The KHIT Blog: The Trump campaign health care policy position

Wednesday, July 20, 2016

The Trump campaign health care policy position

Well, as of July 19th, he's no longer "the presumptive nominee," he's now the official GOP candidate.

Count me among the millions of people continually aghast at the prospect of the vulgar, belligerent, policy-detail-dementia'd, make-shit-up-on-the-fly, unabashed war crimes proponent Donald J. Trump as U.S. President in 2017. Nonetheless, he could very well win the election, given Hillary Clinton's ineradicably high "trustworthiness" negatives.

Can we tell what he might actually try to do in the health care space were he to win the White House?

Probably not. But, here's what's on his campaign website.

We will work with Congress to make sure we have a series of reforms ready for implementation that follow free market principles and that will restore economic freedom and certainty to everyone in this country. By following free market principles and working together to create sound public policy that will broaden healthcare access, make healthcare more affordable and improve the quality of the care available to all Americans...

Congress must act. Our elected representatives in the House and Senate must:

Completely repeal Obamacare. Our elected representatives must eliminate the individual mandate. No person should be required to buy insurance unless he or she wants to.

Modify existing law that inhibits the sale of health insurance across state lines. As long as the plan purchased complies with state requirements, any vendor ought to be able to offer insurance in any state. By allowing full competition in this market, insurance costs will go down and consumer satisfaction will go up.

Allow individuals to fully deduct health insurance premium payments from their tax returns under the current tax system. Businesses are allowed to take these deductions so why wouldn’t Congress allow individuals the same exemptions? As we allow the free market to provide insurance coverage opportunities to companies and individuals, we must also make sure that no one slips through the cracks simply because they cannot afford insurance. We must review basic options for Medicaid and work with states to ensure that those who want healthcare coverage can have it.

Allow individuals to use Health Savings Accounts (HSAs). Contributions into HSAs should be tax-free and should be allowed to accumulate. These accounts would become part of the estate of the individual and could be passed on to heirs without fear of any death penalty. These plans should be particularly attractive to young people who are healthy and can afford high-deductible insurance plans. These funds can be used by any member of a family without penalty. The flexibility and security provided by HSAs will be of great benefit to all who participate.

Require price transparency from all healthcare providers, especially doctors and healthcare organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure.

Block-grant Medicaid to the states. Nearly every state already offers benefits beyond what is required in the current Medicaid structure. The state governments know their people best and can manage the administration of Medicaid far better without federal overhead. States will have the incentives to seek out and eliminate fraud, waste and abuse to preserve our precious resources.

Remove barriers to entry into free markets for drug providers that offer safe, reliable and cheaper products. Congress will need the courage to step away from the special interests and do what is right for America. Though the pharmaceutical industry is in the private sector, drug companies provide a public service. Allowing consumers access to imported, safe and dependable drugs from overseas will bring more options to consumers.

That's pretty much it. A "Seven Point Plan" at this stage. Oh, and, of course, this:

Providing healthcare to illegal immigrants costs us some $11 billion annually. If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.

We'll take these up point-by-point shortly (nothing in the foregoing about InfoTech, we can note). But first...

Also, for now, see "Donald Trump’s Health Care Ideas Bewilder Republican Experts."

And, from Politico a few months back:

“It’s kind of warmed-over Republican mush,” said Tom Scully, who was a top health official in George W. Bush’s administration. “I just don’t think there’s a whole lot to shoot at.”

“I’m not sure health care issues matter much to the Trump candidacy,” added Doug McAuliffe, a GOP consultant who worked on Chris Christie’s super PAC before the New Jersey governor dropped out of the race. “The Trump candidacy is based on his vainglorious message. When it comes to issues, he ranges from uninformed to helter skelter.”

Critics say there’s no way to predict where Trump might come out on these issues if he secures the party’s nomination for president. His evolution — from professed admiration of Scotland and Canada’s single-payer health systems to denunciations of health insurers’ profits — suggests a willingness to tout different, in some cases even contradictory positions, based on political expediency.

I'll eventually get around to the health policy proffers of both the Clinton and Libertarian campaigns as well.

Tangentially, see my prior post "145 Tech Leaders on the 2016 election."

UPDATE

The Libertarian candidates (Johnson-Weld) have nothing directly on health care as of today. From their website "Issues" page.

The Hillary Clinton "Issues" page is fairly overflowing with topical detail across a breadth of policy areas. "Health Care" specifically is here.

ERRATUM

A young writer reached out to me this morning, offering to comp me his new book in return for a review. He'd seen a comment I'd left on Amazon concerning another book on the topic.

I opted to just buy it and add it to my never-ending reading pile. Looks interesting. Stay tuned.

This book will help anyone who is interested in learning more about death, coping with a loss, approaching death, or explaining death to a child. It is an exploratory journey that includes multiple viewpoints, including Steve Jobs’s embrace of his death, Ray Kurzweil’s striving for immortality, and Joseph Campbell’s view of death as the “ornament of life.” The book looks at death from the perspectives of atheists, Christians, and Tibetan Buddhists, among many others. Interestingly, it considers the often unexplored aspects such as the curious relationship between death and ayahuasca. It is a guidebook, offering insights and comfort on a topic that many find frightening or macabre...

Maybe it's again a good time to contemplate death.

“I genuinely believe that if Trump wins and gets the nuclear codes there is an excellent possibility it will lead to the end of civilization.”

LOL. The guy who ghostwrote "The Art of the Deal." See "DONALD TRUMP’S GHOSTWRITER TELLS ALL."

GOP CONVENTION UPDATE

Speaking of "death."

Okeee Dokeee, then. Never mind any due process quibbles and the precise, narrow Constitutional and statutory definitions of "Treason."

UPDATE

RNC: And Now for a Different Take on Obamacare ACA
Reform, not repeal, urged by former HHS Secretary

by Shannon Firth
Washington Correspondent, MedPage Today

CLEVELAND -- Could a Republican administration repeal Obamacare? That was the topic up for discussion at a briefing Tuesday, held outside the Republican National Convention.

"I do not believe ... that my political party is going to be able to put together a complete repeal, and I don't think it should," said Tommy Thompson, JD, a fellow of the Council on Foreign Relations, who served as Secretary of Health and Human Services under President George W. Bush, and four terms as governor of Wisconsin...

Maybe they'll want to shoot him as well.

ANOTHER ERRATUM

I just learned from my sister that my niece April and her brainiac husband Jeff Nyquist, PhD, co-founders of NeuroTrainer, are taking the Silicon Valley startup VC plunge at the end of this month. Way cool. I first mentioned this project back during WinterTech: "#WinterTech 2016: Venture Capital in #HealthIT."

More on my beloved April here.

The NeuroTrainer Facebook page is here.
__

New at THCB: "Is the Public Option an Option?" apropos, see my 2009 post "Public Optional."

FRIDAY NOTE:
2016 PRESIDENTIAL RACE HEALTH POLICY UPDATE

The principal elevator speech on national health policy in two words (irrespective of party)? "Payment Reform." The finest clinical infrastructure in the world is of no use if people can't access it when in need because of crushing costs.

The 2016 partisan span runs from "Single Payer" (which I took a first run at in 1994) to (the mythical) "Free Market" (via which -- all together now -- to "Repeal and Replace ObamaCare").

This just in from Health Affairs:

Since the Affordable Care Act’s (ACA) health insurance marketplaces first took effect in 2014, news story after story has focused on premium increases for certain plans, in certain cities, or for certain individuals. Based on preliminary reports, premiums now appear set to rise by a substantial amount in 2017.

What these individual data points miss, however, is that average premiums in the individual market actually dropped significantly upon implementation of the ACA, according to our new analysis, even while consumers got better coverage. In other words, people are getting more for less under the ACA.

Covered California, that state’s marketplace, just announced premium increases averaging 13.2 percent. But even if premiums increase by the 10 or 15 percent overall that some are predicting for 2017, they will still be far lower than premiums otherwise would have been in the absence of the law. Moreover, this analysis does not include the effects of premium and cost-sharing subsidies that serve to make ACA marketplace plans more affordable for many people...

Of course, the GOP side is not gonna buy any of this. It's an enduring article of faith for them that if we simply permit the (mythical) "free market" to work its wonders, MRIs will soon cost only $29.99 at Jiffy-Scan in the strip mall, and the CABG px will be a mere $149.99 at the Walmart walk-in AcuteCardioCare Clinic near you.

ERRATUM

OK, this is funny. H/T to one of my FB pals.

____________

More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Wednesday, July 20, 2016

The Trump campaign health care policy position

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