The role of government in healthcare under Trump’s HHS secretary

Published 10:00 pm Monday, December 5, 2016

I would like to introduce the readers of The Bulletin to Tom Price, M.D., the congressman from Georgia who President-elect Trump has named to be the Secretary of Health and Human Services.

Dr. Price is an avowed opponent of any role for government in health care. The Affordable Care Act (aka “Obamacare”) is his immediate target and he has spared no effort to entirely dismantle it during the six years of its existence. Dr. Price’s fondest dream would be a totally privatized system of health care with no public support whatsoever. This is exactly the situation that brought us impoverished elders dying for lack of care prior to the passage (with strong bipartisan support) of Medicare in the 1960s.

The first move will be the promised total repeal of the ACA. This will cause 20 million people to lose recently obtained insurance, although implementation may be delayed by a year or two as political cover. The replacement will be mostly a system of tax deductions to purchase health insurance on the private market, which may be helpful if you pay a large percentage of your income in taxes. This is almost never the case with those who were able to purchase subsidized insurance on the exchanges or to gain access to Medicaid. So those folks will be uninsured once again and will be flooding into emergency rooms for basic care, increasing cost and reducing access to needed emergency services for us all.

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Dr. Price is a very good friend of doctors, pharma and the vendors of health care services (the AMA has heartily endorsed him). He is opposed to evidence based medicine, since following the evidence frequently results in restrictions on what the vendors of health care would do to provide more services under a piece work system of payment. Expect medical costs to rise substantially under Dr. Price.

If you are on Medicare, expect aggressive moves to “privatize” it by moving to a federal subsidy to purchase insurance rather than a federal insurance plan. Since the administrative cost in Medicare is well below that of private insurers (no CEOs, directors, or stockholders to enrich), expect the subsidy to pay less and less of the premium as time goes on, and the copays to increase progressively. With increasing costs of care, the subsidy will eventually fail to actually subsidize anything of value, and you are on your own. Medicare is history then — if you like it, you can kiss it goodbye under this administration if Dr. Price is able to prevail.

This is the man that President-elect Trump has selected to lead the US healthcare “system.” And let us not forget that even now, we have the most expensive non-system in the world with some of the worst health outcomes, largely due to lack of access and non-beneficial, poorly coordinated care. We are the only developed country in the world, save Mexico and Turkey, without a system of universal access and coverage. This was actually improving a bit after passage of the ACA. But stay tuned — things are about to change in ways that any of us who depend on good health care, and are not quite wealthy, may find very painful.

If any of this is of concern to you, please contact your representatives in Washington and let them know.

Garrett Snipes, M.D., Tryon, N.C.