It Takes A Village – Thursday Special: We Are Dems (Part 3.5) 7/20/17

I’m continuing my look at the healthcare planks of both the Democratic and Republican Party platforms, despite the fluid events in the news about the status of BCRA[p] and the ever-changing Republican plans to destroy the ACA. We need to know just what the Republican positions are, not matter how unworkable, because if we know anything, it’s that they don’t quit. And if by some miracle a chance for bipartisan fixes to the ACA comes about, we need to know what fixes, additions, and changes Democrats might have in mind; Medicare for All is still unlikely, even if a push to work together somehow comes about.

Starting with the Republican platform, we have this statement, “Consumer choice is the most powerful factor in healthcare reform.” It’s not what I would choose as the most powerful factor, but remembering this is key to understanding any and all proposals made by Republicans. From this basic premise, we get this (it’s worth noting that the House has passed a McCarran-Ferguson repeal bill by a vote of 416-7…actual bipartisanship!):

Today’s highly mobile workforce needs portability of insurance coverage that can go with them from job to job. The need to maintain coverage should not dictate where families have to live and work. We propose to end tax discrimination against the individual purchase of insurance and allow consumers to buy insurance across state lines. In light of that, we propose repealing the 1945 McCarran-Ferguson Act which protects insurance companies from anti-trust litigation. We look to the growth of Health Savings Accounts and Health Reimbursement Accounts that empower patients and advance choice in healthcare.

In another area of potential agreement, we have this statement from the Republicans:

Our aging population must have access to safe and affordable care. Because most seniors desire to age at home, we will make homecare a priority in public policy and will implement programs to protect against elder abuse.

The Democratic statement, although not in the healthcare section of the platform, says this:

Seniors should not have to choose between putting food on the table, keeping a roof over their heads, or buying the medication that they need to stay healthy. We strongly support the Older Americans Act, which funds critical programs to help seniors remain independent in their own homes and communities. We are also committed to fighting the immense problem of elder abuse, neglect, and exploitation. [ed. For more on the Older Americans Act and the inadequate funding that has plagued it since its inception, read here: Older Americans Act]

Of course, the minute you start thinking the Republicans might have a few sane ideas, they throw in this sub-heading, Protecting Individual Conscience in Healthcare; and provide a laundry list of “conscience” policies they would like to implement. I’m inserting the entire section, because it crystallizes the white Christianist viewpoint so thoroughly:

America’s healthcare professionals should not be forced to choose between following their faith and practicing their profession. We respect the rights of conscience of healthcare professionals, doctors, nurses, pharmacists, and organizations, especially the faith-based groups which provide a major portion of care for the nation and the needy. We support the ability of all organizations to provide, purchase, or enroll in healthcare coverage consistent with their religious, moral, or ethical convictions without discrimination or penalty. We support the right of parents to determine the proper medical treatment and therapy for their minor children. We support the right of parents to consent to medical treatment for their minor children and urge enactment of legislation that would require parental consent for their daughter to be transported across state lines for abortion. Providers should not be permitted to unilaterally withhold services because a patient’s life is deemed not worth living. American taxpayers should not be forced to fund abortion. As Democrats abandon this four decade-old bipartisan consensus, we call for codification of the Hyde Amendment and its application across the government, including Obamacare. We call for a permanent ban on federal funding and subsidies for abortion and healthcare plans that include abortion coverage.

From there, the Republican platform closes out their section most directly addressing healthcare with the headings Better Care and Lower Costs: Tort Reform, Advancing Research and Development in Healthcare, Putting Patients First: Reforming the FDA, and Advancing Americans with Disabilities. The tort reform argument is a mainstay of Republican talking points, so rather than rehash it, I’m skipping right to the Republican views on advancing research. For starters, there’s a de rigueur statement of American superiority:

Modern miracles involving genetics, the immune system, cures for deadly diseases, and more are in the research pipeline. This is the consequence of marrying significant investment, both public and private, with the world’s best talent, a formula that has for a century given the American people the world’s best healthcare.

I found the support for stem cell research surprising…until I read the caveats. The reiteration of anti-abortion policy is unsurprising, as is the continued insistence that abortion endangers a woman’s health (apparently the statistics about the dangers of pregnancy are immaterial):

We call for expanded support for the stem cell research that now offers the greatest hope for many afflictions — through adult stem cells, umbilical cord blood, and cells reprogrammed into pluripotent stem cells — without the destruction of embryonic human life. We urge a ban on human cloning for research or reproduction, and a ban on the creation of, or experimentation on, human embryos for research. We applaud Congress’ ban on the FDA approval of research involving three-parent embryos. We believe the FDA’s approval of Mifeprex, a dangerous abortifacient formerly known as RU-486, threatens women’s health, as does the agency’s endorsement of over-the-counter sales of powerful contraceptives without a physician’s recommendation. We support cutting federal and state funding for entities that endanger women’s health by performing abortions in a manner inconsistent with federal or state law.

The Democratic platform statement, Enabling Cutting-Edge Medical Research is a bit more general, in part because specific policy statements are covered in other areas of the platform. It is noteworthy, however, that in contrast to the Republican emphasis on cutting government funding (Planned Parenthood is their obvious target), Democrats support increased funding:

Democrats believe we must accelerate the pace of medical progress, ensuring that we invest more in our scientists and give them the resources they need to invigorate our fundamental studies in the life sciences in a growing, stable, and predictable way. We must make progress against the full range of diseases, including Alzheimer’s, HIV and AIDS, cancer, and other diseases, especially chronic ones. We recognize the critical importance of a fully-funded National Institutes of Health to accelerate the pace of medical progress.

The Republican disdain for the FDA probably shouldn’t have surprised me given that the agency deals with regulations, but an entire plank of the platform is devoted to FDA “reform”; by contrast, the FDA is mentioned nowhere in the Democratic platform. From the Republicans, we have this apparently required statement of American exceptionalism:

The United States has led life sciences and medical innovation for decades, bringing millions of high-paying jobs to our country and helping Americans and people around the world live longer, healthier lives.

Followed with the recommended reforms:

…The FDA has slowly but relentlessly changed into an agency that more and more puts the public health at risk by delaying, chilling, and killing the development of new devices, drugs and biologics that can promote our lives and our health. The FDA needs leadership that can reform the agency for our century and fix the lack of predictability, consistency, transparency and efficiency at the agency. The FDA needs to return to its traditional emphasis on hard science and approving new breakthrough medicines, rather than divert its attention and consume its resources trying to overregulate electronic health records or vaping. We pledge to restore the FDA to its position as the premier scientific health agency, focused on both promoting and protecting the public health in equal measure, so we can ensure that Americans live longer, healthier lives, that the United States remains the world leader in life sciences and medical innovation, that millions of high-paying, cutting-edge device and drug jobs stay in the United States, that U.S. patients benefit first and most from new devices and drugs, and that the FDA no longer wastes U.S. taxpayer and innovators’ resources through bureaucratic red tape and legal uncertainty. We commend those states that have passed Right to Try legislation, allowing terminally ill patients the right to try investigational medicines not yet approved by the FDA. We urge Congress to pass federal legislation to give all Americans with terminal illnesses the right to try.

Finally, the Republican section on Advancing Americans with Disabilities is just plain bizarre in light of their avowed efforts to undermine, if not destroy, Medicaid. This part, for instance, sounds downright noble. (The fact that the ABLE Act was largely bipartisan and signed by President Obama in 2014 is apparently immaterial; information about the act can be found at Federal Achieving a Better Life Experience (ABLE) Act):

Under the last two Republican presidents, landmark civil rights legislation affirmed the inherent rights of persons with disabilities. Republicans want to support those rights by guaranteeing access to education and the tools necessary to compete in the mainstream of society. This is not just a moral obligation to our fellow Americans with disabilities. It is our duty to our country’s future to tap this vast pool of talented individuals who want to work and contribute to the common good. For that reason, Republican leadership led to enactment of the ABLE Act (Achieving a Better Life Experience) and the Steve Gleason Act.

The balance of the Republican planks geared towards Americans with disabilities includes some items which have, or are likely to have, across-the-aisle appeal. The SBA 8(a) certification program expansion would probably receive bipartisan support, although if the Republicans include it as part of a tax reform bill, support for the provision would be mooted by the expected unacceptability of the entire bill. The TIME Act (TIME Act summary and here TIME Act FAQ) is another bill that could potentially receive bipartisan support if offered as a standalone bill.

Persons with disabilities are nearly twice as likely to be self-employed as the general population. To encourage their entrepreneurship, it makes sense to include them in the Small Business Administration’s 8(a) certification program, which opens up federal contracting for emerging businesses. Any restructuring of the tax code should consider ways in which companies can benefit from the talent and energy of their disabled employees.

The Individuals with Disabilities Education Act (IDEA) has opened up unprecedented opportunities for many students. Congressional Republicans will lead in its reauthorization, as well as renewal of the Higher Education Act, which can offer students with disabilities increased access to the general curriculum. Our TIME Act (Transition to Integrated and Meaningful Employment) will modernize the Fair Labor Standards Act to encourage competitive employment for persons with disabilities. We affirm our support for its goal of minimizing the separation of children with disabilities from their peers. We endorse efforts like Employment First that replace dependency with jobs in the mainstream of the American workforce.

We oppose the non-consensual withholding of care or treatment from people with disabilities, including newborns, the elderly, and infirm, just as we oppose euthanasia and assisted suicide, which endanger especially those on the margins of society. We urge the Drug Enforcement Administration to restore its ban on the use of controlled substances for physician-assisted suicide.

At this point, the entirety of the Republican plan for healthcare has been covered, although they do address “drug abuse” later when also talking about criminal justice. There are several more sections in the Democratic platform which I have not covered; I’ll cover those remaining sections next Tuesday.

And if your eyes haven’t fully glazed over after all this, here’s your Basset treat:

@mossthewolf lookit my lovable dingus, he is half Basset Hound and half Real Old House Rug pic.twitter.com/maGqVZchEg

— pajama zane (@weatherzane) July 18, 2017