Relevant Issues – The Victim of Politics
In a prior blog, I encouraged you to watch the debates, ignoring the rhetoric and focusing on the candidates’ statements concerning relevant healthcare issues. I didn’t think I sent you on a fool’s errand, but I certainly felt like a fool as I listened for 90 minutes and couldn’t identify one statement that shed any light on where either candidate stood on any healthcare issue. It quickly became evident that this debate had nothing to do with identifying the candidates’ plans for the next four years and had everything to do with assessing cognitive competence, personal attacks, and untruths.
I accept the premise that it was important for each of us to see and hear the candidates speak and react under the pressure of the debate. Their personalities are important for us to understand, and the debate offered the chance to see and hear the candidates and maybe give us more data points as we work to decide who to vote for. Unfortunately, this debate was NOT the time or place to understand their stances on relevant healthcare issues.
My challenge now is to give you some useful information on where the two candidates might stand on our healthcare. This analysis was a little easier given they have been, or are now, President. It gives me some history to evaluate and provides us with a good but imperfect idea of what we might see from them over the next four years. One caveat is that both candidates have a cloud of uncertainty hanging over their campaigns. Former President Trump has legal problems that could keep him from running, and President Biden, after his poor showing in the debate, has senior Democratic party officials questioning his candidacy. I will continue with the analysis as if one of them will win the election with the understanding that if one or both of them are not the final candidates, their successor will most likely continue the trajectory of the previous candidate.
President Biden – The President has certainly revealed his stance on healthcare issues from the legislation he has already signed into law. The Inflation Reduction Act (IRA) continues to threaten innovation, and President Biden has indicated that he wants to increase the number of drugs subject to fixed prices above those authorized by law. His administration has also expressed a desire to expand this drug price-fixing scheme to commercial insurance. He also wants to further restrict the payments to Medicare Advantage programs. Many economists and the Congressional Budget Office have indicated that these changes will have little or no impact on the prices you and I pay at the pharmacist counter and will probably reduce the number of preventive benefits offered by most Medicare Advantage programs while raising premiums. Some members of the President’s party have lobbied for a Medicare for All, single-payer, national health insurance program. While this is unlikely to become a reality in the near future, the direction the President has taken so far has brought us closer rather than further away from a single-payer system. We can comfortably predict that if President Biden is reelected, he will continue to move toward more government control over our healthcare.
Former President Trump – During the Trump presidency, there was a concerted effort to increase governmental control over healthcare. In 2018, then President Trump authored a blueprint for bringing down the high price of drugs and reducing out-of-pocket costs for the American consumer named American Patients First. It had some good ideas and some bad, more government-intrusive parts. One bad part was the importation of prescription drugs from foreign countries, circumnavigating the quality control measures that we rely on. Another short-sighted solution was the Most Favored Nation (MFN) model. In 2020, he proposed that this approach be adopted through the rule-making powers of the Center for Medicare and Medicaid Services (CMS). This model took pricing from other nations as a guideline for what Medicare should pay for the mostly injectable Part B drugs. This approach took prices from foreign government-controlled healthcare systems and fixed the prices of those drugs in the U.S. While this shows a willingness to allow the government to set prices, it also indicates a predilection for using rules and executive orders to dictate how our healthcare will be changed, rather than the checks and balances of congressional action. This approach was not implemented, but a republican House and Senate with Trump as President could allow an unimpeded pathway to more government control.
I don’t mean to paint an ugly picture for the future, but the fact of the matter is that both Presidential candidates have bowed to the political expediency of increasing governmental controls over both the drug manufacturers and the insurance companies. Either candidate, if elected, would be entering their second term without the worries of being reelected. That is a dangerous period for unshackled politicians. I do have a suggestion that might help our country consider longer-range solutions. Solutions that will help prevent illness, discover cures, and react swiftly to worldwide pandemics like COVID.
I’m a believer in the checks and balances of the Constitution, and I think by electing lawmakers who can limit the presidential decrees and arbitrary rulemaking, we will have a chance to enact long-term solutions that will bring us innovative and accessible healthcare. While electing a President is always important, this time in our country’s history the make-up of the House and the Senate may be the leveling factor that could prove to be the most important outcome of this November’s election. One last thing. State elections may also have a significant impact on our healthcare. Medicaid rules and drug price-fixing legislation have sprung up in many states. These are short-term solutions that have the power to impact access and innovation. We have a website that will give you information on getting registered, voting rules, and candidates, both at the federal and state level. Get involved and vote for lawmakers at the federal and state levels who are looking into the future rather than taking the politically expedient path.
Best,
Thair