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Daily on Healthcare: Revisiting Mick Mulvaney

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Let's revisit Mick Mulvaney's controversial remarks about diabetes: The White House budget director is taking heat for comments he made about healthcare during a panel discussion that was recounted by our own Kimberly Leonard. Mulvaney, in speaking of the "Jimmy Kimmel test" for healthcare (a reference to the late night comic's baby who was born with heart complications), went on to say that while he supported covering those with pre-existing conditions, that category of individuals was different than those whose health problems are linked to their own behavior. (See the 54-minute mark of this video for the full discussion). "We have plenty of people to provide that safety net so that if you get cancer you don't end up broke…that is not the question. The question is, who is responsible for your ordinary healthcare? You or somebody else?" He said the debate centered on whether others should pay the burden of paying for someone's healthcare. "That doesn't mean we should take care of the person who sits at home, eats poorly and gets diabetes. Is that the same thing as Jimmy Kimmel's kid? I don't think that it is." Liberals pounced. Jonathan Cohn at the Huffington Post wrote, "A top Trump official just flunked the Jimmy Kimmel test" and ThinkProgress ran a story headlined, "Top Trump official says we shouldn't take care of someone who 'eats poorly and gets diabetes.'" The American Diabetes Association also weighed in with a statement, noting that a number of risk factors play into somebody getting diabetes, primarily genetics. The controversy follows the reaction when conservative Rep. Mo Brooks, R-Ala., was slammed a few weeks back for making a similar point.

Now, while certainly any public figure talking about other people's health problems should tread carefully, those of us who write about healthcare for a living should be able to acknowledge that there has long been a discussion about the role that behavior plays in healthcare costs. It is simply undeniable that, while certainly many illnesses are beyond one's control, individuals can take actions to reduce their risk of others. This point is fairly uncontroversial in health policy. A 2015 report from the National Association of Health Underwriters noted, "Research shows that behavior is the most significant determinant of health status, with as much as 70 percent of healthcare costs attributable to individual behaviors such as smoking, alcohol abuse and obesity." A 2015 study in the American Journal of Preventive Medicine estimated that 8.7 percent of health costs in the U.S. are linked to smoking alone.

Former President Barack Obama himself made this case repeatedly. On the campaign trail, he proposed reducing costs by encouraging Americans to engage in healthy lifestyles. Michelle Obama made the fight against obesity central to her work as first lady and she is still is talking about the issue, and Obamacare itself promoted wellness programs as a way to reduce costs. In fact, one of the few ways that Obamacare allows insurers to discriminate is that they get to charge more for smokers. Meanwhile, many liberals have pushed the idea of a soda tax to fight obesity.

Sure, there are people who have had huge medical costs because they were stricken by tragedy and illness. But there's an important distinction between those with high costs because they have brain cancer, were born with heart defects or paralyzed in accidents involving a drunk driver, and people who developed health problems because they are chain smokers, ate too much, or never exercised.

One of the many problems with the current healthcare debate is that it's focused only myopically on reducing costs. That is, defenders of Obamacare argue that more generous subsidies could be used to make more comprehensive insurance more affordable, and conservatives have argued that premiums would be lower if people were allowed to purchase insurance that covered less without having to cross-subsidize those who require more expensive care. But it would be productive to broaden the debate to focus on ways to encourage individuals to engage in healthier behaviors. No doubt, liberals and conservatives would disagree whether that encouragement would come in the form of government intervention or allowing market incentives to work. Some might argue, for instance, that being poor, or without access to healthier foods or play spaces for children, makes it more challenging to develop healthier lifestyles. But those who care about health policy shouldn't pretend as if behavioral-driven health issues are no longer a problem just because a few Republicans raised it in a way that can be used as a political bludgeon.

Welcome to Philip Klein's Daily on Healthcare, compiled by Washington Examiner Managing Editor Philip Klein (@philipaklein), Senior Healthcare Writer Kimberly Leonard (@LeonardKL) and Healthcare Reporter Robert King (@rking_19). Email dailyonhealthcare@washingtonexaminer.com for tips, suggestions, calendar items and anything else. If a friend sent this to you and you'd like to sign up, click here. If signing up doesn't work, shoot us an email and we'll add you to our list.

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Monday to Thursday. Sheraton Pentagon City. "Developing Solutions for the Next Generation of Veteran Care." Details.

1:30 p.m. Sheraton Pentagon City. Tara Galovski, VA director of Women's Health Sciences Division, to discuss "Identifying and Mitigating the Potential Toll Combat Deployments can have on Women's Health Functioning and Well-Being." Details.

TUESDAY | MAY 16 House returns from recess. Schedule.

9 a.m. Sheraton Pentagon City. Curtis Coy, VA Deputy Under Secretary for Economic Opportunity, to deliver keynote on "Providing for the Economic Well Being of the Veterans." Details.

9:30 a.m. HVC 215 Capitol Visitor Center. Avik Roy, President of the Foundation for Research on Equal Opportunity will present a new white paper that will describe how federal policy has artificially driven up the cost of prescription drugs.

9:30 a.m. Sheraton Pentagon City. Dr. Thomas Lynch, VA Assistant Deputy USH for Clinical Operations and Management, to speak on "Managing the Continued Improvement of Clinical Care in Today's Veteran Population." Details.

1 p.m. Sheraton Pentagon City. Scott Blackburn, VA Interim Deputy Secretary, to speak on "Update on MyVA and How It Is Affecting Veterans Benefit Delivery." Details.

1 p.m. Sheraton Pentagon City. Tiffany Love, VA Deputy Associate Director of Patient Care Services, to speak on "Social Media and Its Evolving Impact on Veterans." Details.

1:30 p.m. Sheraton Pentagon City. Joseph Ronzio, VA Deputy Chief Health Technology Officer, to speak on "Incorporating Wearable and Implantable Technology into the Next Generation of Healthcare Delivery." Details.

WEDNESDAY | MAY 17 8 a.m. 620 Perry Pkwy. Gaithersburg, Md. FDA committee meeting on gastroenterology and urology devices. Details.

8:30 a.m. 10903 New Hampshire Ave,. Silver Spring, Md. FDA Vaccines and Related Biological Products Advisory Committee Meeting on considerations for evaluation of Respiratory Syncytial Virus vaccine candidates in seronegative infants. Details.

10 a.m. 2358-C Rayburn. Oversight hearing on advances in biomedical research. Details.

10 a.m. Senate Commerce, Science and Transportation Committee hearing on "Current Issues in American Sports: Protecting the Health and Safety of American Athletes." Details.

10 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on "Future of Emergency Alerting." Details.

10:15 a.m. 2123 Rayburn. House Energy and Commerce Committee hearing on "Examining Initiatives to Advance Public Health." Details.


8 a.m. Ronald Reagan Building and International Trade Center. 1300 Pennsylvania Ave NW. Meeting on how how the SMART™ Student Health and Wellness model can transform health care for public school students and impact their education, careers and communities. Includes Democratic Reps. Jan Schakowky of Illinois and Terri Sewell of Alabama.

2 p.m. 1100 Longworth. House Committee on Ways and Means hearing on the "Current status of the Medicare Program, Payment Systems and Extenders." Details.


9:30 a.m. Rayburn 2123. House Committee on Energy and Commerce hearing on Drinking Water System Improvement Act and Related Issues of Funding Management and Compliance Assistance under the Safe Drinking Water Act. Details.MONDAY | MAY 22CBO report on the American Health Care Act expected this week.