By MATTHEW HOLT
In some unspecified time in the future I needed to crawl out of my gap and put pen to paper on the election debacle that simply came about, and what the following lunacy is perhaps like for the well being care system. So that is my try and just do that.
It’s actually exhausting to know why Trump received this election or why Harris and the Democrats misplaced. There was a number of weirdness happening. Keep in mind that earlier than the vote Harris was usually praised for working a gentle marketing campaign, the Democrats had tracked to the correct on immigration (making an attempt to go what IMHO was a horrendous invoice ), and Harris stored speaking about having a Glock, being a prosecutor and campaigned with a Cheney. The swing states (which vote at a a lot greater proportion than everybody else) all (with the slender exception of Pennsylvania) voted for Democratic senators. For President they solely went 3% towards the place they have been in 2020. Even weirder was that a whole lot of 1000’s of Trump voters didn’t seem to vote down the poll in any respect. But nationwide the swing was sufficiently big for Trump to win the favored vote. (In case you actually wish to dig in, Charles Gaba has put collectively a great spreadsheet)
The only clarification is that the teeny center in American politics voted towards the incumbent. And the “center” is getting teenier. In 1964 Johnson obtained 61% of the vote. Nixon (1972) and Reagan (1984) received with practically 60% of the vote. Obama’s huge 2008 victory was with simply 53% of the vote and he received by 7%.
Biden received in 2020 with simply over 51% and Trump will find yourself profitable whereas probably getting simply lower than 50% of the vote. This isn’t an awesome mandate. It’s a small minority of voters switching as a result of they’re pissed off with the established order. This yr the bug bear was inflation, which actually wasn’t Biden’s fault despite the fact that he obtained the blame. It additionally seems {that a} respectable slug of Arab-People and much left Democrats stayed residence or voted for Jill Stein due to Gaza.
And let’s not neglect the impression of the Electoral School which reduces turnout outside of swing states (not completely). Absolutely if we had a well-liked vote wherein each vote counts, turnout could be greater, together with within the huge 2 states which are Dem strongholds (NY & CA).
Nevertheless, even should you assume it’s inconceivable {that a} majority would vote for Trump due to what occurred in 2016 to 2021 (particularly on January 6, 2021!), apparently that’s not sufficient of a disqualifier. He’s going to be President.
So what occurs subsequent? Notably in well being care.
My expectation (and hope) is that it is a snake consuming its personal tail. There are such a lot of repugnant egos circling round Trump that it’s greater than probably they’ll activate one another, and little to nothing will get completed. That doesn’t imply nothing will occur.
The Republicans certainly received’t miss the possibility to chop taxes like they did in 2017. The query is, will they make any important makes an attempt to chop spending? I do know Elon Musk is working round saying that there’s $2 trillion to be lower from the Federal funds, however a) there isn’t and b) historical past means that Republican congresses are inclined to do the simple tax lower and reasonably than do the exhausting work of lowering spending, they’ll go away the Chinese language bond holder (and future generations) with the tab. You’ll keep in mind Dick Cheney telling W Bush that “Reagan confirmed deficits don’t matter.”
However what may change?
I don’t assume a severe try shall be made to overtake or repeal the ACA–McCain’s thumbs down in 2017 was the excessive water mark of that drama. However a full repeal of the Inflation Discount Act is on the desk. Most of that is about renewable power tax credit however it additionally contains each the flexibility for Medicare to barter prescription drug costs and the additional subsidies for the Reasonably priced Care Act. It’s fairly attainable the entire thing might be “repealed and changed” with out truly being changed. However Trump and RFK Jr (nevertheless lengthy he’ll final) don’t appear to be conventional followers of massive Pharma, and there’ll be a number of push-back from the folks benefitting from the ACA subsidies in the event that they get lower (and even simply not prolonged). So my wager is that the well being care associated components of the act keep in tact.
I’m additionally not too positive how draconian cuts to Medicaid shall be. There’s a number of discuss block grants. But it surely’s price remembering that the states that proportionally do greatest (i.e. get the best Federal funds in comparison with their state funds) are the pink voting states within the South. Clearly there’s not a lot love misplaced between a number of the white Republican voters in these states and the black residents who make up an honest proportion of Medicaid recipients. However under no circumstances all these Medicaid recipients are black, and lots of are prototypical Trump voters, in addition to the aged. And naturally a lot of these states have now expanded Medicaid, and their hospital techniques won’t be too eager on seeing these cuts. My sense is that Medicaid will see cuts however no elementary change.
Medicare Benefit plans can anticipate to often get much more sympathy from Republicans. However my guess is that whoever finally ends up working CMS received’t have extra abdomen for important change on both the FFS program or how MA plans get scored and paid. Then again, a number of the regulatory adjustments that CMS has pushed on the MA plans this yr (which has damage their income & inventory value) shall be exhausting to unwind of their favor. I imply they and their lobbyists are on the coronary heart of the swamp!
Equally Lina Khan at the FTC appears to have heard more support from Vance than she obtained from Harris through the marketing campaign. And whereas many within the enterprise and personal fairness world have been extremely vital of her, aside from a few remarks there wasn’t a lot curiosity from the FTC in going after hospital chains merging into trans-state monopolies or addressing personal fairness behaving badly with hospitals or doctor teams. Once more it’s exhausting to see that an administration that claims it needs to cut back regulation goes to alter an excessive amount of.
The one well being care factor that the final Trump administration actually made occur was for hospitals to publicize their costs. So far as I can inform “value transparency” has made the sq. root of bugger all distinction in how well being care is purchased and bought within the US. However there may be bipartisan settlement that PBMs are getting away with one thing, even when nobody is sort of positive what, and there’s a sense that plans, suppliers and lots of intermediaries are doing the identical factor. I believe that there’ll be many extra employee, employer and union lawsuits about this than Federal motion. However possibly there’ll be one thing there and, who is aware of, it would embody some extra HSA pleasant laws.
In the meantime, there was a collective gasp heard from everybody who thinks there may be such a factor as science when RFK Jr was proposed as head of HHS. It’s attainable that he actually tries to go after the FDA. There are for positive some issues with conflicts of curiosity, however normally it’s a properly understood system and doubtless would want important laws to massively overhaul it. I’m not satisfied that anybody in Congress cares that a lot to make any adjustments, or that there’s any actual consensus on what these adjustments must be. And whereas there’s loads of grumbling from insiders about Epic, I don’t see what straightforward adjustments may be made to a well being tech system that’s so built-in into the present cost system. RFK Jr could attempt to have an actual go on the meals system, however wait until he runs into the agriculture committee within the Senate. Screaming from the surface at our well being and meals infrastructure is one factor. For higher or worse, truly making important adjustments is sort of one other. I believe childhood vaccines will proceed for use near universally–at the least I hope so.
The one space that will see a regulation & enforcement change is that if Don Rucker comes again to ONC/ASTP and strikes interoperability past the present TEFCA & QHIN initiatives to more direct API access ++. However to be honest present ASTP Director Mickey Tripathi has been getting extra vocal about improving API Access. Whereas this is able to make some variations to the gamers on this sector it will be one much more of diploma than throwing the cat among the many pigeons.
So my preliminary conclusion is that the Trump administration will ultimately not change American well being care very a lot.
I want I believed the identical for immigration, freedom of the press, and nationwide safety.
