On March 25, in the wake of the failure of the American Health Care Act (AHCA), President Trump tweeted a warning and a prediction: “ObamaCare will explode and we will all get together and piece together a great healthcare plan for THE PEOPLE. Do not worry!”
In the first part of this series, we considered Trump’s warning: The question of whether or not Obamacare will “explode.” And our tentative answer was that the national political system, almost certainly, will seek to prevent, or at least contain, any such explosion.
Okay, so now let’s turn to Trump’s prediction that “we will all get together and piece together a great healthcare plan for the people.”
Trump has, indeed, made some bold promises about his healthcare plan. He has said, for example, that it will be “much less expensive and much better.” And if the failed AHCA fell far short of those aspirations, well, Trump can point out that it really wasn’t his bill; it was the House Republicans’: As he said in the Oval Office on March 24, after AHCA went down, “There were things in this bill I didn’t particularly like.” And as for his own future signature effort on healthcare, if and when that comes, he said, “I’ll tell you what’s going to come out of it is a better bill.”
Indeed, at a March 28 reception for a bipartisan group of senators at the White House, the President, eyeing Sen. Charles Schumer leader of the Senate Democrats, then said, “I know that we are all going to make a deal on healthcare. . . . I have no doubt that that’s going to happen very quickly.” He added, “Hopefully it will start being bipartisan because everybody really wants the same thing.”
Well, not quite everybody, as we saw in the AHCA debate. But here’s what Schumer wants: On the issue of Obamacare “exploding,” he has said, “For the President to say that he’ll destroy it or undermine it, that’s not presidential. That’s petulance. And it’s not going to work.”
And as for working with Republicans to improve Obamacare, Schumer has been blunt as to his basic precondition: “If they would denounce ‘repeal’ . . . then we’ll work with them on improving it and making it better. They can’t continue to want to repeal.” So it’s obvious: If Trumpcare is defined only as health insurance, it will end up looking a lot like Obamacare.
It’s possible, of course, that Trump will choose, in the end, not to work with the Democrats on Obamacare changes. And what will happen then? The Republican Senate Leader, Mitch McConnell, gave the most useful perspective: “I think where we are on Obamacare, regretfully at the moment, is where the Democrats wanted us to be, which is the status quo.”
Such an assessment will cause a lot of glum faces in Republican ranks, as well as declarations of never-say-die defiance. And yet as we shall see, a “great healthcare plan” was never going to come from a rejiggering of insurance. That is, tinkering with finance, alone—shifting, say, more from public to private—is not going to generate a program that’s “less expensive and much better.”
In fact, even a favored solution on the right, interstate competition for health insurance, wouldn’t have much net effect. And why not? Because it would lead to insurance cherrypicking; that is, “young immortals” nationwide would, indeed, get cheaper insurance, because everyone wants to sell insurance to people who aren’t likely to need it.
And yet those savings would mostly come at the expense of the older and sicker, who would have to pay for more to fill up the insurance pool, even as policies became harder to find. (Additionally, of course, the taxpayers could be forced to chip in, further underscoring the point that interstate competition, by itself, wouldn’t save money for the overall system.)
So we can see: If the issue is only moving dollar-numbers around, not much will have changed: For older folks, their health needs won’t be any different just because youngsters can buy less expensive insurance; oldsters that the greatest expenses will all found.
We can also say that a focus on finance—that is, insurance—is never going to address the ultimate problem that confront the health system. That ultimate problem, of course, isn’t money, but rather, health itself.
We can illuminate this point easily enough, by citing a common and dreaded illness, Alzheimer’s Disease (AD). Today, AD makes no distinction between Obamacare or Ryancare. That is, if a patient is diagnosed with AD—as 5.5 million Americans will be this year—there’s no cure, nor any really meaningful treatment, no matter how much money or insurance the patient might have.
To be sure, a rich, or well insured, AD patient will get better care than one without such resources. But given the current lack of a cure, the patient’s ultimate fate is the same, whether the care is gold-plated or copper-plated. Today, in all AD cases, what’s missing is hope—the hope that comes from a cure. Thus we can see: The key variable is not finance, it’s science. That is, whether or not a cure is available.
Of course, common decency—and patriotism—tells us that we want AD victims of all income levels to be treated with compassion; they are, after all, our fellow Americans. As Trump said during the campaign last year, we’re not going to let them “die sitting in the middle of the street.” And yet sadly, we must conclude that our compassion, essential as it is, will not have all that much impact on the patient’s prognosis—all such care is, to be cold about it, ultimately futile.
Now we can make a further point: Care for AD patients, especially those with dementia, is going to be expensive, no matter what the funding source, public or private. That is, it will be costly. Yes, we must beware of unfeelingly bureaucratic public hospitals that are merely warehouses for the dying, but we must also beware of cost-cutting private facilities that are profit-centers for some bean-counter with a spreadsheet. So we can see: Any system that cares for AD victims will be expensive and yet, at the same time, require a great deal of public scrutiny and supervision to protect the public interest.
Indeed, the labor-intensivity of AD care, absent a good treatment or cure, is what makes such care costly; we can think of all those healthcare workers changing bedpans. Economists have a useful concept to describe this phenomenon: Baumol’s Law. We can sum it up readily: If it’s labor intensive, it will be expensive.
And yet there is an escape from this upward cycle of rising costs. And that escape can be summed up in a word that’s far different from finance. And that word, of course, is science.
Medical science, in fact, is a twofer: It offers relief from the human terror of disease, as well as from the terrible fiscal cost of disease. And we can illustrate this point with a story ripped from the latest headlines: On March 28, the Food and Drug Administration approved a new drug, Ocrelizumab, that is the first medication that finally offers true hope to MS patients. MS, of course, is a terrible wasting disease that affects 400,000 Americans. And if, as with AD, MS sufferers are simply financed by health insurance, private or public, they don’t have much to look forward to. And, of course, the taxpayers can look forward only to massive costs.
To be sure, Ocrelizumab isn’t cheap; it’s projected to cost $65,000 a year. And yet if the drug’s creator, Dr. Stephen Hauser of the University of California, San Francisco, is correct when he says that newly diagnosed MS patients will be able to “look forward to a full life without significant disability,” then the drug will likely pay for itself, as MS patients continue on with their productive lives.
Hope for millions? Cures that pay themselves? Surely we can agree: Now that’s a great healthcare program.
In fact, the news of medical miracles, or at least their prospect, is near-continuous. Recently, scientists in the United Kingdom have figured out how to convert spinach into working heart tissue. That’s right, the green leaf might soon become the new heart.
Meanwhile, at Ohio State, they’re working on creating synthetic blood. And at Case Western Reserve, also in the Buckeye State, they have figured out how quadriplegics can use thought to regain motor control. And in a Manhattan emergency room, they’ve already installed telemedicine portals that, almost literally, enable doctors to be two places at once, thereby dramatically shortening waiting times from hours to minutes. Moreover, there’s even new hope for Alzheimer’s: Researchers at the University of Queensland in Australia are developing a possible ultrasound therapy for AD patients.
To be sure, we don’t yet know if any of the approaches described above—will prove effective. Yet still, the history of our collective medical success against other awful maladies—from the bubonic plague to polio to Ebola—gives us ground for cautious optimism. So why not AD, too? And everything else, even new human hearts made of spinach!
So now the real essence of “a great healthcare plan for the people” is starting to come into focus. That is, of necessity, it would put the focus on science, not finance. Yes, of course, finance is necessary, but money by itself won’t cure a thing.
We can sum up the reality: Money is transactional; if cash goes from Smith to Jones, or vice versa, and nothing else, the net benefit of society doesn’t change. By contrast, science is transformational: It transforms both Smith and Jones. The issue is simple: It means extending people’s productive and independent lives. And science has been proven to do that: In 1900, the life expectancy of the average American was less than 50; Today, it’s nearly 80.
Moreover cures transform costs—downward. Aside from the obvious individual gains of better health, there are also societal gains. If we recall that Baumol’s Law speaks to the high cost of labor intensiveness, then we can grasp that a cure for AD would save billions and, over time, trillions on the cost of nurses and caregivers.
The reality of the transformative power of medical science should thus be obvious to all. And yet strangely, for the most part, science has been missing from the Washington, DC, healthcare debate. We might ask ourselves: In the recent fight over AHCA, did the idea of “cures” ever come up? That is, Republicans were trying to save money on healthcare, and yet the notion of helping people to be healthier by curing disease wasn’t part of the debate. As Trump might say, Sad!
One astute Republican observer who gets the point about the transformative power of technology is the veteran politico Alex Castellanos. Two days after the defeat of AHCA, he compared medical progress to computer progress:
Message for Republicans: You don’t replace manual typewriters with bigger manual typewriters. You open up the system to evolve and create laptops and mobile devices. You open up health care to innovate and lower costs by evolving new treatments and cures.
Interestingly, the Trump administration seems to be moving in this direction. On March 27, top White House aide Jared Kushner, the President’s son-in-law, was tapped to lead a White House Office of American Innovation, focused on modernizing the federal government with the latest private-sector thinking. One of Kushner’s specific missions is to think through an overhaul of the Department of Veterans Affairs, and we can all agree that that’s a great place to start.
So here’s one idea, from Dr. Joseph V. Gulfo, MD, of Fairleigh Dickinson University’s Lewis Center for Healthcare Innovation and Technology. In an interview, Gulfo summed up his idea in two words: wearable technology. That is, let’s be sure that all our aging heroes in the VA system have access to the sort of ever-present monitors that could keep them healthier and living longer.
We’re all familiar with consumer health-monitoring devices, such as Fitbit, and any number of wearables and apps, but Gulfo goes further: “With real hospital-equipment-level wearables, we could track vitals, those whose who are not compliant with their regimen [for prescription meds], and those in need of rehab.”
Gulfo adds that such a system of wearables could be implemented quickly, since most of the technology is already available. “We could have one for every veteran, probably within a year. That could be a Trump administration goal.” Translation: If Team Trump is hungry for a quick win that real people would notice, this could be it.
Moreover, we can see in such a program a vision of economic renaissance for US manufacturing: The VA embraces wearable technology, and, at the same time, it stipulates, Buy American.
To be sure, Gulfo’s idea, promising as it might be, is just one of many. But the common thread running through any plan for true healthcare greatness is science, along with its close cousin, technology.
In fact, it’s science that actually cures, while finance merely pays. Paying is important, but curing is more important. So if Trumpcare is ever to be seen as anything different from Obamacare, it will start with science, and then cures.
It’s through a Cure Strategy that we will know that Washington is putting the health of Americans first.
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