The Health 202: Donna Shalala supports Bernie Sanders-style health care. That wasn't always the case.

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Note to readers: Colby Itkowitz wrote today's Prognosis. 

THE PROGNOSIS

As President Clinton’s Health and Human Services secretary, Donna Shalala fended off accusations that she was too liberal for the job. Now, as a candidate for Congress in a competitive Democratic primary, the former secretary must dust off her old progressive bona fides.

Shalala traveled the country in the early 1990s as a public face of the Clinton-era health care effort, explaining to voters why a single-payer system wasn’t feasible. Years later, she told Kathleen Sebelius, who then had her job in the Obama administration, essentially the same thing: “It will not be a government program; it will be a government-organized program.” Now, Shalala says she supports universal health care under a Bernie Sanders-style system that isn't too different than "Medicare for All."

Health care is a top, and according to polls potentially winning, issue for Democrats going into the November midterms. So Shalala's challengers in the crowded field vying for the open seat in Florida's 27th congressional district want to make her look weak on progressive ideas and beholden to insurance companies. 

Shalala's most ardent critic is state Rep. David Richardson, who has questioned Shalala's legitimacy as a Democrat over her past moderation on health care and her time as a UnitedHealth board member, a position that earned the former HHS secretary millions when she cashed in her shares. The setup is reminiscent of Sen. Sanders's (I-Vt.) attacks on Hillary Clinton in the 2016 presidential primary. Similar matchups are occurring all over the country, but Shalala is a special case given her longtime relationship with the Clintons, including a stint as the head of the Clinton Foundation from 2015 to 2017. 

Democrats running for office this year have increasingly embraced Sanders-style progressivism, and have rallied around his idea of "Medicare for All," which would allow anyone to enroll in the government-run health program for seniors. Just last week, Democratic Leader Nancy Pelosi (Calif.) said if Democrats regain control of the House she'd be open to evaluating the idea. 

Pelosi's support -- albeit tepid -- shows that it's no longer a pie-in-the-sky dream for the Sanders' wing of the party. A recent Washington Post-Kaiser Family Foundation poll found 51 percent of Americans support a single national health plan.

Richardson is making the issue of "Medicare for All" front and center in the Florida race. He has an attack ad against Shalala that unearths an old 2007 appearance on The Colbert Report where she says she's not in support of universal health care. In the full clip of the interview, she goes on to explain it's because you can't sell what the people don't want. 

Shalala maintains that pragmatism when she talks about health care now. But in an interview over email with The Health 202 she said she does support universal health care under a "Medicare for All" model. 

"I support efforts to get to universal health care, and would negotiate a transition to get a bill passed," she said. "Allow people to keep their private insurance if they want, and merge the public programs into an enhanced Medicare, creating a simple, less fragmented, affordable public option with a comprehensive package of benefits, including dental and long-term care."

But that's a long-term goal, she says. In the short term, Shalala says Democrats' greatest mission is to save the Affordable Care Act from Republican attempts to dismantle it, which only became more salient Friday as the White House announced it would argue the law's protections for people with preexisting conditions -- its most popular component -- are unconstitutional.

"Right now Democrats are forced to protect what is in place (i.e. Affordable Care Act, Medicare, Medicaid), when what we want to do is move to universal, affordable coverage quickly," she wrote to us. 

Shalala is considered the frontrunner in the Dermocratic primary to replace outgoing Rep. Ileana Ros-Lehtinen (R-Fla.) in what is a key pickup opportunity for Democrats. She is largely benefiting from name recognition -- she was the president of the University of Miami from 2001 to 2015. She's also running in a district located in Miami-Dade County that overwhelmingly voted for Clinton over Sanders in 2016. 

Susan MacManus, longtime political scientist at the University of South Florida, doesn't think Richardson's attack on Shalala is a winning one, but also isn't convinced its wise to move so far left when you have to then compete in a general election. 

"The public is a bit jaded to the argument that people flip flopped and tracking health care policy is very confusing to people anyway," MacManus said. "He’s banking a lot on the fact that it will work there, which is interesting."

It's a funny position for Shalala to now have to prove her leftist credentials. During the Clinton years, Rush Limbaugh, the conservative radio talk show host, aired his regular “Shalala update” – accompanied with a takeoff on the Eric Clapton song “Layla:” Shalala’s as left as she can be….spends her time hugging trees…Shalayyyyla.”

That little piece of trivia comes from a 1993 Washington Post profile of Shalala at a time when she was trying to fit into the Clinton brand of centrist Democrat. She told our colleague Barbara Vobejda then that her ideas had evolved; that she had grown up since her wide-eyed idealism of the 1960s. 

“I did indeed start out as a flaming liberal, and I still have those values,” she said then. “But as an administrator, I’ve been seasoned. I didn’t come here expecting additional resources.”.

Shalala contends she's always been an advocate for affordable care, but said, "I am now more firmly committed to a simplified, affordable public option."

"I'm excited that the Democrats are at a place now that encourages this sort of innovative approach," she said, "and I am eager to join the debate."

AHH, OOF and OUCH

AHH: The American Medical Association's House of Delegates will debate and vote this week on whether its Code of Medical Ethics should be revised to take a neutral stance on physician-assisted suicide, The Post's Lindsey Bever reports. The AMA, the nation's most prominent doctors' group, has maintained the same guidance for the past quarter-century that it is "fundamentally incompatible with the physician’s role as healer, would be difficult or impossible to control, and would pose serious societal risks.”

"The AMA's Council on Ethical and Judicial Affairs spent two years reviewing resolutions, not so much on whether to support the practice but on whether to take a neutral stance," Lindsey writes. "The council is recommending that the Code of Medical Ethics 'not be amended' and continue to refer to 'physician-assisted suicide,' saying that language still 'describes the practice with the greatest precision.' The delegates could accept the recommendation or send it back for further review."

"Although medically assisted death has gained some ground in this country — with six states and D.C. legalizing the practice — it remains a divisive issue among health-care providers," Lindsey writes. "It's uncertain which way the vote will go, but in an open forum on the AMA's website, doctors, delegates and others showed strong support for the status quo."

OOF: There’s still no solid information about the mysterious eruption of health problems for State Department personnel following unusual high-pitched sounds, first in Cuba and now in China, The Post’s Joel Achenbach reports. Staffers in Cuba described “buzzing,” “piercing squeals,” and “grinding metal,” which led to headaches, dizziness, confusion, ear pain, hearing loss, insomnia and fatigue.

But officials have produced no evidence that anyone has intentionally attacked the Americans, nor is there any obvious environmental cause. “No one disputes that American staffers have been suffering from a long list of symptoms," Joel writes. "But a much-publicized research report about the Cuba staffers, published Feb. 15...in the eminent Journal of the American Medical Association, has triggered skepticism among outside researchers."

Two neuroscientists at the University of Edinburgh published a criticism saying the evidence of pathological mental impairment in the patients was "almost unbelievably flimsy." “Whatever the cause of the symptoms, the JAMA paper presented evidence far too thin to support the existence of brain damage,” one neuroscientist Sergio Della Sala told Joel.

Yesterday, Cuba released details of another U.S. diplomat who felt ill after hearing “undefined sounds” in her home in Havana. Cuba said in a statement that investigators were sent to the home and found no potential source of the sound, the Associated Press reports. U.S. officials said Friday they had pulled two workers from Cuba that are “potentially new cases” of the mysterious ailment but have not yet been “medically confirmed.” If confirmed, the individuals would mark the 25th and 26th patients in Cuba related to the strange incidents.

OUCH: Flu killed 172 children from October to May, the Centers for Disease Control and Prevention reported on Friday, making this season the one of the deadliest since federal health officials began tracking pediatric deaths 14 years ago.

The new data exceeds the 171 child deaths from the flu reported in 2012-2013, the previous record. Only the 2009 season was worse, when the flu pandemic killed 358 children, our colleague Lena H. Sun reports. She adds that particular strain of the flu was one for which people had no previous exposure.

This season deaths were in otherwise healthy children ages 8 weeks to 17 years. Less than a fourth of the children who died had received the full flu vaccination, Lena reports, the same proportion as in past winter flu season.

TRUMP TEMPERATURE

— President Trump signaled he will support a bipartisan effort to ease the U.S. ban on marijuana, one day after Sens. Cory Gardner (R-Colo.) and Elizabeth Warren (D-Mass.) introduced such a bill. “(I) probably will end up supporting” it, Trump told reporters Friday during an exchange at the White House, adding “we’re looking at” the bipartisan legislation, the Denver Post reports.

The Gardner/Warren bill would protect the nine states and D.C. that have legalized marijuana from interference from the federal government, our colleague Colby reported last week. Gardner said during a joint news conference on Thursday he had spoken with Trump about the bill and was confident the president would sign it.

— Meanwhile, Canada is one step closer to legalizing marijuana, after its Senate passed legislation late last week to allow recreational use. The Canadian Senate approved 56-30 the bill that Prime Minister Justin Trudeau introduced last year. Medical marijuana is legal in Canada, and the country is also a top exporter of pot for medical purposes, our colleague Katie Zezima reports,

Last year, Uruguay became the first country to legalize the production, sale and consumption of marijuana. Canada could be the second. The House of Commons must now vote to accept or reject dozens of amendments before sending the legislation back to the Senate. “While the majority of the changes are minor and technical, some are large, including a provision that allows provinces to prohibit people from growing marijuana in their homes," Katie writes. "Two provinces, Manitoba and Quebec, plan to prohibit homegrown marijuana. The amendment would make it more difficult for opponents to mount legal challenges.”

Even though the drug is illegal recreationally, people 15 and older spent an estimated $5.7 billion in Canadian dollars on marijuana last year, Katie writes. The Canadian Imperial Bank of Commerce has estimated the country could see $6.5 billion in legal retail sales by 2020 if the legislation becomes law, equivalent to about $5 billion in U.S. currency. 

— Trump told reporters last week first lady Melania Trump wouldn’t accompany him on foreign trips to Canada and Singapore following her surgery, revealing new details about the procedure to treat a benign kidney condition she underwent in May.

“First lady is great. Right there!” Trump told reporters while pointing to the White House residence. “She wanted to go. Can’t fly for one month the doctors say. She had a big operation. That was close to a four-hour operation. And she’s doing great.” Trump said the first lady was staying at the White House due to doctor’s orders.

Melania had directed her aides to release almost no information about her medical condition or detail why she spent five days at Walter Reed National Military Medical Center, the New York Times’s Katie Rogers reports. The first lady’s communication’s director reiterated to the Times on Friday that the May procedure was successful. “The statement I put out on May 14 was correct,” Stephanie Grisham said in a statement. “Mrs. Trump had a successful embolization procedure. She cannot travel internationally yet, and is doing great.”

Meanwhile, Melania Trump attended the Ford’s Theatre annual gala last night, one of the only public appearances she’s made since her surgery, Politico’s Brent D. Griffiths reports.

AGENCY ALERT

— An obscure district court lawsuit over the Affordable Care Act became a potent threat to one of the health-care law's most popular provisions last week, when the Justice Department filed a brief arguing that next year its protections for people with preexisting conditions should be invalidated, The Post's Carolyn Y. Johnson reports. In the brief, DOJ argues the judge should strike down the section of the law that protects people buying insurance from being charged higher premiums because of their health history.

"Approximately 52 million Americans under the age of 65 could find their access to health insurance at risk because of a wide range of preexisting conditions, from diabetes to cancer to pregnancy," Carolyn explains. "Health insurers have for years been raising premiums, complaining about uncertainty and withdrawing from the business of selling individual insurance plans, and more changes could further destabilize the market."

"It would be essentially a return to what the individual market looked like before the ACA, where insurers would require applicants to fill out long questionnaires about their medical histories, and make decisions based on people’s health and how much to charge," said Larry Levitt, a senior vice president at the Kaiser Family Foundation. "Now we're in the situation where very sick people have gotten insurance, and so changing the rules means taking coverage away from people who genuinely need it."

HEALTH ON THE HILL

— The administration’s startling decision to abandon the ACA's ban on insurers charging more to people with preexisting medical conditions put Republicans on the defensive Friday and handed Democrats a potentially potent political message, The Post's Erica Werner and Amy Goldstein report. "The administration’s legal stance injects profound uncertainty into the political debate and the health-care landscape at a critical moment, just as insurance companies are developing rates for the coming year and as candidates head into a summer campaign season that both parties will try to use to solidify a foothold for their agendas," they write.

"Democrats had already made health care a major focus in their campaigns heading into November’s midterm elections, with polls consistently showing it as a top issue among voters," our colleagues continue. "Now, the Justice Department’s stance in a federal-court case in Texas will allow Democrats to argue that Republicans want to deny affordable health coverage to some of the people who need it most."

Senate Minority Leader Chuck Schumer (D-N.Y.) released a letter with other top Democratic senators demanding the administration reverse the move, while the Democratic Senatorial Campaign Committee wasted no time blasting out news releases questioning whether Republican candidates agreed with the administration.

“I’m astounded, and it’s not only recklessness on lots of scores in terms of the legal reasoning,” Rep. Gerry Connolly (D-Va.) told Erica and Amy. “But it’s also political malpractice because you’ve handed us an issue we will ride into the sunset.”

— A few more good reads from The Post and beyond:

MEDICAL MISSIVES

After Celebrity Deaths, Suicide Hotline Calls Jump 25%

As the world learned the news Friday that renowned chef and food writer Anthony Bourdain had died by apparent suicide, the phone number for the National Suicide Prevention Lifeline flooded the internet.

Wall Street Journal

INDUSTRY RX

REPRODUCTIVE WARS

DAYBOOK

Coming Up

  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on prescription drug costs on Tuesday.
  • The Senate Finance Committee will hold a business meeting to consider the "Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018" on Tuesday.
  • The House Energy and Commerce Subcommittee on Oversight and Investigations holds a hearing on public health biopreparedness on Friday.
  • The Senate Health, Education, Labor and Pensions Committee holds a hearing on the 340B Drug Pricing Program on June 19.

SUGAR RUSH

‘This is a new low’: Rep. Pramila Jayapal (D-Wash.) blasts family separation after visiting detained immigrants:

Remembering chef, author and TV host Anthony Bourdain:

'I thought he was invincible': A food writer's memories of Anthony Bourdain: