Nearly 167,000 Colorado residents signed up for 2020 health insurance through the state's official marketplace. That represents a slight decline from last year, although on average rates of enrollment have remained steady for the past couple years.

Connect for Health Colorado, the state insurance exchange set up through Obamacare, announced the final numbers of enrollees after open enrollment closed Wednesday.

Last year, the exchange reported nearly 171,000 Coloradans signed up for health coverage for 2019 by the close of open enrollment in mid-January. The year before, it saw almost 166,000 medical enrollments over the same span of time.

This has been another successful open enrollment period, said Connect for Health Colorado CEO Kevin Patterson in a statement. He said the exchange will keep working to increase access, affordability and choice for residents.

About 20 percent of the customers are new and the rest returned to buy individual plans on the exchange.

Outside the open enrollment period, Coloradans can only sign up for a health plan on the exchange if they have a significant life event like losing job-based insurance, losing Medicaid or some family changes.According to the Wall Street Journal, the administration has taken a number of steps to limit the reach of the Affordable Care Act since Congress failed to repeal it. That includes cuts to funding for outreach and publicity about ACA enrollment by 90 percent. The administration also reduced funding for groups that help consumers sign up for coverage by 40 percent.

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Fewer People Signed Up For Health Insurance Through The State Exchange This Year - Colorado Public Radio

Lawmakers on Thursday introduced bipartisan legislation to boost the role of peer support professionals in Colorado, potentially easing a shortage of specialists who can help treat patients with mental health and addiction issues.

House Bill 20-1139, sponsored by state Reps. Yadira Caraveo, D-Thornton, and Rod Pelton, R-Cheyenne Wells, would authorize Medicaid to pay for additional services provided by peers caregivers who have experienced various mental health and substance-use situations and establish a tax credit to help them pay for continuing education.

Their lived experience and training enable them to relate to and connect with people in powerful ways, said Vincent Atchity, president and CEO of nonprofit advocacy organization Mental Health Colorado, in a release cheering the legislation's introduction.

Added Atchity: Without continuing education, peers may reach a professional ceiling. The tax credit gives these individuals a pathway to continued professional development and incentivizes them to pursue long-term careers in health care, thereby creating better outcomes for the mental health of our state.

The bill, which was assigned to the HousePublic Health Care & Human Services Committee, creates a refundable income tax credit available to peers who go back to school or who graduate and return to work in the health care field. It would be authorized for 10 years and capped at a total of $100,000 annually.

Caraveo and Pelton sit on the Public Health Care committee.

Moe Keller, a former state lawmaker and Mental Health Colorado's director of advocacy, told Colorado Politics before the legislative session opened that peers are considered a vital component in the behavioral health and recovery systems, but their services can only be provided in limited settings.

Some peers work in mental health centers and detox centers, but they cannot work in jails, they cannot work in emergency rooms, Keller said. Were trying to work this up so peers can run clubhouses, do mentoring, provide help with writing psychiatric advance directives.

Atchity said that encouraging peers to fill more roles and helping pay for their continuing education could increase the number of professionalsavailableto treat Coloradans. Currently, he added, only 30% of the documented need for those services is being met.

Other states that have taken similar steps foundthatrobust peer servicesdrasticallyreduced hospitalizations and helped cut psychotic symptoms among patients, Atchity said. In Georgia, reliance on peers helped save the state more than $5,000 per patient.

See the original post:

Bipartisan bill introduced to support Colorado's mental health care, recovery providers - coloradopolitics.com

When it comes to government budget cuts here in Alberta and the inevitable protests that follow weve only sampled the appetizer. But rest assured the main course being cooked-up in the various ministerial back rooms of the current Kenney government promises to be a hearty humdinger of a dish.

Because the main ingredient, heck perhaps the only ingredient given the size of the resulting entree is none other than the behemoth that goes under the title of Alberta Health. This is where the provincial government hopes the future balanced budgetary goose will be cooked and that any lingering bad taste will be long forgotten when the next election rolls around.

You see, theres really not much of a choice than to attempt getting to grips with spending on health, thats if pledges of balancing the books by the end of this governments mandate are to be realized. After all, the dollars doled out are astronomical when you consider theres fewer than 4.5 million of us generally hearty souls actually living in this province.

As a mind-boggling example, this budgetary year were expecting to spend $20.6 billion on health alone. Thats a whopping 43 per cent of the entire provincial budget. So, now Albertas entire medical system is facing yet another major shake-up, according to Health Minister Tyler Shandro, whos expected to release a draft report later this month on whats going to change.

Of course, the basis for this latest kick at the can of re-inventing health care in our province will be based upon a report by Ernst & Young, which has been reviewing the operations of Alberta Health Services. Youd think nobody employed in governmental departments has any clue whatsoever whats actually going on, given politicians love of inviting all sorts of outsiders to take a look-see under the hood.

Last fall another government-appointed panel, led by former Saskatchewan health minister Janice MacKinnon, had its own take on rising health care costs announcing were often getting substandard service despite paying more per head than other similar jurisdictions in Canada.

Well best of luck to Shandro. Because hell need it if he hopes to turn back the tide of relentlessly increasing costs for taxpayers in paying for our health care system. The fights been going on for decades with the outcome rarely in doubt the bill will just keep on rising.

Heck you can go back as far as 1983 when the Lougheed government tried the tide-turning business. Then health minister Dave Russell famously suggested introducing user fees on some hospital stays $20-a-day if my memory serves me correctly. That went down like a lead balloon in Ottawa, which threatened withholding transfer payments because such levies were an assault on the Canada Health Act. The plan was shelved.

Twenty years later it was Ralph Kleins turn, coming up with some confusing bafflegab about a third way of funding health care, one involving public and private partnerships. That too ended in failure.

Back then of course the province was on a roll, thanks mainly to the revenues from spiking natural gas prices across the land. Thats certainly not the backdrop Shandro enjoys. Were more than eight-billion bucks a year in the hole and hopes that rising provincial GDP will eventually close that gap appear less and less likely with the economy stuck in neutral.

So get ready for the health-care battle. Doctors, nurses, unions and a bevy of protest groups covering the gamut of the hard done by is already preparing to march.

Pass the popcorn: this is going to be a doozy.

Continued here:

Get ready for the health-care battle - Airdrie Today

Whats the news: Lawmakers in New Jersey this week opted against moving forward with legislation that would have allowed advanced practice registered nurses (APRNS) to prescribe without any physician oversight. The legislation (Senate bill 1961 and the identical Assembly bill 854) would have also given APRNs full signatory authority, meaning they could have signed off on any document requiring a physician signature by law.

The New Jersey Senates health committee moved the bill to the floor in June 2019, but the states physicians were able to persuade lawmakers against taking up the bill to weaken the physician-led health care team during the 20182019 legislative session that closed Monday. Most states do not allow APRNs to prescribe independently.

The AMA Scope of Practice Partnership gave the Medical Society of New Jersey a grant to support its efforts to defeat the legislation. In 2019 alone, the AMA State Advocacy Resource Center worked with 35 states and secured more than 50 victories on scope-of-practice issues. That includes Mississippi Gov. Phil Bryants decision to maintain Medicares physician-supervision requirements for certified registered nurse anesthetists.

Learn more about AMA efforts on scope of practice.

Why it matters for patients and physicians: The difference in the education and training of physicians and other health professionals is vast. Physicians complete between 10,000 and 16,000 hours of clinical education and trainingthats four years in medical school and another three to seven years of residency training. By comparison, APRNs complete between 500720 hours of clinical training after two or three years of graduate-level education.

Thirty-five states representing more than 85% of the U.S. population require some physician supervision or collaboration of nurse practitioners, one type of APRN.

The issue of doctors leadership role within the health care team also is surfacing at the federal level, where the Centers for Medicare & Medicaid Services (CMS) has requested information pursuant to a presidential executive order that aims, in part, to weaken physician supervision requirements.

Patients deserve care led by physiciansthe most highly educated, trained and skilled health care professionals, says a letter to CMS Administrator Seema Verma from the AMA and nearly 100 other organizations representing hundreds of thousands of doctors nationwide. A physician-led care team is especially needed in the management of medically vulnerable Medicare patients.

We cannot and should not allow anything less, says the letter, which notes that four out of five patients prefer that doctors lead their health care team. That preference for the physician-led care team rises to 86% among patients with one or more chronic conditions.

Whats next: Implementing President Trumps executive order policies would require a combination of congressional and regulatory actions. The administration is at the beginning of the regulatory process. The AMA will actively engage the administration on these and other issues outlined in the executive order.

Meanwhile, the 20202021 New Jersey legislative session opened Jan. 16.

Each year, in nearly every state, nonphysician health professionals lobby state legislatures and regulatory boards to expand their scope of practice. While some scope expansions may be appropriate, others definitely are not.

Through resources, research and the Scope of Practice Partnership, the AMA has what you need to advance your scope of practice advocacy agenda.

Read the original:

New Jersey rejects bill to weaken doctors' role as care team leaders - American Medical Association

As technology gets more sophisticated and stressed-out consumers find it harder to get some shut-eye Sleep Number (SNBR) thinks the day could arrive when a mattress can be covered by health insurance.

Sleep disorders which the Centers for Disease Control (CDC) has deemed a public health crisis have been linked to health conditions like heart disease.

Meanwhile, institutions like the Mayo Clinic are shelling out millions to fund studies on why people find it harder to rest. And just Friday, Sleep Number competitor Casper Sleep filed paperwork to go public, citing the opportunities presented by what it estimated is a $432 billion sleep economy.

Its also a hot button issue for technology companies looking to get a slice of health care spending thats set to get even larger. Apple (AAPL), Samsung (SSNLF) and Google (GOOG) which recently acquired Fitbit are all analyzing sleep patterns through wearables.

Those efforts laying the groundwork for Sleep Number, which is pivoting toward health and wellness. Already, the 32-year old company is working with Mayo to analyze Sleep Numbers anonymous data from its SleepIQ technology.

In 2012...I could see the value of having that technology in our beds, Shelly Ibach, president and CEO of Sleep Number, told Yahoo Finance on the sidelines of last weeks CES technology confab in Las Vegas.

Photo courtesy: Sleep Number

Ibach said the use of wearables helps the company take sleep analysis a step further, since a mattress functions as a whole-body monitoring system.

Still, not everyone can afford one of Sleep Numbers $1,000 mattress. To that end, the CEO said the idea of beds becoming part of the health reimbursement system wasnt far off the mark.

If we see sleep deprivation certified as a disease to the degree that it would be funded by a health care organization, then Sleep Number could become a covered medical device, Ibach told Yahoo Finance.

The Mayo Clinic is collecting data through its Sleep Numbers SleepIQ technology, and studying how sleep (or lack thereof) affects a persons health.

The $1 million endowment for sleep science and $9 million research fund will analyze SleepIQs sleep science information. SleepIQ collects more than 10 billion biometric data points each night and has analyzed 25 million sleep sessions.

To-date, the technology has helped individuals increase sleep time by at least 15 minutes per night, according to Sleep Number.

Prevention is a way to control health care costs. We expect to be able to work together and deliver evidenced-based solutions, she said.

Anjalee Khemlani is a reporter at Yahoo Finance. Follow her on Twitter:@AnjKhem

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Read more:

Cigna-Express Scripts bets on digital care as the future of health

Study: The health sector is splurging on digital, but not reaping the rewards just yet

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Your mattress covered by health care? Why Sleep Number thinks it could happen - Yahoo Finance

The top story out of this week's Democratic presidential debate was Sen. Elizabeth Warren's accusation that Sen. Bernie Sanders called her "a liar on national TV." Both progressive firebrands have a casual relationship with the truth, especially when it comes to their plans for healthcare. But Warren's pitch has grown ever more misleading.

For months, she adamantly defended "Medicare for all," a full-blown government takeover of the U.S. health insurance system. Private insurance would be outlawed, and the federal government would be granted a monopoly over payment for health services.

Many of the 180 million people with private insurance greeted Warren's plan coldly. So she began to frame her plan as a public option first, with a three-year transition to "Medicare for all." At this week's debate, she said she'd "build on the Affordable Care Act, but where we end up is we offer healthcare to all of our people. And we can offer it at no cost or low cost to all of them."

A public option would quickly become the only option for consumers. Private insurers can't match the low prices of a government-run insurer that doesn't have to cover its costs. The public option would also be able to dictate providers' reimbursement rates. Private insurers don't have that kind of negotiating power.

As a result, private insurers would exit the market, unable to compete. One analysis projects that more than 130,000 people with private exchange coverage would be jettisoned from their plans in a public option's first year. Millions more with employer-sponsored coverage could meet a similar fate.

Of course, that's the point. It's easier to nationalize the health insurance system if a government-run public option has already swallowed a few million people who previously had private coverage.

Then there's Warren's "no cost or low cost" claim. She says her plan would require a $20.5 trillion increase in federal spending over a decade more than we currently spend on Social Security, the largest line item in the federal budget. Virtually everyone else who's analyzed "Medicare for all" thinks $30 trillion-plus is more realistic.

That's some definition of "low cost." If this is the best "offer" Warren can make, no thanks.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All, (Encounter 2020). Follow her on Twitter @sallypipes.

More here:

Under Elizabeth Warren, there's no choice but government-run healthcare - Washington Examiner

The healthcare industry is set to see a dynamic 2020 as the presidential election approaches, with questions about who will challenge President Donald Trump and whether the call for "Medicare for All" feared by many in the industry survives the Democratic primaries.

No matter who wins the White House come November, healthcare experts say the push to reimburse providers for value and the aim for greater transparency surrounding prices will keep moving ahead. But uncertainty around the fate of the Affordable Care Act and key legal decisions will linger, including whether HHS can require hospitals to reveal negotiated rates and whether insurers are owed billions in the risk corridor case before the U.S. Supreme Court.

Consolidation is set to continue with deals already underway, though some expect fewer mega deals and more bolt-on acquisitions and regional tie-ups.

Here's a guide to big themes for the year ahead.

The legal threat to overturn the ACA, a law deeply intertwined in the U.S. healthcare system, has racked up two wins in the lower courts and now awaits a decision from the nation's highest court on whether its justices will take on the case. If the Supreme Court decides to take it on an expedited timeline, a decision could be rendered before the presidential election, which would ensure the ACA will once again be center stage throughout another campaign season.

It's unclear how the court will rule, "but there is certainly a significant risk" to the law,Dean Ungar, an analyst for Moody's, told Healthcare Dive.

It would disrupt the insurance market and pose a significant problem for insurers with a large presence on the exchanges and in Medicaid expansion states, including Centene and Molina, Moody's analysts said in a recent note.

Alternatively, the high court could wait to hear the case until the next term, which would push the issue past the election and into next year.

At the same time, Democratic challengers who hope to unseat Trump in November pose their own risk to the industry as they tout ideas for reform, though of varying degrees. The most extreme idea is the call to move to a single-payer system, boxing out traditional insurers.

"Any of it would not be good for the insurers," Ungar said of Medicare for All. "The likelihood of that happening is low, very low, but nevertheless it's there."

Other legal question marks include pending cases over whether HHS can force hospitals to reveal the secret, negotiated rates they reach with insurers for services. The legal clash is set to heat up quickly. The judge has the case on an accelerated timeline as the American Hospital Association wants a swift ruling and summary judgment.

The hospitals argue HHS has exceeded its government authority in crafting the rule, which they say violates their First Amendment rights as it would force them to disclose confidential and proprietary information.

Also before the Supreme Court is the question of whether insurers are owed billions in risk corridor payments, a program that was supposed to financially protect insurers who attracted a disproportionate share of sicker patients through the ACA exchanges. A few nonprofit co-ops were driven to close when CMS declared the program had to be budget neutral and therefore only paid out about one-eighth of the expected payments.

Payers and providers are under increasing pressure to provide heightened transparency into prices as more costs have been shifted to patients through high-deductible plans and as health spending consumes a greater portion of the nation's GDP.

The Trump administration wants providers and payers to publicly reveal the negotiated rates for services, expanding a previous push that required providers to release their chargemaster list, which shows prices for certain services but not necessarily what insurers agree to pay.

The hospital lobby is fiercely opposed to such regulation and filed suit against the final rule.

Regardless, experts say don't expect the push on prices to slow down as regulators and consumers seek to rein in healthcare spending.

"Definitely more [to come] on greater transparency, more requirements and focus on that both in terms of the proposals from CMS and the Trump administration," Rick Gundling, senior VP of the Healthcare Financial Management Association, told Healthcare Dive.

Adding fuel to the transparency push is continued frustration over sky-high surprise bills. Congress zeroed in on the practice last year but never reached a deal for legislation banning it. The issue will no doubt continue into 2020 as it has garnered bipartisan support. The only thing standing in the way is debate over how to craft a legislative solution that will effectively box out surprise bills.

"I will continue to do everything I can to keep surprise medical bills at the top of the congressional priority list until its done," Republican Sen. Lamar Alexander of Tennessee said in December. Alexander is also the chairman of the Senate health committee, which has focused on surprise billing.

Still, lawmakers (and payers and providers) have competing ideas on how to fix the problem.

Payers favor rate-setting when out-of-network issues arise and providers support arbitration, a means to dispute the issue with payers with a third-party.

Hearings on surprise billing this year have yet to be scheduled.

The industry is coming off a wave of significant deals, including CVS' buy of Aetna and Cigna's acquisition of Express Scripts as well as provider unions like Advocate-Aurora and Bon Secours Mercy Health.

Mergers and acquisitions will continue as hospitals struggle to overcome a number of headwinds and as both payers and providers seek greater scale for additional leverage. But the pace and size may slow a bit, experts say.

There are few opportunities left for mega deals, Ungar said. "And we know the Justice Department has stepped in in the past when they're too big," he said, referencing the failed deals of Aetna-Humana and Anthem-Cigna.

A recent report from KPMG also predicted a slowdown. Industry experts told Healthcare Dive they expect to see consolidation bring together more regional players.

"Although size and scale alone do not necessarily result in success, further consolidation is a logical outcome given current industry pressures," Fitch Ratings said in a recent research note finding the outlook is stable for nonprofit providers in 2020.

Still, just days into the new year, Molina said it entered into a deal to buy an Illinois Medicaid managed care provider to expand its footprint.

On the provider side, Michigan-based Beaumont Health and Ohio-based Summa Health announced merger plans.

Gundling expects continued consolidation and the rise of major regional players akin to Advocate-Aurora. Healthcare is not as consolidated as other sectors. "We don't really have a national provider across the country," he said.

Traditional health systems are under intense pressure as their operating model is under threat from the rise in consumerism and the shift in reimbursement.

This rise in the retailization of healthcare is a massive driver of change. "You can't underestimate it,"Patrick Pilch, who leads BDO's healthcare advisory practice, told Healthcare Dive.

Health systems operate in an environment now where consumers are accustomed to seamless customer experiences in other sectors. From an app on their phones, consumers can order groceries or a ride to a particular destination, and they have come to expect that packages containing their orders for just about anything will arrive on their doorstep in just two days or sooner thanks to Amazon.

Meanwhile, more healthcare consumers are saddled with high-deductible health plans and are on the hook for more of their care financially, causing them to look for inexpensive modes of care or put off care altogether.

At the same time, providers are being asked to shoulder more risk through value-based arrangement by caring for a certain set of patients and are expected to reach certain targets or risk a financial penalty (or fail to earn a bonus). Though the change has been slow, more value-based arrangements are expected to continue in 2020, experts said.

Payers and providers "that fail to respond to the imperatives of consumerism will risk losing relevance as the move to value-based payment gains traction, while consumer-savvy organizations will be positioned to thrive," HFMA CEO Joseph Fifer said in a recent report.

Nontraditional players have posed the biggest threat to hospitals in the realization of healthcare.

For its part, CVS made a bet on Aetna. Together, CVS believes it can use its pharmacists and retail clinic model to better coordinate and ultimately reduce the cost of care.

Though it's not just CVS and Aetna making bigger strides into the industry. Walmart is also attempting to make access to care quicker and more convenient for consumers who are demanding such changes by opening its own healthcare stores.

For traditional systems, it means patients are being siphoned away from their outpatient facilities.

In an ominous sign for traditional providers, outpatient visits declined for the first time in recent history for many hospitals, according to data with the American Hospital Association.

Ken Kaufman, managing director of Kaufman Hall, told Healthcare Dive hospital CEOs will need to adapt to that change by offering competitive pricing, exploring more virtual care and listening to what patients want.

"What it means is the introduction of a new business model in healthcare, where that new business model is splitting off inpatient from outpatient so you have numerous competitors who are coming in who are not interested in the inpatient sector at all," he said.

Read this article:

Key 2020 trends for payers and providers - Healthcare Dive

For proponents of the Affordable Care Act, the last couple of months have been quite encouraging, at least as far as the substance of health care is concerned. Totals from the recent open-enrollment period, for example, were solid and in line with expectations, while the latest industry data pointed to stable health care markets, Republican sabotage efforts notwithstanding.

It was against this backdrop that Utah's Medicaid expansion program got underway on Jan. 1, while policymakers in Kansas reached a bipartisan compromise to bring Medicaid expansion to the Sunflower State. Others may soon follow: Phil Cox, a former head of the Republican Governors Association and a well-known figure in D.C. circles, was quoted saying two weeks ago, "The battle has been fought and lost on Medicaid expansion."

There is, however, just one dark cloud hanging over the ACA's head. A Republican lawsuit, backed by the Trump administration, is trying to destroy "Obamacare" in its entirety, and a Texas judge has already ruled in the GOP's favor. The 5th Circuit, in a move that appeared awfully political, recently left the future of the nation's health care system in limbo, almost certainly until after the election.

The legal process may, however, move more quickly. The ACA's proponents asked the U.S. Supreme Court to take up the case, and a week ago today, the justices directed the Trump administration and Republican state officials behind the lawsuit to respond. As NBC News' Pete Williams explained, "Such a highly abbreviated timeline the rules normally allow a month for filing a response gives the court the option to take up the case during its current term, which would mean a ruling on a contentious issue this spring, just as the presidential campaign heats up."

On Friday, the administration filed a brief, effectively telling the high court to cool its heels. The Washington Post reported:

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The Trump administration and a coalition of conservative states that have been challenging the Affordable Care Act said Friday that there is no reason for the Supreme Court to rush a ruling on the issue this term. [...]

President Trump's solicitor general, Noel Francisco, replied that the [5th Circuit's] decision simply preserved the status quo until a lower court looked more closely at which parts of the law should survive. It would be premature to intervene now, he said.

The full filing is online here (pdf).

To put it mildly, the Trump administration's argument is a tough sell, at least as it relates to the ACA itself. On the one hand, the lawsuit argues that the law's individual mandate, which Republicans gutted in late 2017, was so integral to the ACA that the nation's health care system can't function effectively without it, so "Obamacare" should cease to be. On the other hand, the Trump administration is also arguing that the mandate-less ACA is working fine right now, so there's no reason for the justices to act with any haste.

Both points cannot be true.

In case this isn't obvious, political considerations appear to be at the heart of the developments. It's likely that Trump and his team realize that if the Supreme Court takes up the case in the short term, there's a very real possibility that the White House and Republicans would either (a) lose a humiliating health care case in an election year; or (b) convince five conservative justices to take health care benefits away from tens of millions of Americans in an election year.

Or put another way, this isn't a great issue for the president or his party, which helps explain why they're so eager to convince the Supreme Court to push the whole issue off for a long while.

It also helps explain why Trump is peddling truly outrageous nonsense on the issue, including a tweet this morning in which the president claimed, "I was the person who saved Pre-Existing Conditions in your Healthcare." He added, "I will always protect your Pre-Existing Conditions, the Dems will not!"

It's as brazen a lie as Trump has ever told -- and to know anything about the president is to know the competition in that category is fierce. In reality, Trump didn't "save" protections for Americans with pre-existing conditions; he fought to take those protections away through a series of far-right repeal-and-replace proposals he couldn't get through a Congress led by his own party.

Trump, of course, is also helping champion an ongoing federal lawsuit which would -- you guessed it -- strip protections for Americans with pre-existing conditions.

MORE: Today's Maddowblog

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At the intersection of Trump's health care lie and his ACA case - MSNBC

Gov. Chris Sununu has announced that New Hampshire intends to file a waiver with the federal government that could help stabilize the individual health insurance market and lower premiums by as much as 15 percent next year.

Preserving and stabilizing New Hampshires individual health insurance market has been a key priority for our administration, Gov. Chris Sununu said in a news release. Our previous efforts have kept our states three current insurance companies in the market and have lowered premiums for two consecutive years."

But Sununu said federal policy has impeded state efforts to control costs.

"However, continued dysfunction and lack of reform in Washington is likely to produce increased prices next year that could put healthcare out of reach for too many Granite Staters," he said. "Thanks to good financial management and the reforms my administration made to our states Medicaid Expansion program, this waiver, unlike previous proposals, makes sense and could reduce prices for individuals by 15 percent.

What the Section 1332 State Relief and Empowerment Waiver ultimately could do is help bring thousands more people into the individual market in New Hampshire, which currently has about 44,000 people, Greg Moore, state director, Americans for Prosperity New Hampshire, told The Center Square.

When you have more healthy people joining the pool, they will bring more stability to the marketplace, which should help bring down premiums for everyone, Moore said. "If you could bring in another 10,000 healthy people into the exchange, you would really see an effect on premiums.

The long-term success depends on bringing in uninsured people who because of high prices perhaps found it made more sense to sit it out and simply pay for health care when needed.

New Hampshire currently ranks among the nations highest for insurance costs, but premiums have improved the last two years since people with Medicaid expansion began being served through managed care organizations instead of the individual marketplace. That was a one-time opportunity, Moore noted, and now the waiver decision is a good next step.

The federal government has been encouraging innovations at the state level, Moore said, and the 1332 waiver is representative of that goal.

Its a relatively new landscape," Moore said. "Once [President] Trump was elected, his folks at HHS encouraged new and creative solutions under 1332, and states are trying to understand the landscape of whats doable and what isnt.

In theory, this could benefit everybody if it works well, Moore added.

Read the original here:

New Hampshire seeking federal waiver that could lower health insurance premiums - The Laconia Daily Sun

Hello,

Welcome to our annual post-J.P. Morgan Healthcare Conference edition of Dispensed, which is coming to you from a coffee shop in LA. I can use all the caffeine I can get after this week, and I'm looking forward to spending the weekend exploring the city and soaking up as much sun as I can before getting back to NYC next week.

I'm feeling so grateful for all the folks I got a chance to catch up with, all the new introductions, colleagues willing to get drinks at 4 p.m. so I can do happy hour and catch a flight, and all the story ideas that'll keep me busy for at least part of 2020! Until next year, San Francisco.

Are you new to thenewsletter?You can sign up here.

Last week, I mentioned we'd be spending our week in San Francisco running around the conference. It was my fifth time, and the first time I can remember that came and went without any ground-shaking news. Based on the conversations I had around the conference seems to be connected to the elephant in the room: the upcoming 2020 presidential election.

While the election is still months and months away, the sense I got was it's a good time to be as measured as possible, rather than dream up new acquisitions or business strategies. Curious to hear if you all got the same vibe ping me at lramsey@businessinsider.com with your thoughts.

Which isn't to say there wasn't anything to follow along with coming out of the conference. Here's what you might've missed over the week.

First, Verily made waves in its presentation Monday (and ruffled some partners' feathers). I have the play-by-play.

I mentioned I'd be tuning in to both Verily's presentation and Oscar Health's. During his presentation, CEO Mario Schlosser made an interesting comment about where he sees the employer-funded (aka a prevailing way Americans get their healthcare coverage) market going.

Zach Tracer and I followed up with him about it in an interview Tuesday. Here's what he told us.

To kick off the week, we covered the ambitions of EQRx, a startup founded by former Third Rock Ventures VC Alexis Borisy and Foundation Medicine chief business officer Melanie Nallicheri, raising from investors like Andreessen Horowitz, Arch Venture Partners, and GV.

Please enjoy this view of the city from the hill near my AirBnB! Lydia Ramsey

Stocks predictably soared and dropped based off good and bad news. Notably, Adaptimmune's cancer data sent the stock up 330%, while billionaire doctor Patrick Soon-Shiong'scancer drugmaker NantKwest's stock soared 92% on an interview he gave where he mentioned that exactly one person treated with the company's drug was in remission.

Deals (albeit, smaller in scale) were struck, with telemedicine company Teladoc buying InTouch Health for $600 million, Neon Therapeutics selling to German biotech BioNTech, and Pittsburgh-based health system UPMC raising an $800 million fund to invest in life sciences.

We also got updates on company strategies. That includes the potential for the newest most expensive drug in the world, as BioMarin anticipates pricing its gene therapy for the blood disorder hemophilia between $2 million and $3 million, per the Wall Street Journal. Right now, the most expensive drug in the world carries a price tag of $2.1 million. There was also news of a partnership between digital health company Livongo and Dexcom.

More to come as I sort through my notes from our various encounters around Union Square.

Also - if you're interested in clean energy, my colleague Benji Jones just launched his own weekly newsletter, Power Line! You can subscribe here.

(Finally, please send me your LA weekend eats recommendations!)

- Lydia

Read the rest here:

Dispensed: Business Insider's weekly healthcare newsletter JPM 2020 recap - Business Insider

Imagine a visit to your primary care doctor that did as much to assess and treat your mental health as it did your physical health. How would such an encounter differ from the ones most of us are accustomed to? Your doctor would ask about your mental wellbeing along with questions about your diet, exercise, lifestyle choices and social behaviors such as smoking. He or she would integrate behavioral health counseling into your physical health care, providing guidance so you can self-manage your medication, nutrition and exercise.

Under this scenario, a physicians primary care practice would be fluent in behavioral health clinical guidelines and standards of care, confident in clinical decisions, and deeply familiar with the community social supports available to patients.

Sounds great, doesnt it? A growing body of research gives us good reason to think it would be. Unfortunately, making this scene a reality for primary care patients across the country is much more complicated than adding a few questions to physicians typical script. For example, while patients interact directly with a practices reception staff, physicians and other health care providers during their visit, there is a whole back-end infrastructure that patients may not be aware of that enables the practice to function from billing and coding protocols to electronic medical records systems to care management platforms that often isnt built to support behavioral health care integration.

Still, I know that the integration of mental health care into primary care is possible, in part because were making strides in this direction in New York at both the state and city levels, and in part because its a health industry-wide goal thats too important to give up on.

In my roles as a public health leader, practitioner, professor and researcher, I have focused on reconceptualizing and transforming community-based health care delivery systems. Plenty of primary care physicians are reluctant to change how they operate in order to integrate behavioral health care into their practices. This is understandable; doing so would involve developing a familiarity with new assessments, medications, diagnoses and treatment styles a new way of practicing the craft that they have honed for decades. The overhead for accommodating these changes, in addition to the back-end system changes mentioned above, is significant and often prohibitive. What will catalyze such systems-level seismic shifts in motion?

Policy has a role to play. As our countrys health care system and especially legislation regarding its financing continues to evolve at the federal, state and local levels, incentives to integrate mental health care into primary care must be baked into health care financing structures. New York is demonstrating how this might be done. The states Office of Mental Health is building incentive structures to encourage primary care providers to adopt the Collaborative Care Model, or the integration of behavioral health services into the primary care setting. The Collaborative Care Medicaid Program, launched in the state in 2015, offers primary care providers a method of financial sustainability to integrate behavioral health care into the primary care setting through supplemental monthly payments at a specified case rate.

There are still restrictions on health care practices that qualify for and maintain participation in the program; for example, practices must demonstrate achievement of quality metrics and ongoing use of patient registries to continue receiving the full case rate. Additionally, the upfront start-up costs of establishing the necessary infrastructure can be a heavy lift for many independent primary care practices.

Policy changes are not enough. Beyond changing financial incentive structures at the health care system level, we must empower primary care providers to see for themselves how integrating behavioral health care into their practices truly benefits patients and improves health outcomes. In New York City, this education is a critical part of the Department of Health and Mental Hygienes mandate to provide ongoing technical assistance to primary care providers to help them understand how offering behavioral health services will support their success in a value-based purchasing landscape.

Health departments across the country should make it part of their mission to convey the significance that behavioral health integration may have to the primary care providers they serve. Not only is what were doing in New York City replicable elsewhere, but its also highly adaptable to the unique socioeconomic characteristics and needs of other cities that can tailor the model in a culturally humble and accessible manner.

I hope that we in the health care field wont stop there. Lets continue to expand our goals, think broader, reach wider, and acknowledge that beyond the primary care environment, there are many other settings that would benefit from more focus on behavioral health. Consider hemodialysis centers, where people with chronic kidney failure undertake weekly dialysis. Or bring to mind oncology, hematology, palliative care and other community-based settings and the significant occurrence of anxiety, depression, mood disorders and other mental health conditions in these contexts. These are optimal environments to drive behavioral health integration beyond just the primary care setting.

We also must keep in mind that the integration of mental health care into primary care settings is a journey, with each step a milestone. It is part of a broader strategy towards embracing population health as an ideology, not just a model clinical outcome towards which we strive. Whether it starts with enabling a private practice behavioral health clinician to co-locate within a partnering primary care facility, or with having the primary care facility itself directly offer the full suite of behavioral health services, we need to be comfortable that each milestone itself is a means of integration across a continuum of strategies and options.

Were past the point of wondering whether behavioral health care integration can help save lives we know it does. Lets talk more about how were going to make it happen.

Hewett Chiu is an adjunct assistant professor of health administration at New York Universitys Robert F. Wagner Graduate School of Public Service. He also is executive director, MHSC at the New York City Department of Health & Mental Hygiene and president of the Academy of Medical & Public Health Services.

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Integrating mental health care into primary care will require big changes | TheHill - The Hill

The final film in the epic Star Wars saga, Star Wars: The Rise of Skywalker hit theaters this weekend. It should have had fans around the world buzzing. Instead, many of them are either yawning with disinterest, or speculating on YouTube about just how bad the last installment in the 40-year-old series might be. The critics have panned the film in early reviews, with Rotten Tomatoes pegging the critical score at a meager 58%. What happened to Star Wars?

As a doctor, movie lover, and proud tech geek, I often see parallels between work and my other hobbies.

When I think about Star Wars, especially what has happened to the franchise after the Disney acquisition of Lucasfilm in 2013, some stark comparisons to the U.S. health care system come to mind. Our system is in many ways fragmented, bloated with administrative expense and, if were candid, mismanaged at the macro level. Star Wars has followed a similar path since the new Disney trilogy was launched in 2015 that, in my view, accounts for many of the problems the franchise is currently suffering from.

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Rewind to the first Star Wars movie (now called Episode IV: A New Hope), youll find a far different production than the $200 million extravaganzas produced by Disney. A New Hope debuted in the summer of 1977 and went on to become one of the highest grossing films of all time. It featured a clear plot that pitted good against evil, realistic (for the time) special effects and, most importantly, substantial character development inspired by timeless mythological storytelling. Moviegoers were thrilled, and many of them went back to the theaters to see Star Wars again and again.

A New Hope was followed up by two excellent sequels that continued the saga in 1980 and 1983, both which adhered closely to the formula established in the first film.

Fast forward 42 years, and you have a far different Star Wars. The basic elements of an action-adventure set in space are the same. Unfortunately, the iconic film series is now packed with a multitude of characters (some important, many not) and bloated storylines that ping-pong viewers between concrete plot development and over-the-top action sequences. Some moviegoers are satisfied on the surface with the glitz and fancy CGI, but true fans of the series complain that their underlying expectations werent met by the fragmented stories and lack-luster character development. Moreover, the new films now also incorporate elements of current politics that feel out of place in a story meant to transcend time.

Health care in the 1970s was, in many ways, the starting point for the system that we have today. I believe it has followed a similar course to Star Wars. The bill that laid the groundwork for what we now know as Medicare and Medicaid was being implemented, and President Richard Nixon unveiled his plan to require employers to offer health insurance to employees while providing subsidies to those who had trouble affording medical care.

The U.S. health care system made sense. It was becoming clear, affordable for most people, and was set to provide the best medical care in the world. With these legislative imperatives, it appeared everyones health care needs were now going to be met.

However, like the unravelling of Star Wars, bloat began to seep in to the health care system. A bevy of laws required more governance and more administrative staff to ensure compliance and reimbursement for medical services. One can chart the growth in how expensive U.S. health care has become by simply looking at the growth of the ratio of administrators to doctors since the 1970s.

According to a Harvard business Review blog post by Robert Kocher, there are now 10 administrators for every one doctor in the U.S. today. And 95% of new hires in health care arent doctors or nurses, they are administrative hires that have little to do with caring for patients. This represents a growth rate of over 3,200% from where we were in 1975:

By the late 1990s, national health care spending in the United States had sky rocketed and accounted for 12.1% of total GDP the highest thus far in the history of the country. Fast forward to the 2010 and the introduction of the Patient Protection and Affordable Care Act, commonly known as the ACA, which had the potential to dramatically improve the system. Unfortunately, this potential came along with new ACA requirements for electronic medical records, dramatically increasing workloads on physicians with little discernable benefit for patients. Moreover, expanded regulation and insurance benefits mandated by the ACA resulted in even more administrative expenses.

While the ACA did successfully increase insurance coverage, the additional costs were often borne by patients in the private insurance market in the form of skyrocketing insurance premiums and higher out-of-pocket deductibles. Today, the health care system now consumes an eye-popping 17.8% of GDP.

As was the case with the growth in Star Wars film budgets under Disney, bigger and more expensive didnt necessarily translate into better health care. Bigger in health care has led to a reality in which my fellow doctors have their attention diverted into electronic medical records and away from patients, a situation that has contributed to an epidemic of physician job dissatisfaction and burn out.

The following decade was one in which political divisions and competing reimbursement models created an ever more convoluted and fragmented approach. The system is again poised to be a political football in the 2020 presidential election. Recent polling suggests that health care is the number one concern among U.S. voters.

Yet it is tragic that the U.S. now ranks amongst the lowest among developed nations for health care, despite spending the most. This reality is shocking, given that the U.S. is widely acknowledged as having some of the best doctors in the world, along with the most advanced medical technologies and therapies.

As in the new Star Wars, which due to bad management decisions from the top of Lucasfilm has had a rotating cast of directors and writers, there are too many competing stakeholders in the health care system for the average patient to even keep track. And as major tech companies begin moving deeper into the industry, they have inadvertently ignited controversies over patient privacy. Drug costs that many Americans simply cant afford are another pain point. Against this backdrop, its easy to see why the system leaves so many feeling insecure and vulnerable.

In the movie business, the focus should always be on the audience. Giving the audience thrilling films that transported them to a galaxy far, far away is what made Star Wars successful in the first place. The analog in health care is a laser focus on the patient. Delivering the best care possible is what made the U.S. health care system the envy of the world. With the potential re-thinking of the health care system in 2020, my hope is that we can regain that patient focus by simply letting doctors do the work they love.

And as for Star Wars, The Rise of Skywalker, smaller might be the future. After all, who doesnt love the Internets latest sensation, Baby Yoda?

Amit Phull, M.D., is medical director and vice president of strategy and insights at Doximity.

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Star Wars and the US health care system share this: bloat - STAT - STAT

It was great news, meaning as many as 120,000 low-income Utahns will have access to health insurance with the feds paying 90 cents of every dollar in cost. And they can sign up on Jan. 1.

Bill Tibbitts, an anti-poverty advocate who has fought for the expansion, thanked Herbert for his work to get it done.

If only they had adopted my Healthy Utah plan five years ago, the governor replied.

For more than five years since, these legislators relentlessly fought to block Medicaid expansion and to deny care to those who desperately needed it. They succeeded, until voters revolted.

But even after voters, more than 555,000 of them fed up with the ideologically driven intransigence, took the nearly unprecedented move of backing a ballot initiative, lawmakers immediately dismantled portions of it, and opted for a scaled-back partial expansion.

Ignoring the will of the people has meant that, since April, Utah has been covering tens of thousands fewer people than otherwise would have been eligible and at a substantially higher cost while being gaslighted by legislators who claimed it was in the name of fiscal conservatism.

It was surreal watching legislative leaders patting themselves on the back Monday for a job well done.

The [approval] will provide more Utahns with the coverage they need while saving Utah taxpayers millions of dollars in potential costs, said House Speaker Brad Wilson.

Wilson was among the legislators who voted to kill Herberts Healthy Utah plan back in 2015, which, again, is nearly identical to the proposal Wilson is now championing.

The five-plus years of delay had a significant cost.

Over the past nine months when lawmakers were clinging to their scaled-back partial expansion Utah has foregone more than $530 million in federal Medicaid support, according to calculations by Joe Weissfeld of Families USA. Spread over the course of the past six years, it has cost the state an estimated $5.5 billion money you and I paid into the Medicaid program but which Utah lawmakers refused to accept when it was supposed to come back to help the poor.

Thats the dollars and cents or nonsense side of it. Then there are the lives lost.

Even if you think that estimate is inflated, go ahead and cut it in half and it is still a heartbreaking toll.

Stacy Stanford, an analyst with the Utah Health Policy Project, said she got involved in the fight for expansion because she was one of those who spent five years in the so-called coverage gap. Along the way, she said, she encountered a lot of people in the same circumstance and a lot of them died without ever getting the coverage they needed.

There are just so many stories like that, she said. Now we dont have to tell those stories anymore.

Now the challenge becomes getting people signed up. Since the partial expansion got underway in April, enrollment has fallen well short of the projections about 40,000 now covered, rather than the 70,000 expected.

Now, tens of thousands more will be eligible for coverage and at long last have access to preventative care, and possibly early life-saving diagnoses. Theyll be free from the threat of one health crisis leading to financial ruin. Finally, those people have the prospect for a healthier, happier new year.

To find out if youre eligible for Medicaid and to enroll, visit medicaid.utah.gov.

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Robert Gehrke: Getting health care to low-income Utahns never should have taken so long or cost so much - Salt Lake Tribune

Its perfectly fine for politicians to look at ways to keep prescription drugs affordable. But why does the bigger problem of soaring hospital bills get so little notice?

Centers for Medicare and Medicaid Services data out this month show that retail prescription drug prices declined by 1.0 percent last year, to $335 billion, while spending for hospital-care services rose at about the same rate as in 2017, to $1.2 trillion.

And thats nothing new: The Bureau of Labor Statistics reports that drug prices have gone down for more months this year than theyve gone up, something the White House understandably celebrated.

Hospitals represent a third of total US health-care spending, drugs just a tenth. And a new analysis in the journal Health Affairs shows that over the past four years, hospital spending jumped 15.2 percent while retail prescription-drug spending rose just 5.7 percent, less than the overall Consumer Price Index.

One reason pharmaceutical prices get all the attention is that many more people see them: Insurance typically covers a far bigger part of a hospital bill. (And people just dont use hospitals as often as they buy drugs.)

Another reason: Hospitals and unions for their staff have vast political clout. Here in New York, health-care union 1199 is universally feared, while the Hospital Association of New York spreads campaign cash all over state government.

These angles may be why President Trump is almost alone in pushing on hospital costs. His recent executive order requiring them to publicly post their prices as well as the lower prices they agree to with insurers starting in 2021 is a landmark that has the industry screaming and suing.

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Hospitals, not drugs, are the big driver of health care costs - New York Post

A former health insurance executive criticized South Bend, Ind., Mayor Pete ButtigiegPeter (Pete) Paul ButtigiegBloomberg has already spent 0 million on ads in presidential race Buttigieg surrogate: Impeachment is 'literally a Washington story' Buttigieg campaign introduces contest for lowest donation MORE for his time at consulting firm McKinsey & Co. and his work with a medical care provider, accusing the top-tier presidential candidateof using health insurance industry talking points against more progressive health care policy.

Hes absolutely using the talking points that I used to create in my old job and my former colleagues are still turning out, Wendell Potter, who spent 20 years in the health insurance industry, told Hill.TV during an interview that aired on Tuesday.

Potterpointed to Buttigiegs recent jab at rivals Sens. Bernie SandersBernie SandersButtigieg surrogate: Impeachment is 'literally a Washington story' Michael Moore: Sanders can beat Trump in 2020 Buttigieg campaign introduces contest for lowest donation MORE (I-Vt.) and Elizabeth WarrenElizabeth Ann WarrenWarren in Christmas tweet slams CBP for treatment of detainees Buttigieg surrogate: Impeachment is 'literally a Washington story' Buttigieg campaign introduces contest for lowest donation MORE (D-Mass.) as a prime example. Though he didn't mention them by name,the South Bend, Ind., mayorsuggested in an MSNBC interview earlier this month thatthe twoprogressive candidates were calling for a health care policythat "would eliminate the job of every single American working at every single insurance company in the country.

In my old job in the industry, I used to play the jobs card too and I call it that because every time reform is proposed that insurance companies dont like they say, Oh, theyll have to lay people off, he said, referring to Buttigieg's claim. Its called playing the jobs card and hes doing that.

Buttigieg campaignspokesperson Sean Savettpushed back against Potter's remarks, sayinghis claim that Buttigieg is parrotingindustry talking points "doesn't hold up."

"Petes 'Medicare for All Who Want It' plan would make some of the boldest, most progressive changes to our health care system in decades in order to achieve universal coverage for all Americans," Savett said in a statement. "It has also been attacked by the health insurance industry because it would create competition and force insurers to lower costs and improve care or lose customers."

Sanders and Warren have been advocating for a "Medicare for All" planthat would ultimately do away with private insurance.

Getting rid of private insurance has beena point of contention between these progressive candidates and moderate candidates like Buttigieg and former Vice President Joe BidenJoe BidenLawyer for Giuliani associate to step down, citing client's financial 'hardship' Buttigieg surrogate: Impeachment is 'literally a Washington story' Presidential candidates should talk about animals MORE, who have both advocated for expanding existing health care coverage andadding a public option plan.

Buttigieg, meanwhile, has defended his work at the insurance company where he previously worked as a consultant, Blue Cross Blue Shield of Michigan and maintained that he wasnt involved in the decision-making process at McKinsey.His campaign has also noted that the mayor has been critical of his former employer, calling its work with U.S. Immigration and Customs Enforcement disgusting.

Buttigieg, whohas made itto the top of the polls in Iowa and New Hampshire, has faced increasing scrutiny from critics, who argue that he hasnt been forthcoming about his past work.

A feud has emerged between Buttigieg and Warren after the Massachusetts senator called on him to make his fundraisers public and disclose his past clients at McKinsey. In an effort to address this criticism, the South Bend, Ind. Mayor has since acceded to both demands.

However, Buttigiegs campaign left out more than 20 high-profile fundraisers from a list of bundlers it released earlier this month, potentially opening his campaign for more attacks over the issue of transparency.

Tess Bonn

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Former health insurance executive: Buttigieg uses industry talking points against progressive health care policy | TheHill - The Hill

Three-quarters of all workplace assaults happen to health care workers, according to the Occupational Safety and Health Administration. And right now, unlike other professions, there is no federal law requiring prevention, reporting, or action if a health care worker is assaulted while on the job.

You can get into a cab or an Uber, or onto a train, and it says that assaulting an employee is a felony and you can go to prison, Michigan State University professor Judy Arnetz, an expert in workplace violence in the health care sector, told ABC News. And yet, people walk into hospitals to take care of patients every day and they are getting assaulted every day.

From 2009 to 2013, health care professionals reported more than 730,000 cases of assault, according to the Government Accountability Office. And these numbers are likely low due to an issue of underreporting, Arnetz maintains.

There have been reports of workers being bitten, shoved, kicked, shot, and even killed.

Workplace violence is in every health care institution across the country, Arnetz said. Large and small, urban, rural -- it occurs everywhere.

And the problem is growing, prompting a push for legislation to help stem the tide.

A bill passes the House

In February, Rep. Joe Courtney, D-Conn., introduced a bill that would require OSHA to issue a nationwide standard for establishing and implementing workplace violence prevention plans for health care professionals. The bill, the Workplace Violence Prevention for Health Care and Social Service Workers Act, or H.R. 1309, passed the House on Nov. 21 with bipartisan support.

H.R. 1309 would require risk assessment and identification, as well as action, tailored to each type of health care facility outlined in the bill. Each treatment center would have to establish procedures for communication, train its workers to recognize high-risk situations, record incidents using a violent incident log, and plan for future incidents by recognizing past violent incidents.

Experts like Arnetz acknowledge the bills broadness, but still believe it would be a positive step forward by simply putting prevention, in Arnetz's words, "on the dashboard.

Organizations would be required to do the bare minimum, Arnetz said. Record keeping, collecting data on incidents that occur, making sure that there is a prevention plan in place and that employees are involved in that.

Nurses celebrated the measure.

But the American Hospital Association opposed the bill, which is pending in the Senate Committee on Health, Education, Labor, and Pensions, saying hospitals "already stress workplace violence prevention."

ABC News reached out to the committee, which said it was working on its 2020 agenda.

Healthcare workers experience more workplace violence compared to any other private sector professional. A bill passed in the House that could help protect these workers.

Courtney pointed to the fact that 32 Republican representatives supported the bill, along with the Kentucky Nurses Association.

Were hoping that they are going to prevail on [Senate Majority Leader] Mitch McConnell, Courtney said, referring to the Kentucky nurses. Because, you know, saying no to nurses is not easy.

McConnell declined comment.

The rate of violence has increased

The level of violence against health care workers has increased dramatically -- 63% -- from 2006 to 2016, according to H.R. 1309.

Courtney suggests that this increase is due to the rise of heroin and opioid use, as well as an overall increase in general behavioral health issues. Regardless, he says health care professionals didnt sign up for this.

If the bill becomes law, Courtney says it could help more than just health care professionals. By saving on workers compensation costs, lost time from work, and burnout, companies could end up saving money, despite paying for training and the costs of raising standards.

But for many health care workers who have promised to "do no harm," the bill has come too late. Harm has been done to them.

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'Epidemic': 75% of workplace assaults happen to health care workers - ABC News

Warming up for a giant campaign rally in Venice on Dec. 21, Bernie Sanders, the three-term U.S. senator from Vermont making his second run for the Democratic presidential nomination, sat down for an hour with the Los Angeles Times editorial board to talk about the economy, healthcare, immigration, homelessness and other top issues. The following is a partial transcript, edited for clarity and brevity.

Sanders: So this is a major improvement over the old building. God, the traffic, I dont have to tell you. It wasnt bad today. We went, it must have been a mile, and it took us what, 45 minutes or something.

Nick Goldberg, editor of the editorial pages: You complain about that at the rally later, youll make some

Sanders: Thatll win me some votes. (Laughter)

Goldberg: So lets get started. Welcome. This is the editorial board only. The meeting is for the purpose of helping us make decisions about who were going to endorse in the race. Were on the record. Youre being videoed. Youre welcome, if you want, to make a very short, one minute or so intro.

Sanders: Im used to 60-second remarks.

Goldberg: And we have a couple of our [editorial board] members on the phone.

Sanders: We are at an unprecedented and dangerous moment in American history. We have a president who is a pathological liar, who is running, in my view, one of the most corrupt administrations in American history, who rightfully was impeached, was a racist and a sexist and a homophobe and a xenophobe and a religious bigot. And it gives me no pleasure to say that. But that is who the president of the United States is.

I will do everything in my power to defeat him. And in fact, I believe I am the strongest Democratic candidate to do that. We could discuss that later. But the crisis that were facing as a nation, as a world, is not just Donald Trump. And wed be wrong to think that just defeating Trump will solve all of our issues. Were dealing with massive levels of income and wealth inequality. Im deeply concerned about big money controlling the political process and undermining American democracy, not to mention all the voter suppression thats going on among Republican governors.

The more I study the issue, the more frightened I become about climate change. And the scientists now are telling us that they have underestimated the severity and the degree to which climate change is ravaging this country and the world. And there is no middle ground in terms of dealing with climate change. I wish that it was. But right now well need to throw all of the resources and intelligence that we can in leading the world, because this is not just an American issue, to literally save the planet for our kids and future generations. This is a major, major, major crisis.

So, I mean there are many, many other issues out there, obviously, but I just wanted to lay out some of the concerns that I have.

Goldberg: Let me kick it off then by asking you, do you think that the U.S. can repair the damage that Donald Trump has done? Can it be done quickly and easily? And how would you go about it?

Sanders: The answer is I think it will be difficult. I really do think it will require extraordinary leadership. I think what Trump did in the 2016 campaign is rather intelligently pick up on the fact that there are, what, tens and tens of millions of people in this country who are suffering, who are in pain, who are going nowhere in a hurry, are seeing decline in their standard of living, seeing a decline, literally, in their life expectancy, worried about their kids. And theyre looking around them and theyre saying, Who is concerned about me? Is the Democratic establishment worried about my kids? [Are they] worried that Im working for nine bucks an hour, that I dont have any healthcare? That my kid cant go to college? And he played on that.

Now he turned out to be a fraud and a liar, but he certainly exposed, I think, the weakness of the Democratic and the political establishment in general, including the Republican establishment. So what we are going to need is leadership in this country that brings people together around the issues that are of concern to all of us. So if youre a conservative Republican, you want healthcare, if you are a conservative Republican, you want to be able to send your kid to college.

And I think the issues that we have been talking about in this campaign, that I talked about four years ago when I was here, those issues have resonated with the American people. And in fact, as I think you all know, they have become kind of mainstream now in at least in the Democratic Party, when they were seen as pretty out there four years ago.

So I think when you talk about raising the minimum wage, when I think you talk about making educational opportunity available to all regardless of income, where youre talking about canceling student debt, when you talk about healthcare for all as a human right, Medicare for all, when you talk about climate change, criminal justice reform, immigration reform, sensible gun policy in this country, a womans right to control her own body and many other issues, those issues in fact do resonate with a whole lot of Americans and we bring those people together around those issues.

Goldberg: Before we move around the table, let me exercise my prerogative and ask you one other question. What do you say to voters who worry that in a general election a candidate as far to the left as you are is gonna alienate swing voters and moderates and independents?

Sanders: Excellent question, Ive heard it once or twice. (Laughter) I want you to think about this. In my view, and Ive thought about this a whole lot, anyone who underestimates Donald Trump as a candidate, for a variety of reasons, will be very mistaken.

He is going to be a very, very strong candidate. He certainly has a very strong base. He will have unlimited amounts of money to campaign on. He is a pathological liar. He will merge in an unprecedented way agencies of government with his campaign, because he doesnt particularly believe in the rule of law. So he is going to be a very, very tough opponent.

The only way that you beat Trump is by having an unprecedented campaign, an unprecedentedly large voter turnout. And well have to combat every single day the voter suppression which youve recently seen manifest itself in Wisconsin and Georgia. And we can expect that to take place all over the country. We are living in perilous times, and Republicans understand that if they can keep poor people and people of color and young people from voting, theyve got a better shot to do it. And I have zero doubt that they will do it. Theyve appointed right-wing judges who will sustain their efforts. So we have to combat that in every way we can.

But the reason I believe that I am the strongest candidate, and the reason I believe our approach is right is if you want a large voter turnout, if we understand that there are tens of millions of people in this country who dont vote, whove kind of given up on the political process, that young people although were seeing some real gains there and were working really hard on this thing young people, who are by and large progressive my guess is roughly speaking for every three people under 30 who vote, two of them are going to vote progressive, okay, but many of them dont vote I think I am by far the strongest candidate to reach out to those people. I think Im the strongest candidate to bring together a multiracial coalition of African Americans, of Latinos, of Asians.

So to answer your question, I dont believe that the [way to win] this election is to just speak to Republican women in the suburbs. Thats one theory. And I think many of those women will vote for me because they are appalled, correctly so, about Trumps personal behavior and his temperament. I think we can win many of them. Not all of them. But on the other hand, the key to this election is can we get millions of young people who have never voted before into the political process, many working people who understand that Trump is a fraud, can we get them voting? That is the key to this election. So Ive heard that hypothesis, I just dont agree with it.

And let me add to that if I might, [there are] people who run the same old, same old type of campaign. And you know, [former Vice President] Joe Biden is a personal friend of mine, so Im not here to, you know, to attack him. But my God, if you are, if youre a Donald Trump and you got Biden having voted for the war in Iraq, Biden having voted for these terrible, in my view, trade agreements, Biden having voted for the bankruptcy bill. Trump will eat his lunch.

Jon Healey, deputy editorial page editor: So youve noted the widening income inequality. [But] when you look at the consumer confidence indices, they suggest that most people are feeling better about where we are, and their expectations for the future are better and better. If you look the trend lines since the [last recession], its gone steadily up. And in fact, the numbers now in both consumer confidence and expectations for the future are where they were in 99, 2000. So how do you reconcile those two things, where youve got a campaign which is trying to reach out to people who feel that theyve been left behind, but much of the country thinks things are going pretty well right now?

Sanders: I read statistics til Im blue in the face, and Ive got to tell you, I read polls til Im blue in the face. Today theres a poll that says this, and yesterday theres a poll that says that. Half of the people in this country are living paycheck to paycheck. Agreed? Thats a fact. All right?

I dont know the exact number, but theres a hell of a lot of people in this country who if their car broke down and they needed $500 to fix that car, dont have that 500 bucks. Theyll have to go to some payday lender to get to come up with the money. We got 45 million people who are dealing with student debt, and some of it is outrageous levels of student debt. In this city, you got 50,000 people who are sleeping out on the streets.

So I dont accept the premise. I mean, I think what people say is, you know what? If I want to go out and get a job today, I can get a job. Thats true. But on the other hand, and I do this all over the [country], you know, Ive held a whole lot of town meetings and you talk to people. Yeah, I can go out and get a job, but I cant find a job that pays me a wage that allows me to deal with healthcare and pay my rent or put gas in the car. So the economic crisis that were facing now is not unemployment, which is low. It is wages. And last year in the midst of the so-called booming economy the media talks about it, Trump talks about it you know what real inflation [adjusted] wages went up last year? Anyone happen to know?

Healey: Less than a percent?

Sanders: Yeah, one point exactly. 1.1%. What we are looking at is a continuation of a trend in which the very, very wealthy do phenomenally well. I mean, its a fact I keep mentioning I dont know if anyone pays any attention at all of my rallies, that in the last 30 years, the top 1% have seen a $21-trillion increase in their wealth; [the] bottom half of America has seen a decline in their wealth.

So to answer your question, unemployment is low. You want to go out, you can get a job. But by the way, whats also frightening is according to the studies, most of the new jobs being created are low-wage jobs.

And, you know, when were on the campaign trail, we go to restaurants all the time. Thats what we do. And invariably the kids, the young people who will come up to me, who are waiters and waitresses, you know, these are people who often have a college degree, and theyre waiting tables today. And Ill never forget this, I was in New Hampshire a month ago talking to teachers. And a teacher said, You know, my son just graduated college, wanted to be a music teacher. He ended up being a salesman at a liquor store in New Hampshire. He made more money doing that than being a teacher.

So to answer your question, unemployment is low but wages are terribly low in this country, and many people are struggling to get the healthcare they need to take care of their basic needs.

Kerry Cavanaugh, editorial writer: Theres been a lot of focus on a $15 minimum wage. But how does the federal government create more $30-an-hour jobs, $45-an-hour jobs?

Sanders: Thats right. If Im allowed to toot my own horn here, when I was here four years ago and I talked ... about a $15 minimum wage, everyone thought that I was kind of extreme. Since then, seven states, including this state, have passed a $15 minimum wage, as has the U.S. House of Representatives. So your point is well taken.

Nobody should think for one moment that, Ahh! We got a $15 an hour minimum wage. Weve solved our economic problems. It is a minimum. It is a minimum. And I have been to this state, Ive been to Iowa, needless to say, New Hampshire. Ill never forget a woman in Des Moines, Iowa, making $10.25 an hour trying to raise three kids. She cant. Alright, so Im not here to tout that a $15-an-hour minimum wage is the end of the world. Its not, but it is the minimum. We have to do that.

The question of how we create good paying jobs, $25-, $30-an-hour jobs, is the more important question. I think one way we do that, and obviously its going to be a combination of federal policy and the private sector, as president of the United States, what I will do is demand and do everything that I can to end the kind of corporate greed and irresponsibility that we see right now. We were just over in San Bernardino. We had a rally there yesterday, where Amazon apparently has a lot of influence. Theres a lot of pollution, and kids come down with asthma and all that stuff. And people in the warehouses are making $11 or $12 an hour while Amazon is, as you know, an enormously profitable corporation that paid $0 in federal income taxes last year.

So I think what a progressive president has got to do is say to these corporations, You know what? Make money. Thats great. Create jobs. We want you to do that. But it cannot just go to CEO compensation or your stockholders. Weve got to break this mentality, which has been prevalent for so many decades, that the only thing that a corporation has to do is make as much money as possible for its stockholders and pay it CEOs outlandish levels of compensation. And we have to do it culturally, and we have to do it legislatively to say, You know what? Make money. Thats fine. You want to be rich, thats fine. But you cannot have it all. You cant break unions or deny workers the right to join a union. You cant continue to harass women on the job. You cant pay abysmally low wages and expect, you know, to be treated respectfully by the federal government.

Youre going to have to be good corporate citizens. You cant shut down plants in America and move to low-wage countries. You have a certain responsibility. So thats the bottom line. Thats the role I think leadership plays with the private sector.

We also want to stimulate small-business growth in America. But then the role that the federal government can play is enormous. I happen to believe in a federal job-guarantee program, and Ill tell you why. Because there is an enormous amount of work to be done in this country, and I think about it differently than maybe others do. But I look at our childcare system, which is completely dysfunctional, which is so unfair to working families, and more importantly to the children. I dont know the exact number, but hundreds of thousands of good jobs with well-trained, well-paid childcare workers.

I look at our infrastructure, which there is no argument is crumbling, whether its roads, bridges, highways. God, Ive been driving around in L.A. in the last few days. What a traffic disaster you have here. You know, water systems. Everyone knows about Flint, Mich., and we were there. My wife and I were there and it was one of the most emotional and difficult meetings weve ever had, you know, behind closed doors, dealing with parents whose kids were poisoned. But it is not just Flint, Mich., it is all over this country. It is California. I dont know if you know this of course you know this, you live here but there are tens of thousands of homes where we turn on the water, you cant drink the water. So we have major infrastructural crisis. And, last but not least, if we are going to combat climate change, we need to transform our energy system away from fossil fuel to energy efficiency and sustainable energy. And in doing that, we can create up to 20 million good-paying jobs. So the federal government can be very aggressive.

Teachers. What a pathetic state of affairs when you have good teachers who are leaving the profession because theyve got to work two or three jobs. So we pay teachers. I mean, when we rebuild our country infrastructure, education, climate, environmental protection we create a whole lot of good-paying jobs. Thats the role of the federal government.

Dr. Patrick Soon-Shiong, executive chairman, Los Angeles Times: Well, first of all, thank you. I was upstairs because Im with the most inspiring 15 kids from a Jesuit high school in Compton. Senator, listen, first of all, thank you for coming. I want to talk about healthcare. Just so you know, background: I came from South Africa, apartheid. Grew up in South Africa, was the first Chinese doctor, came to this country. Its the greatest country in the world.

So During the debate, we held a focus group at the L.A. Times, with 25 undecided voters. The concern that they related to us was that your Medicare for all plan, as communicated, would not win in the swing states. Question is, what do you mean by Medicare for all?

Sanders: Look, healthcare, as everybody knows, and even the president of the United States recognizes, is a complicated issue. And we have got to do better [explaining Medicare for all]. And sometimes it is difficult, because youre on a debate when you have 75 seconds. Im not so sure as a doctor you can explain healthcare in 75 seconds. Correct? Maybe you can.

Soon-Shiong: If you give me two minutes, maybe.

Sanders: Okay. All right. Well, you dont get two minutes when youre up on the stage, by the way. Thats too much. Unless you cheat and go beyond the red light.

Soon-Shiong: But thats a problem, right?

Sanders: It is a problem.

Soon-Shiong: Because you really should have enough time to [explain it], and maybe in your rallies where you do have time.

Sanders: I do have time. And come to the rally this afternoon. As soon as we leave here were going to a good rally, and I will talk about [healthcare]. But that is one of the problems. On a complicated issue, you are often asked to explain it in 10 or 20 seconds, or 75 seconds. But we have more than that now, so let me explain what I mean. First of all, we go all over the country and we say, OK, tell me about healthcare. And the stories that you hear and we have them on tape, we video these things, we put them out there are just unbelievable. So I start off, Patrick, with the strong belief that there is something fundamentally wrong when we are spending twice as much per capita on healthcare as the people of any other country.

I live 50 miles away from Canada. Is the Canadian healthcare system perfect? No, it is not. But they guarantee healthcare to all of the people spending half as much. We spend about $11,000, theyre something around $5,000 or $6,000 a year. Meanwhile, you got 87 million people in this country who are uninsured or underinsured, and the keyword here is underinsured. Everybodys Ah, well, you dont have any health insurance, thats a problem. But you know what? You may have health insurance, but if you have a $10,000 deductible then your health insurance doesnt mean a damn thing to you because you cant go to the doctor when you need to. OK? You dont have the money to do that. You have 30,000 people who [will] die this year because they dont get to a doctor on time.

And heres what is unbelievable, and Ive been talking about this more, and this resonates with people, by the way: Some half a million people go bankrupt in this country for medically related reasons. Now, that might be the only reason. Now youre struggling financially, youre diagnosed with cancer. Just think about it. You tell me. You make $50,000 or $60,000 a year, youre diagnosed with cancer, you run up a bill for $50,000, $100,000. How do you pay that bill? I mean, its insane. So we are living in a country which says that you can suffer financial ruin for the rest of your life, for what crime did you commit? You were diagnosed with cancer or heart disease. How disgusting is that? It really is. I use that word advisedly. So this system I think is dysfunctional and its really quite indefensible. And we can argue about where we go from here.

But I think on top of everything else, I mean we dont have five hours to discuss it, is the complexity of the system. OK? And I think its not only healthcare, its everything else. People are sick and tired of filling out a million forms for every thing. My wife has a PhD, all right, and she goes crazy trying to fill out the healthcare things, choosing what healthcare program you want, you know, when youre fighting for the coverage that you think you are entitled to. We need a simple system. And the beauty of a simple system and the advantage of single payer over a system which has thousands of separate policies is that it is easier to administer.

Youre asking me what Medicare for all is. It is no more premiums, not for you as an employer. You must spend a fortune, I imagine, right now on healthcare. All right, no more premiums for the worker, for the employer. No more co-payments, no more deductibles, no more out-of-pocket expenses. All gone. Medicare for all expands Medicare to cover dental care, which last I heard is healthcare, hearing aids, eyeglasses and home healthcare. And we do that.

How we do fund it? We fund it through a progressive tax system such that, I suspect your company, by the way, will save money. Youll be paying more in taxes but less in your overall healthcare costs, and the savings will go to the workers. Youll be better off on the Medicare for all. And one of the things that we have not succeeded at, I think, is getting large corporations to understand that. Because we are the only major country on earth not to guarantee healthcare, theyre competing against international concerns who dont have to worry about paying their workers healthcare. Because its government sponsored.

Goldberg: Do you think theres a problem with the way [Medicare for all] is being sold?

Sanders: Yep. The answer is yes. I think there is enormous ignorance about the nature of healthcare, why we spend so much, why our outcomes are not particularly good. Yes. Life expectancy, childbirth, infant mortality. So Im not arguing. I think youre right. But please understand, which I think you do know, that there are people who are benefiting big time from this dysfunctional healthcare system.

Robert Greene, editorial writer: Senator, youve made your position on President Trump quite clear. I want to ask you, is there anything that hes done, any policy that he has, any actions hes taken that you think are worthy and worth building on?

Sanders: I have such contempt for somebody who is trying intentionally to divide this country up based on the color of peoples skins or where they came from or their religion or their sexual orientation. That disgusts me so much. So were in the midst of that. And somebody who was a, you know, is a pathological liar. And a corrupt person.

I mean, he has talked about the need for infrastructure repair. Yes, thats true. Has he done anything? No. Hes talked about the need to lower the cost of the prescription drugs. Has he taken on the pharmaceutical industry? No, he has not.

He has talked about trade policy and, in fairness, probably what has recently happened is probably modestly better than the previous NAFTA. So you want to give him credit and, and the Democrats in the House credit for that? Fine. But I think the overwhelming result of his administration is contemptible.

Mariel Garza, editorial writer: So theres been a lot of talk about electability in this race what is electability, whos electable. There are a fair amount of women who believe that when we talk about electability, when we use that word, its really code for, a woman cant beat Trump. And I wonder if you, if you believe that thats true.

Sanders: I surely do not. I mean, it 100% has to do with the candidate. But I will say that whether youre a man or a woman, Trump is going to be harder to beat than many people think. They think, this guy is a buffoon, of course hes going to be beaten. Not so easy. But it gets back to the question, the original question is, its not a woman or a man or whatever. Its a question of the kind of campaign that you run. And I think in this unprecedented moment in American history, you need an unprecedented campaign. And I think you need ideas that are going to excite and energize millions of people who right now are not particularly active in politics, and who may not vote at all. So I think the question that we want to ask is, which candidate out there is capable of growing voter turnout? Thats the real question. And if youre not dealing with that, I think Trump is going to be hard to defeat, thats true whether youre a man or a woman. But if the question is can a woman beat Trump? Of course.

Carla Hall, editorial writer: You mentioned the thousands of people sleeping on the streets here in the city, and in the county. President Trumps approach to homelessness has been pretty much to scapegoat homeless people and vaguely hint that he would move them all into a big empty federal building somewhere. How would you address homelessness?

Sanders: You know, we started talking about the economy, and what I suggested is that there is so much work to be done in this country. I mean starting with childcare, starting with healthcare. We need more doctors, we need more nurses, we need people who are not pushing paper but providing care to older people. We have a proposal that would build 10 million units of housing. In terms of low-income housing, Im proud to tell you that I co-sponsored successfully with Barbara Lee of Oakland what was called low-income, I think, I forget the name, the low income housing trust fund or something, which Obamas people put, I think, several hundred million dollars into. Nowhere near enough. But it was the first piece of legislation to actually address low-income housing.

But to answer your question, and Ive learned as you travel around the country, boy you do learn this, the housing crisis is not just in L.A.. Its not just in San Francisco or Seattle. It is virtually in almost every part of the country. And it has to do not only with homelessness, which is a disgrace a half a million people homeless in America. It has to do with the fact that 18 million families are spending 50% of their income on housing. It has to do with gentrification all over this country, which is driving rents up to levels that, that working families just cannot afford. We have a proposal that would build some 10 million units of housing and put a hell of a lot of people back to work at good wages, union wages, and it would, in fact, end homelessness as we know it.

We were down in, what do you call it here?

Greene: Skid row.

Sanders: Skid row not a highly technical term (laughter), I thought you had a more sophisticated name for it where, for example, instead of arresting people, you bring them into a shelter, which seemed to me a pretty sensible thing. But the problem with homelessness is not just providing a home. Often, youve got to deal with addiction. Youve got to deal with counseling, you need wraparound services, etc.

Soon-Shiong: Correct. Can I follow up on that? And two, maybe three different topics. Really, the homelessness issue here is really mental health issues.

Sanders: Right.

Soon-Shiong: So the mental health issue is really

Sanders: And addiction is part of it.

Soon-Shiong: And being thrown out of the jails theres a real issue.

The other question I really want to ask you about, and it relates to privacy, it relates to tech, it relates to Facebook, Google, etc. It relates actually to our democracy because it leads now to local news. Newspapers completely being destroyed. In California we have, its a largest incidence of small, local town newspapers being destroyed because frankly the [concept of] fair use is not being fairly used, where these platforms can take this data, say theyre not media, and use them. Whats your feeling about that? How do we save, across this nation, local newspapers that can speak truth to power?

Sanders: Its a huge issue. And youre absolutely right. I can tell you from personal experience, when I was mayor of Burlington, which was a larger city in Vermont of 40,000 people, I cant remember how many radio stations we had. We had newspapers, we had small weekly newspapers all over, right?

Newspapers are in trouble. I would say that what we want to do and by the way, this is not just media, this is many other sectors of our society is have an attorney general who understands antitrust law. And thats true in agribusiness. Its true in many parts of our economy. Start breaking up these huge conglomerates, which have just an unbelievable influence over our general economy.

Media is something different. Because without a free media, you dont have a democracy. So it raises another issue, and we have some ideas out there about and its a tricky thing. You dont want government control over media. You dont want a handful of giant conglomerates to control the media. But were going to have to sit down and have a conversation about how we support local independent media. I dont have a magical answer

Soon-Shiong: But Facebook and Google hide behind the fact that they can give fake news because theyre not media.

Sanders: And also I may add in terms of, you tell me if Im wrong, you know more about this than I do. They gobble up a huge amount of the advertising revenue.

Soon-Shiong: They gobble up everything, in fact, thats exactly why papers are being destroyed.

Sanders: Thats right.

Soon-Shiong: So one of the ideas is, datas now the next oil, basically equal to a utility. Why is there not a data tax on these organizations? That is where that should actually be.

Sanders: Well, I think the idea is that a handful, what have we got, Google, Facebook, who else is out there? Twitter, right? Twitter controlling what percentage of the advertising revenue?

Healey: Google and Facebook together are north of 80%, I think. [Editors note: Analysts put the figure at close to 60%.]

Sanders: Wow, is that right? This is an issue that cannot be ignored, I agree with you.

Michael McGough, senior editorial writer: Senator, when you were here last time, four years ago, we had a discussion about whether you were maybe too averse to military intervention. You thought Hillary Clinton was the opposite. And one of the things you said when we were talking was, as proof that you werent pacifist, was that you had voted for the war in Afghanistan after 9/11. You had some second thoughts about that in the debate. And Im wondering, are you more averse to intervention now than you were when you were running in 2016, and what sort of standards would guide you as president in deciding whether to send U.S. forces abroad?

Sanders: Well, its not a question of more or less. Obviously you have to look at the particular circumstances. No. 1, I think unlike Trump, who has exploded military spending while cutting back on diplomacy and our State Department, I would do exactly the opposite. I think you need and Ive been around the world and met with some of our diplomats. Youve got some really strong and good people who know the language, who know the culture. So we had got, I mean the bottom line is that war has got to be the last response, not the first response. It is very easy for politicians, because its almost always very popular to say, You know what? The only thing that fill-in-the-blank understands is force and were going to go to war.

Its a good speech. It polls very well but it ends up in some cases with horrible circumstances, i.e. the war in Iraq. So I voted against the first war in the gulf. Literally, its one of the first votes that I cast that I thought I would be unelected two years later because that war was popular. I voted against it, led the effort against the war in Iraq. God, I wish check out what I said then, it turned out to be a pretty prescient, and I wish that wasnt the case, but it was. I helped lead the effort to end U.S. intervention in Yemen following the dictatorship in Saudi Arabias lead. So No. 1, youve got to do everything you can to bring people together diplomatically without the use of military force.

Are there some circumstances where genocide is going to be committed where you may have to use military force or other reasons? Yeah, I suspect there will be. But also you want to be mindful that you need, to the degree you can get it, to use international support. Strengthen the United Nations. People say the U.N. is ineffective. Yeah. Compared to what? Nuclear war? You know, so weve got to strengthen the United Nations, and see where we can resolve international conflict.

The other thing that I would say on this is that, in issues like Israel-Palestine, issues like, Saudi Arabia-Iran, the United States for many years has had a kind of one-sided policy. We have loved the brutal dictatorship in Saudi Arabia. We have been very 100% pro-Israel. And I say this as somebody whos proudly Jewish who spent time as a kid, on a kibbutz in Israel. But we need to have an evenhanded foreign policy which brings people together.

And I wont deny for one second, this is complicated stuff. It is not easily resolved. But we throw all of the resources that we can to bring people together. And you gotta do things like rethinking this war on terror, which has cost us some $5 trillion. And I guess people can argue the situation is worse than it was before we got into it. So theres a lot of rethinking. Got to deal with authoritarianism all over the world.

Scott Martelle, editorial writer: Hi, good morning. Thank you. Senator, you call for comprehensive immigration reform, and thats been tried multiple times before and its been failing for decades. As president, what can you do to get a comprehensive immigration reform package through Congress?

Sanders: Yeah, I dont want to tell you Ive been one of the leaders of that in terms of the discussions or the negotiations in Congress, but I have been involved in it. And the truth is, I do believe it can be done. I absolutely do believe it. Trump, of course, because of his xenophobia and his obsession with building a wall, has exacerbated the situation. I think despite Trumps xenophobia, the American people do want comprehensive immigration reform. And I think when you have a president who can speak and Im the son of an immigrant, as a matter of fact, who came to this country with nothing when you can speak to the contributions of the immigrant community, the fact that so many immigrants are working so hard, raising their families, abiding by the law, are so important to our economy, when you can explain that to the American people rather than demonize immigrants, I think we could strengthen the support that exists at the grass-roots level for immigration reform.

Now as you also know, a president has certain authority regarding executive orders. So on day one, what I have promised and will fulfill, is to reinstate the legal status of the 1.8 million young people and their parents in the DACA program. That we can do. And we can stop the very ugly practices at the border in which, you know, babies are literally snatched from the arms of their mothers or children thrown into cages. We can do that as well. But to answer your question, I think there is broad support among the American people. I think theres more Republican support, which I think would be able to play out without having a xenophobe as president of the United States.

Garza: I have a pretty quick question. And that is, normally I wouldnt ask somebody about their health, because you know, we all know that 80 is the new 60

Sanders: 50! 40! 30! (Laughter)

Garza: But the truth is you have had a heart attack fairly recently. And I wonder, you know, convince us that, that you are hale and hearty enough for whats going to be a brutal campaign and probably a pretty, well, we know its a tough job.

Sanders: Yes, its a tough job. Look, all I can say is youre quite right. I did have a heart attack two and a half months ago in Las Vegas. I had two stents put in. I was in the hospital for 2 days and got quite good healthcare. Thank God. I had an artery that was blocked and I think that was dealt with. As I understand it, and (to Soon-Shiong) doctor, you can tell me if Im wrong, but I think that procedures done about a million times a year, roughly speaking in the United States. Its not an unusual procedure. I have been blessed with good health my entire life. I think you can ask my staff the last time other than the heart attack, that I missed work. Im in just, I was a kid, a long-distance runner, so I have a lot of endurance. Since the heart attack we have been running a pretty vigorous campaign.

These guys had me working, what did we do, four rallies in the last couple of you know, I work hard. And youre right. I mean it is, needless to say, president of the United States might be slightly stressful job (laughter) and a difficult job. But I suspect Ill be on the golf course a lot less than Donald Trump is. I dont play golf. But, I mean, thats a fair question. All that I can say is, in some respects, I feel better than I did before the heart attack. I guess having three arteries that work is better than having two, right?

See the article here:

Opinion: Bernie Sanders on healthcare, homelessness and Trump - Los Angeles Times

As healthcare becomes more technology-driven, digital health and IT leaders will be the key executives to watch.

Some of these influential technology leaders are pushing forward withartificial intelligence, data analytics and telehealth capabilities to improve patient care. Others are bringing in technology expertise from outside healthcare to help make the industry more consumer-centric ortacklethecomplex issue of interoperability.

And everyone is keeping an eye on the big tech giants and their next moves in healthcare.Haven, the technology-driven healthcare venture lead by Amazon, JPMorgan and Berkshire Hathaway, has built a team withsome of the brightest in healthcare technology including Zocdocs Serkan Kutan and Blue Cross Blue Shield IT leader Dana Safran Gelb.

Top health industry issues of 2020: Will digital start to show an ROI?

Each year, PwC's Health Research Institute (HRI) names the top issues for the health industry in the coming year. What made the list for 2020? Join HRI for a discussion of the most important trends for providers, insurers, pharma/life sciences and employers.

Here are five healthcare technology leaders were keeping an eye on in 2020. Think we missed someone? Find me on Twitter at @HeatherLandi.

John Halamka, M.D.,president of Mayo Clinic Platform

Health IT pioneer and digital health leader John Halamka is leaving his post at Beth Israel Lahey Health after 23 years to move over to Mayo Clinic starting Jan. 1. He will be leading digital health strategy at the Rochester, Minnesota-based academic medical center as president of Mayo Clinic Platform.

Halamka refers to the Mayo Clinic Platform as an innovation factory for collaboration. Hell lead initiatives that encompass artificial intelligence, the internet of things and an ecosystem of partners to advance Mayos digital health efforts. Mayo is in the midst of a digital transformation supported by a new10-year partnership with Google to move patient data over to the tech giant's cloud platform.

Halamka will play a key role in this partnership to advanced cloud computing, AI and data analytics toadvance the diagnosis and treatment of disease.

Angela Yochem, executive vice president and chief digital and technology officer, Novant Health

Angela Yochem came to Novant Health in 2018 with deep technology roots at Fortune 500 companies. As executive vice president and chief digital and technology officer, she has been tapping into that tech expertise as she redefines the North Carolina health systems approach to technology.

In June, the health system launched theNovant Health Institute of Innovation & Artificial Intelligence (AI), which will use AI to enhance personalized patient care.

That institute, which Yochem co-leads, has already produced AI-based solutions to improve care, such as a tool that helps treat stroke patients more rapidly.

Novant Health also is working with healthcare AI company Jvion to use predictive analytics to reduce readmissions for congestive heart failurepatients. A project with KenScis AI platform is focused on improving the patient experience in its hospitals.

Natalie Pageler, M.D., chief medical information officer at Stanford Childrens Health

Stanford Childrens Health is pioneering cool technology to improve care for pediatric patients. From using virtual reality to help distract and entertain children who are preparing for procedures to diabetes digital health tools, the organization focused on using technology to address the needs of children and their families.

As CMIO, Natalie Pageler, M.D., a board-certified pediatric intensivist, leads the hospitals digital health program with a focus on meeting the needs of tech-savvy patients and families in the Silicon Valley area. Shes focused on expanding virtual visits to enable patients and their families better access to pediatric experts. From 2017 to 2018, Stanford Childrens grew virtual visits by more than six times, from less than 200 visits a year to 1,100 annual visits.

The hospital is on track to double that to 2,500 telehealth visits in 2019. The virtual visits save hundreds of miles in travel for patients who need specialty care.

Vivian Lee, M.D., president of health platforms, Verily

Vivian Lee, M.D. is leading Verily Life Sciences' expanding footprint in healthcare. The life sciences arm of Googles parent company Alphabet has been shifting from research into clinical care and gaining big-name partners.

Verily partners with health insurers like Blue Cross Blue Shield as well as Walgreens and life insurance company John Hancock to provide chronic care management through its Onduo virtual diabetes clinic. Its also developing machine learning tools to help detect diabetic eye disease.

Under Lees leadership, Verily also is moving into population health and supporting the shift to value-based care. The company is working with Atrius Health and the Palo Alto Veterans Affairs healthcare system to improve patient outcomes through population health projects. Verily also is taking on aging by teaming up with Wake Forest Baptist Health to test technologies to help older people stay healthy and independent at home.

Mariann Yeager, CEO of The Sequoia Project

Mariann Yeager is a 20-year health IT veteran taking on the complex problem of healthcare interoperability. She leads the Sequoia Project, apublic-private partnership that advocates for nationwide health IT exchange.

The organization was tapped by the governments IT agency, the Office of the National Coordinator for Health IT, to oversee the implementation of a big data exchange project called the Trusted Exchange Framework and Common Agreement.

Under Yeagers leadership, The Sequoia Project will create baseline technical and legal requirements for different health IT systems, companies and groups to communicate with each other and share electronic information.

View post:

5 health IT executives to watch in 2020 | FierceHealthcare - FierceHealthcare

The Americans for Prosperity-Missouri and the AARP argue that allowing nurse practitioners to treat patients without physician supervision would help ease a health care shortage in Missouri, particularly in underserved areas.However, the editorial failed to mention several important facts. First, like most of the states in the Union, Missouri is not only short of physicians, but also of nurses.By encouraging more nurses to move into a provider role, nurse practitioner independence would have a negative impact on the supply of bedside nurses.

Secondly, while advocates claim that allowing nurses to practice independently will fill the need for primary care in underserved areas, studies have consistently shown that states with independent practice have not this promised increase in rural health shortage areas. Instead, independent nurse practitioners end up working in the exact same places as physicians. Additionally, less nurse practitioners are entering into primary care. More and more, nurse practitioners are forgoing primary care to work in specialty offices.In fact, in areas with independent practice, it is not uncommon to see nurse practitioners opening cosmetic practices offering botox and fillers rather than bread-and-butter primary care medicine.

The opinion piece argues that nurse practitioners are already trained and qualified, and that research has shown that nurse practitioner care is equivalent to that of physicians.Unfortunately, the authors neglect to mention that every single study that has ever claimed to show nurse practitioner safety and efficacy has been performed in a setting in which nurses were supervised by a physician.There are absolutely no studies that show nurse practitioner safety and efficacy when practicing independently.

Moreover, most of the studies that purport to show nurse practitioner safety have been of low quality, often following healthy patients over very short time frames, with one often-cited study having a time frame of only two weeks.These studies are not appropriately designed to show whether nurse practitioners, especially practicing independently, can safely and effectively care for patients over the course of a lifetime in a primary care role.

Additional concerns have been raised regarding the quality of training and education of newer nurse practitioners.While physicians are required to have 15,000 hours of training and experience before being permitted to treat patients independently, nurse practitioners are required to complete just 500 hours.Unlike medical school, many nurse practitioner programs are 100% online, and clinical experience lacks the standardization required of physician trainees. Many nurse practitioner programs no longer require nursing experience, allowing students with any bachelors degree to become a nurse practitioner.

There is no doubt that Missouri needs more physicians and nurses.Legislators would be better off focusing their efforts on ways to increase the supply of both critically important professions, rather than trying to pass off one as the other.

For example, Missouri has led the way in enacting legislation to create a new profession called Assistant Physicians which become effective in late 2014.Assistant physicians are physicians who have completed medical school but not a residency program.They work under the supervision of a fully licensed physician.Since 2015, approximately 300 Assistant Physicians have obtained a license.

Rebekah Bernard MD, Carmen Kavali MD, Purvi Parikh MD, Ainel Sewell MD, Amy Townsend MD, and Roy Stoller DO are Board Members of Physicians for Patient Protection. Physicians for Patient Protection is a grassroots organization of practicing and retired physicians, residents, and medical students. Our mission is to ensure physician-led care for all patients and to advocate for truth and transparency regarding healthcare practitioners. We advance our mission by educating our colleagues, by influencing policy and legislation, and by educating our patients and the public.

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Opinion: Response to 'Expand access to health care by expanding the role of Missourians deserve physician-led care' - The Missouri Times

PARKERSBURG, W. Va. (WTAP) - The Ohio Valley Health Care is a senior facility that has many amenities to help seniors live a comfortable life.

But the organization felt like something was missing.

They found that most activities have more women participating than men.

"We have a couple residents that worked for the railroads, so we thought lets do a model train," said Jay Miller, administrator, Ohio Valley Health Care.

Jay says, they shared the idea with Joe Stephens who builds trains and train stations and they werent expecting it to be this big.

For some seniors, the trains are therapeutic as they sit in front of the window. The train station turned out to be a treat that both men and women enjoy.

"Its great for me to see the smiles on their faces and to me its not just a job, its not about the money, these people mean a lot," said Joe Stephens, owner of Stephens Outdoor Railways.

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Ohio Valley Health Care model train station lit for the holidays - WTAP-TV