The overarching theme of TrumpCare: more choice, less cost
Opponents have accused the Trump administration of taking a fragmented, inconsistent approach toward the health-care system. They are wrong. There is a definite overriding strategy which favors deregulation and the re-introduction of market forces to provide more choices for patients, while at the same time protecting the essential pieces of the existing system — namely, employer-based insurance, Medicare and Medicaid.
Levers have been employed over the past two and a half years to improve transparency and increase competition. This translates to better quality. If a patient knows the price of what he or she is paying for a health service, it puts that patient in a potentially better position to choose a cheaper alternative.
As Health and Human Services (HHS) Secretary Alex Azar emphasized in a speech last Tuesday at the Medicare Advantage Summit, the “Affordable Care Act exchanges represent about 3 percent of our system … health care is much more than just ObamaCare.” Azar pointed out that the ultimate goal of his work is “not just improving health insurance or health-care delivery but improving health.” The theme of maintaining and improving quality of health versus simply extending insurance of any quality is an essential difference from what many Democrats are proposing.
Secretary Azar told me privately, “the president has a holistic vision on health care. He intends to protect what works and fix what’s broken. To protect private insurance and Medicare — covering 240 million people — from anyone who is trying to attack it.”
What tangible accomplishments have been made in terms of quality of health care? For one thing, the introduction of more biosimilar drugs and generics; and speeding approvals by the FDA have been important steps to increasing competition, improving patient choice and bringing down drug prices. Too often, doctors and their patients are eager to jump to the next-generation treatment without considering that a cheaper, older drug is already quite effective. And among brand-name drugs, the rate of price increase is now decreasing.
Making drugs more affordable will improve access to treatments. The FDA approved close to 1,000 generic drugs in 2018, an all-time high. At the same time, loosening regulations on biosimilars allows for more competition and lower prices in crucial areas, including insulin use for diabetics. Executive actions have focused on compelling advertisers to display prices in ads (currently blocked by a federal court) and making list and negotiated prices known to the consumer, moves that will lead to better quality choices.
Improvements are also finally being made in the area of pain management and addiction. Thanks to the administration’s crackdown on opioid prescriptions, doctors areprescribing much fewer pills and the number of overdose deaths — which are around 68,000 per year — has dropped in the U.S. for the first time in nearly two decades.
Other focuses on quality of health care include efforts in the fight to prevent and diagnose HIV/AIDS in the U.S. as well as changing the course of kidney disease by moving more dialysis to the home while increasing the number of available transplants.
But the Trump administration’s biggest success by far is the de-powering of ObamaCare’s individual mandate, which compelled people to buy an overpriced, over-regulated, highly subsidized high-deductible insurance that didn’t provide the care it promised. Many Democrats predicted that with the loss of the mandate, premiums would skyrocket but, instead, they have stayed flat. Even more important, the absence of the mandate has freed the Trump administration to introduce alternative approaches, including national association plans and short-term, scaled-down plans that are better suited for a healthy population. More options ultimately should mean more people with at least minimal coverage. More competition among insurers selling different kind of plans ultimately will cause premiums to drop. This is a major part of the theme of improving quality of care for all patients.
President Trump and HHS Secretary Azar do not have a fragmented approach. Rather, the administration’s strategy is a free-market octopus with many arms. No matter what ultimately happens with ObamaCare in the courts, the focus on extending market forces and deregulating health care with a goal toward improving quality and choice is refreshing to doctors, hospitals, and patients.
Marc Siegel, M.D., is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent. Follow him on Twitter @drmarcsiegel.
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