Dec 22, 2019

Axios AM

⚖️ Breaking: Marc Short, chief of staff to Vice President Pence, said on "Meet the Press" that Speaker Pelosi withholding articles of impeachment from the Senate is "untenable":

  • "How can you possibly justify the contrast to say this is urgent, ... then say, well, we'll have to wait and see?" Go deeper.
1 big thing: The health care debate we ought to be having

Photo illustration: Sarah Grillo/Axios. Photos: Scott Eisen and Erik McGregor/LightRocket via Getty Images

Americans worry a lot about how to get and pay for good health care. But the 2020 presidential candidates are barely talking about what's at the root of these problems:

  • Almost every incentive in the U.S. health care system is broken, Axios health care editor Sam Baker writes as part of our "What Matters 2020" series.

Why it matters: President Trump and most of the Democratic field are minimizing the hard conversations with voters about why health care eats up so much of each paycheck and what it would really take to change things.

  • Instead, the public debate focuses on ideas like how best to cover the uninsured and the relative virtue of health care "choice."
  • The U.S. spent $3.6 trillion on health care last year, and almost every part of the system is pushing its costs up, not down.

Hospitals collect the biggest piece of the health care pie, at about $1 trillion per year.

  • Their incentive is to fill beds — to send as many bills as possible, for as much as possible.
  • Big hospital systems are buying up smaller ones, as well as physician practices, to reduce competition and charge higher prices.

Drug companies are the most profitable part of the health care industry.

  • Small biotech companies often shoulder the risk of developing new drugs.
  • Big pharma companies then buy those products, market them aggressively, and develop a fortress of patents to keep competition at bay as long as possible.

The money bonanza is enticing some non-traditional players into the health care world.

  • Private equity has developed a voracious appetite for health care providers — mainly emergency rooms, ambulances and other areas where, if you need them, you’re in no position to shop for a better deal.
  • Tech companies are also edging into health care — not to disrupt the industry, but to get in on the $3.6 trillion action.

Insurers do want to keep costs down — but many of their methods are deeply unpopular.

  • Making us pay more out of pocket and putting tighter restrictions on which doctors we can see creates real and immediate headaches for patients.
  • That makes insurers the most convenient punching bag for politicians.

The frustrating reality: Democrats' plans are engaging more in the debate about possible solutions than the candidates themselves.

  • It's a tacit acknowledgement of two realities: Controlling the cost of care is imperative, and talking about taking money away from doctors and hospitals is a big political risk.

What they’re saying: The top 2020 Democrats have actually released "insanely aggressive" cost control ideas, says Larry Levitt of the Kaiser Family Foundation. "But they don’t talk about that a lot.”

  • Medicare for All, the plan endorsed by Sens. Bernie Sanders and Elizabeth Warren, would sharply reduce spending on doctors and hospitals by eliminating private insurance and paying rates closer to Medicare's. Estimates range from about $380 billion to nearly $600 billion in savings each year.
  • Joe Biden and Pete Buttigieg have proposed an optional Medicare-like insurance plan, which anyone could buy into. It would pay providers less than private insurance, with the hopes of putting competitive pressure on private plans' rates.
  • The savings there would be smaller than Medicare for All's, but those plans are still significantly more ambitious than the Affordable Care Act or most of the proposals that came before it.

Between the lines: The health care industry has blanketed Iowa with ads and is prepared to spend millions more to defend the very profitable status quo.

  • The strategy is simple: Reframe the big-picture debate about costs as a threat to your doctor, or your hospital.
  • It's an easy playbook that both parties, and the industry, know well. And it usually works.

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2. 99% of Trump TV ads discuss impeachment
President Trump is handed a red "no" card from the impeachment vote by Rep. Dan Crenshaw (R-Texas) yesterday at the Turning Point USA Student Action Summit at the Palm Beach County Convention Center. Photo: Leah Millis/Reuters

More than 99% of the Trump campaign's TV ads this year discussed impeachment, as tallied by the nonpartisan Wesleyan Media Project.

  • Over the past three months, the Trump campaign talked impeachment in 4,594 television ads costing $4.4 million.

Why it matters: This is a vivid new illustration of the alacrity with which the Trump campaign is embracing the stain of impeachment to raise money, rev up the base, and try to build a head of steam against whoever emerges as the Democratic nominee.

  • The Trump campaign declined to comment.

The tally covers national cable and broadcast TV between Jan. 5 and Dec. 14.

  • 99.2% of Trump's 2019 ads were about impeachment, according to Wesleyan, which issued the report in partnership with the Center for Responsive Politics.
  • What about the other .8%? "Between the start of the year and October, he aired just 36 ads on broadcast television or national cable, none of them mentioning the prospect of impeachment," the report says.

See the report.

3. 📱When to take a break from your device

Smartphone and smartwatch wearers are starting to feel phantom vibrations even when there's no new notification, The Wall Street Journal's Daniela Hernandez reports (subscription).

  • "Phantom phone syndrome is sometimes called 'ringxiet' and 'vibranxiety.'"
  • "Researchers say phantom phone syndrome is related to the social-media driven fear of missing out, so-called FOMO."

😱 This was a new one for me: "Another condition, nomophobia, refers to feelings of terror from not having a working phone."

Bonus ... Pic du jour: We three (future) kings
Photo: Chris Jackson/Buckingham Palace via Getty Images

This remarkable photo, released yesterday by Buckingham Palace, shows Queen Elizabeth II with her son, grandson and great-grandson — the next three heirs to the British throne.

  • From left is Prince William, 37; his oldest son, Prince George, 6; the Queen, 93; and her oldest son, Prince Charles, 71.

George was helping prepare a Christmas pudding in the palace's Music Room, as part of the launch of The Royal British Legion's "Together at Christmas" initiative.

4. Christmas reality check
A displaced resident carries a bag from the Red Cross after a fire at a three-story apartment building in Las Vegas yesterday. Photo: David Becker/AP

With so many of us deep in holiday mode, I was struck by this spate of headlines at the top of the AP wire — a suddenly sad Christmas for lots and lots:

  • "6 killed, 13 injured in Las Vegas apartment building fire" (residents apparently using stoves for heat).
  • Chicago police: 13 wounded in shooting at memorial party."
  • "7 people shot early Sunday in downtown Baltimore."
  • "35 vehicle pileup in Virginia results in injuries" (chain-reaction crash in fog and ice, near Camp Peary in York County).
5. Memorable photos of 2019
Photo: Jose Luis Gonzalez/Reuters

Guatemalan migrant Ledy Perez embraces her son Anthony while praying to ask a member of the Mexican National Guard to let them cross into the United States, as seen from Ciudad Juarez, Mexico, on July 22.

6. 🖋️ 1 fun thing: Robots provide personal touch

A rite of passage for Washington interns is discovering the secret of the autopen, which signs the boss's name on form letters. Now, the mystical autopen is being democratized ...

"People are turning to robots to write their ‘handwritten’ cards ... Pen-wielding machines can mimic the intimacy of the human hand — even your own," the WashPost's Abha Bhattarai reports:

  • "At Handwrytten, a fast-growing service in Phoenix, robots are outfitted with Pilot G2 pens in blue ink because, founder David Wachs says, it’s 'more realistic-looking' than black. The pens also offer an advantage over even the most sophisticated printouts: The telltale imprint they leave on paper."
  • "Customers ... can have their own handwriting replicated, for $1,000."

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