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Wednesday, November 9, 2016

What will the 45th President do about health care?





"We have to come up, and we can come up with many different plans. In fact, plans you don't even know about will be devised because we're going to come up with plans, -- health care plans -- that will be so good. And so much less expensive both for the country and for the people. And so much better.” 

- Donald Trump, September 14th, 2016 on the Dr. Oz show


Well, the Republicans will have control of the Presidency, Senate, and House beginning in January. Will they actually repeal "ObamaCare?" And, if so, what, if anything, will replace it?
Trump upset will force healthcare leaders to rethink the future
By Harris Meyer, November 9, 2016

Republican Donald Trump's shocking victory Tuesday will force a major shift in the healthcare industry's thinking about its future. Combined with the GOP's retention of control of the Senate and the House, a Trump presidency enables conservatives to repeal or roll back the Affordable Care Act and implement at least some of the proposals outlined in the GOP party platform and the recent House Republican leadership white paper on healthcare.

Addressing supporters just before 3 a.m. ET, Trump struck a conciliatory tone and did not specifically mention the ACA. “It is time for us to come together as one united people,” he said. “It's time.”

But the assumption of Republican control over both the White House and Congress most likely means an end to the expansion of Medicaid to the 19 states that have not yet implemented it, and puts the expansion in the other 31 states in serious jeopardy.

But there are divisions even among conservatives over issues such as Medicare restructuring and how to help Americans afford health insurance. And Senate Democrats almost certainly would try to use their filibuster power to block major ACA changes...
Post-Election Analysis: Making Healthcare “Great Again”
By PAUL KECKLEY, Nov 9, 2016


The election results are in and Donald Trump will be the 45th president of the United States. His appeal to “Make America Great Again” resonated across the heartland sparking an unprecedented political upset that surprised even the most astute prognosticators and pundits.

When he takes office in January, he’ll face enormous challenges domestically and globally. Healthcare will be at the top of the list: he promised to “Repeal and Replace” the Affordable Care Act, and he pledged changes that strengthen the system in his campaign’s seven-point plan. In this effort, his team will face harsh realities...
What Will Republicans Do about Obamacare Now?
by CHRIS JACOBS, November 9, 2016


They’ve campaigned against the health-care law for years. Now that they’ve won the presidency and Congress, the path to repeal and replace is still far from clear.


For the past six years, Republicans — across Washington, and across the country — have virtually to a person run against Obamacare. Their campaign has helped them win numerous House and Senate seats, a majority of governorships, and now has given them unified control of Washington for the first time in 15 years. Like the dog that finally caught the proverbial car, Republicans will wake up Wednesday morning asking themselves — on Obamacare, as on many other issues — “What now?” 

The answer might be less obvious than it first appears. Democrats used the decade and a half between the defeat of Hillary Clinton’s health plan in 1993–94 and the 2008 election to develop a consensus architecture about what their ideal health-care plan would look like. In the Democratic primaries that year, Senators Clinton and Obama disagreed strongly on the necessity of an individual mandate to purchase coverage — a difference they litigated very publicly, and at great length, during the primary campaign — but agreed on virtually everything else. 
By contrast, Republicans spent comparatively little time debating the finer points of an Obamacare alternative during the presidential cycle just concluded. Donald Trump promised “something terrific” that would tear down “the lines around the states,” but details were few and far between (and occasionally self-contradictory). Speaker Ryan’s House Republican task force produced a plan, but one with few fiscal details attached, and one that few in Washington — whether media analysts or policy-makers themselves — spent time dissecting or debating...
Some thoughts the day after the election
November 9, 2016, Aaron Carroll

This is going to be long, but I hope you’ll bear with me. I have a lot on my mind, and I have some thoughts I’d like to share with you. Clearly last night was a shock for many, many people. I’m being bombarded with questions from family, friends, and people I don’t know about what will happen, both with health care and America at large. Rather than try and handle those queries piecemeal, I’d rather make use of the blog – something that’s been hard to do during the election.

I have written more than once on this blog that “we do not strut” when things go our way. We don’t “celebrate”. We acknowledge the policy gain and then we get back to work trying to make the health care system of the United States better than it is now.

The same still holds when things don’t go our way. We don’t sulk. We get back to work trying to make the health care system better...
Below, in The Atlantic last week:
Trump's Health Plan: Pay Your Own Medical Bills Using Money You Saved
The candidate called a special “meeting” to discuss the future of medicine. Here’s how that went.

James Hamblin, Nov 2, 2016

Five disgruntled Republican physicians and one nurse warmed up the conference room at a Hilton DoubleTree hotel in Pennsylvania yesterday. All were members of the U.S. Congress, gathered for a rally that Donald Trump would call “a meeting talking about health care.”

On the day that health-insurance enrollment began for 2017, the Trump campaign chose to keep the focus on medicine. Health-insurance premiums will be increasing in exchanges for some two to five percent of Americans this year. The U.S. has the most expensive health-care system in the world and needs a great deal of improvement. The candidate has been hostile toward the current health-care system and toward Hillary Clinton’s proposals, but has offered almost nothing in the way of solutions. Perhaps today was the day for a plan.

First to the mic stepped John Barrasso, an orthopedic surgeon from Wyoming. “People need a better way, and that is why we are here,” he said, setting the stage. “There is a better way than Obamacare.” He said that he believes that “government is the problem” and that Hillary Clinton is proposing “more Obamacare,” though it was unclear what part of the system he was referring to. “Republicans are here today to offer solutions,” he said...
And, from STATnews:

What does Donald Trump’s win mean for science and medicine?
By DAMIAN GARDE @damiangarde
NOVEMBER 9, 2016

It’s hard to escape the din of the nation’s prognostication industry coming to terms with its wrongness today, with so many teeth to gnash and garments to rend.

But here in the world of science and medicine, the election of Donald Trump has left many trying to make sense of the vagaries, reversals, and red herrings that have marked his rhetoric on key issues from research funding to drug pricing...
I am bummed at this election outcome, but not really all that surprised. I have a friend in DC who's a liberal policy wonk and former talk radio host. She scoffed at my concerns posted in a Facebook comment last week, citing Hillary's vaunted massive and savvy "ground game."

Whatever. Health policy reform may be the least of our concerns after January 20th.
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NOVEMBER 10TH UPDATE
Dancing on the Grave of Obamacare: Questions
Nov 10, 2016 By JOE FLOWER


I hate to interrupt the festivities, but I have a few questions. There are one or two little unknowns here. The answers to these questions are matters of life and death to many in the industry, literal life and death to many thousands of patients, organizational life and death to thousands of companies, hospitals and systems.

Tuesday’s extraordinary events obviously present an enormous challenge for anyone who wants to think about the future of healthcare. The challenge is far more than simply trying to imagine the healthcare industry without Obamacare, or under whatever Trumpcare will turn out to be. A much more powerful effect will be come into play far earlier: the uncertainty over that future will have reshape the industry before we even get to the actual “repeal and replace” part...
 From The NY Times: Silicon Valley Reels After Trump’s Election
"The tech industry’s relationship with government — not to mention the public — looks bound to shift in a fundamental way."

During the Obama years, Silicon Valley came to see itself as the economic and social engine of a new digital century. Smartphones and social networks became as important to world business as oil and the automobile, and Amazon, Apple, Facebook, Google and Microsoft rose to become some of the most prosperous and valuable companies on the planet.

Mr. Obama, who rode many of these digital tools to the presidency, was accommodative of their rise; his administration broadly deferred to the tech industry in a way that bordered on coziness, and many of his former lieutenants have decamped to positions in tech.

Mr. Trump’s win promises to rip apart that relationship. The incoming president had few kind words for tech giants during the interminable campaign that led to his victory. Mr. Trump promised to initiate antitrust actions against Amazon, repeatedly vowed to force Apple to make its products in the United States, and then called for a boycott of the company when it challenged the government’s order to unlock a terrorist’s iPhone. Mr. Trump’s immigration plans are anathema to just about every company in tech...
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More to come...

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