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Leading Republicans say vaccines linked to autism, should be delayed

Posted on September 17, 2015  |  Permalink

Topics: Public Health, Substance Use, Illicit Drugs, Prescription Drug Misuse, Budget, Federal Government, Access to Care, Care Delivery, Reproductive Health

On Wednesday night, CNN hosted the second official primary debate for the GOP presidential nomination, featuring the 11 candidates who ranked highest in recent national polls.

Foreign policy was the main focus of the debate—but with its runtime of more than three hours, the candidates clashed on several health care topics as well, although the Affordable Care Act went mostly unmentioned. Here are three of the key health care moments from Wednesday's debate.

1. Two doctors and Donald Trump argued over vaccines and autism

The leading GOP candidate in the polls, Donald Trump, was pressed on his past comments linking vaccines to autism. (The debate was held in California, the site of a recent measles outbreak.)

While he said he is "totally in favor of vaccines," Trump wants "smaller doses over a longer period of time." He brought up the story of a young child who he said "went to have the vaccine ... and a week later got a tremendous fever, got very, very sick, now is autistic."

Moderator Jake Tapper also asked the two doctors in the race for their take.

Ben Carson -- the former head of pediatric neurosurgery at Johns Hopkins Children's Center, who is just behind Trump at 2nd in the polls -- pushed back against Trump linking vaccines and autism.

"We have extremely well-documented proof," Carson said, "that there's no autism associated with vaccinations."

Carson backed requiring vaccines that "prevent death or crippling," but said "there should be some discretion" for others. But he added that "we are probably giving way too many [vaccines] in too short a period of time.

When Tapper asked Sen. Rand Paul (Kentucky)—an ophthalmologist—to give a "second opinion," Paul also endorsed allowing parents to space out vaccines. "Even if the science doesn't say bunching them up is a problem," Paul said, "I ought to have the right to spread out my vaccines out a little bit at the very least."

(As Julia Belluz reports for Vox, most researchers say the setup of the vaccine schedule doesn't pose a health threat -- but that spreading out vaccines can decrease their effectiveness.) 

2. Should the government shut down over Planned Parenthood?

The candidates also clashed over whether congressional Republicans should be willing to shut down the government with the intention of stripping federal funding from Planned Parenthood in the wake of a series of videos in which the organization's staff discuss fetal tissue donation.

All the candidates who spoke on the issue said that Planned Parenthood should not receive any funding. But they split on what the current strategy should be. Gov. John Kasich (Ohio) opposed a potential shutdown, noting that President Obama would veto any defunding bill, while Sen. Ted Cruz (Texas) said a shutdown should be on the table.  

3. How marijuana, other drugs should be treated

The candidates also split on their approaches to marijuana, both medical and recreational. Paul said that the issue should be left to the states, and cited the potential benefit of medical marijuana to help individuals suffering from seizures.

Meanwhile, Gov. Chris Christie (N.J.) cited concerns about marijuana being used "as a gateway drug," but backed medical marijuana. And former Hewlett Packard CEO Carly Fiorina said that she "agree[s] with Senator Paul" on states' rights, but said "we are misleading young people when we tell them that marijuana is just like having a beer. It's not."

Several of the candidates also brought up the larger issue of drug misuse, with former Gov. Jeb Bush (Fla.) calling for more treatment and prevention to combat "the epidemic of heroin." Fiorina said the issue is personal for her, noting that she has "buried a child to drug addiction." She added, "We must invest more in the treatment of drugs."

-- by Josh Zeitlin, Daily Briefing associate editor

**Editor's Note: This content originally appeared in the Daily Briefing, published by the Advisory Board Company. The Advisory Board also publishes American Health Line.

Are Talks About Privatizing the VA Health System Premature?

Posted on December 2, 2014  |  Permalink

Topics: Care Delivery, Access to Care, Clinical Quality, Patient Populations, Military, Veterans

Following a national scandal that highlighted reports of care delays at Veterans Affairs health care centers, experts have begun debating whether the VA health system should be privatized.

Earlier this year, President Obama signed a $16.3 billion bill (HR 3230) to overhaul VA and improve veterans' access to care, which includes $10 billion in funding to allow veterans facing long wait times or distances to seek private care outside the VA health system. The Veterans Choice Program was authorized to operate for three years or until funding runs out.

What Privatization Supporters Say: American Enterprise Institute economist Joseph Antos and Dartmouth Institute for Health Policy and Clinical Practice Senior Research Scientist William Weeks are among the experts proposing that VA be privatized. Antos said the government should give most veterans vouchers for them to purchase private coverage, with the VA narrowing its focus only to veterans with the serious, service-related medical issues. Similarly, Weeks said the Veterans Health Administration should provide premium and copayment subsidies for veterans to receive coverage from private insurers and emphasize care coordination among providers. Meanwhile, experts cited various justifications for privatization, including:

Allegedly lower quality of care at VA;

A projected decline in the number of veterans in the coming years;

VA's struggles hiring enough physicians, particularly considering physicians' high workloads and salaries that are lower than those available to private providers.

What Privatization Opponents Say: Other experts have argued against privatization or extending the Veterans Choice Program beyond three years. Lou Celli, who heads American Legion's veterans affairs and rehabilitation division, argued the VA health system provides the best "bang for your buck," citing a Congressional Budget Office report that a version of the Veterans Choice Program eventually could cost taxpayers $50 billion annually. In addition, experts opposed to privatization argued that the VA system provides:

A sense of community for veterans;

Lower prices;

Medical research breakthroughs;

More specialized care; and

Higher quality of care.

Our take: The federal government and other observers should wait to see how well the Veterans Choice Program works before deciding whether to privatize the VA health system. VCP should give federal officials measurable results to determine whether veterans are receiving more timely access to higher quality health care. Based on those results, officials can determine the best way to move forward to ensure that vets get the quality, timely care they deserve.

 by Ashley Fuoco

Elections: What the Midterms Mean for the Affordable Care Act

Posted on November 7, 2014  |  Permalink

Topics: Care Delivery, Access to Care, Health Care Reform, Politics and Policy, Elections, 2014, Health Care Legislation

The GOP's gains from the midterm elections this week set the stage for an attack on the Affordable Care Act.

While a full repeal is unlikely as long has President Obama is in office, experts say, some lawmakers are still planning a symbolic attempt to revoke the law.

However, stakeholders say a piece-by-piece dismantling of the ACA is a viable option for removing from the law certain aspects, such as the individual mandate or medical device tax.

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Elections: What the Midterms Mean for the Affordable Care Act