No, I Didn’t Expect That Either.
What’s Next?

As a Democrat, I can only hope this is a Dewey defeats Truman moment, but at 2.00am ET on Nov 9, President Trump with a Republican House and a open Supreme Court seat seems to be our new reality. For the health care establishment, this is a bombshell. It’s been easy for Congressional Republicans to vote to repeal the ACA when they knew Obama would veto it. But what happens next when Trump is happy to sign the “repeal”?

It’s hard to figure out what’s there in terms of putting together to “replace” either in the Congressional Republicans or in what passes for policy in what passes for the Trump camp. As Margalit Gur-Aire said on THCB recently other than one speech with some stale talking points about block grants for Medicaid and selling insurance across state lines, Trump seems to have no ideas about health care. (To be fair he doesn’t seem to have any ideas about anything, or he claims they’re a secret).

Then we have the issue of his relationship with Congress. Now he’s President he may declare a truce, but then again he might decide to tweet into oblivion Paul Ryan and the many others who wouldn’t support him. And he might of course self-immolate as he tries to manage his business, his relationship with Russia and his soon to be launched TV network–while actually having to be President.

But if he’s going to end Obamacare, Trump is going to have to worry about two things. First, he has said that he wants to repeal it but is going to make sure everyone can buy health insurance, even if they have preconditions. When the middle aged white working class who voted for Trump discover that their Medicaid and their health insurance goes away, and that insurers wont sell them insurance if they’re not a good risk, they might be unhappy.

Second, the other people who are going to be unhappy are the health care industry stakeholders. Health care is a series of complex legislative and market interactions. As a consequence of the ACA, most health insurers, providers and even pharma or device companies have made huge changes to their business strategy. Those business strategies and investment are now six years old. Like Wall Street and corporate America, Trump is going to make the health care establishment deeply uncomfortable. The question is, once big pharma, insurers and providers lean on the Administration, will anything actually change, or will we see the route towards value-based care continue?

Not only that, but the sea-change that is just starting in the shift from FFS to value-based payments from Medicare & CMS is underway because the country can’t afford continued health care cost growth. That remains the same. Eventually that reality will impinge even on a Trump administration.

So what happens next? Well it’s amateur hour and we’ve all failed to predict it thus far, so it’ll be tough to do it now. But health care will be a sideshow.

Oh, and time to repeal the frigging electoral college.

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5 replies »

  1. Matthew, I might. But do I take your reply as a pass on defending the value based model? I really would like to hear someone defend it against the evidence presented in these blogs that they don’t work as a nationwide model. But no one seems willing to directly engage the Koka/Sullivan critiques. Anyone?

  2. You may well be right. But have you got a better idea? More importantly, do you think anyone in Trumpistan towers does?

  3. re your statement: “just starting in the shift from FFS to value-based payments from Medicare & CMS is underway because the country can’t afford continued health care cost growth. That remains the same. Eventually that reality will impinge even on a Trump administration.”
    There have been several recent blogs that carefully analyze the evidence that “value based payments” reduce costs. The conclusion is that these are faith based initiatives (i.e. they have a certain internal logic/rationale that sounds good)….but they don’t work. It sounds like you disagree: I would be most interested if you would defend your statement and engage the arguments that they have not been demonstrated to work.

  4. If people can get health care with preexisting conditions, we have to limit the coverage initially and allow it to build over a 3-5 year period
    In addition, benefits used will reduce the account balance as in any account based plan
    To learn more visit national prosperity.com
    Click on HMA

  5. Immigration is a hallmark for the traditions of our form of government: an attempt to leave and avoid living with another a centralized, coercive and authoritarian government. Guess what, it still is, at least for most of us. Remember now, that there is a large and well studied realm of KNOWLEDGE about how to manage a common pool resource, as in our national economy, to preserve its stability. The Design Principles for this strategy already exist and also are well studied by the political economists. Since the early 1960s, the cost of our nation’s healthcare as measured by its portion of the national economy has risen from 6% to a current level of 18%. It represents a perfect example of Parkinson’s Law. The EXCESS cost, as compared to the other developed nations’ cost within their national economy, represented $800 Billion last year.
    Not even one attribute for healthcare reform currently has even the slightest chance of changing this over-all excess cost within the next ten years.
    See http://www.nationalhealthusa.net/summary/