The Medical News Report

Mid-October, 2020 Update  COVID-19 and Healthcare Proposals from the presidential candidates

www.themedicalnewsreport.com

A. Update on COVID-19—analysis of President Trump’s treatment

B. Healthcare plan comparisons from the presidential candidates

Nothing like the changing of the leaves in the Smokey Mountains

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues. Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit.

  Thanks!! Dr. Sam

A. Update on COVID-19; President Trump’s “cocktail”

  The CDC has revised its statement regarding air (aerosol) transmission of the virus to include closed spaces (i.e.elevators) with poor ventilation. These changes continue to confuse the public. Let’s face it, if you are in side somewhere, you need to protect yourself with a mask and avoidance of group, especially if older or have chroniv medical issues. We need to balance living our lives and being safe. What that means to each individual is different and must be respected.

  Let us all agree, the virus is transmitted through the air either because a person expels droplets sufficient to contaminate another’s airway or less likely contaminates a surface. Airborne transmission also can occur in close quarters that have poor ventilation.

  The bottom line… wear a mask when close to several individuals and stay away from poorly public ventilated areas if possible. There is no perfectly safe place if around other people, but minimizing risk should be everyone’s goal. This holds especially true for high risk individuals.

  Be wise, be respectful, and be careful!

Analysis of President Trump’s therapeutic (cocktail) regimen

  President Trump has recovered from COVID-19 and defied the odds. He is over 10 days from first symptoms without fever for 3 days and that makes him safe to not spread the virus, according to the CDC.

  President Trump has had 2 different tests that have determined he is free of infectious particles of COVID-19. The PCR test is no longer recommended after infection, because it can stay positive for days or weeks, and research has proven non-infectious particles can remain in the body for some time, but there is no ability to transmit infections to others.

  President Trump has been treated with a variety of therapeutic modalities, a so-called “cocktail” of various medications to fight the virus directly and boost his immunity to recover much quicker.

  The president’s prescribed list of medications (cocktail) includes Remdesivir, Regeneron, Dexamethasone, Zinc, Vitamin D, melatonin, and Pepcid. President Trump also takes Crestor for high cholesterol, aspirin as a cardiac preventative, antibiotics for acne rosacea, and Ambien occasionally for sleep.

  An analysis of the medications President Trump has been given mostly intravenously at Walter Reed Medical Center by expert specialists is presented.

  The good news is most of these meds do not have serious side effects when given short term. Because of President Trump is in excellent health, considering he is 74 and overweight, thankfully there are no other risk factors except one.

  The one risk factor that needs to be added to any one who gets sick is STRESS. Imagine the day to day 24/7 stress this president is under. Stress has a direct effect on the immune system and is a serious risk factor. Rest is important to recovery.

  For those criticizing the management and death rate in the U.S., let me remind the readers, it is high because the health of our country is not good with an epidemic of obese people and those with multiple underlying diseases.

  We are not a healthy country because there is a significant percentage of people who do not accept responsibility for their health, following doctor’s orders, taking meds correctly, losing weight, exercising, and eating a healthy diet. This is even in the face of the best medical care on the planet, and that my friends is the sad truth! Americans must get off the couch and do their share.

1—Remdesivir—5 doses

  This antiviral has been discussed widely, but is still in clinical trials, although the FDA approved it as an emergency (compassionate) therapeutic for COVID-19, (it has been established with evidence-based research that it can reduce the number of days to recover from 15 to 11 days. Individual responses would vary depending on the clinical status of the individual. Most physicians are using this treatment in hospitalized patients.

  Remdesivir works inside the cell, whereas convalescent serum antibodies outside the cell to prevent the virus from entering the cell. Regeneron is such an antibody cocktail.

  It has been stated multiple times, that Remdesivir is not sufficient to save the majority of lives if they are in the ICU needing ventilators, etc. It is a combination of drugs including the capability to manage the underlying diseases. We still have a long way to go. As in any disease, the earlier the treatment, the better the outcome.

2—Regeneron-1 dose

  This a 2-antibody combination produced drug also in late stage research showing reduced viral symptoms more quickly than placebo for patients not sick enough to be hospitalized. Early use is the answer.

  Regeneron is 1 of 4 different products currently under investigation.

  Regeneron is in a clinical trial at Sarasota Memorial Hospital. It consists of 2 monoclonal antibodies. One is derived from a human who had the virus (convalescent serum), and the other is from a mouse immunized with the spike protein from COVID-19 humanized antibodies.

  It is one time injection and is a substitute for a natural response to the virus which would take much longer to occur.

  Antibodies are proteins the body make in response to infection and other health challenges. These antibodies attach to the virus to prevent it from invading the human cell wall, especially respiratory cells, whereas Remdesivir works inside the cell to prevent the virus from reproducing, as stated above.

  Convalescent antibodies donated by recovered patients is being widely used, but has a variety of antibodies, whereas Regeneron has specific antibodies specifically to treat COVID-19.

  Patients who have recovered from COVID-19, after 2 weeks, are encouraged to donate their plasma, as one donor can provide life saving antibodies to 3-4 patients.

  Regeneron is being used to treat patients with positive tests, but there are trials for people who have been exposed recently to see if it might prevent or lessen the infection. Sarasota Memorial Hospital is looking for hundreds of volunteers who qualify (been recently exposed to COVID-19). Contact the hospital for details. 941-917-9000

3—Dexamethasone (a corticosteroid)

  This is a classic corticosteroid used to reduce swelling and combat overwhelming stress to the body for any reason (infection, shock, asthma, respiratory distress, etc.). It can also improve the function of the lungs to combat a drop in oxygen levels from COVID-19, as the virus’ effects can damage the lining of the lung’s alveoli where carbon dioxide is exchanged for oxygen. It is also an anti-inflammatory agent to reduce inflammation in the body’s organs. 

  Recent studies have found that this drug reduces mortality by 20-30% in severe cases, but may be valuable in shortening the course of illness if used earlier in the course of illness. It is being used under the “compassionate use” rule in all hospitalized patients. It has shown such value, other studies were stopped, because it was clear that steroids were a key medication in reducing mortality, preventing the need for mechanical ventilation, and reducing the severity of this viral attack.

  Short-term use of steroids have few side effects, but the dose must be tapered off to allow the adrenal glands to start producing its own corticosteroids, vital to life.

4--Zinc

  This is a nutrient that is used widely by the body especially to help boost the immune system, can assist in digestion, healing, metabolism, and supports brain and nerve health if the body is deficient.

  This nutrient is found in many foods including beef, crustaceans, oysters, pork, and yogurt, baked beans, seeds from pumpkins, cashews, chickpeas, lentils, quinoa, oatmeal, and fortified foods such as cereal. An 8 oz. steak can supply a whole day’s needs. A normal balanced diet can easily supply individuals with adequate intake.

  The recommended daily intake is 11 mg for men and 8 mg for women, both over 19 years of age. Even vegetarians can easily take in enough zinc.

  Routine supplementation is not recommended unless a physician feels a person needs added zinc.

  Zinc, because of its stimulation of the immune system was recommended early on by certain healthcare providers in the pandemic, and has stuck as a possible benefit in high doses for a short time. This has been tried on thousands of patients with no proof it helps based on traditional research.

  I used to recommend it for patients with loss of smell, which incidentally can occur in COVID-19 patients. However, it should not be sniffed, as it may cause permanent damage to the olfactory nerves high up in the nasal cavity. It can drop the blood sugar in type 2 diabetics, and can interfere with absorption of antibiotics. It can interfere with absorption of copper and iron. Consult a physician if considering taking it regularly or if you get infected with the virus.

  A recent observational study showed taking zinc when a person has a cold may reduce the number of days of illness. However, an even more recent study published in the British Medical Journal found that zinc lozenges had no benefit  in reducing the time to recovery. No studies have been published regarding its use in COVID-19 patients.

  With minimal proof, zinc remains as an unproven treatment for COVID-19. Reference-- Health.com

  Too much zinc has several side effects especially on the gastrointestinal tract, and the lozenges will leave a bad taste in the mouth.

5--Vitamin D

  I have discussed this in previous updates, and unless a person has a deficiency, it has little proven value (similar to high doses of Vitamin C), yet large numbers of people take megadoses of these nutrients as a preventative or when respiratory illness occurs, with no proven value.

  People who do not get adequate direct sun on a regular basis, those who do not drink Vitamin D fortified milk, or take reflux meds regularly. Strict vegans may have low levels of Vitamin D. Certain patients may not absorb adequate levels. A blood test can determine levels. Taking supplements of Vitamin D (especially D3) is often recommended to the above groups.

  Those who do not eat fish, cheese, mushrooms, or egg yolks might also consider supplementation, as that is the best source of natural foods containing vitamin D. Dairy, orange juice, soy milk, oatmeal, and cereals are fortified.

  The body does not make vitamin D without sunlight exposure on a regular basis. Fair skinned people using sunscreen each time they go in the sun do not absorb enough ultraviolet rays to stimulate the skin to produce vitamin D.

  Vitamin D is necessary to absorb calcium, critical in bone growth and prevention of osteoporosis. 

  Again, there are no adequate studies to prove high doses of IV vitamin D has any value in combating COVID-19, and yet doctors frequently prescribe it including President Trump’s doctors. I find no side effects in short courses of high doses in these patients.

  Long term use of too much vitamin D has side effects although relatively rare.

  This pandemic has seen a lot of people go overboard in food supplements thinking they are providing some type of false control of their health. Talk to your doctor if you are in this group.

  The philosophy in treating COVID-19 patients is that their immune system is suppressed and these vitamins and nutrients may boost the body’s immune system.

6--Melatonin

  Melatonin is a hormone secreted by the pineal body deep in the brain. It is activated by light alternated by dark (sleep). It classically is used to treat insomnia, jet lag, and used in shift workers, including people who live half the time on an airline jetting around the world (President Trump). People in the north who spend months in the dark need artificial light to stimulate melatonin.

  It is also known to have certain properties in immuno-regulation as an anti-oxidant and free-radical scavenger .  It protects regulation of cell function. It also has anti-inflammatory capabilities and counters lung damage in viral infections. This unique capability may enhance other treatment modalities such as the cocktail used for President Trump.

  High dose melatonin has been theorized to be valuable in treating COVID-19 patients by playing an important role with the body’s natural immune cells (B and T-cell lymphocyte).

  Is safety profile is also quite good.

7--Famotidine (Pepcid)

Famotidine is a classic over the counter gastric reflux medicine for acid indigestion. However, there are reports that it helps COVID-19 patients.

  A small study reported that patients treated early with this medication had a reduced mortality including reduced inflammatory markers in the blood.

  This medication is an H-2 inhibitor (inhibits receptors that attach the inflammatory marker histamine), however, the mechanism of how it might help these patients is unknown but hypothesized that the virus has something to do with release of histamine, a known inflammatory marker, which most notably is released in respiratory allergies. Since famotidine inhibits histamine release, perhaps, it helps fight the virus in this way.

  President Trump is overweight and a classic person set up for gastro-esophageal reflux of acid causing heartburn, which may be the reason he is taking it. The other reason for President Trump to take it is to prevent stomach side effects created by corticosteroids (called stress ulcers).  

Medpage Today, August 17, 2020

When is a person who has symptomatic COVID-19 safe to stop quarantine?

  The CDC declares a person ready to re-enter society 10 days from the beginning of symptoms to no continued symptoms for 3 days usually 10 days. There can be no fever (without taking aspirin, Tylenol, or other NSAIDs such as ibuprofen, Aleve, etc.).

  What happened to the 2 negative tests before stopping isolation?

  Research has shown that some patients will continue to have positive tests for days or even weeks after symptoms have stopped. It was found that after those 10 days, the virus particles can still shed into the blood stream, but are not infectious. This research is why it is now not recommended by the CDC to get 2 consecutive negative tests before stopping isolation. That ia why Trump’s doctors do not use that PCR test to decide if he is infectious or not.

  However, there are special cases where it is still permissible or demanded, as in patients returning to a nursing care facility, senior facility, etc.

Lingering symptoms do occur

  Lack of symptoms dictates! However, a significant number patients have lingering symptoms including a non-productive cough, shortness of breath, fatigue, etc., so this decision should be discussed with an individual’s doctor, if there is any question. Those with COVID-19 pneumonia will have prolonged respiratory symptoms without being infectious. Permanent damage is also being seen especially in those who have underlying diseases.

Saliva test kit update

  The FDA just recently approved an Emergency Use Authorization for the protocol used at Yale Medical Center for the self test using saliva to diagnose COVID-19 which could be used at home eventually.

   The brand name is SALIVADIRECT and available free of charge to medical groups who want to perform a study following the Yale protocol. When it will be widely available to the public was not stated.

  It is as effective as the nasal swab and what the country has been waiting for. Both nasopharyngeal and saliva tests are both equally accurate. 

NEJM, September 24, 2020

Survival rates for COVID-19 by age groups much better now!!

  Unfortunately, there is no one magic bullet in treating COVID-19. It is a combination of therapies to fight the immunologic effects of COVID-19 on the cellular functions of the body, while boosting the body’s immunologic response against the virus. Also, the body must weather the infection to recover and that period varies especially in those older, and with high risk factors mentioned many times. The learning curve to successful treatment continues!!

  This chart shows the success in treating COVID-19:

The above results of survival are a far cry from reported poor results early in the treatment of this viral infection. This is a tribute to collaboration between hospitals (and countries) sharing success and failures, and has brought about major revisions in the thinking and ultimate treatment of this potentially devastating infection.

  The major portion of positive tests come from young people 18-30, although those who are frequently in groups at any age are still part of the equation. It speaks for itself that even though masks are helpful, just being around a lot of people increase risk.

  Young people with obesity and hypertension are the ones who are at high risk (regardless of age). A JAMA Internal Medicine Journal article (September 9,2020) studied young people 18-34 needing hospitalization (20% who came to the emergency department), and even admittance to the ICU (5%), with intensive respiratory care. 2% of these patients admitted to the ICU die, so no age is really safe if there are high risk factors. Do you these younger people listen???

COVID-19 and pregnancy outcomes; breast milk

  Fortunately child-bearing aged women tend to follow the pattern of their age and are less likely to suffer a serious case with COVID-19, however, not only do they suffer from all the risk factors all age groups do, but they also have special challenges during pregnancy.

  A JAMA study of over 2600 pregnant women presenting to the hospital in labor, 156 (5.8%) tested positive, while 65% of those women were asymptomatic. These women that tested positive were matched against 600 women who tested negative.

  More test positive women presented with pre-eclampsia (7.7% vs 4%), required more Cesarean section, however, maternal outcome, postpartum hemorrhage, and preterm birth did not differ significantly between groups. Health of the babies (Apgar score, etc.) were also similar.

  Outside of pre-eclampsia which includes hypertension, and the complications of this disorder, which can be serious, most other parameters were the same.

  It is common practice to test pregnant women, cautiously monitor progress in the gestational months, and rapid management of gestational diabetes, hypertension, etc. so that as labor approaches there will be less likely complications from delivery.

  Those test positive must follow guidelines for anyone positive, and if symptomatic, early hospitalization for monitoring should be considered especially those with the usual risk factors that increase the severity of the virus.

  For those who have pulmonary complications, the upward pressure on the lungs from a pregnant abdomen may require earlier oxygen therapy, including intubation and mechanical ventilation. JAMA, September 23, 2020

Breast Milk

  A small study was published in JAMA that found only 1 patient out of 20 had a positive test in their breast milk. The one that had a positive test had no viable virus in the culture. Good news, however, there could be concern for contamination in the hospital environment.

Update on vaccine for COVID-19

  The generation of neutralizing antibodies directed at the spike protein of COVID-19 is the basis of mu;yiple vaccine creations in clinical trials and virus neutralization is the basis of potential therapeutic and preventative monoclonal antibodies also currently in clinical trials (ie. Regeneron)

  A recent report in the NEJM studied the immunologic response in older people receiving 2 doses of vaccine 28 days apart. It has been found with other vaccines that the immune response lessens with age. In fact, the flu vaccine for people over 60 is stronger for that reason. However, there is good news for older individuals with this viral vaccine.

  However, comparing the immune response patients who are infected with COVID-19 and hospitalized were found to have a similar response to one of the current RNA--COVID-19 vaccine candidates in older people. This is great news as these individuals need the most protection going forward.

  The levels of neutralizing antibodies was found to be sufficient to protect from the virus. With a vaccine, the key is the level of antibodies after vaccination and serologic memory of T and B cells that can be called up when the body is challenged in the future. The line of memory plasma cells which produce the T and B cell lymphocyte have been found to be long lived and are key to protect against subsequent infectious challenge.

  The second dose is important in calling up the memory cells to prevent future challenges. Side effects were typical of most other vaccines—headache, fatigue, muscle ache, chills, and injection site reactions.

  There is still hope that other common cold coronaviruses may still play a role in the development of a vaccine.

  NEJM, September 29, 2020, JAMA, October 6, 2020

  Everyone should be very hopeful about a safe and effective vaccine, and anyone putting doubt in people’s minds are doing our country a great disservice and encouraging people to refuse vaccination! The FDA will not clear any vaccine until it is ready for primetime.

Priority for administering the vaccine when available

  There will be priority list of those given the vaccine first including first responders, healthcare workers, those with 2 or more comorbiditites or underlying cardiac disease (or other diseases), teachers, daycare workers, workers in high risk conditions, and finally the younger adults (below 60), children, and last the rest of the population.

  There will be hundreds of millions of units available because several of the pharmaceutical companies’ vaccines will be approved and they all have stockpiled the vaccine ready to be administered.

There are still questions to be answered

  The pathway to injury from COVID-19 is still under scrutiny. It is now thought that the primary injury (inflammatory markers) to the lining of organs (especially the lungs) and coagulation defects are the central mediators of lung injury.

  This injury to lining of the alveoli in the lungs (where oxygenation occurs) prevents adequate oxygen levels to be sent throughout the body and the organs, which are injured not only from the lack of oxygen but also the direct cytokine injury to the lining of those organ’s cell lining. The addition of micro-clots injuring the organ’s lining appears to be the other factor causing the primary injury.

  Of course, in patients with underlying cardiac, kidney, liver disease, etc. will show more injury to those organs and that is why those with underlying pre-existing illnesses make up the bulk of those admitted to the ICU, require more intensive therapies, and die at a higher rate.

  It is also known that age over 70 and obesity are singular risk factors even without other underlying illnesses. President Trump was fortunate but without other risk factors, he may have responded to the therapies better than some.

  Long-term side effects are just now being reported, including lingering symptoms after infection (fatigue, cough, shortness of breath, etc.), and permanent lung damage for those on ventilators.

  Limb nerve damage is being reported in those placed in the prone position (face down) while on a ventilator. Those patients have to be given paralyzing drugs to tolerate the tube in their throat and lungs. It is difficult to move these patients when in this position, but the lungs are better ventilated in this position and now is the standard position. Extreme care in mobilizing patients when paralyzed is critical.

Those who wear eyeglasses for extended periods have less COVID-19 infections

  Those who wear glasses (at least in China) have lower infection rates than those who do not according to a Chinese study published in JAMA Ophthalmology, September 16, 2020. Nearsightedness in Chinese occurs in the majority of the population and require corrective glasses. However, those who don’t wear glasses were found (observational only) to have higher rates of infection (31% vs 6%).

  Studies have found that the virus can be cultured in lacrimal sacs.

  It is theorized that people who wear glasses all day do not touch their eyes as often and are less likely to inoculate themselves with virus.

  Studies have shown that the average individual touches their eyes 10X an hour. Tears drain into the nose, and they continue down the airway potentially contaminating the nose and throat.

  It is known there ample numbers of receptors (angiotensin converting enzyme 2) on the cornea for the coronavirus to attach to and enter the body.

  It would appears that protection of the eyes with glasses might reduce the risk of infection from fewer touches. This study did not discuss aerosol contamination of the eyes and surrounding skin nor are there studies proving it. Touching the face and eye area would make the most sense.

Higher mortality in patients with pre-existing psychiatric disorders

  The JAMA Network cited a study of 1700 patients at one hospital with COVID-19, 28% had a pre-existing psychiatric disorder. 19% of those patients died during hospitalization with a mortality rate of 41% at 3 weeks compared to 22% without that pre-existing psychiatric disorder and medical issues as well. These patients were significantly older, white, and with more complicated medical disorders prior to being infected.

Comparison of Flu vs COVID-19 in children

  1. Children with COVID-19 are older (8.4 vs 3.9).

  2. Hospitalizations, intensive care, and ventilator support for both are similar.

  3. Respiratory symptoms are similar, however, systemic symptoms (headache, fever, muscle ache) are more common in COVID-19 compared to Influenza A, while it is similar for COVID-19 and Influenza B.

  It is crtitical children (and adults) must receive the flu vaccine and the COVID-19 vaccine when available. When these symptoms occur, both diseases must be considered and tested for both. Consult your doctor.

 JAMA Network, Sept. 1, 2020

Air Travel Safety

Alcohol and illicit drug consumption rises since lockdown

  It should be no surprise that alcohol consumption increased during the isolation and lockdown of our country. Medscape Internet Medical Journal now has some statistics to prove that point. One study showed a 54% increase in national sales of alcohol and a 262% increase in online alcohol sales.

  The greatest consumption increase came in ages 30-59, women, and whites published in JAMA Network, September 29, 2020.

  Heavy drinking increased by 41% (4 or more drinks). There is great concern that this increase in alcohol consumption will continue or even increase with the reopening of our country.

  Illicit drug use is on the rise as expected, not surprising with isolation. A report from JAMA Network analyzed 150,000 urine specimens for illicit substances. Comparing the percentage of positive tests prior to COVID-19 and during the pandemic found increases of 3% in fentanyl, 4% in cocaine, 1% in heroin, 2% in methamphetamine. The average age of the tests was 46.

  Suicides are also up not only accidental but from isolation, lonliness, and depression.

High death rates in hospitalized patients who develop cardiac arrest

  Patients likely have cardiac issues prior to hospitalization if older. Of 5000 patients in a multicenter study who were admitted to the ICU, 14% developed cardiac arrest and of those patients, 12% survived.

  Respiratory failure and blood clot development were the most common reason for cardiac arrest. Most of these patients developed cardiac irregularities that were amenable to electric shock CPR. Most were older, black, and with more serious underlying disorders.

British Medical Journal, September 30, 2020

B. Healthcare Comparisons from the Presidential Candidates

The healthcare plans for President Trump and former VP Biden will impact the country like never before, because they differ greatly, and I suspect very few people are undecided how they will vote by now, but there are many unanswered questions on both sides.

  The country suffers because of the extreme nastiness of this campaign, the lies, not answering important questions, and making it about the country instead of them.

  Although there is support for drug reform, continuing the current system is at risk including 178,000 people with private insurance losing their insurance should the radical left push Biden to single payer.

  There are still many uninsured, underinsured, and illegals who still jam our emergency facilities and still cost the American people in the end. Biden will include these groups in his proposals. Trump needs to address those groups with some type of catastrophic medical care, in my opinion.  

  Another pressing issue is the narrowness of many medical markets not providing much choice to recipients of these plans including Obamacare plans. Mergers in large medical centers are driving the cost up, and states need to regulate that better. So far, this issue remains.

   The Republicans are concerned that Trump has not created a clear understandable healthcare plan to prevent continued high healthcare costs and address those uninisured or underinsured. Trump basically supports the same medical plans currently used with major improvement in drug pricing and various other regulations. Obamacare will not go away until a better system can be developed. Pre-existing conditions will also not go way regardless of winner.   

  No matter what plan is supported, the cost of healthcare will continue to rise. Who will pay for it is on the table.

  The choice for president has never been clearer (especially looking at the whole picture), and nothing in this report is going to change any minds. But, it is important for all Americans to be informed about what their candidates support. Each voter will live in a very different America in the future, depending on who wins this presidential race.

  The future of our country is at a crossroads of continuing as a capitalistic, free enterprise system, or a socialist run country by more and more government. This is clear!   

   It is no wonder that well over half of the country supports more support from the government but that means only one thing—much higher taxes for those who pay taxes (now less than 50% of the population).

  President Trump’s plan is to stay the course with major efforts to control Big Pharma costs (20% of healthcare costs), among other things is stated below. Biden’s main changes also are below.

  I am sad that some compromise in both plans could not occur, but the personalities on both sides have shown the American public that they need to make less about them and more about us.

  Here are some of the major issues:

The public option

  2/3 of the public support some form of public option to purchase governmental insurance similar to Medicare. Biden’s proposal is opened to those states that have not expanded Medicaid, are uninsured, those on commercial insurance, illegals, and Obamacare recipients. Add dropping the age of Medicare eligibility to 60, and single payer healthcare is around the corner.

  The public option is a slower process to accomplish the same goal….single federal healthcare.

  The private insurance industry has been the only means of hospitals being able to make any profit, since Medicare and Medicaid cannot cover the costs.

Pre-existing conditions

  Both candidates will protect pre-existing conditions, but by expanding Obamacare, it will more easily be protected with Biden’s plan. Trump will have to initiate a mandate to protect pre-existing conditions for newly insured even if Obamacare continues, which most experts say will indeed continue.

  COVID-19 will add a massive number of people with a pre-existing conditions especially with underlying conditions. Not protecting pre-existing conditions would be political suicide.

Obamacare

  Biden proposes a boost to Obamacare by subsidizing more of the cost with taxpayer dollars.

  Obamacare’s financing was based on mandating that all people purchase healthcare plans which was quite expensive for younger healthier people, and since they would not use their healthcare plan very often, it would essentially fund older sicker Americans using much more care. When it was declared unconstitutional, the mandate was removed. However, Obamacare has survived and plays a role in our healthcare system and there is no reason compromise in that type of system could not worked out, if these politicians would work together.

  Remember, President Obama tried to push single federal healthcare initally, but could not get support to pass it, and then his academicians devised the “Affordable Care Act”. Without the federal mandate (declared unconstitutional), it was immediately too expensive.

  Trump opposes Obamacare because of the high cost, not the concept. But what plan is not expensive? Either patients pay or tax payers pay. Again, why not some compromise in this?  

  Subsidizing Obamacare as Biden proposes will cost an estimated $2.5 trillion and add $800 billion to the federal deficit coming from higher taxes to all American tax payers.

 Lower the age of Medicare Recipients to 60

  Biden also proposes to lower the Medicare age to 60 (now 65). This would add 20 million more Americans to  Medicare. 44 million Americans are already enrolled in Medicare, and it is estimated to rise to 79 million by 2030. Add 20 million more for ages 60-64 this year, and double that number by 2030, and we are facing 120 million who would be on Medicare (a third of the country). Trump opposes this because of the significant tax hikes tax payers and the effect on the economy.

  In 2019, Medicare cost $644 billion (14% of the federal budget). Medicare is the second largest program for the federal government according to Medicare.gov.

  Biden’s running mate, Senator Kamala Harris is already a co-sponsor on Medicare-for-all, which according to Senator Elizabeth Warren’s plan will cost $15 trillion over 10 years. That concern is shared by the majority of Americans, although the younger people support a socialized country.

  The majority of Medicare recipients like their plans the way it is (even as expensive as it is), and with the addition of 20 million more recipients from age 60, it will be Medicaid-for-all, not Medicare-for-all, meaning dilution of healthcare and decreased access to care.

  Biden also supports free healthcare to illegals, which is not mentioned but strongly supported by all the primary candidates including Biden and Harris.

  The public option he proposes is starting the process of a single payer program along with the proposed drop in Medicare age to 60.

  Medicare-for-all would also stop Medicare Advantage, a very popular plan currently. It is not known if this public option would allow continuing the Advantage program, a highly successful program especially with healthier seniors.

  As a physician, I continue to be concerned that part of Biden’s plan decreases reimbursement to healthcare providers and hospitals who are currently losing billions because of COVID-19. They are living on the stimulus packages too. How little income does the public think the hospitals and doctors will tolerate before it turns our healthcare upside down?

  According to Hospital Trust Fund Inc., which finances Medicare Part A, states currently Medicare financing will run out of funds in just 6 years unless Congress increases subsidization. Currently the federal government has had to send $billions of dollars to hospitals and doctors to keep their doors open during the pandemic. Crippling private insurance will also devastate the healthcare field unless the federal government subsidizes it in greater amounts.

Lowering copay for those making less than $400,000 per year

  Currently if a family makes less than 400% of the poverty level, they have to pay 9.8% and Biden wants that dropped it to 8.5%.

  Biden would also remove the limit of subsidy to 8.5% for all Americans on Obamacare.

  Since there is no revenue resource for paying the price for these plans, taxes will by necessity rise to cover the cost. There may be cost saving built in these programs, but it will be at the expense of other Americans.

 Stop surprise billing

  Both candidates are in favor of stopping this practice, but Congress did not pass legislation banning the practice of payers, providers, and medical groups from charging when the person was seen by out-of-network doctors, labs, and medical facilities.

  Most Americans were not aware these bills were out of network and therefore were not covered or had much larger deductibles. Both candidates want this to stop, but the Congress must get on board.

  This has become an even more serious issue with so many losing their unemployment insurance and businesses closing by allover the country with loss of employer-based insurance due to the pandemic.

Prescription reform

  Accordng to Kaiser Family Foundation, 1 in 4 Americans are having trouble paying their medication costs. Drug reform is a hard nut to crack for either candidate, because of the strongest lobby in D.C. and a law protecting Big Pharma from having to negotitate pricing. Both candidates want drug reform, especially Medicare drug prices that desperately need negotiating.

  The Congress passed a law protecting Big Pharma from having to negotiate prices for Medicare. In exchange, they agreed on negotiated prices for Medicaid (a drop of about 20% of the cost).

  20% of Medicare overall spending goes toward subsidizing drug costs (mostly in the catastrophic phase of Part D Medicare).

  With paying the same as most countries, there would have been potential saving of $14.6 billion in 2016 alone, according to AARP.

  Both candidates would allow importation of drugs from other countries. Additionally, Biden would cap drug prices to inflation as a condition for Medicare to negotiate prices for public option recipients. Trump supports a similar plan but not the public option proposal.

Trump Plan

  Trump has found it very difficult to enact much legislation because of a Democratic held House of Representatives, and only with executive orders has he been able to enact much reform in healthcare. He has not been successful in repealing and replacing Obamacare, so he has several important proposals to improve the current programs, especially drug pricing.

  Trump strongly support protecting pre-existing conditions.

America First Healthcare Plan  www.hhs.gov

1. Allow the FDA to import drugs from other countries.

2. Executive order to allow Americans to purchase FDA approved drugs at a lower cost.

3. Boost Medicare Advantage--Lower overall premiums by 34.2%; decrease Medicare Part –D (Medicare Drug Plan) premiums by 12.2%. Trump proposes increasing choices of plans and has negotiated 1600 plans to not charge more than $35 for a month supply of insulin, a huge financial burden on the millions of Americans with diabetes.

4. Trump issued a plan through the Health Resources and Services Administration to provide steep discounts for insulin and epinephrine for needy patients including 3 million diabetic centers.

5. Trump supports stopping surprise billing described above. 

Protecting and rebuilding the economy is the most important issue for President Trump, and does not support asking tax payers to pay much more for other people’s healthcare. In his opinion, the economic future of our country cannot progress if those that support industry and the major capacity of our economy are unfairly burden with higher taxes.

Summary

  Just how either winning candidate can accomplish their proposed reforms depends on who wins the Senate and House of Representatives. I know we are all so ready for this election to be over. To say the United States of America is at a crossroad in healthcare and every other aspect of our lives is an understatement. As has been said, it is the most important presidential election in our lifetime. Vote wisely!!! Your future is at stake!!