What does Trump's victory mean for health care reform?


What does the Trump presidency mean to the cause of health care reform? How will his pledge to dismantle and then rebuild the Affordable Care Act (ACA, or Obamacare), and to leave Medicare alone and somehow watch it fix itself, impact doctors and patients and the entire fabric of our health care delivery system? Will he listen to fresh voices and consider sensible ideas to repair the health care mess, or will he rely on the same harried bureaucrats who are married to hospitals and drug companies and societies representing specialist physicians and follow their self-serving path of reform that demeans primary care and patient autonomy while preserving the status quo?

We have discussed in these pages, and in my book and many others, the wasteful health care delivery system in which we all live, where $750 billion is squandered annually for care that is either unnecessary or harmful, and where 50% of all care is considered low-value whereby it is not useful to the patients upon whom it is thrust. My recent article in RealClearHealth highlights many aspects of our medical system’s flaws. But the system we have always perseveres because it rewards many doctors, CEO’s, and institutions, while scripting a now well accepted narrative that the more tests, medicines, and procedures well-meaning and smart doctors throw at you, the more thorough and caring those doctors are. Thus, all reforms seeping out of Medicare and the ACA have tried to repair the system’s financial collapse not by assailing the institutional deficiencies of health care delivery and those who are being enriched by the system, but rather by placing more burdens on the backs of primary care doctors and their patients through convoluted strategies that no one understands and that will inevitably neither save the system any money nor help patients improve their health and their satisfaction. Can Donald Trump forge a different path?

There are of course many Donald Trumps. The maverick who ran for office and promised to shake up Washington and butt heads with special interests would be very amenable to listen to people like me, people who actually take care of patients every day, who understand the system because we live in its shadows, and who have thought about how to fix it and expressed such ideas in print and in blogs like this. But the republican operative who speaks a big game and then calls in the usual gang of special-interest advocates, like President-elect Trump is doing now, will not want to grapple with the medical landscape, will not want to alienate his allies who have financial stake in the current system, and will instead simply call for business as usual. Which Donald Trump will emerge at the end of January, and how can we get our voices heard now to make sure he hears us? Will he rely on health care wonks like Lanhee Chen and Scott Gottlieb who think the free market can help rescue our mess? And if so, will these people help Trump guide our system away from the wasteful rules that pay doctors and hospitals too much for poor care while neglecting the vital role of primary care, or will they consort with corporate and specialty driven health care "experts" who drive us further into debt and substandard care?

There are more doubters out there than believers when it comes to my contention that effective change is not only possible but it is easy, and that it will benefit both doctors and patients while saving the health care delivery system billions of dollars every year. My book and others prove this fact, and offer ideas that are hardly radical or disruptive, but rather reek of common sense and basic capitalistic principals. Effective health care reform is not partisan; liberals and conservatives equally have devised solutions that are far too complicated and ineffective, and liberals and conservatives have also devised solutions that likely could work. In my book I suggest that if you put 20 primary care doctors and patients in a room, people of differing political/cultural/ethnic positions, that we would give you the framework of a feasible health care system that is economically feasible and medically effective, and that our reforms would be so simple that we could hand them to you on one page and have it completed by lunchtime. This is not brain surgery; if Ben Carson can split conjoined twins, then certainly he and the rest of Donald Trump’s health team can understand this. The reasons that other politicians have not grasped it is because they do not want to; it flies in the face of the lobbyists and special interests who are incessantly talking in their ears.

To those of you who read this blog, I implore you to contact the Trump transition team and make your voices heard. I sent him a book and tweeted his advisory team. I am happy to send them more, to talk to them, and to offer a view that likely diverges from the banter that they are hearing now. We know how to change the system, and we know that the games that reformers now call progress are entirely missing the point. Does Donald Trump really want to make health care great again? Well, here is his opportunity to get it right.

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