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Take a deep breath: Trump may not mean that much change–for health care, that is

By MATTHEW HOLT

At some point I had to crawl out of my hole and put pen to paper on the election debacle that just took place, and what the ensuing lunacy might be like for the health care system. So this is my attempt to do just that.

It’s really hard to understand why Trump won this election or why Harris and the Democrats lost. There was a lot of weirdness going on. Remember that before the vote Harris was generally praised for running a steady campaign, the Democrats had tracked to the right on immigration (trying to pass what IMHO was a horrendous bill ), and Harris kept talking about having a Glock, being a prosecutor and campaigned with a Cheney. The swing states (which vote at a much higher proportion than everyone else) all (with the narrow exception of Pennsylvania) voted for Democratic senators. For President they only went 3% against where they were in 2020. Even weirder was that hundreds of thousands of Trump voters didn’t appear to vote down the ballot at all. Yet nationwide the swing was big enough for Trump to win the popular vote. (If you really want to dig in, Charles Gaba has put together a great spreadsheet)

The simplest explanation is that the teeny middle in American politics voted against the incumbent. And the “middle” is getting teenier. In 1964 Johnson got 61% of the vote. Nixon (1972)  and Reagan (1984) won with nearly 60% of the vote. Obama’s big 2008 victory was with just 53% of the vote and he won by 7%.

Biden won in 2020 with just over 51% and Trump will end up winning while likely getting just less than 50% of the vote. This isn’t an overwhelming mandate. It’s a small minority of voters switching because they are pissed off with the status quo. This year the bug bear was inflation, which really wasn’t Biden’s fault even though he got the blame. It also appears that a decent slug of Arab-Americans and far left Democrats stayed home or voted for Jill Stein because of Gaza.

And let’s not forget the impact of the Electoral College which reduces turnout outside of swing states (not exclusively). Surely if we had a popular vote in which every vote counts, turnout would be higher, including in the big 2 states that are Dem strongholds (NY & CA).

However, even if you think it’s inconceivable that a majority would vote for Trump because of what happened in 2016 to 2021 (especially on January 6, 2021!), apparently that’s not enough of a disqualifier. He’s going to be President.

So what happens next? Particularly in health care.

My expectation (and hope) is that this is a snake eating its own tail. There are so many repugnant egos circling around Trump that it’s more than likely they’ll turn on each other, and little to nothing gets done. That doesn’t mean nothing will happen.

Continue reading…

Mental Health Crisis in Miscarriage–an Unrepresented Patient Population

By TAMARA MANNS

I walked into the emergency department already knowing the outcome. In these same rooms I had told women having the same symptoms as me, “I am so sorry, there is nothing we can do for a miscarriage”. I handed them the same box of single ply tissues I was now sobbing into, as I handed them a pen to sign their discharge paperwork.

Two weeks after my emergency room discharge, I continued to live life as if nothing happened, returning to work without any healthcare follow-up to address my emotional burden. Luckily, I had established obstetrician (OB) care with the physician who previously delivered my second child. At only nine weeks gestation I had not seen my OB physician yet, but I was able to follow up in the office to talk about my next steps.

After that two-week hospital follow up, I heard from no one.

Due to the environment of the emergency department, women often complain of unprepared providers with ineffective and impersonal delivery of miscarriage diagnosis and discharge education; this lack of emotional support can result in feelings of abandonment, guilt, and self-blame. Due to the psychological impact of pregnancy loss, a standard of care for screening and referral must be implemented at all facilities treating women experiencing miscarriage.

If I had not reached out to my healthcare provider after my miscarriage, I would have continued suffering through an aching depression without help.

Depression, anxiety, and grief are most severe in the first four months after miscarriage. The symptoms decrease in severity throughout the following year. These symptoms may influence future pregnancies by increasing maternal stress and fear, possibly leading to pregnancy complications.

In the United States (US), one in five women suffer with mood and anxiety disorders while pregnant, and up to one-year after delivery.

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THCB Gang Episode 144, Thursday November 14

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday November 14 at 1PM PT 4PM ET. Today we have also a special guest – former Permanente Medical Group CEO Dr Robbie Pearl @robertpearlmd. Robbie has been diving into AI in his latest book ChatGPT-MD and we’ll be chatting about that as well as his forecasts for health care post election.

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Will Trump and RFK Jr. Revive His Covid Pandemic Performance?

By MIKE MAGEE

It has been a collision of past, present and future this week in the wake of Trump’s victory on November 6, 2024. The country, both for and against, has been unusually quiet. It is unclear whether this is in recognition of political exhaustion, or the desire of victors to be “good winners” and no longer “poor losers.”

Who exactly are “the enemy within” remains to be seen. But Trump is fast at work in defining his cabinet and top agency officials. In his first term as President, Trump famously placed himself at the front of the line of scientific experts sowing confusion and chaos in the early Covid response.

His 2024 campaign alliance with Robert F. Kennedy Jr. suggests health policy remains a strong interest. As his spokesperson suggested, his up-front leadership led to a resounding victory “because they trust his judgement and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”

For those with a memory of Trump’s checkered, and disruptive management of the Covid crisis, it is useful to remind ourselves of those days not long ago, and consider if throwing Bobby Kennedy Jr. in the mix back then would have been helpful.

I have been revisiting the Covid pandemics I have prepared for a 3-session course on “AI and Medicine” at the University of Hartford’s Presidents College. The course includes a number of case studies, notably the multi-prong role of AI in addressing the Covid pandemic as it spun out of control in 2020.

The early Covid timeline reads like this:

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America the Schizophrenic

By KIM BELLARD

I must admit, last week’s election took me by surprise. I knew all the polls predicted a close race, but I kept telling myself that the American I believed in would not elect such a man, again, knowing full well all the things he has said and done – in his personal, professional, and political lives.  I was giving us too much credit.

Democrats might tell the public that Wall Street was hitting record highs, that GDP growth was among the best in the world, that unemployment was low, and that inflation was finally back under control, but voters didn’t believe them. For most people, the economy isn’t working.

When two-thirds of voters say the country is on the wrong track (NBC News), when almost three-quarters of Americans are dissatisfied with the way things are going in the U.S. (Gallop), when 62% of voters think the economy is weak and 48% say their personal financial situation is getting worse (Harvard CAPS/Harris) – well, threats to democracy tomorrow don’t compare to the price of eggs today.  

Let’s face it: we are on the wrong road. We’re not on a road that is good for most people. We’re not on a road that is getting us ready for the challenges and opportunities that the 21st century is bringing/is going to bring us. And we’re kidding ourselves about the America we believe in versus the America we actually live in.  Our views about our country are delusional, they’re disorganized thinking, they may even be hallucinations. I.e., they’re schizophrenic. 

For example:

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Medicare’s Hidden Information Hurts People & Policy

By MICHAEL MILLENSON

Open enrollment season for Medicare, which began Oct. 15 and ends Dec. 7, triggers a deluge of information about various options. Since I’m a health care consultant and researcher as well as a Medicare beneficiary, I’ve looked critically at what we’re told and what we’re not. Unfortunately, information crucial both for the individual and for the broader policy goal of moving toward a “value-based” care system is often difficult to find or not available at all.

The most glaring example involves Medicare Advantage, the increasingly popular insurer-run plans that are an alternative to traditional fee-for-service Medicare. Plans receive a quality grade from one to five stars from the Centers for Medicare & Medicaid Services. Those grades are designed to incentivize providing the highest quality care for the money ­— the very definition of “value.” A high grade triggers both a boost in payment from Medicare and a boost in enrollment. Not surprisingly, almost three-quarters of people chose a plan with a 4-, 4.5- or 5-star rating, according to CMS.

Those ratings, however, should come with a large asterisk attached. It’s not just that the methodology can be controversial, particularly when a lower grade is meted out. It’s that the star ratings aren’t anchored in geography, as one would naturally expect; i.e., the rating is for the plan offered in my area. What is colloquially called a “five-star plan” is actually a plan that’s part of a five-star Medicare contract ­­— and those two typically are not the same thing.

For instance, one large insurer contract that I tracked included at least 17 plans scattered across the country. It defies common sense to believe that care quality is identical among plans in, say, Rhode Island, Mississippi, Illinois, Colorado, and California just because they all share the same government contract number.

If you’re wondering who benefits from this not-very-transparent transparency, some insurers have been known to improve the rating of a low-performing plan with a small number of members by merging it into a contract with more members and a higher rating.

In 2024, nearly 33 million people, or 54% of Medicare beneficiaries, were enrolled in an MA plan, according to KFF (formerly the Kaiser Family Foundation). KFF expects that number to increase to nearly 36 million in 2025. It’s a long-accepted truism that “All health care is local.” Medicare beneficiaries deserve local plan information.

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THCB Gang Episode 143, Friday November 8

Joining Matthew Holt (@boltyboy) on #THCBGang on Friday November 8 are THCB regular writer and ponderer of odd juxtapositions Kim Bellard (@kimbbellard); Principal of Worksite Health Advisors Brian Klepper (@bklepper1); patient safety expert and all around wit Michael Millenson (@mlmillenson); and digital health investment banker Steven Wardell (@StevenWardell). There may well be a discussion about an election.

You can see the video below live (and later archived) & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Heat-related illnesses are preventable; here’s how

By PHIYEN NGUYEN & KRISTINA CARVALHO

As we enjoy the crisp air of fall, a harsh reality remains: our planet is heating up. With more frequent and intense heat waves, 57.5 million Americans are living in areas with dangerously hot summer conditions, yet many states remain unprepared for the heat crisis already unfolding.

Impact of Heat on Health

Extreme heat poses a growing health threat, causing more deaths in recent years in the United States than any other weather-related event. Heat-related illnesses (HRIs), such as heat exhaustion and heat stroke, are on the rise, particularly among the elderly, children, outdoor workers, and individuals with certain preexisting medical conditions.

Not all communities are affected equally. Low-income neighborhoods and communities of color, often situated in urban “heat islands,” face greater exposure and have less access to cooling resources.  Moreover, extreme heat worsens air pollution and spreads disease-carrying insects, exacerbating health risks.

Without stronger protections, HRIs will continue to escalate, especially among populations who are already at increased health risks. Heat standards are a key part of the solution.

What are Heat Standards?

Heat standards are regulations that protect workers from excessive heat by requiring breaks, water access, and emergency procedures to prevent HRIs. Yet few states have heat standards in place.

In 2005, California was the first state to implement a mandatory HRI prevention standard requiring water, shade structures, and rest breaks for outdoor workplaces when temperatures exceed 80°F. Employers are also required to educate their workers about HRIs and have additional precautions in place when the temperatures exceed 95°F. A few months ago, California even expanded protections to include indoor workplaces when it is over 82°F inside.

Washington, Colorado, and Oregon followed suit with similar policies, though without indoor regulations. On the other hand, Minnesota’s heat standard only applies to indoor workspaces. But it’s unique in that it also applies to care facilities such as nursing homes and daycares, protecting the elderly and young children. Lastly, Maryland just passed a heat standard that applies to all outdoor and indoor workers across all industries.


All other states, including warm ones like Arizona, have no established heat standards. Texas and Florida have even tried to prevent their cities and towns from mandating that employers provide heat protections like water breaks.

Heat Standards Work!

Although formal studies are limited, there’s enough observational data to suggest that heat standards are effective at keeping people safe and healthy.

For example, California saw a 30% decrease in reported HRIs following implementation of its heat standard in 2005. Similarly, HRI-related medical visits in Oregon dropped by 75% in the year after the state enacted its standard. What’s more, that was in spite of having more days with temperatures above 80°F as well.

In short, HRIs are preventable. And they’re also cost-effective.

Continue reading…

Inventors (and Innovators) Wanted

By KIM BELLARD

I thought about writing about the election, but I’m too anxious – and a little terrified – about it, so I’ll take a pass. I was intrigued by Oracle Health’s promise of an AI-driven, “next-generation” EHR, or the news that OpenAI was introducing ChatGPT search, but I felt that each was inevitable and yet that both would prove underwhelming in the short term.

So I decided to write about invention.

The November issue of IEEE Spectrum magazine is all about invention, starting with the tantalizing overview Why the Art of Invention Is Always Being Reinvented. “Invention doesn’t come from some innate genius, it’s not something that only really special people get to do,” says Stephanie Couch, executive director of the Lemelson MIT Program. 

Still, authors Eliza Strickland and Peter B. Meyer warn, “…the limits of what an individual can achieve have become starker over time. To tackle some of the biggest problems facing humanity today, inventors need a deep-pocketed government sponsor or corporate largess to muster the equipment and collective human brainpower required.”

Tell that to UTEP student Tayia Oddonetto. While an undergraduate, she had an epiphany. “During class, the professor said that if someone discovered how to turn brine, water with a high salt concentration, into something of value, it’d be revolutionary for the planet. At that moment, I told myself I was going to be the one who found the solution for brine, and that thought has never left me.”

And she did it. Instead of the more common reverse osmosis (RO) method of desalination, which at best converts 85% of salt water into fresh water and leaves a problematic 15% of concentrated brine, Ms. Oddonetto used something called salt-free, electrodialysis metathesis. As the press release describes it: “Salt-free electrodialysis metathesis treats brine by passing it through ion exchange membranes, thin sheets or films, and electrical currents that work to separate salt from water at the molecular level.”

Her approach produced over 90% fresh water, and generated higher levels of valuable metals and minerals that can be repurposed across several industries including technology, health and food.

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Patty Hayward, Talkdesk

Patty Hayward is GM of Healthcare and Life Sciences at Talkdesk. Talkdesk runs the technology for contact centers that helps companies across health care connect and manage their consumers. You’ve probably unknowingly used their technology when you call (or now text or email) your health plan, your provider system or call into one of those numbers on the drug adverts. Patty told me about the business of technology for contact centers, and how the transition is happening between voice to text and for that matter from on-prem to cloud. They’re also deeply integrated with Epic. Pretty interesting view into a not-often-thought-about part of the puzzle.–Matthew Holt

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