Trumpcare Risk Analysis
Conservatism — Is a political and social philosophy promotes retaining traditional social institutions in the context of culture and civilization. Some conservatives seek to preserve things as they are, emphasizing stability and continuity, while others, called reactionaries, oppose modernism and seek a return to “the way things were”. There is no single set of policies that are universally regarded as conservative, because the meaning of conservatism depends on what is considered traditional in a given place and time. Thus conservatives from different parts of the world — each upholding their respective traditions — may disagree on a wide range of issues. https://en.wikipedia.org/wiki/Conservatism
In addition to being a chronic patient with multiple arthritis and chronic pain issues, I have a degree in Political Science from Boise State University. I’ve ran political campaigns, been involved in local party leadership, and have annoyed many family and friends with my political knowledge. Conservatives in Idaho call me a bleeding heart liberal while bleeding heart liberals in California call me a right wing nut job because I like wearing shoes. Labels… My personal opinion is that I’m a proud liberal but after this presidential election I’m losing interest in being identified as a liberal. I’m Alan; I’ve had a lifetime of experiences, thoughts, opinion, and accumulation of knowledge that has shaped me. If you must label me, call me a proud member of the Alan Political Party.
Coming from Idaho, the reddest of states, I have a strong biased towards “conservatism” I will admit. For example, instead of trying to upgrade schools so that roofs don’t cave in I’ve witnessed conservative Idaho leaders advocate for more guns. Instead of trying to protect our LGBTQ citizens from violence and stigma, Idaho’s conservative legislature has spent 10 plus years trying to carve out some kind of so called “religious protection” amendment to our states Human Rights Declaration. Yet another example would be instead of bringing equality to women’s healthcare I’ve witnessed conservative Idaho male leaders advocate that women can’t be raped. I know that these views do not represent all conservatives; however, my experience as an Idaho resident has taught me that many conservatives in this state and around our country believe these statements as truth. That is why I am bias.
In regards to this post, I have a strong second bias I would like to mention now before you read on. I am a chronic pain and arthritis patient; I see much of life through that the lens of pain. With such a bias, it will be hard to write what is essentially a white paper about President Elect Trumps nomination for Health and Human Services Secretary Tom Price. Any transition of power across party lines is going to cause anxiety since healthcare is now a political topic. This transition is different though, we have President Elect with no leadership experience filling his cabinet with staunch supporters of conservatism. There is a lot of unknown right now, that’s not good for patients.
“I Serve at the Pleasure of the President”
Dr. Tom Price was born in Lansing Michigan and grew up in Dearborn. He graduated from the University of Michigan Health System. After completing his residency in Atlanta, Dr. Price ran an orthopedic clinic for 20 years. In addition to being an orthopedic surgeon, Dr. Price was also the director of the orthopedic clinic at Atlanta’s Grady Memorial Hospital.
Mr. Price began his career in politics as a State Senator for Georgia in 1996. In 2004, Dr. Price ran for and won a seat in the U.S. House of Representatives. During his time in the U.S. House of Representatives he has not had a serious challenger for his seat. While in the House, Representative Price has been assigned to the Budget and Ways & Means Committee with subcommittee assignments on the Health and Human Resources Committee’s.
During his tenure in the House, Dr. Price has voted to prohibit funding for National Public Radio (NPR), voted against a bill prohibiting job discrimination based on sexual orientation, in favor of the Constitution defining marriage as one-man-one-woman, and of course opposes all gun control. The doctor opposes abortion and has been frequently rated 100 by the National Right to Life Center. In 2008 Dr. Price signed a pledge, sponsored by Americans for Prosperity, promising to vote against any Global Warming legislation that would raise taxes.
First introduced in the 111th Congress (2009 — 2010), the Empowering Patients First Act (EPFA) was originally intended to be Rep. Price’s alternative to the Democratic efforts at that time to reform the health care system of the United States. It has since been positioned by Dr. Price and other Congressional Republican’s as a potential replacement to the Patient Protection and Affordable Care Act (aka Obamacare).
The Empowering Patients First Act-
On Congressman Price official House website, he has posted an 11 page overview of H.R. 2300, the Empowering Patients First Act. Much of my post will come from this 11 page overview just to let you know.
To begin with, I looked up the length of both bills in their respective legislative form. The Patient Protection and Affordable Care Act is over 20,000 pages long while the Empowering Patients First Act is 242 pages in legislative speak. Obviously great legislation does not depend on length; however, I do think that in this case the length of each bill demonstrates the difference between designing new opportunities for patients versus helping the Republican Party. Healthcare is complex and slow moving; the reforms needed in order to raise the quality of life of all can’t be done in 30 minutes or less, sorry pizza delivery people.
As we all know, Obamacare was not perfect. I don’t think even the most staunch supporter of President Obama would argue that it was. The 2 things that Obamacare did well though was preventing insurance companies from discriminating against chronic patients with preexisting conditions and allowed kids to stay on their parents health insurance plans through college. However, section 2 of the Empowering Patients First Act calls for a “full repeal of the ACA and all health care-related provisions included in the Health Care and Education Reconciliation Act”. Dr. Price and Congressional Republicans don’t seem to have an issue with insurance companies discriminating against patients with preexisting conditions again and with college students losing good health insurance. Both are casually dismissed as the healthcare market doing its job.
According to a recent Kaiser Family Foundation analysis, there are approximately 52 million adults under the age of 65 that have a preexisting health conditions. Their preexisting condition would make them uninsurable if we went back to the medical underwriting practices that existed in states before the Affordable Care Act. To put it another way, almost 30% of our country’s population would lose their insurance, along with hopes of finding another plan, if President Elect Trump and Congressional Republican get their way regarding the repeal of Obamacare.
Section 101 of the Empowering Patients First Act is probably the most worrisome of all the sections in Dr. Price’s proposal. At this point I would like to take a moment and talk about Dr. Price’s membership in an organization known as the Association of American Physicians and Surgeons. As the Science Blogs managing editor David Gorski (also a surgeon) explains it, that organization takes an Ayn Rand view of healthcare, “doctors are brilliant superheroes constantly undermined by government meddling in the forms of demands for evidence and accountability and things like that.” Sounds like paternalistic medicine. As Republicans are fond of saying, “drown government in a bathtub”.
As I mentioned at the beginning of this post, I am biased. This is a biased post, no sense denying that. Personally, I can’t stand any politician that cries fowl the evils of government while at the same time running for their 3,323,452 term in Congress for example. If you want a government job, then do work son. With that in mind, I would argue that Section 101 of Dr. Price’s Act proves, without a doubt, that his intention is to make government incompetent, versus functional.
As a fellow taxpayer, any tagline that states “refundable tax credit for Health Insurance Coverage” is going to bring green to my eyes, everyone loves a refundable tax credit. However, the devil is in the details. Dr. Price is proposing to provide people ages 18 to 35 with a $1,200 credit, 35 to 50 with a $2,100 credit, 50 and up with a $3,000 credit, and $900 per child credit up to the age of 18. Sounds amazing right!? These credits would be available to those who purchase health insurance FIRST through the individual market place. I would argue this is only a credit for those in the upper middle class to 1% income bracket, the poor and unemployed would not be able to participate because they are making constant choices between rent/food and insurance as seen all too often pre ACA. Health Insurance is too expensive!
If you read deeper into the details, Dr. Price is paying the credit to us by taking money out of Medicare. His program is a voucher system, plain and simple. Imagine a landlord that returned your rent at the end of the lease so you could either buy the apartment you were living in or spend the rent on a new apartment. The real estate market would completely crash in such a system but that is exactly what is being proposed. Dr. Price is not shy about his ideological dislike of Medicare; he has now found a way to destroy that particular program.
Let’s also show some common sense and decency to our fellow chronic patients that live in poverty or can only work part-time at best due to their health. They are not buying health insurance because they are cheap bastards, they can’t afford it. Our chronic friends in these situations are literally deciding if an extra $10 will go to a medication or a fresh piece of fruit. Every month they have to worry whether or not they can make rent, feed themselves, buy most of their medications, have heat, or simply cloth themselves. I find it insulting and degrading to believe that the President Elect or Tom Price think a 24 year old chronic patient can come up with an extra $5,000 for health insurance in order to receive a $1,200 credit at a later date. In the spirit of honesty let’s face the fact that more teachers, soldiers, cops, professors, and small business owners are now forced to make similar choices as those already in poverty due to current health care costs. Anyone that thinks healthcare can be solved through tax policy doesn’t understand truly what it means to be a patient or doctor in our current system.
Until President Elect Trump creates and fully implements a policy he will be nothing more than a political entertainer or political marketer in my mind. He has NO experience in policy development that I can work from. That said, we (public) have to look closely at the individuals President Elect Trump is appointing to key positions like Health and Human Services, Tom Price. Political, policy, management styles, and general ethos of these people have to be considered fair game since they will literally be making life and death decisions for chronic patients like me until President Trump can become more familiar with his new job.
By most any measure, Rep. Tom Price is a highly successful doctor and surgeon. He has helped many acute and chronic patients raise their quality of life. However, once he entered politics his focus seems to have gone from the patient to conservative Republican policies. Looking at his voting and legislation one can conclude that in the world of politics that there is only one way, the conservative ideological way. This might make for great tax policy; my health and being can’t be explained by the conservative ideology though.
Based on my research for this post, I have no qualms with calling Dr. Price a political ideologue. He wants and will only deal with absolutes that follow the conservative ideology. His policy and legislation are completely based in politics, not in “How might we…”. His Empowering Patients First Act is simply a tax policy that does not help those most in need of healthcare access now and does next to nothing for those of use that believe healthcare needs reformed. It continues a paternalistic system that increasingly only exists for the rich and super rich. Representative Price’s Act is a voucher system designed to take money from a program that millions currently rely on for a basic level of healthcare. Being a chronic patient is incredibly tough, not everyone can pull themselves up by their own boot strap which is a common phrase in conservative politics. If our country can send a spaceship to Pluto, surely we can provide a basic floor for all citizens that might need a helping hand.
Finally, since we have a political marketer as our President Elect, we must look for warning signs as chronic patients. Phrases like ‘empowering patients’, ‘patient centered’, ‘tax credits’ should be thought of as warning signs with the Trump administration versus a step in the right direction. We must dig deeper into the weeds of each policy coming from the new adminstration. For example, Dr. Price has called for an end to different types of payment experiments, like Accountable Care Organizations, that have the ultimate advantage of raising my quality of life under the guise of empowering me. True healthcare reform and design will require risk and failure, but that doesn’t mean we shouldn’t try.