As we begin to reflect on the chaos of 2016, there is only one major bioethics story for healthcare providers: the fate of American healthcare access. Again. As December began, the picture for 2017 was beginning to fill in – particularly with the Cabinet pick of Dr. Tom Price as HHS secretary. Here are some alarming facts in a compelling piece published in the New England Journal of Medicine: (See: http://www.nejm.org/doi/full/10.1056/NEJMp1615714)
The authors, who both formerly served as Assistant Secretaries at the Department of HHS, make these points:
- “…Price’s record demonstrates less concern for the sick, the poor, and the health of the public and much greater concern for the economic well-being of their physician caregivers.”
- Price supports changing the Medicare and Medicaid systems so substantially that it would “shift financial risk from the federal government to vulnerable populations.”
- “Price has also been a vociferous opponent of the Affordable Care Act (ACA) and a leader of the repeal-and-replace movement.” Essentially, Price endorses a dismantling of the American healthcare system with a “regressive” plan that “offers much greater subsidies relative to income for purchasers with high incomes and much more meager subsidies for those with low incomes.”
In essence, Price opposes any cost-sharing subsidies, which could “doom millions”. See: https://www.washingtonpost.com/national/health-science/trump-could-quickly-doom-aca-cost-sharing-subsidies-for-millions-of-americans/2016/12/21/05349066-c2fc-11e6-9a51-cd56ea1c2bb7_story.html?hpid=hp_hp-top-table-main_costsharing-10pm%3Ahomepage%2Fstory
Price is a polarizing figure for American doctors. Although the American Medical Association endorsed Dr. Price as a pick, many of its members were dismayed. Over 5,000 doctors have signed a petition opposing him, while many AMA members have spoken out, or not renewed their memberships. (See:
Price also is a member of the Association of American Physicians and Surgeons (AAPS), which has been coined a “crank medical society” by Scienceblogs.com. The AAPS is noted for its anti-vaccine stance. (See: http://nymag.com/scienceofus/2016/12/tom-price-belongs-to-a-really-scary-medical-organization.html)
Advocates of women’s health are concerned that even the most basic contraception for women would become a challenge because “the extremity of Mr. Price’s views on women’s health.” For example, he was a co-sponsor of legislation that defines life at conception, arguing that “common forms of birth control constitute a murder weapon.” (See: http://www.nytimes.com/2016/12/28/opinion/how-donald-trumps-health-secretary-tom-price-endangers-women.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-right-region®ion=opinion-c-col-right-region&WT.nav=opinion-c-col-right-region&_r=0
It gets worse. Price has alarming conflicts of interest according to a Wall Street Journal Report. He has all kinds of ties to the pharmaceutical industry, having traded over $300,000 in big pharma stock while in Congress. See: http://www.wsj.com/articles/donald-trumps-pick-for-health-secretary-traded-medical-stocks-while-in-house-1482451061
Of course, the HHS Secretary cannot, alone, repeal the ACA. That is an act of Congress, which has made clear that it’s the first thing on its agenda in 2017. That is sending “red flags” (no – not the Russia hacking thing) across the healthcare spectrum. For example, as the New York Times reported:
“In a letter to Mr. Trump and congressional leaders this month, the two biggest hospital trade groups warned of ‘an unprecedented public health crisis’ and said hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.” See:
It’s clear to any bioethicist that the new GOP-led Congress is about to step into the mire of what scholars call a “wicked problem”. Anyone who looks closely at the muckiness of the U.S. healthcare system will see that there are two options: a market-based system, which basically looks like the ACA, or some form of a single-payer universal healthcare system, which is what every other democracy has. So for the GOP, it’s a wicked problem of BernieCare of ObamaCare, because voters will not like any of the voucher-based plans they have been discussing for years, which do not resolve distributive justice problems.
The GOP Congress, in recognition of this “wicked problem” has come up with a “neither fish nor fowl” solution, called Repeal and Delay. But that has problems, too, according to the Urban Institute, which estimates that “repeal and delay” would “increase the number of uninsured by 4.3 million people near immediately”. (See: https://www.brookings.edu/research/why-repealing-the-aca-before-replacing-it-wont-work-and-what-might/)
As for the Trump voters, they don’t want to see the ACA repealed, either, which makes their vote for Trump perplexing. In two of the poorest states (one of them, mine), the uninsured rate has fallen from 25 percent in 2013 to 10 percent today. One reporter decided to investigate the paradox of the Trump voter and ACA-lover, and took a deep dive into my own state of Kentucky (See: http://www.vox.com/science-and-health/2016/12/13/13848794/kentucky-obamacare-trump.) Voters who understood that their Kentucky healthcare of “Kynnect” was “Obamacare” simply didn’t take Trump seriously about taking it away. They thought he was kidding, proving the adage of “taking him seriously but not literally”. Other voters who love their healthcare in Kentucky, didn’t understand that what they love, is in fact, Obamacare, proving there is a wide gap in understanding the law. (See: https://www.washingtonpost.com/opinions/trump-voters-didnt-take-him-literally-on-obamacare-oops/2016/12/20/46ef3cae-c6f3-11e6-bf4b-2c064d32a4bf_story.html?hpid=hp_no-name_opinion-card-c%3Ahomepage%2Fstory&utm_term=.0decc010c34c )
Patients who voted for change are going to get it in 2017. It just may not be the change they want. And many bioethicists fear some may have unwittingly voted for their own executioner if their healthcare goes away.