Must-Reads Of The Week From Brianna Labuskes

Newsletter editor Brianna Labuskes wades through hundreds of health care policy stories each week, so you don’t have to.

Happy Friday! Where yours truly has parsed approximately 4,346,276,986 coronavirus stories to bring you the most important ones — such as the fact that 38% of Americans won’t buy Corona beer “under any circumstances” because of the outbreak; that apparently dog masks are now all the rage, despite the fact that health professionals say even healthy humans don’t need them; and that if you need of a cheat sheet on what facial hairstyles are officially called you can head over to the CDC for a nifty graphic. (The “walrus” might be my favorite.)

More seriously, here’s what you need to know about the outbreak dominating global attention, sending stocks plunging and creating a booming demand for hand sanitizer. I can tell you one common thread running through coverage about experts’ advice: Keep calm, carry on and wash your hands.

President Donald Trump cracked jokes about his germophobia and downplayed the severity of the coronavirus outbreak at a press conference this week, in which he put Vice President Mike Pence in charge of the country’s coronavirus response. This raised immediate eyebrows, considering that under Pence’s watch Indiana weathered a major HIV outbreak largely attributed to decisions he made as governor.

By contrast, you have the CDC’s Dr. Nancy Messonnier, who has become a leading player in the crisis, saying it’s not a question of if but when the coronavirus will sweep into the U.S. She also said that she’s been talking with her kids about how to prepare and that “the disruption to everyday life might be severe.”

Not surprisingly, after all that whiplash, the administration decided all information released to the public must first get the OK from Pence.

Politico: Coronavirus Gets a Trumpian Response

The New York Times: Pence Will Control All Coronavirus Messaging From Health Officials

The New York Times: What Has Mike Pence Done in Health?

The New York Times: C.D.C. Officials Warn of Coronavirus Outbreaks in the U.S.

Meanwhile, a new case out of California put a harsh spotlight on the deep flaws of the CDC’s original testing parameters. The patient — who may be the first in the U.S. with no link to traveling abroad — was in the hospital for more than 10 days before the CDC approved a coronavirus test. The delay exposed about 100 health workers to the virus as well as set back any attempts to contain people she’d been in contact with.

Stat: A Single Coronavirus Case Exposes a Bigger Problem: The Scope of Undetected U.S. Spread Is Unknown

ProPublica: Key Missteps at the CDC Have Set Back Its Ability to Detect the Potential Spread of Coronavirus

If a whistleblower is to be believed, those testing missteps weren’t the only ones made by the government in the early days of the response: New allegations have come to light that HHS workers who were sent to help with the U.S. evacuees weren’t given proper medical training or gear before being exposed to the patients.

The Washington Post: U.S. Workers Without Protective Gear Assisted Coronavirus Evacuees, HHS Whistleblower Says

Meanwhile, for a president who has tied his fate to the health of the stock markets, the global financial turmoil is more worrisome than ever.

Politico: Trump Faces ‘Black Swan’ Threat to the Economy and Reelection

One of the few good things about the coronavirus is that the vast majority of cases are mild. However, that’s also one of the things that might tip it into a pandemic. For more extreme illnesses (like Ebola), it’s far easier to isolate patients. But for those with symptoms that are essentially presenting as a mild cold, it’s harder to contain the spread.

On that note, it’s hard to tell just how lethal the disease is (and anyone who tells you otherwise, question their motives). Because so many cases are mild, some experts say we’re seeing only the tip of the iceberg, and the mortality rate would drop if we had a better sense of how many people are actually infected. Others argue that there’s no evidence that officials don’t have an accurate count.

Right now, from what’s available, it seems the death rate outside the epicenter in China was 0.7%. That’s still soberingly high, but also a long way away from SARS’ 10%.

The New York Times: Most Coronavirus Cases Are Mild. That’s Good and Bad News.

Stat: New China Coronavirus Data Buttress Fears About High Fatality Rate

As someone who has little kiddos in their life (and who affectionately calls them Typhoid Marys), I can’t help but include this story. Are kids innocent bystanders in this outbreak, getting infected if someone brings the virus into their households? Or are they, in fact, a population that is stealthily driving this epidemic, as they can do with the flu?

Stat: Key Question for Coronavirus Response: What’s Kids’ Role in Spreading It?

Globally, cases are climbing, with patients showing up in Lithuania, the Netherlands, Iran, Kuwait, the United Kingdom … you get the gist. Although we’re not really seeing it yet in Latin or South American countries beyond a Brazilian patient who had traveled to Italy, where cases skyrocketed 45% in one day.

In China, officials are tapping their tried-and-true propaganda playbook, but the anger that has boiled up over the government’s handling of the outbreak may be cracking the party’s stronghold. Meanwhile, authorities, in an ongoing attempt to contain the spread, are offering people more than $1,400 to self-report if they have coronavirus symptoms.

The New York Times: Coronavirus Weakens China’s Powerful Propaganda Machine

Reuters: China City Offers $1,400 Reward for Virus Patients Who Report to Authorities

And South Korea gets a shoutout for implementing a very cool idea to create “drive-thru” testing for potential patients.

Reuters: South Korea Launches ‘Drive-Thru’ Coronavirus Testing Facilities As Demand Soars

Remember, there are plenty more stories were those came from. If you’re interested in the full scope of coronavirus coverage, check out all our Morning Briefings from the week.


Believe it or not, there was other news this week! Democrats held a rowdy debate in South Carolina ahead of Super Tuesday, where Sen. Bernie Sanders (I-Vt.) fielded the inevitable attacks that come with being a front-runner. He was put on the hot spot about topics ranging from the cost of his “Medicare for All” plan to his past stance on guns.

Reuters: At Rowdy Debate, Democratic Rivals Warn Sanders Nomination Would Be ‘Catastrophe’

The New York Times: Fact-Checking the Democratic Debate in South Carolina

Sanders (after releasing a plan on how he was going to pay for his ambitious agenda) said that “‘Medicare for All’ will lower health care costs in this country by $450 billion a year and save the lives of 68,000 people who would otherwise have died.” But experts are skeptical of the findings.

KHN: Sanders Embraces New Study That Lowers ‘Medicare For All’s’ Cost, But Skepticism Abounds


A federal appeals court upheld a Trump administration ban on federally funded family planning centers referring women for abortions, arguing that the rule is slightly less restrictive than a 1988 version upheld by the Supreme Court. What’s interesting to note is that the court was the California-based U.S. Court of Appeals for the 9th Circuit. Trump has now named 10 judges to the 9th Circuit — more than one-third of its active judges — compared with seven appointed by President Barack Obama over eight years.

The Washington Post: Appeals Court Upholds Trump Ban on Abortion Referrals by Family Planning Clinics

Los Angeles Times: Trump Has Flipped the 9th Circuit — and Some New Judges Are Causing a ‘Shock Wave’

WBUR: Looking at Changes Happening Within the Nation’s Largest Federal Appeals Court

Beyond fighting for survival in the courts, abortion clinics are often faced with so many fees and unexpected costs that they can face closure from their financial burdens alone. Among those are: security to protect staff and patients; airfare to get doctors to areas lacking trained physicians willing to perform abortions; higher rates for contractors concerned about protesters and boycotts; more stringent loan terms; insurance that can be canceled unexpectedly; and, for some clinic owners, legal fees for defending the constitutionality of the procedure.

Bloomberg: Abortion Clinics Are the Most Challenging Small Business in America


Vocal opposition continues to pour in about the arcane Medicaid rule change that could reduce Medicaid spending by 6% to 8%, or $37 billion to $49 billion, a year. The Trump administration says the change would increase transparency and prevent abuses that enable states to draw down more federal money than they’re entitled to. But, so far, more than 4,200 organizations or individuals from both parties are sounding alarm bells about it.

Stateline: Medical Groups Slam Trump Medicaid Rule


In the miscellaneous file for the week:

— The Sacklers, under fire over allegations about their role in the opioid crisis, turned to Mike Bloomberg to help them manage their reputation. Will that haunt him in his presidential bid?

ProPublica: When the Billionaire Family Behind the Opioid Crisis Needed PR Help, They Turned to Mike Bloomberg

— Are some people immune to Alzheimer’s? Scientists studying donated brains have identified patients who have all the markers for the debilitating disease but didn’t seem to have any symptoms when alive. The findings offer hope that the seemingly inherent protection could be replicated by a drug.

Stat: They Have ‘Alzheimer’s Brains’ But No Symptoms. Why?

— America is facing an autopsy crisis: Large swaths of the country don’t have a medical examiner. Bodies are even having to be shipped across state lines if an autopsy is needed. At one point the problem was so bad that Oklahoma’s overloaded medical examiner declined to perform autopsies on people over 40 who died of unexplained causes.

The New York Times: Piled Bodies, Overflowing Morgues: Inside America’s Autopsy Crisis

— Colorado is continuing to move forward with plans for its public option, this week unveiling reimbursement rates that officials say would keep hospitals profitable under the system. Hospitals were … uh … a little skeptical of those claims.

The Denver Post: Colorado Consumers Could Save Up to 20% Under State Health Insurance Option, Polis Says

— In this terrifying story, a student died after calling 911 because the responders couldn’t locate him.

The Washington Post: College Student Yeming Shen Died of Flu in Troy, N.Y., After 911 Couldn’t Track His Location.


That’s it from me! Have a great weekend.

Readers And Tweeters Dive Into Debate Over ‘Medicare For All’

Kaiser Health News gives readers a chance to comment on a recent batch of stories.

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


Savings For All?

Your criticism about former Vice President Joe Biden’s “Medicare for All” cost estimates is spot-on but leaves out important savings (“KHN & PolitiFact HealthCheck: Would ‘Medicare For All’ Cost More Than U.S. Budget? Biden Says So. Math Says No,” Feb. 14). Under Biden’s plan, private insurance stays intact, meaning there are premiums and point-of-service costs that do not appear as taxes but are added to the nation’s health care expense. Medicare for All, on the other hand, is zero at the point of service, meaning Americans would have no financial qualms seeking comprehensive care. Public options add bureaucratic costs, are subject to personal income fluctuations and have deductibles and copays. We depend on organizations like yours to present the full picture. Here’s hoping you will, in the public’s interest.

― Dr. Donald Green, Pennington, New Jersey


— Manuel Freire, Fort Lauderdale, Florida


For Alzheimer’s Patients Like Me, Knowing Is Half The Battle

I want to thank Judith Graham for her piece discussing the uncertainty and fear patients feel when faced with the potential onset of Alzheimer’s disease or dementia (“Stalked By The Fear That Dementia Is Stalking You,” Feb. 21).

As an Alzheimer’s patient with a confirmed diagnosis, I know all too well how unsettling it can be to suffer from cognitive decline without knowing the nature of your condition. For me, it started with little things like forgetting a name or misplacing a set of house keys. Still, it wasn’t until I applied to participate in an Alzheimer’s clinical trial and received a PET scan identifying amyloid protein buildup in my brain did I definitively know I had the disease.

Like many of the patients discussed in the article, dealing with these early warning signs can be an enormous source of anxiety — especially when it’s unclear whether or not the cause is Alzheimer’s or another cognitive issue. That’s why getting a precise diagnosis was such a critical step for myself and my husband, Jim.

As mentioned in the article, amyloid PET scans are not fully covered by Medicare, a critically important detail, which I believe must be remedied. As the prevalence of Alzheimer’s continues to grow as our population ages, expanding access to diagnostic tools that can identify this disease will become ever more critical. I remain optimistic that our representatives in Washington can come together and address this issue ― so more patients like me don’t have to live under a cloud of uncertainty.

— Geri Taylor, New York City


An Infusion Of Debt

Glad you are pointing this out (“Patients Stuck With Bills After Insurers Don’t Pay As Promised,” Feb. 7). It’s happening again, post-Affordable Care Act. For us, it’s my husband’s battle with multiple sclerosis, but more the battle with his insurer. It approved his treatment cost for a new drug, sent a letter saying everything was covered. Then, lo and behold, we get a bill for $4,000 that it said we had to pay. No reason or rationale given. So now we are on a payment plan with the hospital that gave him his infusion. Not sure why we even bother with paying our premiums in the first place, considering the out-of-pocket expense and worthlessness of preapprovals; it doesn’t really matter. Please keep writing these articles ― it helps.

― Margaret Paez, Los Angeles


When Choice Of Hospitals Is A Life-Or-Death Choice

Thanks so much for your coverage of death-with-dignity situations (“Terminally Ill, He Wanted Aid-In-Dying. His Catholic Hospital Said No,” Jan. 29). We all need to know as much as possible about the institutions and structures that may prevent patients from choosing a dignified death. Please consider linking to the Catholic ethics rules so readers can read them for themselves. Please make us a map of Colorado showing the hospitals that are abiding by these rules. Please explain that emergency services in rural areas may have no choice but to take patients to the nearest (possibly non-law-abiding) hospital. Rewired has written about Eastern hospitals where serious pregnancy issues were poorly treated by Catholic hospitals.

Many of us do not understand that hospital choice may become a life choice and doctor choice may also become a life choice. And, please, also feature regularly and loudly all the practitioners and organizations being formed to protect patients’ legal right to die. Thanks so much for the good work that you do.

― Diane Curlette, Boulder, Colorado


Taking Pains Over Statistics

In stories about the opioid crisis (“No Quick Fix: Missouri Finds Managing Pain Without Opioids Isn’t Fast Or Easy,” Feb. 13), I always see total death statistics but never a breakdown of how many of the fatalities represent responsible legal users vs. illegal users.

A lot of us elderly folks have a very hard time getting our pain meds nowadays. Thirty used to last me five to seven months, and I took them only when I couldn’t get to sleep due to pain throughout my body. We have discussed it on our seniors’ webpage in our rural area and many of us used to get them. Overdoses and addiction aren’t the norm and aren’t even in the realm of our experiences. Why do we have to pay for others’ mistakes? They don’t outlaw cars even though many people die from wrecks caused by bad drivers!

― William Scriven, Valley Springs, California


— Nicolas Terry, Indianapolis


Collateral Damage From Insurers’ Dispute

When I read Brian Krans’ article about the Dignity-Cigna dispute (“Patients Caught In Crossfire Between Giant Hospital Chain, Large Insurer,” Feb. 6), I was reminded of my own situation: In California, Oscar dropped coverage for all UCLA care facilities in its Covered California (Affordable Care Act) plans, as of this year. I don’t know how many people use Oscar, but the UCLA system is a major health care provider here in West L.A. There’s no indication that there’s a dispute — this is represented as a final decision. UCLA is gone!

I figured I could get similar care from the Providence network, but my first choice for a primary care physician proved a bit odd: On our first visit, he presented at least four ideas that seem outside the medical mainstream. With some embarrassment, I asked for a different PCP. That physician ordered lab work but said no one in the building was authorized by Oscar to do blood draws, so I was sent to a facility in another city … which turned out to be out of business. I was finally referred to a third facility, which turned out to be more convenient than the last ― but the inconvenient run-around for something as simple as a blood draw and the penny-pinching by my insurance company do not bode well for the future of American medicine.

This is the second disruption I’ve had in insurance providers since the ACA began, and another indication that our current health care system is still very broken.

— Gary Davis, Los Angeles


— Scott Gordon, Fennimore, Wisconsin


Raising A Red Flag On Animal Rights Group

As a registered dietitian, I do not promote the keto diet. Mentioned in the article “As VA Tests Keto Diet To Help Diabetic Patients, Skeptics Raise Red Flags” (Feb. 3) is the group Physicians for Responsible Medicine, which is an extreme animal rights group with ties to PETA. About 3% of its members are physicians. Attending a seminar on nutrition for cardiovascular disease, I was dismayed to see the speaker had ties to Physicians for Responsible Medicine. After hearing about all the terrible effects of eating animal products, when the speaker could no longer contain himself and shouted out, “You don’t eat dead animals, do you?” I walked out and called my professional association to complain. Please do not give credibility to this organization.

― Mary Lucius, Beavercreek, Ohio


— Nancy Coney, South Bend, Indiana


Price-Gouging At Its Core

I read your most recent story on surprise medical billing (“When Your Doctor Is Also A Lobbyist: Inside The War Over Surprise Medical Bills,” Feb. 12) and found it to be largely one-sided against physicians and, somewhat, hospitals. Although private equity certainly is an influence in the conversation, very little to any time was spent discussing the efforts of insurance companies to continually drive down reimbursements. Furthermore, when we look at Medicare rates, which insurance companies rates are based on, the actual reimbursement has not significantly increased over the past few decades when you account for inflation or the consumer price index. So to paint the picture that physicians are trying to gouge patients does not seem very fair. While there are always a few bad apples and opportunists, the majority of physicians simply want to be paid fairly. Remember: Over the past few years, insurance companies have reported record profits — billions per fiscal quarter. Why are we not talking about why more of our premiums are not going to the provision of health care and instead to shareholders? I think the article fails to paint the entire picture for a lay audience. Nowhere does it report the amount of money spent on lobbying by the insurance industry.

― Dr. Shamie Das, Atlanta


— Gene Christian, Memphis, Tennessee


Health Care’s High-Cost Formula Goes Beyond Drug Prices

What patients care about more than drug prices is how much they have to pay out-of-pocket for their critical medications (“Watch: Let’s Talk About Trump’s Health Care Policies,” Feb. 4). Because of high-deductible health plans and tiered formularies, what patients pay at the pharmacy counter often has less to do with the list price of the drugs they need and more to do with the design of their health benefits. It is especially troubling that high-value drugs for chronic conditions like diabetes are often subject to unaffordable cost sharing that hits disproportionately at the beginning of the benefit year. Employers and health plans need to exempt these drugs from high deductibles as now permitted by the IRS. The same goes for Medicare Part D, which hugely penalizes seriously ill patients at the start of each year when they have yet to reach the catastrophic threshold.

Clearly, the problem of high drug prices needs to be addressed, but this will require a systematic and comprehensive approach that is certain to be resisted by one vested interest or another. In the meantime, patients need immediate relief from unaffordable out-of-pocket costs. Some steps that should be taken immediately include exempting high-value care from plan deductibles and capping and smoothing out-of-pocket costs in Medicare Part D. Much, if not all, of the cost associated with these measures can be offset by not paying for low- and no-value care that costs billions per year.

― Daniel Klein, president & CEO of the Patient Access Network (PAN) Foundation, Washington, D.C.


Cause For Investigation

The example you give presents an illegal activity by the home health agency (“Why Home Health Care Is Suddenly Harder To Come By For Medicare Patients,” Feb. 3). At a minimum, that agency should have a complaint registered against them, if not investigated by the Office of the Inspector General. The agency lied about Medicare not covering the patient’s needs. And they should have had the patient sign an ABN/NOMNC (Advance Beneficiary Notice/Notice of Medicare Non-Coverage) and explained it to the patient as required, so he could choose to appeal with the Quality Improvement Organization (QIO) for coverage of medically necessary care.

Kaiser Health News needs to provide education for the elderly and families to make sure they don’t fall prey to this type of behavior. If the agency simply says “I don’t have the staff to cover you,” they are responsible to assist the patient in finding another agency. But they cannot elect to just stop providing a medically necessary service, just as they cannot keep seeing someone when it is not medically necessary. Key here is to get people to know their rights as a Medicare beneficiary.

― Edward Dieringer, Salt Lake City


— Tom Cassels, Arlington, Virginia


— Peg Graham, Washington, D.C.


Privacy Concern: I Lack Seamless Access To My Own Records

I work in a medical center and have taken HIPAA training repeatedly over the years. I have also noted the staggering amount of money spent on medical electronic records. Yet in four attempts over a 20-year period, I have yet to get my medical records sent from one doctor or practice to another. I could not get records of my husband’s hospital stay sent to his primary physician, dental records sent from one dentist to another and, this fall, the pertinent records when my rheumatologist changed practices. My insurance paid for blood tests four times a year and X-rays over a five-year period. I have contacted the facilities and submitted a complaint to HHS Office for Civil Rights, which appears to be the correct office.

I find it unacceptable that, with all the talk about how expensive medical care is, tests over time are not easily available to patients when requested. I read Kaiser Health News regularly and at least I feel informed about what can go wrong. Thank you.

— Susan Klimley, New York City


— Dr. Sarah Nguyen, Los Angeles