A Slow Drip of Health Cost Savings

Terry H. Schwadron

Aug. 12, 2019

The slow drip of very incremental White House responses to challenges in health care is continuing. Interestingly, most of the individual pieces that are oozing out slowly actually are consumer-oriented — in fact, that seems to be the glue here — but not enough to provide health care..

The White House is on the hunt for budgetary concerns in the health field rather than overall attention to health. This is not leadership, this is a hunt for political points.

Many of the suggestions have come from the Centers for Medicare and Medicaid services, curiously acting increasingly as if it were a public-option-for-all government health agency, along the lines of what Democratic candidates say they want and which Republicans, including Donald Trump, say they hate.

Now it is being reported that there is a small group in the White House that is committing itself to coming up with a steady series of narrow health announcements for Trump to trumpet.

Curiously, many of them sound as if they could have come from Democrats.

Just recently, then, the Trump administration announced another regulations proposal that will become law as it hits the Federal Register to require hospitals to identify the costs it has negotiated with insurers. That might make it possible for the savvy consumer to more easily decide that a hip operation at hospital A is less expensive than at hospital B.

However, even this is complicated. Consumers might know the negotiated base prices, but not what hospitals actually charge, and the wide variety of insurance plan coverage, deductibles, and location might make the information virtually meaningless.

And, in any case, most patients headed for a hospital stay are going there on the orders of the doctor they have been consulting, and a decision on hospital is merely a reflection of where the doctor has sought affiliation. With more and more private doctors’ offices affiliating with hospital chains, the final consumer decision about a hospital has long since been arranged.

In recent weeks, similar price-sensitive consumer decisions have emerged involving a small slice of pharmaceuticals pricing, requiring transparency in hospital billing, as well as more spending in the opioid epidemic, although almost all on policing rather than treatment. It is as if the Trump administration is readying an argument for the 2020 elections, with a list of pro-consumer health moves.

At the same time, of course, the Trump administration, through the Department of Justice, has joined a Court of Appeals case to destroy the Affordable Care Act or Obamacare.

A piece in The Washington Post confirms my own observations that someone in the White House has come alive to issue a series of announced of perceived improvements in health care, recognizing that the issue is dominating the 2020 campaigns. “White House advisers, scrambling to create a health-care agenda for President Trump to promote on the campaign trail, are meeting at least daily with the aim of rolling out a measure every two to three weeks until the 2020 election,” the Post reported.

Among these initiatives is one to allow the import by states of lower-priced prescription drugs from Canada or other countries. As described, another would bar Medicare from paying more than any other country for prescription drugs.

Itt remains unclear that the administration has the legal authority to execute some of these policies without Congress, where some Republicans are pushing back. The pharmaceutical industry is indicating that it likely will go to court to challenge any measure it opposes; recently the industry won a court challenge that blocked an administration proposal to require television ads for drugs to include the price.

That also speaks to Democrats, of course, for whom such measures are the least of what they are discussing as proposals.

The Post carried the official word from the White House: “President Trump has said we will protect people with preexisting conditions, lower drug prices, end surprise medical bills, and make sure Americans get the highest quality of care they deserve,” said White House spokesman Judd Deere. “While the radical left has sweeping proposals for a total government takeover of the health system that will hurt seniors and eliminate private insurance for 180 million Americans, the Trump administration is working on real solutions.”

As an example, the White House is supporting a bipartisan Senate bill to cap Medicare drug price increases to the rate of inflation, essentially telling congressional Republicans that they must accept Trump’s agenda and abandon conservative ideas about interference in the marketplace or buck the president on one of his top priorities.

Senate Majority Leader Mitch McConnell has not said whether and when the bill will be brought up for a vote, but is known to oppose doing so before the election.

The Post said the health care effort is being driven by the White House’s Domestic Policy Council Director Joe Grogan, Chief of Staff Mick Mulvaney and the White House Office of Management and Budget acting director Russ Vought. Other participants in sometimes contentious daily meetings include Azar, the president’s son-in-law Jared Kushner, counselor Kellyanne Conway and representatives from the vice president’s office.

According to the Post, the White House advisers are working on an Obamacare replacement plan that Trump could campaign on, especially if the Fifth Circuit should declare the law unconstitutional this fall and catapult the issue to the forefront of the 2020 races. It is unlikely, however, that such a plan would pass the Congress without substantial Democratic involvement. Such a White House plan reportedly would eliminate Obamacare subsidies for low-income consumers and replace open-ended federal commitment to Medicaid with a lump-sum payment for each state in the form of a block grant, according to a copy posted online.

This is largely the same outline as a failed 2017 Republican bill.

Maybe Trump should talk with Bernie Sanders and Elizabeth Warren instead of his failed Republican partners.



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