“In politics you can tell your friends from your enemies, your friends are the ones who stab you in the front”.* Look at what the Republicans are saying about each other now about health care

First prize goes to..
“Sen. Ron Johnson suggested that fellow Republican Sen. John McCain’s brain tumor and the after-midnight timing of the vote were factors in the Arizona lawmaker’s decisive vote against the GOP health care bill.
In a radio interview Tuesday with AM560 ‘‘Chicago’s Morning Answer,’’ Johnson answered questions about the collapse of the years-long Republican effort to repeal and replace Barack Obama’s Affordable Care Act, his criticism of the process and McCain’s dramatic vote…
‘‘He has a brain tumor right now. That vote occurred at 1:30 in the morning. Some of that might have factored in,’’ Wisconsin’s Johnson said.
That surprised the interviewer, who asked, ‘‘Really?’’ and wondered whether the senator’s illness and the late night affected his judgment.
Johnson said he didn’t want to speak for any other senator, ‘‘I don’t know exactly what. … I really thought John was going to vote yes.’’ (A)

And tied for second place…
President Trump and Senate Majority Leader Mitch McConnell (R-Ky.) are publicly criticizing one another as Republicans point fingers over why they have struggled to score political wins.
The public shots between the GOP president and Senate leader follow growing conservative criticism of McConnell, who has become a target for two right-wing candidates in an Alabama Senate race.
Conservatives suspicious of McConnell have used his failure to win a victory on ObamaCare repeal against him.
And they’ve found an ally, at least temporarily, in Trump.
“Senator Mitch McConnell said I had ‘excessive expectations,’ but I don’t think so,” the president said on Twitter Wednesday. “After 7 years of hearing Repeal & Replace, why is it not done?”…
Trump was responding to McConnell’s remarks in Kentucky that the president’s “excessive expectations” were partly to blame for the perception that Republicans hadn’t accomplished anything.
“Our new president has of course not been in this line of work before and I think had excessive expectations about how quickly things happen in the democratic process,” McConnell said during a Rotary Club event. (B)

“President Donald Trump resumed his public feud with Senate Majority Leader Mitch McConnell Thursday over his party’s failure to repeal and replace the Affordable Care Act, a sign of the fraught relationship between two branches of government that are both controlled by Republicans.
“Mitch, get back to work and put Repeal & Replace, Tax Reform & Cuts and a great Infrastructure Bill on my desk for signing. You can do it!” Trump tweeted, his third tweet in two days calling out the Senate majority leader.
“Can you believe that Mitch McConnell, who has screamed Repeal & Replace for 7 years, couldn’t get it done…”
The tweets continues a public exchange of criticism between the two GOP leaders this week, exhibiting further tension between the White House and Congress, both of whom have an ambitious policy agendas that have struggled to make progress. On Tuesday, McConnell said Trump had “excessive expectations” for the legislative process and suggested there was a false perception that Congress is underperforming in part “because of too many artificial deadlines unrelated to the reality of the legislature, which may have not been understood.”… (C)

“The phone call, first reported by The New York Times, and comments at Bedminster mirror what Trump has said in private, according to four White House officials and Trump friends: that he is preparing to distance himself from Republicans in Congress if they aren’t successful in passing legislation and that he will not take the blame for them if they can’t.
Increasingly, these people say, the president is prepared to cast himself as an outsider — and Congress as an “insider” Washington institution. He has reminded advisers his poll numbers are higher than Congress’ and that he ran against Washington — and wants bills to sign — and will blast his own party if he doesn’t get them. Trump believes that his supporters will largely blame Congress instead of him, two people who have spoken to him said.” (D)

*attributed to many

(A) GOP senator suggests brain tumor affected McCain health care vote. By By Donna Cassata, https://www.bostonglobe.com/news/politics/2017/08/09/gop-senator-suggests-brain-tumor-affected-mccain-vote-health-care/QIo1YCJazIFTB05GMnGGpL/story.html
(B) McConnell, Trump point fingers, by Jordain Carney, http://thehill.com/homenews/senate/345980-mcconnell-trump-point-fingers
(C) Trump to McConnell in third tweet: ‘Get back to work,’ ‘You can do it!’, by Ashley Killough, http://www.cnn.com/2017/08/09/politics/mitch-mcconnell-dan-scavino/index.html
(D) Behind the Trump-McConnell feud, by JOSH DAWSEY, http://www.politico.com/story/2017/08/10/trump-mcconnell-gop-feud-241508


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“For most of my surgical career, I gave out opioids like candy….” “With approximately 142 Americans dying every day”….” We need to take away the matches, not put out the fires.”

“President Donald Trump on Tuesday vowed his administration would beat the opioid epidemic by beefing up law enforcement, strengthening security on the southern border to stop illegal drugs from entering the country.
Trump, joined in Bedminster, New Jersey, by Health and Human Services Secretary Tom Price and other administration officials, emphasized a tough law-and-order approach, rather than new treatment or social programs, as the White House’s primary strategy for halting an epidemic that kills 142 Americans every day, according to federal statistics. (A)

“President Trump declined yesterday to declare the opioid epidemic sweeping the United States a national emergency, despite a recommendation last week by his own commission. Trump’s top health administrator, Health and Human Services Secretary Tom Price, argued that extra step wouldn’t have helped much anyway — and experts tend to agree. (B)

“How did this happen?
In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive. Opioid overdose rates began to increase. In 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid. That same year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 591,000 suffered from a heroin use disorder (not mutually exclusive). Here is what we know about the opioid crisis:
Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them; Between 8 and 12 percent develop an opioid use disorder; An estimated 4 to 6 percent who misuse prescription opioids transition to heroin; About 80 percent of people who use heroin first misused prescription opioids.
This issue has become a public health crisis with devastating consequences including increases in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid use and misuse during pregnancy. The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and hepatitis C. As seen throughout the history of medicine, science can be an important part of the solution in resolving such a public health crisis.” (C)

President Trump’s commission on the opioid crisis asked him Monday to declare a national emergency to deal with the epidemic.
The members of the bipartisan panel called the request their “first and most urgent recommendation.”
Mr. Trump created the commission in March, appointing Gov. Chris Christie of New Jersey to lead it. The panel held its first public meeting last month and was supposed to issue an interim report shortly afterward but delayed doing so until now. A final report is due in October.
“With approximately 142 Americans dying every day, America is enduring a death toll equal to Sept. 11 every three weeks,” the commission members wrote, referring to the 9/11 terrorist attacks. “Your declaration would empower your cabinet to take bold steps and would force Congress to focus on funding and empowering the executive branch even further to deal with this loss of life.”
In addition to seeking an emergency declaration, the commission proposed waiving a federal rule that sharply limits the number of Medicaid recipients who can receive residential addiction treatment.
It also called for expanding access to medications that help treat opioid addiction, requiring “prescriber education initiatives” and providing model legislation for states to allow a standing order for anyone to receive naloxone, a drug used to reverse opioid overdoses. (D)

“Drug wholesalers shipped 780 million hydrocodone and oxycodone pills to West Virginia in just six years, a period when 1,728 people fatally overdosed on these two painkillers, according to an investigation by the Charleston Gazette-Mail.
That amounts to 433 of the frequently abused opioid pills for every man, woman and child in the state of 1.84 million people….
The drug distributors say they’re just middlemen in a highly regulated industry and that pills would never get in the hands of addicts and dealers if not for unscrupulous doctors who write illegal prescriptions, and pharmacists who turn a blind eye. (E)

“My own “Aha!” moment came recently after my father had gallbladder surgery and recovered comfortably at home with a single ibuprofen tablet. Wow. It directly contradicted my residency training 15 years ago, when I was taught to give every surgical patient a prescription for 30 to 90 opioid tablets upon discharge. Some of my mentors told me that overprescribing prevents late night phone calls asking for more. The medical community at that time ingrained in all of us that opioids were not addictive and urged liberal prescribing. So that’s exactly what we did.
The hundreds of excessive opioid prescriptions I wrote in 2015 alone (the last year for which national data are available) were a tiny part of the country’s 249 million opioid prescriptions filled that year, almost one for every American adult. Last year, America produced 14 billion opioid pills (40 for every U.S. citizen), mostly paid for by the American public in the form of tax dollars or increasing health insurance premiums.
Take C-section for example, one of the most common operations paid for by Medicaid tax dollars. Some doctors appropriately prescribe five to 10 opioid tablets after the procedure (in combination with non-opioid meds as recommended by the American Pain Society), while other doctors are still doing what I did for years — give every patient a bottle of 30-60 highly addictive opioid tablets. (F)

(A) Trump says he’ll beat opioid epidemic with law-and-order approach, by BRIANNA EHLEY, http://www.politico.com/story/2017/08/08/trump-opioid-epidemic-heroin-241416
(B) The Health 202: Trump doesn’t need to declare the opioid crisis a national emergency, by Paige Winfield Cunningham, https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2017/08/09/the-health-202-trump-doesn-t-need-to-declare-the-opioid-crisis-a-national-emergency/5989eb7530fb045fdaef11bf/?utm_term=.ed73a64ab6bb
(C) Opioid Crisis, https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis
(D) White House Panel Recommends Declaring National Emergency on Opioids, by ABBY GOODNOUGH, (A https://www.nytimes.com/2017/07/31/health/opioid-crisis-trump-commission.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0
(E) Probe reveals flood of 780M painkillers in 6 deadly years in West Virginia, http://www.cbsnews.com/news/probe-780-million-painkillers-in-6-years-west-virginia/
(F) Doctors like me must stop overprescribing opioids, by Marty Makary, https://www.nytimes.com/2017/07/31/health/opioid-crisis-trump-commission.html?smprod=nytcore-ipad&smid=nytcore-ipad-share&_r=0

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“.. here’s the first thing I thought about: feel better, Hillary Clinton could be president..” (Senator McConnell) (A) “McCain Voted Against Health Care Bill…Because it Would ‘Screw’ Arizona.” (B)

Despite President Trump’s call to let Obamacare implode its unlikely come September that the Republicans in Congress, many facing reelection, will let Obamacare fail.
Here’s a wrap up as Congress goes on vacation.

“After the failure early Friday of the latest Republican plan to repeal the Affordable Care Act, President Trump said that he wants to “let ObamaCare implode, then deal.” Mr. Trump has already been doing three things to undermine important provisions of the health law, and there is more he could do.
What Trump can do: Weaken enforcement of the individual mandate; Impose work requirements for Medicaid recipients; Fail to do advertising or outreach; Make tax credits for premiums less generous; Defund subsidies that help people pay out-of-pocket costs; Redefine essential health benefits.” (C)

The politics are exceedingly tricky in a divided and dysfunctional Washington, but economists, insurers, doctors and health policy experts across the political spectrum agree that immediately addressing three or four basic shortcomings in the existing system would go a long way toward making the law more effective and financially stable. Stabilize the Markets. Reduce Drug Prices. Expand Access for Poor. (D)

“In an attempt to hit Republicans where it counts, Trump on Monday morning tweeted, “If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?” It was at once an effort to threaten insurers about withholding Obamacare cost-sharing reduction payments and to threaten Congress about the special treatment it receives under Obamacare.”(E)

‘The first part of Trump’s tweet appeared to be referring to the approximately $8 billion in cost-sharing reduction subsidies the federal government pays to insurers to lower the price of health coverage for low-income Americans.
The second part appeared to be a threat to end the employer contribution for Congress members and their staffs, who were moved from the normal federal employee health-care benefits program onto the Obamacare insurance exchanges as part of the 2010 health-care law.’ (F)

“Finance Committee Chairman Orrin Hatch of Utah, whose panel oversees both health care and tax policy, said he was ready to tackle taxes. “I think we are moving on to tax reform but that doesn’t mean we can’t do more than one thing at a time,” he said, adding that Senate Republicans should not vote on health care again unless there is “a reasonable chance of success.”” (G)

“A group of around 40 House Republicans and Democrats known as the Problem Solvers Caucus has endorsed an outline of ideas aimed at making urgent fixes to Obamacare. While there is no legislative text yet, members in the caucus are moving quickly to seize the defeat of a Senate bill last Friday to garner broader support for their proposals — and force the GOP to ditch its quest to gut the current health care law once and for all.
The group’s proposal includes mandatory funding for cost-sharing reduction payments; the creation of a stability fund; a repeal of the medical device tax; and increasing the employer mandate’s threshold so that companies with 500 employees or more, rather than 50, are required to provide workers with health insurance.” (H)

“The apparent demise of the Republican drive to scrap the Affordable Care Act may open the door to bipartisan fixes to the law. If it does, some of the proposals being touted by a bipartisan group of governors may get a hearing on Capitol Hill….
For example, the governors want the federal government to continue to provide subsidies to low-income Americans so they can afford to purchase insurance on the marketplaces. In 2017, the federal government is expected to give tax credits totaling $38 billion to about 9 million people.
The governors also insist that at least through 2018, the federal government should continue to make it easier for lower-income Americans who purchase coverage on the marketplaces to afford out-of-pocket expenses.” (I)

“Sen. Lamar Alexander, R-Tenn., the influential chairman of the Senate Health, Education, Labor and Pensions Committee, announced Tuesday that his panel would begin work in early September on legislation to “stabilize and strengthen the individual health insurance market” for 2018. He publicly urged Trump to continue making payments to health insurance companies to reimburse them for reducing the out-of-pocket medical expenses of low-income people.
In the House, two Republicans, Reps. Tom Reed of New York and Charlie Dent of Pennsylvania, teamed up with Democrats to promote incremental health legislation that also would fund the cost-sharing subsidies.
The two moves were a remarkable response to the president’s repeated threats to send health insurance markets into a tailspin. They offered tangible indications of cooperation between the parties after Republican efforts to scrap the Affordable Care Act collapsed in the Senate last week, all but ending the seven-year Republican quest to overturn President Obama’s signature domestic achievement. Lawmakers from both parties concede that the health law needs improvement, as consumers face sharp premium increases and a shrinking number of insurance options in many states.” (J)

“Independent health-care experts agree that the Affordable Care Act has resulted in the lowest percentage of uninsured Americans ever and the slowest rate of inflation in health-care spending in 50 years. Incentives in the law are improving the quality of care, Medicare beneficiaries have saved nearly $27 billion on prescription drugs, nearly 600,000 unnecessary hospital readmissions have been prevented and the cost of premiums in the individual market today is almost exactly where the Congressional Budget Office predicted it would be eight years ago. The law is also projected to reduce federal deficits by more than a trillion dollars in coming years.
That’s an impressive record, but serious repairs are needed. While most marketplaces are stable, some are in danger of collapse. Costs are still too high for many families, and uncertainty over federal policy is making it treacherous for plans to price premiums accurately.
Both Republicans and Democrats have already proposed remarkably similar solutions targeted to solve these problems. They are affordable, not technically difficult to implement and would help families in all parts of our country. And they demonstrate that the law — and all the good it has done — doesn’t need to be destroyed to make needed improvements.” (K)

(A) McConnell on healthcare failure: ‘Feel better, Hillary Clinton could be president’, by JULIA MANCHESTER, http://thehill.com/homenews/senate/345464-mcconnell-after-healthcare-failure-feel-better-hillary-clinton-could-be
(B) McCain Voted Against Health Care Bill…Because it Would ‘Screw’ Arizona, by Cortney O’Brien Cortney O’Brien, https://townhall.com/tipsheet/cortneyobrien/2017/08/02/why-mccain-voted-against-health-care-bill-n2363645
(C) 3 Things Trump Is Already Doing to ‘Let Obamacare Implode’, by By HAEYOUN PARK and MARGOT SANGER-KATZ, https://nyti.ms/2vDytIK
(D) How to Repair the Health Law (It’s Tricky but Not Impossible), By REED ABELSON, ABBY GOODNOUGH and KATIE THOMAS, https://www.nytimes.com/2017/07/29/health/aca-obamacare-repeal-how-to-fix-health-care.html
(E) Daily on Healthcare: Angry Trump demands GOP Senate pass healthcare bill … but McConnell’s fundamental problem remains, by Philip Klein and Robert King and Kimberly Leonard, http://www.washingtonexaminer.com/daily-on-healthcare-angry-trump-demands-gop-senate-pass-healthcare-bill-but-mcconnells-fundamental-problem-remains/article/2176736
(F) Trump threatens to end insurance payments if no health-care bill, https://www.cnbc.com/2017/07/30/trump-threatens-to-end-insurance-payments-if-no-health-care-bill.html
(G) Dejected Republicans on Obamacare repeal: Barring a miracle, ‘it’s over’, By Lauren Fox, MJ Lee and Ted Barrett, http://www.cnn.com/2017/07/31/politics/future-of-health-care/index.html
(H) After collapse of Obamacare repeal in the Senate, growing calls for bipartisanship, MJ LeeDeirdre Walsh Profile, by MJ Lee and Deirdre Walsh, http://edition.cnn.com/2017/07/31/politics/senate-health-care-bipartisanship/index.html
(I) A Bipartisan Health Care Fix? Governors Have Some Ideas, http://www.huffingtonpost.com/entry/a-bipartisan-health-care-fix-governors-have-some-ideas_us_59808b02e4b07c5ef3dc1827
(J) Congress bypasses Trump on health care, by Robert Pear and Thomas Kaplan, http://projects.registerguard.com/rg/news/local/35822579-75/congress-bypasses-trump-on-health-care.html.csp
(K) How Congress can get a second chance on health care, by Nancy-Ann DeParle and Phil Schiliro, http://projects.registerguard.com/rg/news/local/35822579-75/congress-bypasses-trump-on-health-care.html.csp


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Is Chief Innovation Officer an oxymoron? Innovation is cultural not structural.

“Back in the day” Chief Medical officers were all men and you could tell when a new CMO had lost touch with his clinician peers when he started wearing suspenders and bow ties to look CEOish.
Almost by definition, the same is likely to happen with Chief Innovation Officers.

Here’s one description of a Chief Innovation Officer in a job posting:
The Chief Innovation Officer is responsible for managing the innovative processes within the organization that identifies strategies, business opportunities and new technologies. Develops new capabilities and architectures with partners, new business models….” (A)

As a doctoral student at the UNC School of Public in the early 1970s I was mentored by two of the thought leaders on the “diffusion of Innovation”, Drs. James E. Veney and Arnold Kaluzny. (B) There work is still a gold standard.

The innovation literature identifies a continuum of organizational innovation types, which can easily be applied to health care organizations. (C)
Innovators: When a product is put on the market the first individuals to buy the product are the ‘innovators’. This small group of people wants to be the first to try the product and they are willing to take risks. These exclusive users in this group are therefore trend setters. Subsequently, the product will become increasingly popular and sales will increase.
Early adapters: Just like the innovators, the early adapters like to try out new things and they are not afraid to invest in new products. This group is significantly larger than the ‘innovators’ group and often they already know much about the new product. Because of this knowledge they play an important role in word- of- mouth advertising with respect to the new product as a result of which sales will increase strongly.
Early majority: The early majority group loves trends, but prefers to wait and see before making a purchase. The product will be bought in droves by this group of people. The product will become extremely popular and this will cause a landslide in demand.
Late majority: The late majority group actually lags behind and will only buy the product after many other people have bought it and its popularity is already decreasing. The reason why this group does not buy the product from the start has to do with confidence in the product. This group has to be absolutely certain that they are not making a bad buy. The product is also sold frequently in this ‘late majority’ stage.
Laggards: The laggards group lags behind (consciously or unconsciously) in the trend and does not like innovation or change. It is not until the product is not much in demand anymore and is about to leave the market that this group decides to buy the product after all. The most obvious reason is that this group waits until the sales price is lowered.

Steve Jobs, perhaps the greatest innovator of his lifetime said:
“Great things in business are never done by one person. They’re done by a team of people.”
“You can’t connect the dots looking forward; you can only connect them looking backwards. So you have to trust that the dots will somehow connect in your future. You have to trust in something – your gut, destiny, life, karma, whatever. This approach has never let me down, and it has made all the difference in my life.”
“A lot of people in our industry haven’t had very diverse experiences. So they don’t have enough dots to connect, and they end up with very linear solutions without a broad perspective on the problem. The broader one’s understanding of the human experience, the better design we will have.”
“If you’re gonna make connections which are innovative… you have to not have the same bag of experiences as everyone else does.”

“Facebook was introduced in February 2004 by Mark Zuckerberg from his dorm room at Harvard University. Eight years later more than 900 million people have a Facebook account. This is a dramatic success story of the diffusion of an innovation. Normally when somebody develops a new product it can take years to get it out on the market.” (D)

Bottom line is if the CEO is not also the de facto Chief Innovation Officer, the organization will be “late majority” or “laggard“, not an “innovator” to be emulated.


“By definition, breakthrough innovation is the introduction of new ideas that drive a different way of doing things. This requires risk taking, of course, since no one can foresee the outcome or results of such initiatives. Breakthrough innovators are willing to make decisions and choices as much on the basis of intuition and insight as on data and forecasts – they bet on people rather than manage a process.” (E)

Did I just save the need for a doctoral dissertation?

(A) Chief Innovation Officer Jobs, http://www.careerbuilder.com/jobs-chief-innovation-officer
(B) Innovation of Health Services: A Comparative Study of Hospitals and Health Departments, by AD Kaluzny et al. https://www.ncbi.nlm.nih.gov/labs/articles/4496529/
(C) Diffusion of Innovations theory, by Patty Mulder, https://www.toolshero.com/marketing/diffusion-of-innovations-rogers/
(D) Diffusion of Innovation https://www.openabm.org/book/export/html/3525
(E) Innovation and Organizational Culture, by Ralph Ohr, http://innovationexcellence.com/blog/2016/09/05/innovation-and-organizational-culture/

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What Congress, President Trump and Former President Obama are saying about healthcare

“Politically, the collapse of the repeal effort is potentially devastating for Republicans. It leaves Trump without a significant policy achievement in the critical first six months of his presidency; it casts a pall over the party’s coming drives to pass a budget and overhaul the tax code; and it exposes GOP lawmakers to rising anger from their conservative base.
Substantively, it leaves much work undone. While the ACA has made health insurance accessible to millions of Americans, it has failed to contain rising costs, especially in the individual insurance market, where people without access to employer-provided coverage buy policies. Without federal action — and additional cash — those marketplaces could become unstable.”
“ “The vote last night presents the Senate with an opportunity to start fresh,” McCain said in a statement. Democrats, too, expressed interest in working across the aisle, especially on a plan to make federal cost-sharing subsidies permanent. The subsidies — which will total about $7 billion this year and $10 billion in 2018 — reimburse insurers for reducing co-payments and deductibles for certain low-income customers, reducing their out-of-pocket costs….” (A)

“House Republicans are fed up and openly blaming their Senate colleagues across the Capitol for torpedoing their party’s pledge to repeal and replace Obamacare.
They headed home for a five-week summer recess having failed on a key policy goal they vowed to get done once they controlled Congress and the White House. And things aren’t getting any easier as major fiscal fights are hanging over them this fall.
House Speaker Paul Ryan, who spent weeks urging his members to hold their fire and give Senate Republicans some space to get a health care deal, didn’t hide his frustration at a closed-door meeting in the Capitol basement on Friday. He effectively threw the Senate under the bus, telling his colleagues that the House of Representatives was the only arm of the government that was working.” Their overall message to voters: don’t blame us, it’s all the Senate’s fault.”(B)

““Trump, meanwhile, continued to express mainly hostility toward the ACA. On Friday, he unleashed a series of tweets blaming “3 Republicans and 48 Democrats” in the Senate who “let the American people down” by rejecting the latest overhaul proposal.
“As I said from the beginning, let ObamaCare implode, then deal. Watch!” Trump wrote. He also called for Senate Republicans to abolish the filibuster — a venerable Senate procedure designed to protect the minority party that requires contentious matters to receive the votes of at least 60 senators.”” (C)

“President Obama has always said we should build on this law, just as members of both parties worked together to improve Social Security, Medicare, and Medicaid over the years,” the statement continues. President Obama still believes that it is possible for Congress to demonstrate the necessary bipartisanship and political courage to keep delivering on the promise of quality, affordable health insurance for every American.” (D)


(A) Republican divided on whom to blame for health-care defeat, and what to do next, by Juliet Eilperin, Paul Kane and David Weigel, https://www.washingtonpost.com/powerpost/senate-rejects-measure-to-partly-repeal-affordable-care-act-dealing-trump-and-gop-leaders-a-major-setback/2017/07/28/f2865b10-7364-11e7-8f39-eeb7d3a2d304_story.html?utm_term=.b7a201c0398
(B) House Republicans rail on Senate GOP for torpedoing health care, by Deirdre Walsh, Phil Mattingly, MJ Lee, Kristin Wilson and Lauren Fox, http://www.cnn.com/2017/07/28/politics/house-republicans-blame-senate-health-care/index.html
(C) Trump lashes out over healthcare reform failure, by: Barney Jopson and Sam Fleming, https://www.ft.com/content/60659e20-73b0-11e7-aca6-c6bd07df1a3c(
(D) Obama speaks out after GOP health care bill failure, https://www.aol.com/article/news/2017/07/28/obama-speaks-out-after-gop-health-care-bill-failure/23054794/


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The House and Senate played “dodgeball” not wanting to be held accountable when twenty million people, their constituents, would lose access to affordable care.

“The Senate in the early hours of Friday morning rejected a new, scaled-down Republican plan to repeal parts of the Affordable Care Act, derailing the Republicans’ seven-year campaign to dismantle President Barack Obama’s signature health care law and dealing a huge political setback to President Trump.
Senator John McCain of Arizona, who just this week returned to the Senate after receiving a diagnosis of brain cancer, cast the decisive vote to defeat the proposal, joining two other Republicans, Susan Collins of Maine and Lisa Murkowski of Alaska, in opposing it.
The 49-to-51 vote was also a humiliating setback for the Senate majority leader, Mitch McConnell of Kentucky, who has nurtured his reputation as a master tactician and spent the last three months trying to devise a repeal bill that could win support from members of his caucus. (A)

Several Republicans, in fact, said they would vote for this bill only if guaranteed that it would never, ever, ever become law. And then they voted on the legislation that many considered terrible and were devastated by its defeat. Senate Majority Leader Mitch McConnell was visibly upset.” (B)

“Senate Republicans unveiled a “skinny repeal,” a narrow measure to roll back parts of the Affordable Care Act. It would leave 15 million more Americans without insurance next year, the Congressional Budget Office said.
Speaker Ryan tried to reassure senators balking at the narrow bill, but he left the door open for “skinny” passage.” (C)

““Speaker Paul Ryan’s statement saying he would conference with the Senate on a healthcare bill is not sufficient enough for Sen. John McCain (R-Ariz.)
“I would like to have the kind of assurances he did not provide,” McCain told reporters.” (D)

“As the highly unusual process of passing a bill to repeal the Affordable Care Act drew to a close Thursday, a number of Republican senators said they would like to see the upper chamber return to normal.
After a process that included skipping the usual public hearings, beginning debate without a final bill and sending a bill to the House hoping it won’t pass, senators said they want to return to the usual process of passing legislation….
(Senators) Shelby and Crapo were echoing Sen. John McCain of Arizona, who, earlier this week decried the process that Senate Majority Leader Mitch McConnell used on the health care bill. McCain had just returned to the Senate after being diagnosed with brain cancer and undergoing surgery to remove a tumor.” (E)

6. You read that right: 1, 2, 3, 4, 5, 6 percent. Six. As the Senate prepares to vote on a “skinny repeal” version that its members haven’t seen – and don’t actually want to see enacted – a new statewide poll shows that half of Arizona voters would prefer to keep Obamacare but make revisions to the law. (F)

(A) Senate Rejects Slimmed-Down Obamacare Repeal as McCain Votes No, by Robe Pear and Thomas Kaplan, https://www.nytimes.com/2017/07/27/us/politics/obamacare-partial-repeal-senate-republicans-revolt.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(B) Senate Fails To Pass Latest GOP Health Care Bill by Tamara Keith, http://www.npr.org/2017/07/28/539945644/senate-fails-to-pass-latest-gop-health-care-bill
(C) Health Care Debate: Obamacare Repeal Fails as McCain Casts Decisive No Vote,By ROBERT PEAR, THOMAS KAPLAN and EMILY COCHRANE, https://www.nytimes.com/2017/07/27/us/politics/senate-health-care-vote.html?smprod=nytcore-ipad&smid=nytcore-ipad-share
(D) McCain says Ryan’s assurance on a healthcare bill is insufficient, by JESSIE HELLMANN, http://thehill.com/policy/healthcare/344254-two-gop-senators-say-ryans-assurance-on-a-healthcare-bill-is-insufficient
(E) Republicans Want the Senate to Return to Normal After Health Care by Jack Brewster, http://time.com/4877348/health-care-senate-norms-republicans/
(F) Only 6 percent of Arizona voters like Senate health care bill, by Laurie Roberts, http://www.azcentral.com/story/opinion/op-ed/laurieroberts/2017/07/27/only-6-percent-arizona-voters-support-senate-healthcare-bill-poll-says/518427001/


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Locally transmitted ZIKA case in Texas! Are we ready?

“Officials in Texas reported what they believe is a case of mosquito transmission of the virus within the state’s border, the first within the continental United States this year.
If correct, it would be the first known instance of local mosquito transmission within the continental United States this year.” (A)

This past April –
“The state now recommends that all pregnant women in six South Texas counties — currently in their first and second trimester — should be tested for the Zika virus.
The Texas Department of State Health Services is expanding their guidance for Zika prevention for the 2017 mosquito season, as they prepare for additional local transmission of the virus, meaning people who have not recently traveled getting bitten by a mosquito and then infected. Most Texas cases, however, are travel-related.
Cameron, Hidalgo, Starr, Webb, Willacy and Zapata counties are included in the new guidance. In addition to women in their first or second trimester, any pregnant woman who has a rash and at least one other Zika symptom — fever, joint pain, or eye redness — should be tested as well.
For pregnant women in Texas not in the six listed counties, they should be tested if they have traveled to areas with ongoing Zika transmission, including any part of Mexico.” (B)

….. organizing principles are urgently need to be established for tiered Zika hospital preparedness. Here are some thoughts. (C)
1. There should not be an automatic default to just designating Ebola Centers as ZRRCs, although there is likely to be significant overlap. There should not be an automatic default to just designating Ebola Centers as ZRRCs, although there is likely to be significant overlap.
2. Zika Centers should be academic medical centers with respected, comprehensive infectious disease diagnostic/ treatment and research capabilities, and rigorous infection control programs. They should also offer robust, comprehensive perinatology, neonatology, and pediatric neurology services, with the most sophisticated imaging capabilities (and Zika-related “reading” expertise).
3. National leadership in clinical trials.
4. A track record of successful, large scale clinical Rapid Response.
5. Organizational wherewithal to address intensive resource absorption.
6. Start preliminary planning for Zika care out of the initial designated ZRRCs.
Zika protocols will be templates for are other mosquito borne diseases lurking on the horizon, such as Chikungunya, MERS, and Dengue.

(A) Case of Zika Virus, Likely Spread by Mosquito, Is Reported in Texas, by Donald McNeil Jr, https://www.nytimes.com/2017/07/26/health/zika-virus-mosquito-texas.html
(B) Texas prepares for more local transmission of the Zika virus, by Andy Jechow,http://kxan.com/2017/04/07/texas-prepares-for-more-local-transmission-of-the-zika-virus/
(C) Former hospital prez says: Designate local Zika centers now, http://doctordidyouwashyourhands.com/wp-admin/post.php?post=6528&action=edit


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