This is a special post-election edition of Health Wonk Review – we asked our contributors to share their thoughts about how the GOP’s sweep will affect health care, health reform, and the health care system.
I’d like to profusely thank our contributors. For most, this was a totally unexpected result that no one i know (except Michael Moore, who I don’t “know”) predicted or even considered possible. Our contributors have focused, dug in, and come up with some terrific insights into implications for health care.
Before we jump in, a couple key data points.
- Health care accounts for one-sixth of our GDP. This is a HUGE, incredibly complex, deeply entrenched business.
- Unlike any other part of our economy, health care is unique because it profoundly affects us as individuals.
- ACA is MUCH bigger than the Exchanges; only 1 American out of 19 is covered via the Exchanges.
More on what ACA is and is not, and how it has been portrayed in the media from Daniel Dawes at healthinsurance.org. If you’re up for more fact-checking, Daniel’s got you covered.
David Williams encourages Democrats to go ahead and allow Republicans to repeal ACA. Filibustering such a move, while possible, would delay the death by a thousand cuts from executive action and the budget reconciliation process. That being the case, let ’em at it.
David correctly notes that the GOP’s positions are often directly contradicted by (some of) Trump’s positions, and health care is no exception. He also breaks down the key “policy initiatives”, most of which won’t do anything to bend the cost curve. David concludes that once Trump figures out these initiatives aren’t going to solve the problem, he may well decide to go back to his earlier plans to adopt a Canadian-style system.
We welcome Matthew Holt back to HWR! Somehow able to write a cogent post while watching election returns (when I was hiding under the covers), Matthew wonders how Trump is going to A) repeal “Obamacare” while ensuring everyone has access to high quality, affordable health care. The middle-aged white folks who supported him expecting he’d “fix” health care are going to be disappointed if he doesn’t deliver…
That, plus the fact that the entire health care system – payers, providers, IT, pharma – have spent six years working to adapt to ACA and there will be an awful mess if there’s a hard stop on Inauguration Day.
Bob Laszewski tells us the GOP does have a written plan, and it’s ready to go. He also believes the Dems will work with the GOP to replace ACA because there are a lot of Democratic Senators up for election in 2018.
Thanks to Peggy Salvatore for her contribution; she notes that for many voters “Obamacare” may well have been a big reason they pulled the lever for “anyone else”. She also hopes Trump will assemble a team of experts to plan the new health care laws.
Brad Wright notes that while most may think ACA will be repealed, most also thought Clinton would be our next President. The real question is what will happen to the 20 million + who have coverage due to ACA.
Tim Jost of Health Affairs reminds us that the simplistic statement “repeal Obamacare” is not going to happen. Most Americans equate the Exchanges with “Obamacare”; ACA is much more than that. An outright repeal would impact everything from pharmaceutical pricing to biosimilars to Medicare reimbursement to hospital financing; the entire system will grind to a halt if the “replacement” plan isn’t carefully thought out and well planned.
Given Trump’s wildly inconsistent stances on health care and the low likelihood that the Ryan plan’s policies will do anything to bend the cost curve, I don’t see a solution coming that will make Trump voters happy.
Thanks to Roy Poses for his post on how the current system is “rigged” to enable companies to sell useless stuff. The FDA finally caught up with a company shilling its “beads” as a drug delivery tool, when it had been explicitly prohibited from doing just that. Perhaps we need MORE regulatory enforcement, not less.
President Trump will be quickly brought up-to-speed regarding the risks of messing around with an industry that contributes 18% towards GDP. ‘Fixing’ healthcare in ways that his supporters want will throw the country into a recession. Nobody in DC has an appetite for taking that kind of risk.
Also, there’s a long list of powerful interests who BENEFITED from the PPACA (big pharma, hospitals, insurance companies, etc.) and who will use their influence to prevent a full “repeal.” Republican infighting is all but guaranteed.
After 6 years of implementation of the PPACA, much of which can’t be easily undone, we are most likely going to end up with is a modified version of Obamacare but with a new name… How does the Making Healthcare Tremendous and Spectacullar Act of 2018 sound?
The Problem: Obamacare focused on insurance coverage of disease treatment, not health or the systems of healthcare.
The Good-Health Plan: Health can be created by paying most for health, not procedures and encounters.
The Details: Build a nationally-standardized, patient-centered electronic medical record that measures health and drives prevention at each encounter. The Regional Health Systems (RHSs) manage this data to reward the doctors who create the most health, not those that run up the bills, thus constraining unnecessary procedures and encounters, and creating savings. The patient trust created by every good outcome is leveraged by the RHSs to motivate prevention compliance and health.
Bottom Line: Health can be managed, and prevention is less costly than treatment; good systems are essential.
Big Bonuses: More healthy people will increase workforce participation and productivity, improving competitiveness; help balance federal budgets (increased wage tax revenue, decreased disability payments); and enrich American culture.