Trump

Trump

The Politics of Hillary’s Pneumonia

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It is selfish of a leader of a nation to drop dead during office. Jawaharlal Nehru, India’s first prime minister, died suddenly at 74, apparently from a ruptured aneurysm. His aneurysm, allegedly, had something to do with Edwina Mountbatten – the wife of Lord Mountbatten, the last Viceroy of India. Shortly after Nehru’s death, Pakistan attacked India. Nehru’s replacement, Lal Bahadur Shastri, died mysteriously in Tashkent two years after Nehru’s death, and was succeeded by Indira, Nehru’s daughter. India’s future was forever changed by a burst aneurysm or, if rumors are to be believed, by a flagellating spirochaete which left the Raj in bliss.

Clearly, the death of a leader creates turmoil for a republic. So it is understandable that a nation obsessed with health is obsessed with the health of its presidential runners. Mr. Trump’s doctor declared he’s the healthiest presidential candidate ever. Mr. Trump has drawn attention to his super health by pointing to the size of his hands – by Mr. Trump’s standards a rather decorous allusion. It matters not what has hypertrophied Mr. Trump’s hands, what matters is that Mr. Trump’s large hands signal vigor and imagination. The American Psychiatric Association, to their credit, in ruling out a new diagnostic code for Mr. Trump’s colorful soundbites in the next edition of their Diagnostic and Statistical Manual, ended all hopes of banning Mr. Trump from the presidential race on health grounds.

Obama Channeled Orszag, Orszag Channeled the Dartmouth Institute

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flying cadeuciiIn an open letter to President Obama that I posted here on August 24, I stated that his expectation that the Affordable Care Act would have a deflationary effect was naive. I said he was badly misled by the managed care movement, and that he should never have accepted the movement’s diagnosis (overuse) and solutions (shifting insurance risk to doctors and micromanaging them). To help him understand that, I said I would post criticism of three prominent managed care proponents who influenced him: Elliott Fisher and his colleagues at the Dartmouth Institute, Atul Gawande, and Peter Orszag.

I will start with Elliott Fisher and his colleagues at the Dartmouth Institute for Health Policy and Clinical Research because they have been so influential with the entire health policy elite, not just Obama. I will devote this post and the next to them. I devote this post to demonstrating how influential they have been; I devote the next post to demonstrating how misleading they have been.

The Dartmouth Institute deserves credit for assembling data that shows substantial variation in the rate at which medical services are provided, both within small areas and between regions of the country. This data is very useful for generating hypotheses in need of further research. But the group deserves severe criticism for promoting the conclusion that variation can be explained primarily by overuse and virtually none of it can be explained by underuse, and for promoting “accountable care organizations” and other forms of “integrated care” as the solution that will address their erroneous overuse diagnosis.

The Physician’s Case For Trump

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Brexit has been hailed as a turning point in the history of Western Democracy by a collection of liberal and conservative elites that decry the vote of a disenchanted and ignorant populace.  The greatest threat to democracy in the modern age turn out to be the very same people that make up the democracy.  We are told these are the same forces that propel Donald Trump forward.  It is a convenient narrative that extinguishes any real debate on policy.  If you support Brexit or Donald Trump you are an uninformed, xenophobic bigot.  Yet here I am – an Indian immigrant, a physician, and a lifelong democrat to boot, who sees no other choice than Trump this election cycle.

I must confess that I have no emotional connection with Mr. Trump – his public demeanor, braggadocio, and above all, the coarseness of his manner when he engages opponents are not what are familiar or soothing to eye or ear.  Yet, as a physician who has struggled through the last eight years of policies and regulations that have made my ability to take care of patients more and more difficult, Mr. Trump has taken on the form of an orange-tinged life preserver.

An Independent Medical Review Panel for the Candidates

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Screen Shot 2016-05-19 at 9.10.32 AMAs unusual as the 2016 presidential election has been, one obvious aspect has gone largely unnoticed: By the time the next president of the United States is inaugurated on Jan. 20, 2017, he or she will have reached or come close to reaching 70 years old.

That all the remaining major candidates are among the “young old” at this stage of the election process is unprecedented. Yet, in spite of the stakes for the American people, there is no independent source that can provide an adequate accounting of the medical condition of the next president.

Historians have examined the ways that previous administrations have been affected by the medical problems of presidents including Abraham Lincoln, William Henry Harrison, Woodrow Wilson, Franklin Roosevelt, John Kennedy, Lyndon Johnson and Ronald Reagan. The news has not always been positive.

Trump’s Healthcare Plan: Right Diagnosis, Wrong Prescription

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Screen Shot 2016-04-08 at 9.37.58 AMDonald Trump recently released a healthcare reform plan. If only he had spent as much time crafting it as he does his hair. 

The GOP frontrunner is right that Obamacare has failed to fix what ails America’s healthcare system. As Trump put it, the Affordable Care Act has “tragically but predictably resulted in runaway costs, websites that don’t work, greater rationing of care, higher premiums, less competition and fewer choices.”  He famously said that he wants to “repeal and replace with something terrific.”

But “terrific” his plan is not.

Take, for instance, his proposal to legalize the importation of “safe and dependable [prescription] drugs from overseas.”

Importing cheaper drugs from other countries may seem like a great way to reduce the cost of medicine for Americans. But there are important reasons why it’s currently prohibited.

Repealed or Repaired?

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Last Wednesday marked the sixth anniversary of the passage of the Patient Protection and Affordable Care Act. As of this week, the five Presidential aspirants have each articulated key changes they’d propose, though polls show interest in the law is largely among Democrats who consider healthcare a major issue along with national security and the economy.

GOP candidates Trump, Cruz and Kasich say they will repeal the law; Democratic frontrunner Clinton says she will repair it, and her challenger, Bernie Sanders, promises to replace it with universal coverage. Some speculate that candidate Clinton’s plan will ultimately mirror her Health Security Act of 1993 that parallels the Affordable Care Act in many respects. But the law gets scant attention on the campaign trails other than their intent about its destiny if elected.

I have read the ACA at least 30 times, each time musing over its complexity, intended results, unintended consequences and hanging chads. At the risk of over-simplification, the law purposed to achieve two aims: to increase access to insurance for those unable to qualify or afford coverage, and to bend the cost curve downward from its 30 year climb. It passed both houses of Congress in the midst of our nation’s second deepest downturn since the Great Depression. Unemployment was above 10%, the GDP was flat, and companies were cutting costs and offshoring to adapt.

The “Patient Protection and Affordable Care Act” soon after became known as the “Affordable Care Act”, and then, in the 2010 Congressional Campaign season that followed its passage, “Obamacare”. It was then and now a divisive law: Kaiser tracking polls show the nation has been evenly divided for and against: those opposed see it as “the government takeover of healthcare” that will dismantle an arguably expensive system that works for most, while those supportive see it as a necessary to securing insurance coverage for those lacking.

Seven Pillars of Trumpcare

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flying cadeuciiIt is possible that in a few months from now, only Nate Silver’s prediction models will stand between Donald Trump and the White House. I will leave it to future anthropologists to write about the significance of that moment. For now, the question “What will President Trump be doing when he is not building a wall?” has assumed salience.

This is relatively easy to answer when it comes to health policy. Just ask what people want. Seniors don’t want Medicare rescinded. Even the free market fundamentalist group, the Tea Party, wants Medicare benefits as they stand. At one of their demonstrations against Obamacare a protester warned, without leaving a trace of irony, “Government, hands off my Medicare.

Rest assured, Trump will protect Medicare. Even raising the eligibility age for Medicare may be off the cards as far as he is concerned. He has promised that no one will be left dying on the streets. That people no longer die on the streets, but in hospitals, because emergency rooms must treat patients regardless of their ability to pay, is irrelevant. The point is that Mr. Trump knows that the public values their healthcare. Trumpcare will show that Trump cares.

The End of Civilization and the Real Donald Trump

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The pandemic started quietly.  In the spring of 2017 A few hundred dead chickens appeared in markets in Hong Kong and a few other cities in China.   Public health officials in China were slow to respond.  They did not want to panic the public about an avian flu outbreak.  Nor were they eager to take the steps necessary to contain such an outbreak—the killing hundreds of thousands of chickens and poultry with devastating economic consequences.  While the delay went on a few cases began to occur on Canadian and American poultry farms.  Department of Agriculture experts traced the outbreak to waterfowl migrating from Northern flyways, probably from Asia.   Inquiries were made about avian flu outbreaks in Asian nations.  Then the unthinkable happened.   Humans in Hong Kong began to get sick.  Very sick.  Some died.  Those who died were in their twenties.

The avian flu virus had mutated.  H7N9m had transformed into an agent that not only could infect humans but did so with a transmissibility and lethality that had not been seen since the Spanish flu outbreak of 1918.

Then the first American died.  A young man back from a business trip to Hong Kong.  The media, already primed for hysterical coverage following the severe Zika outbreak in the Southern United States in the summer and fall of 2016, went into full panic-dispensing mode.  ‘Experts’ began to appear on the cable channels who suggested that the outbreak was the result of irresponsible genetic research in China.  Still others suggested that it was the bioterror work of North Korean scientists.  One or two pointed toward ISIS arguing that they had grown desperate in the face of the massive air war that the new administration had launched.  Still others saw the hand of right or left wing domestic terrorists.  And an accident at an American lab was put into the boiling cauldron of speculation and conspiracy.

Feeling the Bern on Universal Single-Player Healthcare

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“Elephant in the living room” is an English metaphorical idiom for an obvious untruth going unaddressed. In most political platforms about healthcare and its coverage, there is a most resolutely immovable elephant in our living room. It is there with every single candidate.  But with Bernie….

You’ve just got to love Bernie Sanders.  It makes me feel like I’m 22 years old in the 1960’s and dumb as all get out about how you pay for things. But let us consider Mr. Sanders’ healthcare proposal. From his own website:

“Bernie’s plan would create a federally administered single-payer health care program.  Universal single-payer health care means comprehensive coverage for all Americans.  Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs…[etc.].”

Bernie sure didn’t go half way on this one. All care, whenever, wherever, however. A fundamental right with no filter. OK. So he jumped in with both feet. You’ve got to admire his elan.  But what might this mean and how can he ignore what happened in his own home state?

The Trump Healthcare Interview: Part 2

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Screen Shot 2016-03-12 at 9.55.09 AMDonald Trump is leading the Republican delegate count and has the best chance of becoming the Republican nominee and, just maybe, even President. In February, we at THCB asked Scottish-Canadian-Californian healthcare futurist Ian Morrison to conduct an interview with Trump, figuring that Morrison would have an in with Trump given Trump’s praise for Scottish and Canadian healthcare. Fittingly, that interview was published on THCB on President’s Day, February 16th. Since then Donald Trump has racked up impressive victories and more importantly has released some specifics of his healthcare proposal. THCB thought it was time for Morrison to reach out to Mr. Trump again–Matthew Holt

MORRISON: Thanks for making time Mr. Trump, it is a pleasure to have a chance to follow up with you.

TRUMP: You were a little rough on me last time, but I enjoyed it, I thought I did very well in the interview.

MORRISON: Indeed you did, it was incredible. Mr. Trump before we get to your healthcare plan, let’s just catch up on the race. Since we last talked you have had some impressive victories in a wide variety of states from Hawaii to Mississippi. Why do you think you have done so well?

TRUMP. I’m winning everywhere, everywhere, and with all the groups: vets, high income, low income (we love the low-income). I won Hispanics in Nevada? Hispanics, Trump? They like me because I am a winner, and I’m winning everywhere. I am winning by a lot.

MORRISON: You did particularly well in the South, the so called SEC primaries, where Ted Cruz was expected to do well, particularly with evangelicals. You won by more than 20 points in Alabama for example.

TRUMP: Well they loved me in South Carolina, I won big there and then I did the dog whistle to the Klan and that probably helped, in the South.

MORRISON: You mean being slow to disavow David Duke and the Klan before those southern primaries?

TRUMP: It worked well, we had hats ready: “Make America White Again” but Corey (Editor’s note–He’s referring to Corey Lewandowski Trump’s Campaign Manager who himself made news recently by manhandling a female reporter) told me it probably wouldn’t work in the General, but we trademarked them anyway, I couldn’t believe it was available, so we may use the “Make America White Again” hats later, we’ll see. But now I disavow, I disavow, how many times do I have to say it.

MORRISON: Mr. Trump are you a racist?

TRUMP: Look I told the New York Times Editorial Board the whole story on deep background. Republican primaries are about getting angry, white people to turn up. Those people are tired and angry at the Mexicans, the Muslims, and Obama (we still don’t know if he was born in Kenya). So when we win, we can be nicer in the general election, because I get along with everyone.