WALL STREET PLUNDERS - KEEPING AMERICA DRUGGED FOR PROFITS!

Analysis on Washington's health-care debate. Not on the list? Sign up here.  Share  Share  Tips/Feedback Bernie Sanders is betting Iowans are ready for Medicare-for-all. They weren't four years ago.   BY PAIGE WINFIELD CUNNINGHAM with Paulina Firozi THE PROGNOSIS Tuesday's Democratic presidential primary debate at Drake University in Des Moines. (Photo by ROBYN BECK/AFP via Getty Images) Almost exactly four years ago, Sen. Bernie Sanders (I-Vt.) sparred with Hillary Clinton over Medicare-for-all in a primary debate. A majority of Iowa caucus-goers picked Clinton — the candidate who was against Medicare-for-all— a few weeks later. Sanders faced similar attacks on Medicare-for-all at last night’s debate in Des Moines, this time from several Democratic opponents he’s seeking to beat in the pivotal Feb. 3 caucuses.  And like Clinton did in 2016, they argued Medicare-for-all isn’t feasible in the United States. Sen. Amy Klobuchar (D-Minn.) called it a “pipe dream.” Both she and former vice president Joe Biden implied Sanders wasn’t being honest about how much it would cost. Politico's Carla Marinucci: Former South Bend, Indiana mayor Pete Buttigieg said his own plan to expand coverage is better than “running up $20 trillion, $30 trillion, $40 trillion bills.” From Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation: Sanders, Biden, Buttigieg and Sen. Elizabeth Warren (D-Mass.) are in a four-person pileup in Iowa, where polls suggest a variety of caucus outcomes are possible. Sanders and Warren are leading according to a Selzer & Co. poll, while a Monmouth University poll has suggested Biden and Buttigieg will take the spoils. We know this much: Iowa’s outcome will likely be complicated, considering each candidate will collect a percentage of delegates (versus winner-take-all) and voters’ second choices come into play if their first-pick candidate doesn’t generate enough support in a particular caucus location. Iowa’s outcomes can be critical: Every single winner of the Iowa Democratic caucus since 2000 has gone on to be the party’s nominee for the general election (that’s not true for Republicans). And Iowa voters care a lot about health care. Forty-five percent of Iowa caucus-goers say it is their No. 1 concern, according to the Monmouth poll released this week. That’s down from 56 percent in August but still ranks above any other single issue – including beating President Trump and climate change. There’s been a lot of focus on how the 2020 candidates are picking sides between Medicare-for-all and the public option approach. Many of them have moved towards a more moderate position, a shift that was most evident last night in Warren, who spoke enthusiastically about shoring up Obamacare and barely mentioned Medicare-for-all.  Washington Examiner's Kimberly Leonard:  The Hill's Jessie Hellmann:  But their tangles are an extension of the fight Sanders and Clinton were having in 2016. At the time, Clinton suggested Medicare-for-all could never happen.  “People who have health emergencies can't wait for us to have a theoretical debate about some better idea that will never, ever come to pass,” she said a few days before the 2016 Iowa caucuses. Clinton and Sanders in a 2016 debate. (Photo by Melina Mara/The Washington Post) At an NBC debate on Jan. 17, 2016, Clinton accused Sanders of withholding details about Medicare-for-all. “When we are talking about healthcare, the details really matter and therefore we have been raising questions about the nine bills he introduced over 20 years, as to how they would work,” Clinton said. “He didn't like that, his campaign didn't like it either and tonight he's come out with a new plan and again we need to get into the details.” Sanders is hoping for a better fate four years later. “Now is the time to take on the greed and corruption of the health care industry, of the drug companies, and finally provide health care to all through a Medicare-for-all single-payer program,” Sanders said at last night’s debate. The question is whether Democratic voters have shifted enough for a Medicare-for-all candidate to win. The other candidates argue that voters – and most Democratic leaders – haven’t. “I was in Vegas the other day and someone said ‘don’t put your chips on a number on the wheel that isn’t even on the wheel.’ That’s the problem,” Klobuchar said, noting that majorities of House and Senate Democrats and numerous Democratic governors don’t support the approach. (AP Photo/Patrick Semansky) More health highlight from the debate:  — There was nary a mention of President Trump's claims a day earlier that he championed protections for patients with preexisting conditions (read our Health 202 fact-check here). The candidates mostly stuck to their own differences over expanding health coverage, which one could argue makes for a better debate but disappointed Democratic activists who are primarily concerned with beating Trump. — The Trump campaign responded to the debate with a statement saying all the candidates showed they'll "ruin health care." “Based on their performances on stage, the six Democrat candidates demonstrated that not one of them deserves to win the Iowa caucuses in less than three weeks," Tim Murtaugh, Trump 2020 communications director, said in a statement. "They will tank the economy, ruin health care, raise taxes, and fail to adequately defend the United States. President Trump would dominate any of them in November.” Warren and Sanders talk after the debate. (AP Photo/Patrick Semansky) — Prescription drug prices got some air time.  Warren said she'll use executive powers on her first day in office to help lower the cost of key drugs, like insulin, EpiPens and treatment for HIV/AIDS. She also called for increasing generic drug competition and said the pharmaceutical industry blocks access to them. “There are a whole lot of drugs, about 90 percent of drugs, that are not under patent. They're generic drugs. But the drug industry has figured out how to manipulate this industry to keep jerking the prices up and up and up," Warren said. "So my view is, let's give them a little competition... This is a way to make markets work."  Klobuchar said she is open to looking at Warren's plan for generic manufacturing but touted her own proposals, like allowing Medicare to negotiate drug prices and importing cheaper drugs from foreign countries.  She pointed to her bill with Sen. Chuck Grassley (R-Iowa) on drug importation as well as her bill to stop generic drugmakers from "taking money from big pharmaceuticals to keep their products off the market. The issue here is there are two pharma lobbyists for every member of Congress,” she said. “They think they own Washington. They don’t own me.”  Buttigieg and Biden also separately expressed support for allowing Medicare to negotiate prescription drug costs.  Sen. Klobuchar. (AP Photo/Patrick Semansky) — Klobuchar also made an impassioned call for improving long-term care, citing her own family’s experience.  “What should we do about long-term care, the elephant that doesn’t even fit in this room,” she said. “We need to make it easier for people to get long-term care insurance, we need to make it easier for them to pay for their premiums." — Health care didn't come up until midway through the two-hour debate, a notable shift from most of the previous debates, in which candidates vigorously debated Medicare-for-all right out of the gate. Former CBS news anchor Dan Rather: Kaiser Family Foundation CEO Drew Altman: Politico health reporter Dan Diamond: You are reading The Health 202, our must-read newsletter on health policy. Not a regular subscriber? SIGN UP NOW

AHH, OOF and OUCH

From 2006 through 2014, more than 100 billion doses of oxycodone and hydrocodone were distributed nationwide, according to federal drug data. (John Moore/Getty Images)  AHH: More than 100 billion doses of oxycodone and hydrocodone were shipped across the country between 2006 and 2014, according to newly disclosed federal drug data, our Washington Post colleagues Steven Rich, Scott Higham and Sari Horwitz report.  The data reveals there were 24 billion additional doses of the pain pills than previously known to the public.  In addition to data from 2006 through 2012 obtained by The Post and the company that owns the Charleston Gazette-Mail in West Virginia, two more years of information from 2013 and 2014 was “recently posted by a data analytics company managed by lawyers for the plaintiffs in a massive lawsuit against the opioid industry.” The data points again to six companies that distributed the majority of the pain pills -- McKesson Corp., Cardinal Health, Walgreens, AmerisourceBergen, CVS and Walmart made up 76 percent of the oxycodone and hydrocodone pills shipped during those years. “The volume of pills distributed skyrocketed as the epidemic claimed more lives. From 2006 through 2014, more than 130,000 Americans died from prescription opioids,” Steven, Scott and Sari write. “The number of pills shipped went from 8.4 billion in 2006 to 12.8 billion in 2011. Pill distribution started to decline slightly in 2012, and the additional data shows that, by 2014, the number of pills distributed was 11.8 billion." A pharmacist holds boxes of the drug Humalog at a pharmacy in Provo, Utah. (Reuters/George Frey/File Photo)