Happy Friday! August has arrived, which means lawmakers have officially blown this pop stand of a humid swamp and headed back home. A quick programming note: I’ll be following their lead, which means the Breeze will be on a brief hiatus for Aug. 9 and Aug. 16. I’ll be back in your inboxes on Aug. 23, so don’t miss me too much.
Now that housekeeping is out of the way, here’s what you may have missed this week.
To the shock of no one, both nights of the Democratic debates heavily featured attacks over health care, which has become an almost shorthand for the division in the party between progressives and moderates.
On Night 1, Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt.) stood like unmovable twin pillars defending “Medicare for All” against jabs from their rivals. The progressive health care plan was slammed as “political suicide” and an overreach in which the left might as well “FedEx the election to Donald Trump.” The conversation dominated the entire first half-hour of the debate, a sign of just how volatile the issue is — and how it’s unlikely to fade into the shadows anytime soon.
The second night pitted former Vice President Joe Biden against Sen. Kamala Harris (D-Calif.), who had just earlier in the week released her own health plan. (The SparkNotes: It keeps private insurers but also expands Medicare and would be phased in over 10 years.) The barbs weren’t quite as sharp on the second night, but the clear divide between the flanks of the party was solidified.
Other notable things coming out of the debate nights:
• Why aren’t the candidates talking about preexisting conditions? Is there just too much else going on? The issue helped create a cohesive, easy-to-understand message for the Democrats during the midterms, yet it took until Night 2 before the popular topic was mentioned in any of the debates.
• The temperature has most definitely shifted on gun control in the past 10 years. Even moderate Montana Gov. Steve Bullock spoke about the need to remove the NRA’s influence from D.C. (note: that was taken by some as a sidestep from having to comment on restrictions, but he didn’t shy from the topic completely as candidates have in elections past).
• What was missing? Opioids, Flint (for the most part) and drug prices. Although this week’s debates took place in Detroit, not far from Flint, the water crisis got only a brief mention. The country is being ravaged by the opioid epidemic, yet it’s been mentioned by candidates only in passing. And even the perennial hot topic of high drug prices didn’t spark any memorable moments. We are only four debates in, though, so we’ll check back in September.
For comprehensive roundups of fact checks, hot takes and play-by-plays, check out these Morning Briefing pages.
Meanwhile, insurers are having to perform a delicate tightrope act as the Democrats put them on blast on a national stage. They want to fight these plans but also stay out of the spotlight in case investors start getting jittery about the prospects of a Medicare for All-type proposal actually passing.
Medicare has become the belle of the ball for Democrats, but what is the program really like? Yes, Medicare is popular, but its has its own limitations and is unlikely to be a panacea for all the health industry’s woes. The truth is, there are important things that Medicare currently doesn’t cover, and the program allows for a lot of low-value care.
Nowadays, if a candidate supports a public option instead of Medicare for All they’re viewed as a moderate, but that wasn’t always the case. Historically, a public option was a “very progressive policy.”
The Trump administration — some say in an effort to gain ground on health care for 2020 — had two big announcements this week.
The first came in the shape of a federal rule that would force hospitals to publicly disclose the closely guarded discounted prices they negotiate with insurance companies. The requirement is part of a broader strategy that we’ve seen from the administration that focuses on increasing transparency. Critics of the tactic say that because of health care’s unique and complex makeup, those newly disclosed numbers can be meaningless to patients.
Trump also managed to hang onto headline space amid the two-night debate extravaganza with the announcement that HHS will set up a system so Americans can import cheaper drugs from Canada. This was an about-face for Secretary Alex Azar, who just a year ago called importation a “gimmick.” Don’t think this is going to be a free-for-all, though. There are quite a few limitations in place. “This is a plan to make a plan on importation,” said Rachel Sachs, a law professor and drug policy expert.
Meanwhile, Canadians are like, “Excusez-moi? Keep your mitts off our prescription drugs, please and thank you.”
Despite the national outrage over family separations and promises from government officials that they’re now “rare,” new data shows nearly 1,000 children have been taken from their parents since the separations were ordered stopped. Although officials have said they take the children only when their safety is in question, a look at the reasons documented in the new report call that assertion into question. Among the cases was a man who hadn’t changed his sleeping daughter’s wet diaper and a father who lost his child because of a conviction on a charge of malicious destruction of property with alleged damage of $ 5.
The always hotly anticipated annual hospital rankings from U.S. News & World Report dropped this week. The Mayo Clinic in Rochester, Minn., nabbed the top spot on the adult honor roll, while Boston Children’s Hospital ranked first on the children’s list.
In the miscellaneous file for the week:
• In the months since the Paradise fire, I’ve read some great play-by-plays, but this one is particularly enthralling. This particular tidbit grabbed me: When talking about giving fire safety tutorials to kids, Paradise emergency operations coordinator Jim Broshears said you’ll always get a student who keeps asking about more and more complicated scenarios.
“At some point, they’ve painted you into a corner and, well, do I tell an 8-year-old kid, ‘In that case, you’re going to die?’ Do you tell a community, ‘If this particular scenario hits, a bunch of you are going to die?’ Is that appropriate? I don’t know the answer.” He added, “I think that people are going to conclude that now.”
• It’s a common enough image to call up: a boot camp drill sergeant yelling at a soldier, loaded to the gills with gear, to push through the heat. But what happens when that scenario turns fatal? It’s an issue that’s becoming more urgent as temperatures continue to rise, yet an investigation shows that efforts to prevent deaths have been uneven at best.
• What happens to patients when the price of a month’s supply of a crucial psychiatric drug jumps from $ 16 to $ 348? “We were seriously looking at dog clomipramine for a patient of mine with OCD,” one psychiatrist said in response to the price hikes on the 55-year-old drug. The example highlights the human toll of what investigators have called one of the most “egregious and damaging price-fixing conspiracies” in U.S. history.
• Another NYPD police officer committed suicide, bringing the total since June up to five. The commissioner had already declared a mental health crisis before this last death and urged officers to reach out and seek help.
That’s it from me! Have a good weekend, and beginning of August!