Terry H. Schwadron
July 18, 2019
Someone in the White House has woken up to the importance of health care issues, and has started feeding Donald Trump suggestions for improvements to current-day practices.
Trump then takes them, gathers some folks for a photo op signing, claims credit for improving health care and thinks he is checking off a reelection box requirement to appeal to a voter base that wants better health care services. Like most such check-box efforts, they vary as to whether they deliver as promised, are fully thought through, or even if promised costs or patients have issues.
Now that this portion of the campaign is under way, we should expect more of it.
To Trump, that means cheaper policies and less spending by the federal government, and moving responsibilities for many health services to the states or to you and me.
So far, policies that he says help the lives of kidney disease patients or promise lower costs for some sliver of prescription drug prices are individual pops that may or may not fit with a more overall plan, and that seem to have cost-savings at the heart of each.
We should recognize them as political statements that may or may not work, but are no substitute for a full-blown approach to the most complicated public policy problem in the United States. As such, we ought to be paying more attention to each one, because they may come to substitute for actually having a system of health care insurance should the lawsuit Trump’s Justice Department is now supporting in the Court of Appeals results in nullifying the Affordable Care Act or Obamacare.
Within the last week or two, for example, Trump signed an executive order that he says would improve the lives of patients with kidney disease while lowering health care costs.
The administration notes that kidney disease is the ninth leading cause of death in the United States and makes up 20% of Medicare’s payments to providers per year. Trump said his executive order is expected to save about $4.2 billion annually. The order directs the Department of Health and Human Services to revamp a system that currently favors more expensive treatment in commercial dialysis centers.
The order expects to address U.S. organ shortage by incentivizing people to donate while increasing scrutiny of the 58 nonprofits that collect organs from deceased donors.
It also emphasizes early treatment to slow the progression of kidney disease, as well as early transplants and home-based dialysis for those with end-stage kidney failure.
“This action will dramatically improve prevention and treatment of this life-threatening illness while making life better and longer,” Trump said. By 2025, HHS wants 80% of new patients to either be receiving dialysis at home or receiving a transplant.
It will take HHS months to put a system in place, The change is substantial: Currently about 12% of patients nationwide receive dialysis at home. In the days after the order was signed, the biggest dialysis clinic companies saw stock prices fall measurably.
HHS Secretary Alex Azar noted that early treatment and transplants are preferable to dialysis, which keeps patients alive but can weaken the immune system. About half of dialysis patients dies within five years. To make more kidneys available for transplant, the administration plans closer scrutiny on the 58 groups that collect transplant organs.
Some of these organs are discarded for minor reasons or are not delivered to transplant centers on time, experts say.
The organ-procurement system in the United States hasn’t been updated in decades, and thousands of people a year die waiting for kidney transplants. There are nearly 100,000 people on waiting lists to receive kidney transplants. HHS will also issue regulations allowing organ donors to be reimbursed for lost wages and child care expenses. The administration estimated that the changes would result in the donation of 17,000 more kidneys a year.
This order seems to have bipartisan backing, but others that the administration has taken have run into heavier water.
A few weeks ago, in a similar announcement, Trump said an executive order would drop some prescription drug prices by eliminating middleman fees between pharmaceutical companies and Medicare, which buys them. But then the White House reversed itself, saying it had decided said to kill its proposal to eliminate back-end rebates in Medicare Part D and Medicaid because it turns out that Congress is working on an alternative, and the White House did not want to interfere in whatever progress that bill is making. But the real reason seemed to involve fears that the effects could be to drive up the prices of policies for seniors.
Separately, Trump has promised an executive order that would create a “favored nations clause,” under which the U.S. would pay no more for a drug than the lowest price paid by another country, a curious exception to America First thinking.
And in a different drug price effort, a federal judge stopped efforts by the administration in trying to require that pharmaceuticals list prices on any television advertising it buys to promote individual drugs. The judge said simply that the move exceeded the authority of the government to regulate, not that the idea was good or bad.
According to Axios, The administration has also expressed interest in a controversial measure that would limit how much drug prices can rise in Part D — an idea distasteful to both pharmaceuticals and free-market Republicans.
Over time, Trump also has touted efforts to end HIV, curb the opioid epidemic, increase price transparency in health care and invest in child cancer cures. Of course, it has also sought to end abortion and health services for women, particularly rural women, and it has been active at trying to knock out underlying supports for Obamacare.
I, for one, am not ready to sign on to the Trump channel for my health.