THE PROGNOSIS

Medicare-for-all has dominated much of the 2020 president race, but there’s another pressing health-care issue getting much less attention: The country’s persistent battle with opioid addiction.

The problem is ongoing and severe: The average American has a 1 in 96 chance of dying from an opioid overdose in his or her lifetime, compared to 1-in-103 odds of perishing in a car crash. While there are signs drug overdoses are declining somewhat, they still killed more than 70,000 people in 2017.

And in New Hampshire, where voters delivered Sen. Bernie Sanders (I-Vt.) a narrow win last night, overdose deaths are double the nationwide rate.

"Sen. Bernie Sanders (I-Vt.) claimed unchallenged control of the Democratic Party's left wing with a victory in the New Hampshire presidential primary Tuesday as two moderates, Pete Butti­gieg and a newly surging Sen. Amy Klobuchar (D-Minn.), vied for the opposition mantle in a campaign that has been remade over the past eight days," my colleagues Matt Viser and Sean Sullivan report.

Four years ago, Republican presidential primary candidates got deeply personal as they discussed opioid abuse – an issue that was just starting to get nationwide attention at the time.

Former Florida Gov. Jeb Bush spoke at length about his daughter, Noelle, who was arrested several times for illegal drug possession.

Carly Fiorina, the former Hewlett-Packard CEO, talked about her stepdaughter who was found dead in her home after battling drug addiction for years.

Yet this time around, the Democratic presidential candidates aren’t discussing the topic nearly as much. It did get more airtime in the New Hampshire primary than elswehere, as candidates visited rehab facilities and defended their policy approaches at a debate at St. Anselm College. But they mostly only brought up the issue when questioned by voters or moderators.

“We owe it to the people of New Hampshire – [which has] one of the biggest addiction rates in the countries and death rates when it comes to opioids – to explain how we will pay for the treatment and the beds,” Klobuchar (D-Minn.) said at the debate.

Voters in New Hampshire rank opioids quite low on the list of issues they're interested in hearing about from candidates. One percent of respondents to a recent WBUR New Hampshire poll said they wanted to hear about the topic, compared to 48 percent who wanted to hear about health-care prices and Medicare.

But it's certainly an issue the Democrats could hit President Trump on, if they chose to.

Progress in reducing addiction and overdose on opioid painkillers, heroin and fentanyl has been slow in New Hampshire and elsewhere, even as the Trump administration and Congress have directed some resources and funding toward combating the problem.

Deaths are ticking downwards, but slowly. Last month, the Centers for Disease Control and Prevention reported the number of fatal drug overdoses in 2018 declined for the first time in 28 years. But such fatalities remain at historically high levels, killing more people year than traffic accidents. And while deaths from opioid painkillers are down, likely because doctors are prescribing them less frequently, deaths from fentanyl, cocaine and methamphetamine continue to rise.

“There are tangible things that Granite Staters feel,” Michael Pearson, the president of the New Hampshire College Democrats and executive director of the Dartmouth Democrats, told my Power Up colleague Jackie Alemany. “And health care wise, this is a state that has felt the full effects of opioid crisis and been left out to dry.”

— Six months ago, Buttigieg chose a campaign stop in New Hampshire to roll out his proposal to combat opioid addiction.

Buttigieg wants to provide $100 billion in grants over a decade to communities most affected by the crisis and increase the number of available treatment beds. He also emphasizes ensuring people have coverage for mental health and addiction treatment, particularly medication-assisted treatment, which has been shown to be highly effective. 

— Buttigieg and other Democratic contenders are also calling for decriminalizing all drug possession so people are directed into treatment instead of incarcerated. 

“What I’m calling for is that we end the use of incarceration as a response,” Buttigieg said at Friday’s debate, adding that the crisis is partly due to opioid makers who “were acting irresponsibly with substances that were lawful.”

Klobuchar and Sen. Elizabeth Warren (D-Mass.) have proposed $100 billion to fight drug abuse.  Warren’s ideas are embedded in a bill called the CARE Act, which both Klobuchar and Sanders have signed onto. 

The measure, paid for through a wealth tax on the ultra-rich, would give state and local governments money for treatment, distributing the opioid overdose drug naloxone and employing more health staff to help those struggling with opioid use disorder.

— Klobuchar nabbed a third-place finish soundly ahead of Warren and former vice president Joe Biden, with particularly strong support among white, college-educated women. 

“Klobuchar's third-place finish was powered by a strong debate performance that persuaded late-deciding voters to look her way,” Matt and Sean write. “It represented a remarkable turnabout for a candidate who placed fifth in the caucuses in the state next door to her own. In joyous remarks before a crowd in Concord, she made clear that without Tuesday's results, she would have found it difficult to continue to the next contests, on Feb. 22 in Nevada and one week later in South Carolina.”

“Because of you we are taking this campaign to Nevada, We are going to South Carolina. And we are taking this message of unity to the country,” she said. " … Donald Trump's worst nightmare is that the people in the middle, the people who have had enough of the name-calling and the mudslinging, have someone to vote for in November.”

In New Hampshire, Klobuchar went particularly hard after Sanders and Buttigieg on Medicare-for-all, casting them as extreme on the issue and positioning herself as the reasonable, incrementalist reformer. 

Klobuchar has said she wants to expand health coverage by offering a nonprofit government plan similar to Medicare or Medicaid that people could choose to buy, while still keeping the employer-sponsored system of coverage in place.

— Here's another issue on which Klobuchar is sounding moderate: Abortion. She said there's room in the Democratic Party for voters who oppose abortion rights -- something other candidates, including Buttigieg, have been unwilling to state as Democrats move to the political left on the issue.

Chris Crawford, of Democracy Fund:

AHH, OOF and OUCH

AHH: The number of confirmed coronavirus infections continues to rise, but the rate of growth is slowing, The Post's Simon Denyer, Rick Noack and Siobhán O'Grady report. About 1,000 have died, and there are now more than 43,000 confirmed cases.

— Also, some good news: The virus is sparing kids, CNBC reports. Chinese officials say about 80 percent of people who died from the virus in China were over the age of 60, and 75 percent had preexisting conditions.

— Health officials say an evacuee from China who was briefly released from a San Diego hospital before further testing is in fact infected, our colleagues Hannah Knowles and Derek Hawkins report. The error was made because of mislabeling.

The individual was among four cleared Sunday to return to a nearby air station after testing negative for the virus, but returned to the hospital for “observation and isolation” after Monday morning came back positive for coronavirus. 

— A Chinese epidemiologist, who is most known for his work combating the SARS epidemic in 2003, predicts cases will plateau and decrease by April, Reuters reports.

— The new coronavirus will be designated “severe acute respiratory syndrome coronavirus 2,” or more simply “SARS-CoV-2” while the disease it causes was named “covid-19,” our colleague Joel Achenbach reports

Yesterday the World Health Organization announced the names, which came from a committee of experts who published a paper.

— Federal Reserve Chair Jerome H. Powell told Congress on Tuesday that he expects continued economic growth, although the coronavirus is a major unknown, our colleague Heather Long reports

“Some of the uncertainties around trade have diminished recently, but risks to the outlook remain. In particular, we are closely monitoring the emergence of the coronavirus, which could lead to disruptions in China that spill over to the rest of the global economy,” Powell said.

— As the virus spreads, as are hoaxes, half-truths and flat-out lies, our colleague Kim Bellware reports. Among the misinformation that has surfaced are reports that the death toll in China was over 100,000 more than the real number in January, claims that Chinese people eating bats were the source of the outbreak and suggestions that the virus was engineered by the Chinese as a bioweapon.

— More than 170 people aboard the Diamond Princess cruise ship have been confirmed to have coronavirus, including 10 crew members. Yet the crew aren't being afforded the same protections as the passengers they serve, our colleagues Simon Denyer, Tania Dutta and Akiko Kashiwagi report

There is no effort to keep them apart from one another, while passengers are largely confined to their cabins with limited opportunities to exercise. Crew members eat in the same mess, use the same plates and share the same toilets.

“Five dining waiters have already tested positive,” one cook said. “How will we not get affected?”

— North Korea is launching a national effort to disinfect against coronavirus using an herbal remedy made from burdock roots, Min Joo Kim reports. State media appealed Tuesday to “workers at all levels and fields” to join health officials in the battle against the virus.

Local
In 1898, a guest died in a District hotel room. Doctors raced to discover what killed him.
John Kelly

OOF: Researchers found that more than 20 percent of patients get hit with surprise medical bills after elective surgeries, with the average bill being more than $2,000, according to a study released Tuesday in JAMA. Most surprise bills were often from either anesthesiologists or surgical assistants.

Legislation to protect patients from surprise bills is moving in Congress, but lawmakers and the industry are taking sides over how to calculate those payments. The House Education and Labor Committee approved its bill yesterday and today the House Ways and Means Committee is scheduled to consider its own legislation. Both sides have attracted support that doesn't necessarily split down partisan lines; the Education and Labor bill is seen as more favorable to insurers while the Ways and Means bill is more favorable to doctors and hospitals.

And, the House Energy and Commerce Committee has its own bill. Differences between all the competing proposals would have to be worked out before a vote in the full House.

Rep. Donna Shalala (D-Fla.), former Health and Human Services secretary under President Clinton, said the Education and Labor approach would narrow networks and hurt doctors. Instead, Shalala prefers the Ways and Means proposal, which doctors have lobbied for. 

OUCH: The number of babies delivered earlier than 37 weeks rose for the fourth year in a row in 2018, The New York Times’s Christina Caron reports. That means far more infants are being admitted to expensive neonatal intensive care units, increasing the financial burden on families with preterm infants.

“The March of Dimes estimates that the average societal cost of each preterm birth, which includes medical care, early intervention services and lost productivity, is $65,000. But there is very little research on the costs shouldered by families,” Christina writes.

And even if women have insurance, they're facing higher out of pocket costs. The out of pocket cost for women with employer-based health insurance has increased to $4,569 in 2015 from $3,069 in 2008, according to Health Affairs study published in January. 

AGENCY ALERT

— Responding to criticism about how the Food and Drug Administration has given the green light to several controversial drugs, Peter Stein, FDA’s director of the Office of New Drugs, said there has been a shift in the types of drugs the agency is reviewing, Axios’s Bob Herman reports. Stein said the agency gives leeway in the approval process to treatments for cancer and rare conditions because "patients and physicians are willing to accept a bit more uncertainty."

"If you look in the last couple years, we still see some drugs for chronic diseases, but even there, it tends to be subgroups and populations that were undertreated with drugs previously available, and what we're seeing is a dramatic increase in drugs for rare diseases," Stein said.

MEDICAL MISSIVES

— Livestrong, the cancer charity known for its yellow wristbands and founder Lance Armstrong, is seeking to reinvent itself, Jim Vertuno from the Associated Press reports

The charity announced it will pivot from offering one-on-one cancer support services for patients dealing with insurance, counseling and medical trials to spending $5-6 million annually to entrepreneurs developing treatment and patient care products.

It will continue partnering with the Livestrong Cancer Institutes at the University of Texas Dell Medical School, which focuses on cancer research, patient care and treatment.

—The World Health Organization said Tuesday that it’s “very encouraged” after there were only three new reported cases of Ebola in eastern Congo, a sign that the second deadliest Ebola epidemic in the world’s history could be waning after a year and a half, the Associated Press reports

The epidemic has killed at least 2,249 people. All the more challenging, health workers were attacked in the conflict zone, bringing vaccination efforts to a standstill. 

REPRODUCTIVE WARS

— Fighting back against a Trump administration rule change to requirer insurers bill abortion services separately, Planned Parenthood, the American Civil Liberties Union and four individuals are suing the Health and Human Services Department in a federal court in Maryland, per court records.

The lawsuit, filed Tuesday, says additional administrative burdens will lead to higher premiums for consumers and will cause some insurers to drop coverage for abortion.

“This rule exists for one reason: to make it more difficult for people to access safe, legal abortion,” Alexis McGill Johnson, Acting President and CEO of Planned Parenthood Federation of America, wrote in a statement. “The administration itself admits this rule has no quantifiable benefit — its sole purpose is to create extra red tape for millions of people across the country. We will not stand for this administration’s attempt to shame people and keep them from accessing health care. 

— The Senate Judiciary Committee debated the Born-Alive Abortion Survivors Protection Act, sponsored by Sen. Ben Sasse (R-Neb.), on Tuesday. The bill, that failed last year, would require medical care of infants born after failed abortions.

Sasse said the bill doesn’t challenge Roe v. Wade and is a human rights issue.

Democratic Whip Sen. Dick Durbin, of Illinois, questioned the bill: “Does it add anything?” He said states’ have already passed similar legislation.

— A few more good reads from The Post and beyond:

As lawmakers consider bills to protect patients against surprise medical bills, doctors have waged a stealth on-the-ground campaign to win over members of Congress. Here’s how they did it.
Kaiser Health News
Parents feel emotionally and financially stressed by caring for young children and older relatives at the same time.
New York Times
Rising numbers of older adults are unable to care for themselves, often leading to serious health problems and even death, according to state and local government agencies.
Wall Street Journal

DAYBOOK

Coming up:

  • The House Homeland Security and Governmental Affairs holds a roundtable to examine protecting the United States from global pandemics on Wednesday.
  • The House Subcommittee on Health of the Committee on Energy and Commerce holds a hearing about women's access to reproductive health care on Wednesday.
  • The Senate Special Committee on Aging will hold a hearing on home health care in rural America on Wednesday. 
  • The Supreme Court will consider hearing a case that could settle the face of the Affordable Care Act at its conference on Feb. 21.

SUGAR RUSH

A Trump tweet appeared to backfire when on Monday when he shared a clip from the 10th season premiere of "Curb Your Enthusiasm" to tout his base. But the scene actually mocks MAGA hats.