The political battle for universal healthcare within the White House was long, epic and personal.
“Each time I met a parent struggling to come up with the money to get treatment for a sick child, I thought back to the night Michelle and I had to take three-month-old Sasha to the emergency room for what turned out to be viral meningitis,” former President Barack Obama recalled in an excerpt from “A Promised Land,” the forthcoming first volume of his memoirs of his time in the White House. The excerpt was published Monday in the New Yorker.
“I remembered the terror and the helplessness we felt as the nurses whisked her away for a spinal tap, and the realization that we might never have caught the infection in time had the girls not had a regular pediatrician we felt comfortable calling in the middle of the night,” he continued. “Most of all, I thought about my mom, who had died in 1995, of uterine cancer.”
The chapter — which offers an inside look into the passage of Obamacare at the end of the former president’s first year in office — comes at a crucial moment for his signature piece of legislation, as its future could be threatened by the expected confirmation on Monday of Judge Amy Coney Barrett to the Supreme Court.
“In the middle of a pandemic, this administration is trying to dismantle the Affordable Care Act in the Supreme Court,” Obama said on Twitter Monday while presenting the excerpt. “Here’s how Joe and I fought to expand healthcare, protect millions of Americans with preexisting conditions, and actually get it done.”
The journey toward passage was messy and prone to second-guessing, particularly from Obama’s closest allies: David Axelrod, his advisor, and Rahm Emanuel his chief of staff, who warned him of the political hazards: “[This] can blow up in our faces.”
In the middle of a pandemic, this administration is trying to dismantle the Affordable Care Act in the Supreme Court. Here’s how Joe and I fought to expand health care, protect millions of Americans with preexisting conditions, and actually get it done: https://t.co/U9RbHRLPBw
Emanuel warned Obama that the process of getting the bill passed would lead to unpleasant compromises and a potentially huge backlash. “Making sausage isn’t pretty, Mr. President,” he told his boss. “And you’re asking for a really big piece of sausage.”
In another passage, Obama writes about the rise of the Tea Party movement, which became harder for him to ignore, especially when it resurrected an old rumor from Obama’s campaign days: that he was Muslim and born in Kenya, which would have barred him from serving as president. This lie would eventually be used by Donald Trump to consolidate the base that would help make him Obama’s successor.
WASHINGTON — The strange sound came at night: a crack like a marble striking the floor of the apartment above them.
Mark Lenzi and his wife had lightheadedness, sleep issues and headaches, and their children were waking up with bloody noses — symptoms they thought might be from the smog in Guangzhou, China, where Mr. Lenzi worked for the State Department. But air pollution could not explain his sudden memory loss, including forgetting names of work tools.
What began as strange sounds and symptoms among more than a dozen American officials and their family members in China in 2018 has turned into a diplomatic mystery spanning multiple countries and involving speculation about secret high-tech weapons and foreign attacks.
One of the biggest questions centers on whether Trump administration officials believe that Mr. Lenzi and other diplomats in China experienced the same mysterious affliction as dozens of diplomats and spies at the American Embassy in Cuba in 2016 and 2017, which came to be known as Havana Syndrome. American employees in the two countries reported hearing strange sounds, followed by headaches, dizziness, blurred vision and memory loss.
But the government’s treatment of the episodes has been radically different. The State Department, which oversaw the cases, has produced inconsistent assessments of patients and events, ignored outside medical diagnoses and withheld basic information from Congress, a New York Times investigation found.
The State Department soon retreated, labeling what happened in China as “health incidents.” While the officers in Cuba were placed on administrative leave for rehabilitation, those in China initially had to use sick days and unpaid leave, some officers and their lawyers say. And the State Department did not open an investigation into what happened in China.
The administration has said little about the events in China and played down the idea that a hostile power could be responsible. But similar episodes have been reported by senior C.I.A. officers who visited the agency’s stations overseas, according to three current and former officials and others familiar with the events.
That includes Moscow, where Marc Polymeropoulos, a C.I.A. officer who helped run clandestine operations in Russia and Europe, experienced what he believes was an attack in December 2017. Mr. Polymeropoulos, who was 48 at the time, suffered severe vertigo in his hotel room in Moscow and later developed debilitating migraine headaches that forced
OAKLAND — In initiative-happy California, one set of ads stands out — those involving dialysis clinics, an industry that’s historically been a lower-profile player in politics.
The ads are unusual not only because of their unlikely topic but their volume, which is high because industry opponents of a labor ballot measure are spending more than any group opposing the other 11 proposals California voters must decide on.
The massive spending gap between the $100 million opponents, including DaVita Inc., have raised and the $8.9 million by supporters led by SEIU United Healthcare Workers West means that the dialysis industry has flooded airwaves as it defends itself against organized labor. The same chain of events played out two years ago, resulting in a resounding defeat for the union’s ballot initiative.
California’s ballot wars have escalated in recent years as industries see little problem spending more than $100 million — and nearly twice that amount in the gig industry’s case — to persuade the electorate. Businesses and organizations that don’t get their way in the state Capitol often use the ballot to change state laws or as leverage to pressure lawmakers and other powerful interests. Proposition 23 is the third most expensive ballot initiative in 2020, according to data compiled by POLITICO.
While SEIU-UHW says it is committed to passing Prop 23, political strategists suggest that labor backers may simply be playing the long game by placing an initiative on the ballot every two years challenging the industry. Win or lose, the union is putting pressure on dialysis companies to spend gobs of money each general election.
“The threat of a ballot measure is something UHW has used strategically,” said Brian Brokaw, a Democratic strategist in Sacramento who is not involved in the Prop. 23 campaign. “In order for a threat to actually be credible, sometimes you have to put it on the ballot. But appearing on a ballot and actually running a campaign to support something are two different things.”
Proposition 23 faces long odds not just because of the industry’s $100 million war chest, but also because it involves a regulatory matter on a crowded ballot — a perfect recipe for voter rejection.
Two years ago, Californians voted 60-40 to reject Prop. 8, another SEIU-UHW-backed initiative that would have capped dialysis profits. But to get that win, the dialysis industry, led by the dominant franchises DaVita Inc. and Fresenius Medical Care, invested about $111 million to defeat it, or nearly six times what the proponents spent.
One day after that Nov. 6, 2018 election, the union vowed to refile the initiative in California and other states. SEIU-UHW did file another initiative, but Prop 23 looks dramatically different, focusing on requirements that clinics must meet such as staffing one doctor on site.
John Logan, director of labor employment studies at San Francisco State University, said unions have long used non-traditional tactics like ballot-box campaigns to get
The singer, 69, who is known for hits like “Arthur’s Theme (Best That You Can Do)” and “Sailing,” told CBS Sunday Morning that while he’s doing fine these days, his bout with COVID-19 earlier this year nearly killed him.
“There was some, you know, come-to-Jesus moments or whatever, where I was looking for any help I could get, you know, through this, to get outta this thing,” Cross told correspondent Serena Altschul. “‘Cause I wasn’t sure.”
When asked by Altschul when he thinks he was exposed, Cross said he assumes it was on a trip to Mexico.
“It was early March that I went to Mexico City for a concert,” he recalled. “And, to be frank, you know, nobody knew about masks or anything like that. No one wore masks on the plane. No one was doing that. We weren’t made aware that it was a problem.”
Along with his girlfriend Joy, Cross got very sick, and was left laid up at home for several weeks.
“We both got very sick with COVID,” he said. “We were sick for about three weeks. The biggest thing I remember is just incredible malaise — just, you couldn’t lift your head.”
Cross revealed his diagnosis on April 3 in a lengthy Facebook post, and advised those who weren’t taking the virus seriously to do so from now on.
“For those of you who still do not believe the COVID-19 virus is real, or think it is a ‘hoax’ or part of some conspiracy,” he wrote at the time, “my advice to you is to understand right now that this is a deadly illness spreading like wildfire throughout the world.”
While Cross soon felt he was on the mend, the virus proved to take more out of him than he realized.
“I went to the market. Then when I got home, I just, my legs just gave out,” said Cross. “That was it. Couldn’t walk at all.”
He was soon diagnosed with Guillain-Barré Syndrome, an illness where the body’s immune system attacks the nerves. Cross says his doctor believes the disease was caused by COVID-19. As his body struggled with the virus, he found himself hospitalized and unable to walk.
“You know, just, boom, I’m paralyzed. I’m in the hospital, but I can’t turn over. I can barely do anything,” said Cross. “My hands were also paralytic, which is hard, ’cause I play the guitar, of course. I wasn’t sure whether I would get that back.”
Cross calls his period of hospitalization “the worst 10 days of my life.”
“I couldn’t walk, could barely move. And so, it was certainly the darkest of times for me, you know?” he said. “It was really touch-and-go, and tough.”
When asked by Altschul what he was saying to himself during those horrifying moments in
Our health-care system is experiencing rapid, powerful change, far more consequential than is generally recognized. Although these changes are welcomed by many in the health-policy community (see our assessment a year ago), even those who applaud them have been surprised at their speed and impact.
What follows is a brief overview of what the Trump administration has done to reform the health-care system — in some cases, with the compliant help of Congress. The vision behind the Trump reforms can be found in Reforming America’s Healthcare System Through Choice and Competition. This 124-page Health and Human Services document from 2018 argues that the most serious problems in health care arise because of government failure, not market failure.
In pursuing its vision, the administration has aggressively pursued its options under current law. We now need Congress to make the revolution complete.
Virtual Medicine. The ability to deliver medical care remotely is growing by leaps and bounds. It promises to lower medical costs, increase quality, and reduce the time and travel cost of patient care. For example, most people in hospital emergency rooms don’t really need to be there. With a phone or a computer and an app or two, many of them could be examined and triaged in their own homes.
The benefits of telehealth have been known for a long time. Yet as we entered 2020, it was illegal (by act of Congress) for Medicare doctors to consult with their patients by phone or email, except in rare circumstances. Even non-Medicare patients were constrained. For example, it wasn’t clear if visual communication by Zoom or FaceTime satisfied the federal government’s privacy regulations. While some state governments were clearing away barriers, progress was incremental and uneven.
Two things made radical change possible: COVID-19 and the Trump administration. Sweeping away the regulatory barriers to telehealth was not a simple act. There are roughly 7,500 procedures that Medicare pays doctors to do. The Centers for Medicare & Medicaid Services (CMS) had to sort through those and determine which were candidates for virtual medicine and which were not. There were also the questions of whether a virtual visit would pay doctors the same as an office visit, and whether an audio visit would pay the same as an audio/visual visit.
Fortunately, CMS had already been sorting through those problems in the first three years of the Trump administration, for example allowing Medicare patients to use telehealth to determine if an office visit was necessary and allowing patients to send medical pictures to their physicians electronically. CMS also allowed great leeway for telehealth in the Medicare Advantage program. So when COVID struck, the administration was ready. Congress was only too willing to let the administration do what it had wanted to do all along. State governments also got on board, not only loosening prior restrictions but also, in many cases, allowing doctors to practice across state lines.
The take-up by doctors and patients has been nothing short of breathtaking. According to