How does Donald Trump’s health compare with the average American?

As the president heads for his regular physical check-up on Friday, what clues are available to assess his fitness? An expert weighs in

Every so often , American chairpeople are expected to go to the doctor- for their checkup and merely to reassure the American public that everything is alright. On Friday, it’s Trump’s turn.

A physician at Walter Reed medical center will operate Trump through many of the same tests regular Americans receive, such as blood pressure and cholesterol screenings. Details about the president’s health are at his discretion to release, but with what clues are available in so far, a natural question originates: how is Trump likely to compare with his fellow American?

If Trump’s past quizs hold true, amazingly average.

Like many American men, the 71 -year-old president enjoys fast food, and is overweight. He takes statins to keep cholesterol in check. He golfs but probably does not get enough exercise. He does not smoke.

In some styles Trump is in a much less risky position than the average American senior. He nearly predicted as much before the exam, telling:” I think it’s going to go are you all right .” In fact, he said he would be” surprised if it doesn’t “.

He has reported only one serious medical problem, ever: an appendectomy at 11. He is shuttled around the country in an ultra-safe auto, so unlikely to have an accident. He is a teetotaler. He takes statins without a history of heart disease, which could create eyebrows, but is common.

” He’s median in terms of health ,” said Steve Schroeder, a professor at the University of California at San Francisco and a public health expert.” The most important thing he’s done is never smoking in his lifetime, and that puts him ahead of most American humen .”

Former New York mayor Rudy Giuliani and Donald Trump grab some cookies. Photograph: Evan Vucci/ AP

However, if a letter from Trump’s doctor is accurate, he’s nearly obese. In 2016, his campaign released a doctor’s letter which said the 6ft 3in candidate weighed 236 pounds. That sets his body mass index at 29, just shy of the medical definition of obese.

Further, despite the apparent openness of a public physical, the White House already ruled out releasing one exam: a psychiatric exam.

Trump’s mental competency has been on trial since the Guardian published excerpts of Fire and Fury, in which advisors questioned Trump’s fitness for office.

In any case, Trump will have a high bar compared with his predecessor. President Obama, who is more than 10 years Trump’s junior, actually get healthier toward the end of his second word in office, after he increased his lean body mass.

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Republican senators return to work on healthcare bill amid resistance

At least one Republican senator predicted a consensus was still several more weeks away, and few senators have been willing to defend the bill publicly

Republican senators left Washington more than a week ago without voting time a long-promised repeal of the Affordable Care Act or their unpopular plan to replace it. The GOP lawmakers return on Monday with the daunting task of crafting a bill still very much in front of them, amid swirling doubts concerning the prospect of finding a solution any time soon.

My view is its probably going to be dead, Arizona senator John McCain told CBS on Sunday. I fear that its going to fail.

A vote is unlikely to take place this week, with at the least one Republican senator predicting that his colleagues are still several more weeks away from reaching a consensus on a healthcare replacement. Last week at a town hall, Senate majority leader Mitch McConnell compared the process of negotiating healthcare reform with intransigent Republican senators to solving a Rubiks cube.

Im in the position of a guy with a Rubiks cube, trying to spin the dial in such a way to get at least 50 each member of my conference who can agree to a version of repealing and replacing Obamacare, McConnell said. That is a very timely subject that Im grappling with as we speak.

Republicans were not meant to still be grappling with healthcare over the Fourth of July recess. When Trump took office and the GOP kept control of Congress, they laid out an ambitious agenda that included repealing Obamacare as early as January and then moving on to taxation reform and infrastructure.

But intransigent Republican opposition and a groundswell of political activism following the completion of Trumps election derailed that timeline. Now its summertime and with merely a handful of running weeks left before the August recess, the Senate Republican leadership is still searching furiously for 50 votes, a tally that would only push them over the finishing line with a casting vote from the vicepresident, Mike Pence.

The clearest sign of Republican resistance to the bill was how few senators were willing to defend the bill publicly. During the Fourth of July recess politicians typically relish the opportunity to march in patriotic parades and clasp hands with constituents. But this year those appearances were scarce.

And the few Republican senators who made public appearances were met with protests and pleas from constituents concerned about the Republican healthcare plan.

Susan Collins. Photograph: J Scott Applewhite/ AP

At a parade in Eastport, Maine, Susan Collins, whose opposition to an initial draft of the healthcare law helped delay the vote, said her constituents were singularly focused on healthcare.

There was only one issue. Thats unusual. Its usually a wide range of issues, Collins told the Washington Post. I heard, over and over again, encouragement for my stand against the present version of the Senate and House healthcare bills. People were thanking me, over and over again. Thank you, Susan! Stay strong, Susan!

Where a Republican senator refused to hold a town hall, voters stimulated their views known. Tens of thousands of liberal activists and concerned constituents turned out for dozens of rallies across the country to recommend their senators to vote no on the healthcare bill. Some groups coordinated protests and staged sit-ins at senators offices, and in Columbus, Rob Portmans constituents held a cookout.

As initially drafted, the Republican healthcare plan would repeal major pieces of the ACA, including the mandate that all Americans buy health insurance or face a penalty. It would also build deep cuts to Medicaid, a joint state-federal public health program for low-income Americans, compared with spending under the current law.

An analysis by the nonpartisan Congressional Budget Office( CBO) estimated that 22 million people would lose healthcare over the next decade for the purposes of the Republican healthcare plan. In a new report that assessed the plans impact over two decades, the agency estimated that spending on Medicaid under the replacement scheme would be 35% lower by 2036 than under current law.

McConnell has introduced a number of changes, including adding $45 bn to combat the opioid outbreak. Also under consideration is a compromise amendment by Ted Cruz, the conservative Texas senator who opposed the bill because it did not go far enough in repealing Obamacare.

Under the Cruz proposal, insurance companies could sell non-AC-Acompliant healthcare plans as long as they also offered at least one that fulfilled the laws mandates, including coverage for maternity care, mental health treatment and prescription drugs. Though the proposal is gaining traction among conservatives, healthcare experts on both sides of the political debate believe the measure would likely result in prohibitively high costs for comprehensive schemes, which sicker Americans would need.

McConnell sent an update, including the Cruz amendment, of the healthcare plan to the agency, and a new report is expected this week. The CBO is expected to release another analysis sometime next week, a likely indicator that Senate Republican will not vote on the scheme until later this month.

I think we are making steady progress, Cruz told ABC on Sunday. The conversations have been coordinated and in good faith.

If Republicans fail to reach an agreement on a replacing scheme, McConnell said he would work with Democrats to stabilize the insurance markets.

No action is not an alternative, McConnell told constituents at a Rotary Club lunch on Thursday, in agreement with the Associated Press. Weve got the insurance markets imploding all over the country, including in this state.

But Cruz said he agreed with a proposal by Trump seen as unhelpful and unrealistic by many Republican that the GOP should try to repeal Obamacare without concurring a replacing if the Senate bill fails.

If we cant get this done right now, I agree with the president, then lets honor the promise on repeal and expend more time to get it done, Cruz said on Sunday.

I believe we can get it done.

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Julia Louis-Dreyfus shares breast cancer diagnosis

The star of Seinfeld and Veep tweeted a note to praise her glorious support network and fantastic insurance but added that not many women were so lucky

Julia Louis-Dreyfus has revealed that she has been diagnosed with breast cancer.

The Emmy-winning star of Seinfeld and Veep shared a note on Twitter on Thursday to inform her followers while also reminding them of the importance of universal healthcare.

” The good news is that I have the most glorious group of supportive and caring family and friends, and fantastic insurance through my union ,” she wrote.” The bad news is that not all women are so lucky, so let’s battle all cancers and construct universal health care a reality .”

The 56 -year-old has received support on Twitter from fellow actors Sarah Silverman, Debra Messing, Veep star Tony Hale, Christina Applegate and Michael McKean. According to a statement from HBO, she received the news the day after she won her record-breaking sixth Emmy for playing the lead in HBO’s hit comedy Veep. The show is set to finish at the end of next season. That decision was not influenced by the diagnosis.

” Our love and support go out to Julia and her family at this time ,” a statement from HBO reads.” We have every confidence she will get through this with her usual tenacity and undaunted spirit, and look forward to her return to health and to HBO for the final season ofVeep .”

Louis-Dreyfus’s plea for universal healthcare arrives after other political statements criticizing the decisions being made by the Republican party.” My father fled religion persecution in Nazi-occupied France ,” Dreyfus said at the SAG awardings earlier this tear.” I’m an American patriot, and I love this country. Because I love this country, I am horrified by its blemishes, and this immigrant banning is a blemish and it’s un-American .”

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‘We need fundamental changes’: US doctors call for universal healthcare

More than 2,000 physicians want a single-payer system similar to Canadas and say the Affordable Care Act didnt go far enough

A group of more than 2,000 physicians is calling for the establishment of a universal government-run health system in the US, in a newspaper in the American Journal of Public Health.

According to the proposal released Thursday, the Affordable Care Act did not go far enough in removing barriers to healthcare access. The physicians bold plan calls for implementing a single-payer system similar to Canadas, called the National Health Program, that would guarantee all residents healthcare.

The new single-payer system would be funded mostly by existing US government funding. The physicians point out that the US government already pays for two-thirds of all healthcare spending in the US, and a single-payer system would cut down on administrative costs, so a transition to a single-payer system would not require significant additional spending.

Our patients cant afford care and dont have access to the care they need, while the organizations of the system is ever more wasteful, throwing away money on bureaucratic expenditures and absurd costs from the narcotic companies, told David Himmelstein, a prof in the CUNY School of Public Health at Hunter College and lecturer on medicine at Harvard Medical School.

Himmelstein, one of the authors of the plan, said the proposal is meant as a rallying cry for physicians and other healthcare professionals around the cause of a single-payer model. According to the paper, even with the passage of the Affordable Care Act many patients face rising co-payments and deductibles that compromise access to care and left open vulnerable to ruinous medical bills. Despite the present high healthcare spending levels in the US, healthcare outcomes are worse than in comparable well-funded countries.

There has been a conviction that we can approach this incrementally and get there in small steps and one of the advantages of having passed the ACA is that modest steps cant do the job, and in a way make it easier to make arguments that we need more fundamental changes, told Himmelstein.

Under the proposal, all US residents would be able to see any physician of their choosing in the country and be treated at any hospital. With guaranteed coverage and no co-pays, deductibles and premiums, patients would not have fiscal barriers to seeking care, which would lead to greater utilization of the organizations of the system and improved health outcomes, Himmelstein argues.

The additional funds would be made up by modest taxation increases in exchange for abolishing insurance premiums, deductibles and co-pays.

We would have to abolish the insurance companies, there is no way around that, Himmelstein told. The employees at the private insurance companies would be retrained for other jobs, he explains, and receive job placement assistance. The insurance CEOs, who earn multimillion dollar salaries, would not get comparable job placement, Himmelstein said wryly.

Fees for drug would be negotiated with pharmaceutical companies the same style other countries with single-payer systems already negotiate for lower cost medications. Currently, US drug costs are some of the highest in the world.

While Himmelstein acknowledges that the physicians proposal would meet with political and business interest opponent, and he cant say when such a system would realistically have the political backing needed to be implemented, he is hopeful that as more Americans view a single-payer system favorably, pressure will continue to mount on the government.

Proposing a single-payer system in the US is not new. Vermont previously attempted to implement a single-payer system, which passed the legislature but was shut down by the once supportive governor when cost estimates increased beyond what the state was able to afford.

Coloradans will vote this November on whether to institute a single payer system statewide. One of the leaders of the movement in Colorado is state senator Irene Aguilar, “whos also” a physician. The Colorado proposal would be financed by a payroll taxation increase of 7% for employers and 3% for employees. For the self-employed, that would translate into a 10% tax increase.

But Himmelstein said this type of reform cant be done state by state. The physicians scheme depends in part on cost containment through having a single payer with the power to negotiate narcotic pricing with pharmaceutical companies as well as eradicating many levels of bureaucracy in billing and insurance registration.

The American Medical Association( AMA ), which is the largest organization of physicians in the US, has opposed the idea of a single-payer model. When contacted, the AMA pointed to its policy considering assessing health reform proposals, which states in part that: Unjust concentration of market power of payers is detrimental to patients and physicians, if patient freedom of choice or physician ability to select mode of practise is limited or denied. Single-payer systems clearly fell under such a definition and, consequently, should continue to be opposed by the AMA.

But Himmelstein finds change around the corner. I think the AMA and its member organisations are slowly starting to come around and I am confident that they will eventually come around. He points to the passing of resolutions by a few of the state medical associations that make up the AMA membership to study the impact of a single-payer system as indicators of change.

For Himmelstein and another novelists of the editorial, the biggest indicator of change seems to be the talk of a single-payer system in the presidential primaries which has brought attention back to the issue.

Bernie Sanders showed you can do extremely well campaigning on this issue, told Himmelstein, who is confident that if enough American people demand a single-payer system, Congress will eventually have no choice but to change their intellects and subsistence it. But what the American people truly think of a single-payer system is a lot murkier. While in some polls demonstrate majority support for a single-payer system, deeper digging by some polls finds that support dwindles when individuals are asked about giving up their private health insurance and paying additional taxes.

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The Guardian view on Trump and Obamacare: a welcome failure for a damaging scheme | Editorial

Editorial: In spite of controlling the White House and both wings of Congress, the Republicans let ideological obsessions to derail a scheme they have been trumpeting for years

President Donald Trumps failure to repeal Barack Obamas Affordable Care Act is a huge event. It may even eventually be an epochal one. It is huge for the United States, which expends much more on healthcare than most advanced nations( 17.1% of US GDP, compared with 9.1% for the UK ), but where healthcare was profoundly expensive and unequal until the occur of Obamacare seven years ago brought more than 22 million of Americas poorer citizens under its umbrella. It is huge for Americas politics, because Mr Trump had staked his blowhard presidency on his supposedly exceptional ability to do deals my art sort, as he sets it. One of the first and most important of these would be a replacement of Obamacare by a Republican party that controls both houses of Congress and the White House, a scheme now in tatters. It also has implications for Mr Trumps America and its standing in the world, as if Mr Trump becomes a wounded chairwoman domestically which is still not the case, in spite of Fridays failure it will shape the style that the president and other countries decide to play international relations too.

Ever since Mr Obamas Affordable Care Act was signed into statute in 2010, the Republican party has remained obsessed with its supposedly evil repercussions. Unlike the Conservative party in Britain, which chose after the creation of this countrys very differently constructed NHS that it would work with the new state system , not seek to undo it, the Republicans have constructed no endeavour whatever to create a historic compromise with Obamacare. Driven in big portion by their extreme rightwing anti-government activist base and conservative funders who loathe the federal governments involvement in almost anything except military spending, Republicans have instead vied with one another to pledge to kill the ACA and replace it with a cost-cutting alternative. Repeal and replace was Mr Trumps motto on the campaign trail. It was to be the new administrations domestic priority. It would show that Mr Trump can get things done.

Yet on Friday, Mr Trump and the congressional Republican had to admit that their scheme had comprehensively made the wall. It is dead and will not be quickly revived in any form. The failure casts a shadow over the administrations future tax and spending programs too. This is the most serious shame yet for Mr Trumps battered nine-week-old presidency. At this stage it outranks even the courts rejection of his migration forbidding, the resignation of national security adviser General Mike Flynn, the spiralling arguments over campaign links to Russia, the allegations about wiretapping against Mr Obama, and members of the general air of administrative chaos that has now descended over a US government in which only 21 out of 553 key administration postures have yet gone through the confirmation process.

The most important practical reason that the bill failed was because the Republican could not get the scheme that had been cobbled together between the Trump White House and House speaker Paul Ryan through the Congress. That is a striking enough failing. But the deeper reasons for it also matter. Mr Trump had not set enough supposed into the bill. He had also put Tom Price, a Georgia congressman who opposed not just the ACA but also the federal Medicare insurance programme for over-6 5s, in charge of federal health policy, sending a reckless signal. Mr Trump also absence the political skill to build the inevitable political trades that would give him a majority.

But the fundamental reason why the Trump-Ryan package failed was simply that it was a bad scheme about a key programme that would have stimulated things worse for a lot of voters. Repeal and replace was a mottoes , not a policy. If it had become the policy, which hardline Republicans wanted, it would in fact have injury their constituents, many of whom have benefited from the ACA and depend upon its provisions. Many budget hawks in the Republican party, of whom Mr Ryan is often the spokesman, dont care too much about that. They care more about a small country and low taxes for business than about decent healthcare for the poor. Yet they are also clearly happier in opposition than with the responsibilities of government. Even Mr Ryan was not able to persuade some conservative hardliners, while what remains of the moderate wing of the party excavate its heels in too, particularly in those districts that voted for Hillary Clinton last November. Both Mr Ryan and Mr Trump look like damaged goods right now and a good thing too.

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Senate Republicans admit defeat in latest effort to repeal Affordable Care Act

Senate leaders admitted they did not have the votes to pass a bill, hours after Trump railed against certain so-called Republicans for refusing to vote for it

The latest Republican attempt to repeal the Affordable Care Act died on Tuesday as it became obvious they did not have the votes to pass a bill that would leave millions without health insurance.

The admission of defeat received from Senate leader Mitch McConnell and the sponsors of the bill after party debates over lunch on Capitol hill left them in no doubt their slim majority could not survive a revolt.

Republicans were at least one vote short in their effort to repeal Obama’s signature domestic policy accomplishment and were running out of time to force-out the bill through this week before a key procedural deadline.

They confessed defeat on one of their central promises of the past several decades, hours after Donald Trump was left railing against” certain so-called Republican” refusing to vote for the latest bill.

” To be clear, through events that are under our control and not under our control, we don’t have the votes ,” said Louisiana senator Bill Cassidy, one of the authors of the measure.” We’ve attained the decision since we don’t have the votes, we will defer that election. Am I frustrated? Utterly .”

At a press conference after lunch, the bill’s writers insisted that Republicans supported the substance of their proposal, which would direct billions of dollars under the healthcare law to states in the form of block awards, transferring sweeping new discretion over how to deliver healthcare.

” Patience is a virtue ,” co-author Lindsey Graham, of South Carolina, said.” Time is actually on our side. The elections “were in” absence were actually more about process than substance. We can fix the process and we can improve the substance, so that’s why I’m optimistic .”

Addressing conservative voters and donors who helped revive the repeal effort after it failed in a dramatic fashion in July, Graham pledged Republican still had the “fight” left to ensure the law is replaced.

Senator John Thune of South Dakota, a is part of Republican leadership, said he expected voters would be frustrated.” I don’t blame them ,” Thune said.” They have to hold us accountable and we made a commitment. I hope they’ll have a little bit of patience .”

Lindsey Graham with John Barrasso, Bill Cassidy John Cornyn and Mitch McConnell. Photo: Aaron P. Bernstein/ Reuters

On Tuesday, McConnell opened debate in the Senate by assailing the ACA, widely known as Obamacare, but offered no guidance on whether he would hold a election or not. Hours afterwards, he admitted defeat. Later that afternoon, McConnell made clear his caucus was moving on to other legislative priorities.

” We haven’t given up on changing the American healthcare system. We are not going to do that this week but it still lies ahead of us ,” McConnell said.” We do think it’s time to turn to our twin priority: reforming the tax code. We’ve reached significant agreements inside the budget committee to go forward and I’m optimistic that we’ll achieve that .”

Trump has been frustrated by Republican’ repeated failings on healthcare and has expressed displeasure with the senators who have stood in the way of repeal measures.

Asked on Tuesday if he would demand Republican leadership hold a vote on the healthcare bill, Trump replied:” We’ll see what happens .”

He told:” It’s going along and at some phase, there will be a repeal and replace. But we’ll see whether that point is now or whether it will be shortly thereafter. But we are disappointed in certain so-called Republicans .”

His frustration came after the very public opposition of Susan Collins, Rand Paul and John McCain, who made clear they would vote no. That would be enough to sink the bill given the Republican’ narrow 52 -4 8 majority in the Senate.

On Monday, Collins announced her opponent moments after the non-partisan Congressional Budget Office published an analysis that find millions of Americans would lose their health insurance if the bill became law.

During a televised debate on healthcare on Monday night, Cassidy and Graham recognise the setbacks but vowed is to promote with their bill.

” We are going to press on ,” Graham said during the CNN debate.” It’s OK to vote. It’s OK to fall short, if you do, for an idea that you believe in .”

For seven years, Republican have won elections on the promise to repeal the healthcare statute and replace it with a conservative scheme that removes decision-making power from the federal government. Repealing the ACA was also a central thrust of Trump’s campaign, though his fickle expectations for its replacing have complicated Republican attempts to repeal the law.

To overhaul the healthcare system on a party-line election, Republican want to use a process called ” reconciliation” that allows lawmakers to pass bills affecting taxes and spending with a simple majority. But the reconciliation process is time-bound, tied to a budget resolution Congress passed earlier this year, which ends on 30 September.

The analysis followed a frantic try by the bill’s writers to win over reluctant senators, rewriting the bill to deliver more federal funds to countries where the senators were undecided, such as Alaska and Maine.

While Paul opposed the measure because he believed it did not go far enough in repealing the ACA, Collins and McCain, two of the three senators who derailed a repeal try in July, lamented a rushed process and exhorted a return to” regular order”, which includes public hearings and a full CBO analysis.

Reacting to the news, Senate minority leader Chuck Schumer said Americans would” exhale a sigh of relief” and praised the voters and activists who quickly mobilized against the bill.

” Our colleagues got no choice, in the face of opposition from one end of the land to the other, to withdraw their bill ,” Schumer told.” Now we hope that Republicans don’t come back to this bill. It will meet the same fate that it did this time because the people didn’t like it .”

Schumer recommended Republicans to resume the bipartisan negotiations over ways to stabilize the insurance markets.

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The Resistance Now: big, angry crowd to fight back against Trumpcare

Activists opposing Trumps healthcare bill take the fight to town hall; liberals raise$ 1m for Democratic challengers in 2018; and the GOP loves Bud Light

Republicans duck town hall after voting for Trumpcare…

After working hard to pass a bill that would strip millions of Americans of their health insurance, Congress is taking a well-earned recess for the coming week. The notion is that politicians return to their home districts to satisfy their constituents. But if your representative is a Republican, youll have a hard time receiving them.

According to the Town Hall project, which tracks face-to-face meetings held by members of Congress, merely nine out of the 217 Republican who voted for Thursdays healthcare bill have plans to hold town halls during recess week.

People let Utah representative Jason Chaffetz know how they feel at a town hall in February. Chaffetz has not scheduled any town halls this week, which people may also disagree with. Photograph: Rick Bowmer/ AP

In lieu of the great Republican no-show, Indivisible, a progressive group which aims to use Tea Party tactics to influence politicians, has posted the names and office telephone numbers of every Republican who voted for the bill. Indivisible is encouraging people to call those representatives.

but not all of them

A big, angry crowd is expected at a Tom MacArthur town hall in Willingboro, New Jersey, on Wednesday.

MacArthur, who is a moderate, is being credited with helping to pass the American Health Care Act. He worked with the hardcore conservative Freedom Caucus to get the bill passed. Specifically, MacArthur drafted suggested amendment that would allow states to waive rules that protect individuals with pre-existing conditions being charged more for healthcare coverage.

MacArthur represents New Jerseys third congressional district which voted for Obama twice and only narrowly swung for Trump in 2016. He told the Guardians Lauren Gambino he expects to encounter angry residents, but said he would relish talking to them.

Tom MacArthur. Whats the opposite of healthcare advocate? Photograph: Kevin Lamarque/ Reuters

Liberals raise over$ 1m for Democratic challengers

The passing of the Republican bill has inspired thousands and thousands of people to contribute to Democratic congressional nominees in countries where Republicans are particularly vulnerable ahead of the 2018 midterms.

ActBlue, a Democratic supporting political action committee, has identified 24 Republican congressmen and women who voted for the bill and represent districts where Trump won less than 50% of the vote in 2016. It has set up two fundraising pages and had raised more than $1.3 m by Friday morning

In many districts Democrat have not even proclaimed yet, but ActBlue said the money will be reserved for the eventual candidates.

Theres no accounting for taste

Republicans reportedly celebrated their healthcare #win with cases and cases of beer. In particular, the Bud Light was flowing, according to Vices Alexandra Jaffe. users do not appear to be fans of Bud Light.

Alexandra Jaffe (@ ajjaffe)

Cases upon cases of brew merely rolled into the Capitol on a cart covered in a sheet. Spotted Bud Light peeking out from the sheet

May 4, 2017

This is a generic pint of brew. We would have had to pay to use a picture of a Bud Light. Photograph: Fairfax Media/ Fairfax Media via Getty Images

What were reading

Were sorry for a healthcare-heavy email the coming week, but needs must. Adam Gaffney , writing for us here at the Guardian , describes the Republican healthcare bill as homicidal. Gaffney says that in passing the bill, moderate Republicans proved to be a cheap date as they kowtowed to the hard right Freedom Caucus.

The New York Times editorial board said the way Republican rushed through the bill indicated breathtaking hypocrisy after they had, for years, falsely accused Democrats of rushing the Affordable Care Act through Congress.

Teaching time at Trump Tower

The environmental group 350. org is holding a teach-in at Trump Tower in New York City on Tuesday.

The organization is fostering New York Citys government to divest pension funds from fossil fuel companies, and thereby lead on opposing climate change.

Trump is expected to decide whether to stay in the Paris climate agreement in which 195 nations, including to US, committed to limit global warming to two degrees above pre-industrial levels as early as next week.

Activists plan to head to the public terrace in Trump Tower as the name indicates, the terrace is open to the public and the event will feature music, speeches, chanting, teach, merry-making and colorful signs.

Despite visiting New York City on Thursday, Trump is yet to visit his home since the inauguration. He is not expected to attend the teach-in.

Trump Tower on Thursday. The sanitation department trucks are filled with sand and are there to protect the presidents home. Photo: Drew Angerer/ Getty Images

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Physicians can’t ignore politics. Our patients’ lives are at stake | Farzon Nahvi

Our patients depend on us for their care we must help them get onto, whether that comes in the form of pill or policy

If all politics is local, then Washington’s healthcare debacle has brought politics to the front stoop of every healthcare provider in America. There is no escaping it- debates taking place on Capitol Hill are set to affect the very survival of our patients. Irrespective of political tilts, doctors, nurses and providers of all stripes have ethical and professional obligations to speak up and become engaged in order to protect their patients.

While politics have always affected medicine- obstetricians and gynecologists have long fought for women’s health issues, for example- current political events have pushed this into overdrive. In our current political climate, it no longer even induces sense to distinguish between events in Washington and my patient in front of me.

Earlier this year, Congress put forth a bill that among other things would strip 23 million patients of their health insurance, allow insurance companies to omit people with preexisting conditions, remove essential health benefits such as pediatric services, ambulance rides, and laboratory tests from their plans, and increase expenses, especially to older Americans.

Politicians are speaking frankly- even eagerly- about stripping services away from patients who currently have them. Each patient I insure becomes another example of someone whose life could be at risk should any of the measures debated in Congress pass into statute.

My elderly patient’s infected bedsore, for example, could only worsen, leading to sepsis and even death if she could no longer fill her antibiotic prescription. My patient with breast cancer, if unable to obtain chemotherapy due to her “preexisting condition”, would unavoidably die. And any pediatric patient I assure could abruptly be at risk of entirely preventable maladies if left unimmunized due to the elimination of their essential health benefits.

Suddenly, being a physician and ignoring politics has become a lot like being an airplane pilot and ignoring the fact we are flying with the cabin doors wide open. Patients are about to be whisked into the sky with no parachute- it is just as unethical to dismis politics as it would be to continue flying that plane pretend everything was OK.

The truth is that avoiding politics is not only unethical, but also unprofessional. While many physicians, scientists at heart, find political advocacy uncomfortable, it is in fact a required part of the job.

In order to be allowed to practice independently, physicians must graduate from a residency training program and demonstrate proficiency in six “core competencies”. Most of them, such as medical knowledge and patient care and procedure abilities, are well known. It is the sixth- systems-based practise – that is often overlooked, but equal in important.

To quote the governing body that mandates these requirements: doctors” must demonstrate an awareness of and responsiveness to the larger context and system of healthcare … and are expected to advocate for quality patient care and optimal patient care systems “.

In other terms, to practice independently, we must not only know how to prescribe our medications and perform our procedures, but also work toward improving our entire healthcare system. Our professional governing body builds no distinction between helping patients through syringes, scalpels or ordinances.

As German physician Rudolph Virchow noted in 1848:” Medicine is a social science, and politics is nothing else but medicine on a large scale .”

Importantly, as physicians, we advocate for our patients all the time. We feel wholly at ease when we do this on the day-to-day level. If one of our patients cannot get an appropriate follow-up appointment with functional specialists or their insurance company denies them a specific medication, for example, we eagerly take up arms. We opposed a million reams of red tape on a daily basis to get that one patient what she needs.

We must now embracing this same ethos on a macro level by lobbying our representatives, joining activist groups and even operating for office ourselves. The only change is the outsize impact these efforts could have: working through a single ream of red tape in the form of legislation could positively affect the lives of millions of patients.

Laws affecting human lives should not be drawn along partisan lines, but by evidence-based policy that’s best for constituents. As Washington fails this litmus test, citizens must step up. As healthcare providers, advocating for our patients is both an ethical imperative and a professional requirement. Our patients depend on us for their care- “were supposed to” help them get onto, whether that comes in the form of pill or policy.

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‘ Move fast and break things ‘: Trump’s Obamacare failure and the backlash ahead

Republicans suffered a devastating defeat on Obamacare. But the pulling of the American Health Care Act could be a blessing in disguise for Trump

The James S Brady Press Briefing Room at the White House was crammed as usual but there was an extra frisson of suspense. As the press secretary, Sean Spicer, walked to the lectern, a conversation was unfolding merely 27 paces away in the Oval Office. It would negate almost everything he said.

Paul Ryan, the speaker of the House of Representatives, told Donald Trump the news he did not want to hear. Weeks of cajoling and arm-twisting to win over skeptics of their healthcare reform legislation had failed. Ryan asked the president to trench the bill and avoid the dishonour of putting it to a vote in the House. Trump agreed.

It was a chastening defeat for a president whose electoral campaign was built on his reputation as a negotiator and a win. His book, The Art of the Deal, brags: Deals are my art kind. Other people paint beautifully on canvas or write wonderful verse. I like attaining deals, preferably big deals. Thats how I get my kickings. When it came to his first major legislation as chairman and the question deal or no deal, the answer was, emphatically , no deal.

In a poetic twist, the president who has espoused a rightwing agenda of economic patriotism, law and order and America first was undone by the right wing of his own party. Conservatives said the bill did not go far enough to repeal and replace Barack Obamas signature healthcare policy, the Affordable Care Act( ACA ), also known as Obamacare.

Today was a big win for the president. The 44 th chairperson, Barack Obama, declared Tv host Lawrence ODonnell on MSNBC. And it was, to set it in Trump-speak, a complete catastrophe for the current president.

It came hard on the heels of two legal knock-backs to his attempt to ban travelers from certain Muslim-majority districts. That policy too was imposed with a missionary zeal that masked a lack of competence and grasp of detail. But Trump appears to be playing the role of a chief executive intent on shaking up a business and his chief strategist, Steve Bannon, was reported to admire a creed from the tech sector in Silicon Valley: Move fast and breach things.

But Washington politics are different. Add in the Russia affair the resignation of the presidents national security consultant, groundless claims of wiretapping against Obama and an ongoing FBI investigation into his associates and the first two months of the Trump presidency reek of chaos, crisis and confusion.

Nobody knew healthcare could be this complicated

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Trump supporters in the heartland dread being left behind by GOP health plan

Republican proposal would upend a healthcare system in Indiana that encompasses many low-income people in a program that Mike Pence put in place

Janice Phelps, a 60 -year-old incapacitated factory worker in Evansville, Indiana, knows how expensive healthcare is.

Each month, shoots for her severe asthma cost $3,000. Quarterly injections for knee pain expense $3,200. Medication for depression expenses $900. She has had seven back surgeries, two shoulder surgeries, and two knee surgeries since 1985. The largest public health programs in America Medicaid and Medicare, which aid the poor and the elderly paid for nearly all of it.

Yet those programs are now threatened by the men she voted for: Donald Trump and former Indiana governor Mike Pence.

Im all in favor of repealing it, she said about Republican pushing to do away with the Affordable Care Act( ACA ), popularly known as Obamacare. But, she said, when “were talking about” cutting Medicaid: I dont agree with that at all.

Dramatic changes to Medicaid the scheme to help poorer Americans get healthcare are just part of the reforms in a Republican bill leaders are trying to force-out through Congress at lightning speed. However, since it was introduced last Monday, the American Health Care Act has fulfilled opponent from the left, significant sections of the Republican party, and a slate of physician, hospital and patient associations. Its been called a legislative orphan appealing to no one.

Though Phelps said she would support Trump even if it passed, she is upset by the idea of Medicaid cuts.

For Medicaid to say, Were going to expend X quantity of dollars on you, and thats all were going to spend are presumed to just roll over and succumb because we cant pay it ourselves? she said. X-rays, and MRIs, and CT scans, surgeries and stuff we have no control over how much that is … I would not be able to pay that out of my pocket, and I have to pay that to live … to put a cap on it is uncalled for.

Anxiety and ambivalence about health are common in this part of Trump country. The city of Evansville is the seat of rural Vanderburgh in deep red Indiana. It lies at a bend in the Ohio river, only north of Henderson, Kentucky.

This is Pences home state. When he was governor, he took political advantage of the ACA and used federal funds it made available to provide healthcare for half a million of the poorest people in his state.

Of course, while helping Trump win the White House, Pence was an implacable opponent of the healthcare statute. By February this year, he was whipping up a crowd of conservatives, telling them Obamacare must go. He revived that line while pushing for the Republican bill in Louisville, Kentucky, this weekend.

In a word, were going to construct the best healthcare system in the world even better, Pence said.

Yet here, in a rural corner of Indiana where Trump won 40,000 elections to comfortably beat Hillary Clinton by 10,000, many low-income people are covered by a programme designed Pence put in place only two years ago and which Republican proposals would severely cut.

Pences program, called HIP 2.0, is an example of Medicaid. It is funded by the ACA, the law that Pence continues to hall against. Including Medicaid, more than one in three people use government health coverage in Indiana.


Vanderburgh is one of only two Indiana districts where more than 10,000 people are on HIP 2.0 and that voted for Trump. Obamacare expanded Medicaid coverage to single adults through country programs such as HIP 2.0, a change that insured 500,000 new people statewide, and 14. 4 million people nationally. All told, Medicaid programs encompass 1.4 million people in Indiana and 73 million Americans.

Republican proposals would upend that system. First, funding for programs such as HIP 2.0 would start to dissipate by 2020. At that point, the federal government would stop paying for anyone who dropped off HIP 2.0 rolls. Republican would also cut traditional Medicaid by aiming some assured benefits, leaving nations such as Indiana with a tab they can scarcely afford and residents facing high anxiety.

If it wasnt for Medicare and Medicaid, I wouldnt even be sitting here today, said Fred Cook, an Evansville man and Clinton voter whose teaching career was aimed by heart disease. He had open heart surgery a triple bypass and a double leg amputation, in part caused by his longtime habit of smoking Kools. I weighed 438 pounds. Fred had to be weighed in a bed, he said.

Fred Cook: If it wasnt for Medicare and Medicaid, I wouldnt even be sitting here today. Photo: Justin Gilliland for the Guardian

We live in fear, said Pam Martin, a retiree and Clinton voter who cares for her mentally disabled brother, Darrell Martin. Though Darrell has a chore, he earned only $11,000 per year, which left him in a healthcare purgatory until Pence approved HIP 2.0.
His coverage is really good, and were really scared its going to go away, Martin said. On Monday, her family must decide whether to rushing an expensive eye surgery while her friend still has coverage, or wait for vision to return to his right eye, as doctors recommended.

Pences mission to undo what one Indiana lawmaker called his single most significant achievement is part of what House speaker Paul Ryan called a united Republican government push to repeal the ACA.

For seven years, House Republican sought to repeal the law and voted more than 50 periods to send the Senate bills that would never become law. Now, though, with control of the governmental forces, Republicans have a chance to repeal the act but are divided over the scheme put before them.

Ideological conservatives who believe the bill does not go far enough to repeal have dubbed it Obamacare lite. Leaders of the left called it fundamentally cruel. The bill is being pushed through congressional committees but seems to have little chance of gaining the votes to pass through the House and Senate to reach Trumps desk. Yet Trump is in full sell mode, seeking to woo and cajole, even inviting his former presidential nomination rival, Ted Cruz, to dinner and conservative House members for pizza and bowling at the White House.

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