The resurgent debate about President Trump’s mental health prompts me to update a piece I wrote for THCB last June. That piece drew lively comments and debate.
It’s also the one-year mark of the Trump presidency.
As The New York Times editorial page recently asked, bluntly, on Jan. 11: “Is Mr. Trump Nuts?”
Since last summer, that question has gained more traction and spurred more earnest debate. The results from Trump’s medical and “cognitive” exam on Jan 12 are unlikely to quell concern. (More about those results below.)
Nearly every major newspaper and magazine has run stories. Print media columnists and TV commentators dwell on it constantly. It’s catnip for late night comedians. It’s been a trending topic on social media for months. And, of course, it’s a topic of discussion and banter almost everywhere you go.
Lawmakers have finally joined in, too, after reluctance for the better part of 2017. Some even render an opinion publicly.
Articles have begun to pop up in medical journals, too—most recently Dr. Claire Pouncey’s piece in the New England Journal of Medicine (Dec. 27, 2017).
And then there’s the book, which sparked Dr. Pouncey’s piece as well other articles and reviews since it came out last fall. I’m not talking about Fire and Fury: Inside the Trump White House by Michael Wolff—although that book is certainly relevant in this context.
Rather, I’m talking about The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President, edited by Dr. Bandy X. Lee, a specialist in law and psychiatry at the Yale School of Medicine.
With all the machinations over ACA repeal and replace, the new law that makes big changes in the way the federal government pays doctors—the Medicare Access and CHIP Reauthorization Act, or MACRA—hasn’t garnered much attention lately.
But doctors nationwide are sure thinking about it. That includes many of the regular commentators on THCB. I think it’s accurate to say that most of them have been highly critical of MACRA since the law was enacted in April 2015, and even after it was significantly amended late last year to address physician complaints. (See, for example, Kip Sullivan’s most recent post here.)
The law’s main provisions kicked in on Jan. 1, 2017, with 2017 being the first performance-reporting year, affecting payment in 2019.
In a policy brief on MACRA for Health Affairs published late last month, I raised a host of questions about MACRA.
As Kip and many others have noted, some parts of MACRA are weakly designed and both the law and regulations implementing it make some big assumptions. Excerpts from one section of the policy brief are below. The whole brief can be had at the link above. If you are well versed in MACRA, you can skip to the section titled “What’s the Debate?
Is the overall design coherent and workable?
Major special-interest groups, including those representing physicians, industry, and consumers and patients, supported MACRA’s intent and the general framework of the regulations through three comment periods.
However, almost all groups sought changes and raised questions. CMS’s final revisions were most responsive to physician groups, which were insistent on an easier path and more flexibility for doctors in the initial years of the program.
Senate leaders now say they won’t consider companion legislation to the House-passed 21st Century Cures Act until September, after months of delay. Lawmakers would then have to reconcile the differing House and Senate versions, presumably by year’s end during a lame-duck Congress.
We believe the summer delay is a good thing, and that Congress should actually extend consideration of the complex legislation into 2017 when must-pass FDA funding through industry user-fees will be on the congressional calendar. That way, lawmakers can debate the implications of the proposed bills in the context of the resources FDA needs.
Why further delay? Because the legislation—which makes substantial changes to the way the Food and Drug Administration (FDA) approves drugs and devices—is flawed. As currently crafted, it lowers standards for drug and device approvals and safety, and risks adding to the rising cost of prescription drugs.
The ostensible rationale for the legislation—being pushed by drug and device companies—is that the FDA stifles innovation and advances in treatment by approving drugs and devices too slowly compared with other countries.
Lawmakers in Washington are gearing up to pass major, far-reaching legislation on drug approval and cancer research. This is a good thing in the main but—no surprise here—Republicans and Democrats differ on approach and details, and things are already getting messy.
This makes the proposed legislation very risky. It could all implode in an election year, but momentum is building fast and both parties have something to gain by passage.
This blog is a primer on what’s happening. Future posts will track the legislation’s progress and delve into some of the issues at stake. Comments are invited.
Despite the many flaws in our healthcare system, we could always point to data showing that over the last few decades we were living longer and healthier lives—even if not quite as long and healthy as our contemporaries in many European and some Asian countries.
It now appears that’s no longer true for one segment of the U.S. population.
I’m talking, of course, about the surprising findings released last week that the death rate among non-Hispanic white men and women ages 45 to 54 increased from 1999 to 2013 after decreasing steadily for 20 years, as it did for other age cohorts and ethnic groups.
The third ACA health insurance exchange open enrollment period begins Nov. 1, and things look iffy. The Obama administration this month reduced the estimate of new enrollees for 2016—possibly to lower expectations but also because signs point to the difficulty of luring the remaining uninsured into the fold over the next few years.
It’s time for some fresh strategies to ramp up enrollment and get where we need to go. At the end of this piece I offer some suggestions and invite yours. (This article assumes the ACA will be in place over the next five years even if a Republican becomes president in 2017.)
Health insurance numbers can be confusing (and hyped out of context from both sides of the political aisle), so here’s a quick rundown of the current situation and the Obama Administration’s new projections.
The current U.S. population is 326 million. According to the Census Bureau’s latest authoritative annual report (released in Sept) 10.4% of the population, or 33 million people, were uninsured for the entire year in 2014. That’s down sharply from 13.3%, or 41.8 million people, in 2013. Thus, as of the end of 2014, there were 8.8 million fewer uninsured people, due primarily to Obamacare.