Health economists and every concerned citizen should disseminate the facts in this NEJM article about Donald Trump’s nominee of Tom Price to be the next secretary of HHS.
Coauthor Richard Frank is also a BU Ph.D. alum!
Care for the Vulnerable vs. Cash for the Powerful — Trump’s Pick for HHS
Sherry A. Glied, Ph.D., and Richard G. Frank, Ph.D.
New England Journal of Medicine
December 21, 2016DOI: 10.1056/NEJMp1615714
Since there is no abstract, here are the first two paragraphs.
Representative Tom Price of Georgia, an orthopedic surgeon, will be President-elect Donald Trump’s nominee for secretary of health and human services (HHS). In the 63-year history of the HHS Department and its predecessor, the Department of Health, Education, and Welfare, only two previous secretaries have been physicians. Otis Bowen, President Ronald Reagan’s second HHS secretary, engineered the first major expansion of Medicare, championed comparative effectiveness research and, with Surgeon General C. Everett Koop, led the fight against HIV–AIDS.1 Louis Sullivan, HHS secretary under President George H.W. Bush, focused his attention on care for vulnerable populations, campaigned against tobacco use, led the development of federally sponsored clinical guidelines,2 and introduced President Bush’s health insurance plan, which incorporated income-related tax credits3 and a system of risk adjustment. In their work at HHS, both men, serving in Republican administrations, drew on a long tradition of physicians as advocates for the most vulnerable, defenders of public health, and enthusiastic proponents of scientific approaches to clinical care.
Tom Price represents a different tradition. Ostensibly, he emphasizes the importance of making our health care system “more responsive and affordable to meet the needs of America’s patients and those who care for them.”4 But as compared with his predecessors’ actions, 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.
Since the NEJM full article requires a subscription, here is a summary what they document:
Price has sponsored legislation that
- supports making armor-piercing bullets more accessible
- opposes regulations on cigars
- Repeals and replaces the ACA (see details below)
- Against the Affordable Care Act (ACA)
- Against regulating tobacco as a drug
- Against the Domenici–Wellstone Mental Health Parity and Addiction Equity Act
- Against funding for combating AIDS, malaria, and tuberculosis
- Against expansion of the State Children’s Health Insurance Program
- In favor of allowing hospitals to turn away Medicaid and Medicare patients seeking nonemergency care if they could not afford copayments
- Against reauthorization of the Violence Against Women Act
- Against legislation prohibiting job discrimination against lesbian, gay, bisexual, and transgender (LGBT) people
- Against enforcement of laws against anti-LGBT hate crimes.
- Against expanding the NIH budget
- Against the recently enacted 21st Century Cures Act
Price stated views:
- Favors converting Medicare to a premium-support system
- Favors changing the structure of Medicaid to a block grant program
- Favors amending the Constitution to outlaw same-sex marriage
- Opposes stem-cell research
- Inconsistent in supporting investments in biomedical science.
His proposal for repealing and replacing the ACA is H.R. 2300, the Empowering Patients First Act,5 which would
- Eliminate the ACA’s Medicaid expansion and
- Replace ACA subsidies with flat tax credits based on age, not income
- Be regressive, with larger subsidies for high than low incomes.
- Credits would pay only about one third of the premium of a low-cost plan
- Credits proposed are smaller than those proposed by President Bush in 1992, and will not be sufficient to get most people to buy health insurance
- Eliminate the guaranteed-issue and community-rating requirements in the ACA, with ineffective substitutes.
- Withdraw almost all the ACA’s federal consumer-protection regulations, including limits on insurer profits and requirements that plans cover essential health benefits.
- Allow the sale of health insurance across state lines, effectively eliminating all state regulation of health insurance plans
- Fund his plan by capping the tax exclusion for employer-sponsored health insurance at $8,000 per individual or $20,000 per family, caps that are lower than the unpopular Cadillac tax in the ACA, which Price himself has voted to repeal, and hence is unlikely to ever be approved
- Directly advance physicians’ economic interests by permitting them to bill Medicare patients for amounts above those covered by the Medicare fee schedule and allowing them to join together and negotiate with insurance carriers without violating antitrust statutes.
- Oppose strategies for value-based purchasing and guideline development,
- Oppose the use of bundled payments for lower-extremity joint replacements and
- Propose that physician specialty societies hold veto power over the release of comparative effectiveness findings.
Consider what you can do to make sure that these facts are widely known. Perhaps ask your legislators which of these views they support.