Daniel Stone – The Health Care Blog

What Is a “Co-Presidency”? Would It Work? Biden-Obama 2020

Jan 31, 2018• 8

By DANIEL STONE, MD

Why would the last certifiably sane occupant of the White House consider a run for the Vice-Presidency, an office that Vice-President John Nance Garner derided as “not worth a pitcher of warm spit” and John Adams scorned as “the most insignificant office that the invention of man contrived or his imagination conceived?” In a word, Trump. The former President told voters in 2016 that his legacy and life’s work would be threatened by a Trump presidency. That would be doubly true of a second Trump term.

Federal law poses no obstacle to the Democrats’ dream ticket. The 22nd amendment, ratified in the wake of FDR’s four electoral victories, prohibits the election of a president to more than two terms. No provision prevents a former president from assuming the office through succession nor from running for the vice-presidency. Securing Obama’s assent for the race would likely require Biden to offer him a virtual “co-presidency.” The notion has been raised before. In 1980, Ronald Reagan, also facing a challenging run against an incumbent president, briefly considered former President Gerald Ford for his running mate and “co-president.” Ultimately, Reagan lacked sufficient comfort with his former opponent to test such uncharted political waters.

The Pri(n)ce of Healthcare

Jul 28, 2017• 21

By DANIEL STONE, MD

Tom Price, President Trump’s new Secretary of Health and Human Services (HHS) strode to the podium to the sound of applause. The two thousand medical administrators and physicians at the annual meeting of CAPG, a trade organization representing physician groups, heard him described as the most influential person affecting the 300+ participating groups that provide care for millions. Only the third physician to lead HHS, many hoped that the orthopedist and six term GOP congressman would bring new sophistication to the federal government’s healthcare programs.

The perfectly coiffed Secretary looked every bit the new man in charge of healthcare. Sadly, his resonant voice soon dashed any hope for substance. He might have commented on the essential U.S. healthcare quandary: A country with average household income of $56,000 can’t afford the $15,000 annual cost of health insurance for a family of four. Neither Republicans nor Democrats can conjure up inexpensive insurance that covers unaffordable healthcare services. What does the Secretary think? He sidestepped the issue, twice patting his audience on the back by touting the American health system as “the finest in the world.” Seriously? If Price had attended the morning session he would have heard that the U.S. spends about 6% more of its GDP on healthcare than average developed country. That extra $1.2 trillion amounts to more than twice the defense budget. Yet U.S. health outcomes for crucial measures like infant mortality and lifespan rank average or even worse. Yes, U.S. medical technology leads the world and foreign dignitaries still travel here for world class, high tech care. But shouldn’t the secretary of HHS understand that the measure of a healthcare system is the quality and accessibility of care provided to average citizens? Continue reading…

Beyond “Repeal and Replace”

Jul 5, 2017• 8

BY DANIEL STONE, MD

The toxic polarization of Washington politics might lead even the most stubborn optimist to abandon any hope for bipartisanship on healthcare. Despite endemic pessimism, the flagging efforts to forge a Republican consensus on “repeal and replace” might set the stage for overdue efforts at compromise. Congress will be tempted to move on to more promising areas such as tax reform and infrastructure funding. That temptation should be resisted. The threat to the nation posed by the current state of American healthcare calls for Congress to resurrect the long lost spirit of bold bipartisanship.

Before considering opportunities for compromise, the obstacles confronting the GOP reform efforts are worth considering. Republicans face the same stubborn reality that confronted the framers of the Affordable Care Act (ACA): Expensive services cannot be covered by cheap insurance. The cost of U.S. healthcare has simply priced low income and even middle income individuals out of health insurance. Without subsides, they get left behind. The Congressional Budget Office’s estimated that the Ryan plan would result in 24 million losing coverage underscored the political divide: Confronted with unmanageable healthcare costs, most Republicans would opt to reduce public expense whereas Democrats plus a handful of Republican moderates prefer more extensive coverage. The effort of the GOP leadership to split the difference by preserving some residual subsidies and the structures supporting them—“Obamacare light”—remains unacceptable to many on the right. No clear middle ground has yet emerged.