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POLITICO New York Health Care: Debating substance abuse, Cuomo in Puerto Rico

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written by Dan Goldberg

TUESDAY’S MUST READ POLITICO New York’s Josefa Velasquez examines the debate on substance abuse. Freshman Sen. Robert Ortt, a Republican and chairman of the Senate’s heroin task force, is crafting a bill that would require anyone administered naloxone, also known by its commercial name Narcan, to enter treatment. But a public health official and advocates say the solution to addiction isn't so simple, and they warn that studies have shown mandatory treatment doesn't work. Read the full story here:

...Ortt’s argument: “We need to ask ourselves: What is the end goal here? Is the goal to stop the epidemic, or is the goal to just enable the addiction or enable the use of heroin and opioids? To me, the goal is to save lives, but also to end addiction and try to treat this epidemic.”

...But Patty, a 49-year-old addict, said treatment only works when someone is ready. Patty said she was administered naloxone by her husband after overdosing, or “falling out" — but the overdose wasn't a wake-up call. “I’m an addict. So I’m not going to think like that. I’m not consciously thinking about Narcan when I’m getting high,” she said. “I’m not thinking about overdosing. I just want to feel better. Nobody is thinking about that when they get high."

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DATELINE SAN JUAN — I’m in Puerto Rico this morning along with Gov. Andrew Cuomo and a couple dozen elected leaders, appointed officials and other health care policymakers, including state health commissioner Dr. Howard Zucker, state Medicaid director Jason Helgerson, Greater New York Hospital Association president Ken Raske and 1199 SEIU president George Gresham.

…Cuomo on Monday urged Congress to allow Puerto Rico to restructure its debt through bankruptcy. Citing New York’s “deep, personal, institutional relationship,” with the island, Cuomo also said Puerto Rico should have relief from its Medicaid cap, and “a fair reimbursement” for its Medicaid expenses. It was the first time Cuomo took a position on whether Puerto Rico should be allowed to restructure its debt, an option available to insolvent municipalities in the United States, but not to the island. Read my story here:

...The reason the governor invited so many health policy experts is because one of the largest problems facing Puerto Rico is its health system. Cuts to Medicare Advantage and a low reimbursement rate for Medicaid are crippling the health infrastructure on the island. Cuomo and Helgerson believe they can work with the island to reform its health care delivery system, create some efficiencies and then use those to leverage a better deal with the Centers for Medicare and Medicaid Services.

NOW WE KNOW — Researchers from the University of Missouri decided to figure out what counts as authentic Mexican food and who should decide. Stephen Christ, who led the study, worries Mexican-American restaurants, while claiming authenticity, may be leading to the assimilation of Mexican culture into the American lifestyle. "The power to define something as authentic rests not with the restaurant owner but rather in the hands of mostly white, American consumers who have had little experience or knowledge of Mexican food or traditional styles of preparation," Christ said in a press release accompanying the article. "The owner of a Mexican restaurant may claim to have the most authentic facility because his chef is from Mexico or he has more employees from Mexico than any of his competitors. But for the consumer, the most important consideration is 'how much does this food fit my expectation of what Mexican food is based on growing up and having taco day at high school or eating at fast-food taco restaurants?'"

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REACHING OUT — The city's health department sent a letter to Orthodox Jewish schools and parents last week, warning them of a pertussis (whooping cough) outbreak, and encouraging them to get their children vaccinated. "The majority of people sick with pertussis in the Orthodox communities have been children who were not up to date with pertussis vaccination," wrote Jane Zucker, assistant commissioner in the bureau of immunization. "We urge you to make sure that your children are up to date with their vaccination and that they are vaccinated on time. ... Delaying vaccines puts your children at risk for serious complications."

JOBS DAY — The U.S. gained 173,000 jobs in August, and Dan Diamond says 41,000 of those were in the health care sector. Diamond also points out that hospitals have gained more jobs in the past year (134,000) than they had in the previous five years combined (122,000).

PHARMA REPORT: Ed Silverman, now with The Boston Globe, looks at whether women taking the female libido drug Addyi will be able to obstain from alcohol.


-THE LAST CAMPAIGN — POLITICO takes a look at how Michael and Kitty Dukakis have tried to reduce the stigma surrounding electroshock therapy, which Ms. Dukakis, wife of the 1988 Democratic presidential nominee, has credited with helping her combat alcohol abuse and depression. “Together, Michael and Kitty decided that they had a platform to advocate a medical treatment that, despite its massive image problem, is widely credited with saving lives and setting patients once crippled with depression on the road to happy and productive futures. In the process, the Dukakises have found themselves to be the unexpected champions of one of the most controversial and misunderstood — but highly effective — procedures in modern medicine.”

-THE PLAGUE — The plague is on the rise across the United States and no one is quite sure why.

TODAY'S TIP Comes from the Cleveland Clinic: You've lost the weight now trim the skin. Here's how to do it


-GROWING CONCERN — Researchers at the Icahn School of Medicine at Mount Sinai worry that repeated exposure to anesthesia early in life causes alterations in emotional behavior, according to an article in Anesthesiology. “Our results confirm that multiple anesthesia exposures alone result in emotional behavior changes in a highly translational animal model,” Dr. Mark Baxter, professor in the Departments of Neuroscience and Anesthesiology at the Icahn School of Medicine at Mount Sinai, said in a press release from the school. “This raises concerns about whether similar phenomena are occurring during clinical anesthesia exposure in children.”

-EATING ON THE GO — The New York Times reports eating on the go may be worse than eating in front of the television because it may lead people to overindulge later.

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