THE PROGNOSIS

Moderate Democrats are clearly hoping Sen. Bernie Sanders's Medicare-for-all plan proves to be a liability in Saturday's Nevada caucus. And did everything they could at last night's debate to make it happen. 

They seized on simmering tensions between Sanders and the state's most influential labor union – which opposes the government-run health care proposal – to paint the independent Vermont senator as out-of-touch with workers who want to keep their plans. 

Former South Bend, Ind. mayor Pete Buttigieg accused Sanders of being “at war” with the Culinary Union, which represents some 60,000 hotel and casino workers across the state. 

Buttigieg tried to capitalize on the desire from some workers to keep their employer-bargained plans, arguing his Medicare-for-all-who-want-it approach would allow them choice. 

“This idea that the union members don't know what's good for them is the exact kind of condescension and arrogance that makes people skeptical of the policies we've been putting forward,” Buttigieg said. 

The cross-fire was the latest example of how labor unions have been thrown into the center of the brawl over the best path forward on health care taking place within the party. 

The rift within labor unions, however, means the political benefits are up for grabs. Those skeptical about single-payer could prove a boon for center-left candidates, as Sanders must thread the needle between insisting as he did last night that he has “the support of unions all across the country” even as he pushes policies some oppose. 

Sanders vigorously defended his signature plan, saying that replacing union members' private health plans with a government-run program would only expand their benefits. 

“Let me be very clear to my good friends in the Culinary Workers Union, a great union: I will never sign a bill that will reduce the health care benefits they have," he said. "We will only expand it for them, for every union in the America, and for the working class of this country.”  

The onstage squabbles in Las Vegas also showed how some unions – even while silent on endorsements – have made their voices heard during the campaign season. 

Sen. Amy Klobuchar (D-Minn.), who touted her proposal for a public option, positioned herself as addressing union workers' concerns. 

“These are hard-working people, housekeepers like Elizabeth and I met with last night, who have health care plans that have been negotiated over time, sweat and blood. And that is the truth for so many Americans right now,” she said. "There are 149 million Americans that would lose their current health insurance under Sen. Sanders' bill.” 

Let's take a step back to explain the background: Last week, the Culinary Union issued a flier that was critical of Sanders's Medicare-for-all plan. In summarizing candidates' policy proposals, the group said he would “end Culinary healthcare.” 

“The union, which insures about 130,000 workers and their families, has strongly opposed Medicare-for-all, arguing it would dismantle the organization’s health insurance program, widely considered one of the best in the state,” my Post colleagues Holly Bailey and Felicia Sonmez reported. Later, the union said Sanders supporters had “viciously attacked” members over that criticism. It also announced it would not endorse a candidate. 

As The Health 202's Paige Winfield Cunningham wrote last week, “workers typically pay lower premiums for these plans than for employer-sponsored coverage, because union members have a seat at the table when it comes to deciding on their health benefits. So many unions view Sanders’s Medicare-for-all approach with skepticism, fearing it could eliminate with health benefits for which they’ve fought hard.” 

The questions during Wednesday's debate pivoted to the crux of the union's concern: how their benefits would be affected by Medicare-for-all. And who has their best interests at heart. 

In response to Sanders's brag that he has “more union support than you have ever dreamed of,” the former mayor responded that his campaign can “actually empower workers and lift wages without further polarizing this country.” 

“The vision I'm putting forward has the support of the American people. We can actually deliver health care without taking it away from anyone,” Buttigieg said. 

Days before the debate, Buttigieg tweeted defending his health-care approach, saying union workers have “fought hard for strong employer-provided health benefits.” 

Yet not all union members agreed. Buttigieg's message drew the ire of Sara Nelson, the president of the Association of Flight Attendants, who challenged the premise and said “for profit healthcare” is “killing people & putting working people in financial ruin.” 

In another example of the divide among labor organizations, Service Employees International Union leaders in Nevada also released a statement recently calling the debate over Medicare-for-all versus union-negotiated plans a “false choice." 

“While some working people have good health care plans through their jobs, many do not,” said SEIU leaders Grace Vergara-Mactal and Maria Rivera. “Access to quality healthcare shouldn’t be based on luck, it should be a right.” 

The latest debate-stage fracas over whether Medicare-for-all is tenable also comes as the newest Washington Post-ABC poll found more than 6 in 10 Democrats support replacing private insurance with a single government plan that covers everyone. 

My colleagues Emily Guskin and Scott Clement point out that if Nevada voters turn out to be as supportive of single-payer health insurance as voters were in New Hampshire and Iowa, it could be a good sign for Sanders's campaign. They note support for government-provided health insurance has “proved to be a good predictor for vote choice in Iowa and New Hampshire.” 

But looking ahead, there's less support for the policy from the broader public – the poll found 41 percent of Americans support the policy nationally, compared with 52 percent that are opposed. 

AHH, OOF and OUCH

AHH: The national press secretary for Sanders acknowledged that she misrepresented former New York mayor Mike Bloomberg’s previous heart issues in an interview following Tuesday night’s CNN town hall, as our Post colleague John Wagner writes. 

Sanders mentioned his medical history during the event, arguing the medical records he had already released were “quite as much as any other candidate.” 

Later on CNN, the campaign’s national press secretary Briahna Joy Gray suggested the questions about Sanders’s health were unfair.

“What you’re seeing right now is really reminiscent of some of the kind of smear, kind of skepticism campaigns that have been run against a lot of different candidates in the past. Questioning where they’re from, aspects of their lineage, et cetera, et cetera,” Gray said. “It’s really telling given that none of the same concern is being demonstrated for Michael Bloomberg, who is the same age as Bernie Sanders, who has suffered heart attacks in the past.”

In a statement, Bloomberg campaign manager Kevin Sheekey called Gray’s remarks an “absolute lie” and said Bloomberg in 2000 “had two coronary stents placed.” 

Gray in a tweet said she had “misspoke when I said Bloomberg had a heart attack.” 

During Wednesday's debate, Sanders' poked at Bloomberg on the issue, saying the “one area maybe that Mayor Bloomberg and I share is, you have two stents as well.” 

OOF: Former Senate majority leader Harry M. Reid (D-Nev.) spoke critically of Medicare-for-all ahead of the Nevada debate, telling ABC News he is “against” the policy proposal he says has little chance of becoming law. 

"It’s impractical ... There’s not a chance in hell it would pass," Reid said. He instead called for bolstering the Affordable Care Act and moving to pass a public option, ABC News’s Quinn Scanlan writes. 

“I think the world of Bernie Sanders,” he said, also saying the same of Sen. Elizabeth Warren (D-Mass.). “One of the things that I feel very good about is that I discovered Elizabeth Warren, brought her to Washington when we had the Wall Street collapse," Reid said. He added: "She became head of the oversight committee and did a really good job ... so I think the world of Elizabeth Warren"

But Reid declined to endorse a candidate ahead of the state’s caucus. 

OUCH: About two percent of those infected with the novel coronavirus have died, according to preliminary numbers. 

And while no one knows exactly how or why the virus is killing this small percentage of patients, here’s what we do know: “Based on what we know about related illnesses, including severe acute respiratory syndrome (SARS), experts hypothesize that the difference between a lethal infection and one that feels like a bad cold probably hinges on the interaction between the virus and a person’s immune system,” our Post colleague Carolyn Y. Johnson reports. “While the virus attacks and kills cells in all cases, serious illness will depend on how the immune system responds, and that can be influenced by age, gender, genetics and underlying medical conditions.” 

Matthew Frieman, a virologist at the University of Maryland School of Medicine said there’s an “initial damage and rush of inflammatory cells, but the damage is so extensive that the body’s immune response is completely overwhelmed — which causes even more immune response, more immune cells and more damage.” 

“In the patients who recover, the immune system’s response has worked: It has cleared the virus, with inflammation receding,” Carolyn adds. “Yet experts don’t know the long-term outcome for these individuals. It’s possible they will gain immunity and be protected from reinfection. Or they might get a less severe case in the future — or not be protected at all. They also might just gain temporary immunity." 

Countries around the world are working to contain the spread of the coronavirus. Here’s how masks and quarantines fight the virus.
Joe Fox, Youjin Shin and Armand Emamdjomeh
Asia & Pacific
In Japan, the government is under fire as a slow-moving bureaucracy struggles with a fast-moving virus.
Simon Denyer
Asia & Pacific
International experts say the disease will continue to spread globally even as the Chinese government seeks to present the image that it is coming to grips with the epidemic.
Gerry Shih and Teo Armus

HEALTH ON THE HILL

The bipartisan efforts to try to overhaul drug pricing is one sign the drug industry’s lobbying influence is not what it once was, the Wall Street Journal’s Brody Mullins and Stephanie Armour report in this deep dive. 

Another sign is the number of new measures and proposals on drug pricing, whereas the drug lobby once had the influence to block nearly any bill. 

“A growing rift between the GOP and longtime drug-industry allies is shaking up pharmaceutical policy, and for the first time in a generation, some Republicans and Democrats are joining to overhaul drug-price regulation,” they write. “Most Republican lawmakers still side with the powerful drug-industry lobbying arm, the Pharmaceutical Research and Manufacturers of America. PhRMA and drug companies might still squelch the overhaul efforts, and the drug-price bills are still up for debate with no clear indication whether they will pass. Industry lobbyists are out in force, and drug companies remain big donors to key Republicans and Democrats.”

PhRMA Chief Executive Officer Stephen Ubl told the Journal in some ways the lobby’s approach has changed. “In the past PhRMA had a reputation for rolling the tanks against every proposal irrespective of industry impact,” Ubl said. “We are now taking a more proactive approach of coming to the table to offer policy makers solutions that would address patient affordability challenges."

STATE SCAN

In New Jersey, there are hundreds of vape shops stocked with flavored nicotine products that will soon be prohibited. Last month, the state become the second to adopt a measure to make nicotine vaping liquids illegal, banning fruit and menthol-flavored e-cigarettes and cartridges, the New York Times’s Tracey Tully reports. 

Only flavors meant to taste like tobacco will be allowed. The law in New Jersey also goes far beyond the new federal partial flavor ban.

“How does a whole store that pays employees and rent survive on five flavors of tobacco?” Adam Mitrani of the Darth Vapor shops in New Jersey told the Times. “The answer is it can’t.”

“Many shop owners say they are selling off as much inventory as possible, operating on month-to-month leases and preparing to close. Others are making plans to sell pipes, tobacco products, CBD oil and kratom, an herbal supplement that the Food and Drug Administration has said can be dangerous, to try and stay afloat,” Tracey adds. “New Jersey’s move is part of a flurry of government action aimed at slowing the alarming rate of vaping by teenagers. Vape shops nationwide are grappling with F.D.A. restrictions on flavored e-cigarette cartridges that took effect this month.” 

— And here are a few more good reads:

TRUMP TEMPERATURE

Senate Democrats are demanding the Trump administration withdraw a proposed rule that would expand religious exemptions for federally funded faith-based social service providers.
The Hill

AGENCY ALERT

Chair Jerome H. Powell and his colleagues discussed the potential economic effects of the virus and lower bank capital at their last meeting, a recap released Wednesday showed.
New York Times

MEDICAL MISSIVES

As China doubles down on its efforts to control the coronavirus epidemic, patients with other conditions that require urgent medical attention have emerged as particularly vulnerable, facing difficulties in receiving treatment and securing drugs.
Wall Street Journal
In the wake of the coronavirus outbreak, school districts, especially those with large Chinese student populations, are in uncharted territory as they apply new federal travel rules to their studen…
Kaiser Health News

INDUSTRY RX

Lobster Unlimited of Orono is investigating whether lobster blood can be used as a potential weapon against viruses and cancer.
Stat
Health
The patient was anxious about losing the motor skills key to her music, so she stayed awake and played for part of her procedure.
Hannah Knowles

OPIOID OPTICS

Two hedge funds are reducing their ties to the embattled family that owns OxyContin maker Purdue Pharma.
Wall Street Journal

REPRODUCTIVE WARS

The burden of many of the most common contraceptive methods falls on women. Some heterosexual couples try to fix that imbalance by splitting the cost.
The Atlantic
Welcome to the Louisiana clinic at the center of the court case that could gut Roe v. Wade.
Vox

DAYBOOK

Coming Up

  • The Washington Post will host a live talk on Feb. 26 on the plight of working families and low-income workers in the United States. Discussions will include topics such as the rising cost of health care.
  • The House Transportation Subcommittee on Water Resources and Environment will hold a hearing on proposals for a Water Resources Development Act of 2020 on Feb. 27.

SUGAR RUSH