessica Bursztynsky. “What’s driving the youth use is primarily Juul.”

He pointed to a pair of studies out last week in the Journal of the American Medical Association that found Juul “dominates the e-cigarette market among teens, with its mint pods being the most popular flavor. The studies also highlighted that 27.5% of high school students and 10.5% of eighth graders said they currently use e-cigarettes. More than half of both groups said they used Juul as their e-cigarette of choice,” Jessica reports. 

“You’ve hooked a lot of kids,” Gottlieb said. “Kids now, it’s become sort of fashionable and they like the form and fashion of this product. It could be that this product can’t exist on the market anymore.”

OOF: Google has been collecting detailed personal health data of millions of Americans as part of a project with Ascension, the second-largest health system in the country, the Wall Street Journal’s Rob Copeland reports.

The data involved in the effort, called “Project Nightingale,” relates to lab results, diagnoses and hospital records, names and dates of birth — essentially making up a complete health history — but neither patients nor doctors are aware of the data collection. The information is being gathered from millions of Americans across 21 states.

“Some Ascension employees have raised questions about the way the data is being collected and shared, both from a technological and ethical perspective, according to the people familiar with the project, but privacy experts said it appeared to be permissible under federal law,” Rob reports. “That law, the Health Insurance Portability and Accountability Act of 1996, generally allows hospitals to share data with business partners without telling patients, as long as the information is used ‘only to help the covered entity carry out its health care functions.’ Google in this case is using the data, in part, to design new software, underpinned by advanced artificial intelligence and machine learning, that zeroes in on individual patients to suggest changes to their care.”

OUCH: Authorities say a Virginia obstetrician and gynecologist mutilated women by performing unnecessary hysterectomies, conducting repeated invasive and irreversible procedures, and even burning one woman’s fallopian tubes without her knowledge. 

Javaid Perwaiz was arrested on Nov. 8 on one count of health-care fraud and one count of making false statements related to health-care matters.

“The reason, authorities say, was to make more money,” The Post’s Katie Mettler reports. “In court documents filed in U.S. District Court in the Eastern District of Virginia last week, federal officials claim the 69-year-old doctor has been falsifying medical records since at least 2010 to justify medically unnecessary procedures on female patients in a scheme to defraud Medicaid and the Blue Cross Blue Shield Federal Employee Program.”

“From January 2014 to August 2018, investigators found that Perwaiz performed surgery on 510 patients who receive Medicaid benefits — which meant 40 percent of all his Medicaid patients went under the knife. Of those 510 patients, about 42 percent had two or more surgeries,” she adds. “… Charging documents allege Perwaiz’s volume of in-office hysteroscopies far outpaced that of his colleagues. In fiscal year 2016, he performed 86 of them, and in 2017 he performed 87. The next leading provider performed six hysteroscopies in the same time frame.”

AGENCY ALERT

— Pete Buttigieg wants to name the first woman to lead the Department of Veterans Affairs.

The former Navy intelligence officer told the Associated Press’s Hope Yen in an interview that female veterans and service members have been particularly ignored by the Trump administration, especially with respect to sexual harassment and women’s health concerns. “I think leadership plays a huge role so absolutely I’d seek to name a woman to lead VA,” Buttigieg said, adding: “The president has let veterans down.”

“Buttigieg, like Warren, would seek to improve responses to sexual assault in the military by shifting prosecution from military commanders to independent prosecutors. He also wants to put particular focus on stemming homelessness among women vets, many of whom may have experienced sexual trauma,” Hope writes.

— And here are a few more good reads: 

Veterans are using games to heal, with the Xbox adaptive controller providing help to those who have suffered traumatic injuries.
Alex Andrejev

HEALTH ON THE HILL

Nearly 8 in 10 Americans say the cost of prescription drugs is unreasonable, but the odds look grim for Congress to pass significant pricing legislation this year.
Kaiser Health News

INDUSTRY RX

The policies have focused on three distinct areas: allowing direct Medicare negotiation; allowing importation, and fostering generic drug competition. 
Stat

MEDICAL MISSIVES

The American Academy of Pediatrics has a new policy statement on bariatric surgery for adolescents.
New York Times

DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the response to lung illnesses and the rise in youth e-cigarette use on Wednesday.
  • HHS Secretary Alex Azar, Sen. Ron Wyden (D-Ore.) and Sen. Mike Braun (R-Ind.) will participate in an Axios event “Health Care in 2020” on Wednesday.

SUGAR RUSH