The Health Policy of President Trump

I was going to write a blog post about the outcome of the election and what it means for health policy going forward. But I’m stressed enough with work, so I don’t need to add that to my to do list. But at the same time, I cannot be completely silent on the matter. So what you’re going to get is an abbreviated post and several great links. It seems no one saw our next president, Donald J. Trump, coming. No one thought he was a serious candidate. No one thought he would win the GOP nomination. And, even until late last night, few thought he had any real chance of winning the Presidency. So much for what people thought. I hope the same principle applies now, because many people think he won’t be a good president, and won’t govern effectively. For the sake of the country I love and the people that comprise it, I really hope he proves them wrong.

Of course, the rhetoric around repealing Obamacare has already begun. It certainly looks like, with control of both the House and Senate, President Trump will be able to sign such a bill repealing the ACA into law. Whether or not he will, or what popular provisions he and the Congress may try to keep truly is unknown. I say this because, even as half of the country seems to think the sky is falling, the optics of taking insurance away from more than 20 million Americans are not good. I don’t think things look good for the future of Obamacare, but I also thought Clinton was going to win last night. In fact, I’m already envisioning how Republicans will blame Obama when insurance premiums increase in 2018 following the repeal of the ACA in 2017. But, right now, it’s all conjecture. As things move forward next year, we’ll know more and I’ll do my best to weigh in then. If you want to see the immediate “hot takes” from those in the health policy world, I suggest you read this summary from Kaiser Health News, this excellent overview from Tim Jost at the Health Affairs Blog, and these pieces from Toluse Olorunnipa and Alex Wayne at Bloomberg Politics, and Susan Cornwell and Richard Cowan at Reuters.

Best of all, I highly recommend you read this heartfelt reflection from Aaron Carroll of The Incidental Economist. After I read Aaron’s piece, I thought to myself, what did I write in my first post when I created this blog back in July 2009? If you’re curious, here’s the link. This was a project born in the midst of the debate over the ACA–some 6 months into Obama’s first term. It is a project that has withered considerably as I confronted life on the tenure track, and the reality that my success would be measured by how many grants I received and how many peer-reviewed publications I had, rather than how much time I spent writing a blog for public consumption. More than once, I’ve contemplated retiring this space. After all, blogs only thrive when fed a steady stream of regular content. I’ve tried to recruit guest authors and co-bloggers to spread the workload around a bit, with limited success. But the vision remains. And, while some period of mourning is natural (even healthy), there remains increasingly important work to be done. Today, I’m thankful that I still have this space to write. My commitment to the cause of making our healthcare system better for everyone remains strong, as does my desire to make the complex topics of health policy and health services research accessible to all. For now, my writing is likely to remain sparse, but my passion is renewed. The cause is too important to abandon amidst the politics. I hope you’ll join me.

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Health Wonk Review: The Game 7 of Politics Edition

By this time next week, we’ll *hopefully* know who our next President is. And, this morning, we already know that the Chicago Cubs won Game 7 of the World Series to claim their first championship in 108 years. Last night’s game was some of the best baseball I’ve ever watched. The election, well, let’s just say it’s an exciting time people! As Matt Viser (@mviser) said on Twitter last night “This World Series is as good as our politics are bad.” “Most Americans want neither of these teams to lose. Most Americans want neither of these presidential candidates to win.” So, let’s jump right into this Game 7 of Politics Edition of the Health Wonk Review.

Let’s start with a couple of pieces closely related to the Presidential contest. With the election less than a month away, it was rather odd timing for the Obama Administration to release the news of an average 25% increase in premiums. Opponents of “Obamacare” were quick to pounce on this–including the Donald–but as Joe Paduda points out at Managed Care Matters, in a post entitled “ACA: the real story” there is something sorely missing from pundits’ and TV “experts” talking about this reported increase in premiums: It only applies to the Marketplaces, and only 6% of insureds are covered that way.

The Affordable Care Act has made it much easier for a lot of the previously uninsured population to obtain high-quality individual health insurance and – through considerable financial assistance in the form of cost-sharing subsidies and premium subsidies – affordable coverage. But Louise Norris says there are still situations when a short-term policy makes a lot of sense. In a post at Healthinsurance.org she runs down those reasons – and also provides a list of caveats for prospective buyers.

Not everything’s about the election, thankfully. Here are some great pieces from my fellow wonks that don’t mention November 8th, but are timely nonetheless:

Brad Flansbaum of The Hospital Leader writes about how healthcare providers who read the opinion pieces of bioethicists know they shouldn’t treat celebrities, pro athletes, and board members differently when they show up at the hospital, but how they all do it anyway when faced with the reality of the situation. It’s a bit like the person who votes for their candidate despite their myriad scandals, or how Cleveland Indian fans know they should have rooted for the Cubs to win, because it’s been so much longer since the Cubs won, but still pulled for The Tribe anyway.

In a post entitled “Information Technology Expertise vs. Literacy: A Lesson from the Hillary Campaign for President”, Jaan Sidorov of the Population Health Blog compares information technology “literacy” vs. “expertise” and suggests that organization leaders have an obligation to be IT literate. You know, they need to have the “best words.”

Over on the HealthBlawg, David Harlow recently spoke with Glen Tullman, CEO of Livongo (living on the go … get it?), which enables people with diabetes (and, coming soon, people with certain comorbidities) to use care management tools that free them from being tethered to home, to a phone, to concerns about test strips running out, to intrusive questions and instructions from well-meaning family members and care managers, and empower them by establishing their own parameters for alerts to caregivers. Do people want to be more engaged with their chronic conditions? Tullman says: No — and Harlow agrees. Many, if not most, people would rather be able to manage their care automagically, in the background, without having to make an effort, without having to be more engaged. Check out the interview (audio or transcript). The company’s approach has implications for the way in which we conceive of chronic disease management and of payment for such services.

Over at the Health Affairs Blog, Mildred Solomon offers up “The FDA’s Controversial Duchenne Drug Approval And The Moral Impulse To Rescue.” Her piece asks “What can we learn from the Food and Drug Administration’s controversial approval of the first drug for Duchenne Muscular Dystrophy (DMD)?” Against the recommendations of the FDA’s expert panel, Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, approved the drug under the FDA’s accelerated approval pathway for a subset of patients, approximately 13 percent of the DMD population with a gene mutation amenable to the drug’s action. The controversial decision is defensible, but only if there is adequate follow through, writes Solomon.

David Williams writes “PCSK9 experience shows drug market isn’t completely broken” at the Health Business Blog. Williams asks (and answers) the question: “If drug makers can charge high prices at will, why have the new PCSK9 drugs for high cholesterol been such a failure?” It’s worth a read.

At the Health System Ed blog, Peggy Salvatore writes about the recent internet outages that hit the country. Widely used websites like PayPal, Netflix and Twitter were unavailable due to a distributed denial of service (DDOS) attack. Hackers got into those systems through technical holes in hundreds of thousands of personal wifi-enabled devices like baby monitors and personal devices to bring down a website host, Dyn. For people in healthcare who are concerned about security, it brought a system vulnerability into sharp relief. In “Healthcare Devices and the Internet of Things – Promise, Peril and Distributed-Denial-of-Service Attacks” Salvatore provides a review of some of the vulnerabilities they face and advice from IT experts on tightening up security.

The always upbeat Hank Stern takes a look at MediShare–a healthcare sharing ministry–over at the InsureBlog. He asks whether such plans are a viable alternative to other options under Obamacare and has a surprising answer. I was especially surprised, given what I’ve written previously on this same topic.

Ever the watchdog, Roy Poses writes “Legal Settlements to Remind Us How Our Health Care System Became Rigged: by GSK, Novartis, CVS” at the Health Care Renewal blog. Says Poses: “Yet more monetarily small legal settlements by huge health care corporations of unethical practices leading to overuse of pharmaceutical, and likely harm to patients given drugs they did not really need remind us of how the (US at least) health care system has been rigged to benefit corporate insiders, to the detriments of health care professionals, and especially patients.  We hope that true health care reform would lead to responsible, accountable leadership of large health care corporations, ending their impunity.  Unfortunately, we are also reminded by recent events in the US that revealing how our systems may be rigged could inspire reform, or could inspire the rise of a “man on a white horse” who promises to fix everything.”

For the first time in more than two decades, lost-time medical severity has declined in workers comp – no thanks to prescription drugs, which account for $17 of every $100 in medical spend. These and other key data and trends can be found in Julie Ferguson’s post at Workers Comp Insider: Highlights: Fall NCCI Issues Report.

Finally, at the Healthcare Economist, Jason Shafrin writes a post entitled “The Value of Adherence Information.” Information on patient adherence can lead to better prescribing decisions, but can we quantify the value of better decision-making? The Healthcare Economist does just this in his latest published research.

Well, that’s it for this edition of the Health Wonk Review. Congratulations to the Cubs, and remember to vote if you haven’t already!