Healthcare Musings For August 30, 2024

August 30, 2024

Dear Interested Readers,

 

Standing On A Solid Platform 

 

Back on July 12, when Democrats were still in disarray, I tried to write about the healthcare platforms of both parties. To my surprise, perhaps because the Democratic Convention was still more than a month away, there was no official Democratic platform to be found online. Most of the July 12 letter was about the Republican platform which was online because they were just three days from their convention which was held in Milwaukee July 15-18. If you read or reread the letter you will see that I asked ChatGPT to summarize the Republican healthcare platform and then predict what the Democratic platform would say about healthcare based on President Biden’s speeches. ChatGPT’s conclusion about the Democratic position was:

 

Overall, President Biden’s recent statements and policy actions reflect a comprehensive approach to tackling some of the most pressing issues in healthcare, with a strong focus on affordability, accessibility, and consumer protection.

 

For balance, I should give ChatGPT’s conclusion about the Republican platform which was a little more gracious than my analysis had been. ChatGPT said of the Republican platform.

 

These proposals reflect a broader philosophy of reducing federal oversight and increasing the role of states and the private sector in managing healthcare. The platform aims to create a more market-driven healthcare system that emphasizes individual choice and responsibility while attempting to lower costs through competition and innovation.

 

My bias is that since the private sector has miserably failed over decades to move us closer to the Triple Aim, why would we expect that would happen during a second Trump presidency?

 

The Democrats have now published their platform, and unlike the Republican platform which said precious little about healthcare the section on healthcare in the Democratic platform is over 4000 words long and is strikingly similar to what ChatGPT predicted. 

 

Former President Trump has disavowed any relationship to Project 2025.  His denial of Project 2025 may well be another of his thousands of misrepresentations of the truth. I discussed Project 2025 in the letter of July 19. Since Project 2025 may be a foundational document for Trump’s second administration, I have now asked ChatGPT to summarize the healthcare-related proposals in Project 2025. ChatGPT’s answer was:

 

Project 2025 is a comprehensive policy agenda developed by the Heritage Foundation and other conservative groups aiming to shape the direction of the U.S. government in 2025, particularly if a Republican president is elected. The healthcare proposals in Project 2025 focus on several key areas:

• Dismantling the Affordable Care Act (ACA): The plan advocates for the repeal of the ACA, also known as Obamacare. It proposes rolling back regulations and policies implemented under the ACA, emphasizing the reduction of government involvement in healthcare.

• Market-Driven Healthcare: The agenda pushes for a healthcare system driven by free-market principles. It suggests that competition among private insurers and healthcare providers will lead to lower costs and better quality of care. The plan promotes the use of Health Savings Accounts (HSAs) and other consumer-driven healthcare options.

• Medicare and Medicaid Reform: The project proposes significant changes to Medicare and Medicaid, including shifting Medicare to a premium support model where beneficiaries receive a fixed amount of money to purchase insurance, either from traditional Medicare or private plans. Medicaid would be block-granted to states, giving them more flexibility in how they manage the program but with less federal funding over time.

• Reducing Government Regulations: The plan seeks to reduce federal regulations on healthcare providers and insurers, arguing that these regulations drive up costs and stifle innovation. This includes rolling back mandates on insurance coverage and reducing the power of federal agencies like the Department of Health and Human Services (HHS).

• Focus on Innovation and Technology: Project 2025 supports fostering innovation in healthcare, particularly through the use of technology and personalized medicine. The agenda highlights the need to modernize healthcare delivery and leverage new technologies to improve patient care and reduce costs.

• Addressing Public Health and Pandemic Preparedness: The project also touches on public health issues, including pandemic preparedness. It advocates for a more decentralized approach, with states and private entities playing a larger role in managing public health emergencies.

Overall, the healthcare proposals in Project 2025 are aligned with conservative principles, emphasizing reduced government intervention, increased market competition, and greater state control over healthcare programs.

 

If you look at the comments ChatGPT made back in July about the Republican platform positions on healthcare and the healthcare position in Project 2025, you will discover that they are strikingly similar. For completeness and as a step toward ChatGPT’s comparison of the Republican and Democratic healthcare platforms, I asked ChatGPT to summarize the Democratic platform on healthcare. The answer I got was an incomplete summary of the 4000 words in the Healthcare Section of the platform. ChatGPT said:

 

The healthcare section of the 2024 Democratic platform emphasizes the belief that healthcare is a right, not a privilege. The platform builds on the successes of the Affordable Care Act (ACA) and commits to further expanding access to affordable healthcare. Key points include:

• Protecting and Expanding the ACA: Democrats are committed to safeguarding the ACA, ensuring it remains intact against Republican efforts to repeal it. The platform highlights the success in reducing the uninsured rate and expanding premium tax credits, which have made insurance more affordable for millions of Americans.

• Medicaid Expansion: The platform strongly supports expanding Medicaid, particularly in states that have resisted doing so. Democrats aim to provide coverage to the remaining uninsured low-income adults and simplify processes for children’s health coverage under Medicaid.

• Reducing Healthcare Costs: The party plans to continue efforts to lower the cost of prescription drugs by negotiating prices for essential medications. Additionally, they propose expanding protections against surprise medical billing and cracking down on low-quality health insurance plans.

• Strengthening the Healthcare Workforce: To address shortages in healthcare providers, especially in rural and underserved areas, Democrats plan to invest in training programs for primary care practitioners, nurses, and mental health specialists.

• Combatting Discrimination and Expanding Access: The platform also emphasizes cracking down on discrimination in healthcare and expanding investments in community and rural health centers to ensure quality care is accessible to all Americans.

These proposals reflect the party’s broader goal of making healthcare more affordable, accessible, and equitable across the United States.

 

That summary left out a lot of the points in the Democratic platform. It didn’t mention reproductive rights, advocacy for a “public option,” or expanding mental health and substance abuse treatment options. For completeness, I have compiled a list of the subject headings in the healthcare  section of the Democratic platform which is entitled “ACHIEVING UNIVERSAL, AFFORDABLE, QUALITY HEALTH CARE.”

 

• Securing Universal Health Care Through a Public Option

• Bringing Down Drug Prices and Taking on the Pharmaceutical Industry

• Reducing Health Care Costs and Improving Health Care Quality

• Expanding Access to Mental Health and Substance Use Treatment

• Expanding Long-Term Care Services and Supports

• Eliminate Racial, Gender, and Geographic Health Inequities

• Protecting Native American Health

• Securing Reproductive Health, Rights, and Justice

• Protecting and Promoting Maternal Health

• Protecting LGBTQ+ Health

• Strengthening and Supporting the Health Care Workforce
• Investing in Health Science and Research

 

Despite the fact that I thought the ChatGPT review of the Democratic healthcare platform was too brief and failed to mention many of the positive initiatives proposed in the Democratic platform, I decided to ask ChatGPT another question. Could it contrast and compare the healthcare proposals in the official Republican Platform, the Project 2025 proposal, and the official Democratic platform? Once again ChatGPT did a partial job of answering the question. Most notable again was its failure to include reproductive rights. Its comparison was limited primarily to coverage and cost. 

 

The healthcare proposals in the official Republican platform, Project 2025, and the official Democratic platform represent distinct visions for the future of American healthcare, reflecting their respective ideological underpinnings. Here’s a comparative overview:

1. Approach to the Affordable Care Act (ACA):

• Republican Platform: The official Republican platform consistently advocates for the repeal of the ACA, arguing that it represents government overreach and leads to increased healthcare costs. Republicans prefer a market-driven healthcare system with minimal government interference.

• Project 2025: Similar to the Republican platform, Project 2025 emphasizes dismantling the ACA. It aims to reduce government involvement in healthcare, promote free-market solutions, and encourage competition among private insurers to drive down costs.

• Democratic Platform: Democrats firmly support the ACA and seek to expand it. The Democratic platform emphasizes the success of the ACA in reducing the uninsured rate and proposes making healthcare more affordable by expanding premium tax credits and Medicaid.

2. Medicaid and Medicare:

• Republican Platform: Republicans advocate for reforming Medicaid and Medicare to reduce federal spending. This includes proposals for block-granting Medicaid to states and introducing a premium support model for Medicare, which would shift more responsibility to states and individuals.

• Project 2025: Project 2025 echoes the Republican platform’s approach, supporting block grants for Medicaid and restructuring Medicare to reduce federal involvement and spending.

• Democratic Platform: Democrats oppose cuts to Medicaid and Medicare, instead proposing to expand Medicaid in more states and enhance Medicare benefits. They advocate for using government power to negotiate drug prices within Medicare to reduce costs for seniors.

3. Healthcare Costs and Access:

• Republican Platform: The Republican platform focuses on reducing healthcare costs through deregulation, increasing competition, and promoting Health Savings Accounts (HSAs) to give individuals more control over their healthcare spending.

• Project 2025: The Project 2025 agenda also prioritizes cost reduction through market-driven strategies. It emphasizes reducing regulatory burdens on healthcare providers and insurers to foster innovation and competition.

• Democratic Platform: Democrats prioritize making healthcare more affordable through government intervention, such as negotiating drug prices and expanding subsidies for health insurance. They focus on expanding access to care, particularly for low-income and underserved communities, through investments in public health infrastructure.

4. Regulation and Government Role:

• Republican Platform: Republicans advocate for reducing federal regulations, arguing that they stifle innovation and increase costs. They support allowing states more control over healthcare policy.

• Project 2025: Project 2025 takes this a step further by proposing to significantly roll back federal regulations and reduce the role of federal agencies like the Department of Health and Human Services in healthcare oversight.

• Democratic Platform: Democrats believe in a robust role for the federal government in regulating the healthcare industry to ensure equity and fairness. They propose expanding government oversight to protect consumers from surprise billing and discriminatory practices by healthcare providers.

5. Public Health and Innovation:

• Republican Platform: The Republican platform emphasizes individual responsibility and private sector innovation as key to improving public health. There is less focus on centralized pandemic preparedness and more on state-level responses.

• Project 2025: Project 2025 advocates for a decentralized approach to public health, encouraging state and private sector leadership in managing health crises and fostering innovation in healthcare delivery.

• Democratic Platform: Democrats emphasize the importance of a coordinated federal response to public health challenges, including pandemic preparedness. They support significant investments in public health infrastructure and the healthcare workforce to improve overall healthcare delivery and outcomes.

Summary:

• Republican and Project 2025: Both push for reduced government involvement in healthcare, emphasizing free-market principles, deregulation, and individual responsibility. Project 2025 aligns closely with the Republican platform but is more detailed in its proposals for dismantling federal healthcare regulations and restructuring entitlement programs.

• Democratic Platform: Contrasts sharply by advocating for an expanded role of government in healthcare to ensure that it is accessible, affordable, and equitable for all Americans. Democrats emphasize the success of the ACA and propose further expansion to protect vulnerable populations.

These differences illustrate the broader ideological divide between the parties, with Republicans and Project 2025 focusing on market-driven solutions and reduced federal involvement, while Democrats advocate for a stronger government role in ensuring healthcare access and affordability.

 

I decided to be direct and ask ChatGPT why it had not contrasted the Democratic, Republican, and Project 2025 positions on the critical issue of reproductive rights. I asked:

 

Why did you not contrast the Democratic, Republican, and Project 2025 positions on the critical issue of reproductive rights when comparing their healthcare proposals?

 

ChatGPT’s answer was surprisingly direct:

 

I focused on the broader healthcare proposals and did not initially include reproductive rights because the discussion was centered on general healthcare policies like the ACA, Medicaid, and Medicare. However, reproductive rights are indeed a critical aspect of healthcare policy and are deeply intertwined with the broader healthcare agendas of both parties and Project 2025. Here’s a comparison of their positions on reproductive rights within the context of healthcare:

1. Democratic Platform:

• Reproductive Rights: The Democratic platform strongly supports the right to abortion and access to reproductive healthcare. Democrats aim to protect and expand access to abortion services, particularly in light of the Supreme Court’s decision to overturn Roe v. Wade. They advocate for codifying the protections of Roe v. Wade into federal law and oppose state laws that restrict access to abortion and other reproductive services.

• Healthcare Integration: Democrats view reproductive rights as a fundamental aspect of healthcare, arguing that access to abortion, contraception, and comprehensive reproductive health services is essential to women’s health and autonomy.

2. Republican Platform:

• Reproductive Rights: The Republican platform generally opposes abortion and supports the rights of states to regulate or restrict abortion. The party advocates for policies that protect the unborn, including supporting legislation that bans abortion after a certain point in pregnancy and opposing federal funding for organizations that provide or promote abortion.

• Healthcare Integration: For Republicans, reproductive healthcare is more focused on protecting the rights of the unborn, and there is a strong emphasis on defunding organizations like Planned Parenthood that provide abortion services. The platform also supports conscience protections for healthcare providers who oppose abortion on religious or moral grounds.

3. Project 2025:

• Reproductive Rights: Project 2025 aligns closely with the broader Republican platform. It emphasizes dismantling federal protections for abortion rights and returning control to the states. The project supports policies that would restrict access to abortion and limit federal involvement in reproductive healthcare, including cutting federal funding for reproductive health services that include abortion.

• Healthcare Integration: Like the Republican platform, Project 2025 integrates reproductive rights into a broader agenda of reducing federal influence in healthcare. It advocates for policies that prioritize the rights of the unborn and restrict access to abortion, reflecting a conservative approach to reproductive healthcare.

Summary:

• Democratic Platform: Strongly supports abortion rights and seeks to integrate comprehensive reproductive healthcare into the broader healthcare system, viewing access to such services as essential to women’s health and rights.

• Republican Platform: Opposes abortion, supports state-level restrictions, and advocates for policies that protect the unborn, with a focus on reducing federal support for abortion services.

• Project 2025: Mirrors the Republican platform in opposing abortion and promoting state control over reproductive healthcare, with an emphasis on restricting federal funding for services that include abortion.

This comparison shows the sharp contrast between the Democratic platform, which seeks to expand reproductive rights, and the Republican and Project 2025 proposals, which focus on restricting access to abortion and reducing federal involvement in reproductive healthcare.

 

In answering my request to compare the healthcare platforms of Democrats and Republicans and the recommendations of Project 2025, ChatGPT never mentioned any policy proposals that were directed at t he Social Determinants of Health. I wanted to give the machine one more chance so I asked it what the Democratic platform for 2024 says about the Social Determinants of Health. The answer demonstrated ChatGPT’s understanding of the question.

 

The 2024 Democratic platform emphasizes the importance of addressing the Social Determinants of Health (SDOH) as a critical part of improving overall health outcomes and reducing health disparities across the United States. Here’s how the platform addresses SDOH:

1. Focus on Equity:

• Health Equity: The platform highlights that achieving health equity requires addressing the social, economic, and environmental factors that influence health outcomes. This includes tackling issues like poverty, education, housing, and access to nutritious food, which are key determinants of health.

• Systemic Inequities: Democrats emphasize the need to dismantle systemic inequities that disproportionately affect marginalized communities, particularly people of color, low-income individuals, and rural populations. This includes ensuring equitable access to healthcare and social services that can mitigate the negative impacts of SDOH.

2. Addressing Social Determinants:

• Investments in Communities: The platform proposes significant investments in communities to address the root causes of health disparities. This includes increasing access to affordable housing, expanding educational opportunities, and improving transportation and infrastructure in underserved areas.

• Cross-Sector Collaboration: Democrats advocate for a cross-sector approach to health, where healthcare providers, public health officials, and community organizations work together to address the broader social determinants that impact health. This approach includes partnerships to improve access to healthy food, safe environments, and economic opportunities.

3. Integration with Healthcare Policy:

• Community Health: The platform supports expanding community health initiatives, including funding for community health centers that provide comprehensive care addressing both medical and social needs.

• Public Health Infrastructure: Democrats emphasize strengthening public health infrastructure to better address SDOH, particularly in response to public health crises like the COVID-19 pandemic. This includes improving data collection on health disparities and investing in public health programs that target the social determinants of health.

Summary:

The Democratic platform for 2024 recognizes the critical role that social determinants play in shaping health outcomes. By advocating for policies that address economic, social, and environmental factors, the platform aims to create a more equitable healthcare system that serves all Americans, particularly those in marginalized and underserved communities. The emphasis is on a holistic approach to health that goes beyond medical care to include the social conditions that impact well-being.

These policies reflect the party’s broader commitment to reducing health disparities and improving health equity through systemic change and comprehensive community investments.

 

Since the machine clearly understands the Social Determinants of Health, I wonder why it had not included this information in its earlier answers to my questions. My guess is that ChatGPT is like a lot of Americans. When asked about healthcare in general it responds only with the nuts and bolts of coverage and the differences in philosophy. Democrats want the government to be an active player and consider healthcare to be a virtual entitlement. Republican proposals suggest that they want healthcare to be managed like any other market, and an individual’s experience is a function of market forces.  

 

For completeness, I asked ChatGPT to report what the Republican Platform for 2024 and Project 2025 had to say about the Social Determinants of eHalth. The answer:

 

The concepts of Social Determinants of Health (SDOH) are approached differently in the Republican Platform for 2024 and Project 2025 compared to the Democratic platform. Here’s a summary of how each addresses or does not address SDOH:

Republican Platform for 2024:

• Limited Focus on SDOH: The Republican platform generally does not emphasize the Social Determinants of Health in the same way the Democratic platform does. The Republican approach to healthcare is primarily centered around market-driven solutions, individual responsibility, and reducing government intervention. While the platform acknowledges issues like poverty and education, it tends to focus more on economic growth, job creation, and personal responsibility as the means to improve overall well-being, rather than directly addressing social determinants as a specific healthcare strategy.

• Healthcare Perspective: The platform’s healthcare proposals are more focused on reducing costs, increasing choice through private markets, and dismantling the Affordable Care Act. Addressing SDOH is not a central theme, as the emphasis is more on individual empowerment and less on systemic social and economic factors that impact health.

Project 2025:

• Minimal Reference to SDOH: Similar to the broader Republican platform, Project 2025 does not place a significant emphasis on the Social Determinants of Health. The project focuses on rolling back federal regulations, promoting free-market healthcare solutions, and reducing the role of the federal government in healthcare. While it advocates for innovation and improving efficiency within the healthcare system, it does not directly address social determinants like housing, education, or economic inequality as key components of health policy.

• Approach to Health and Well-Being: Project 2025’s approach to health and well-being is largely shaped by conservative principles that prioritize individual responsibility and state-level control over social and healthcare programs. The focus is on reducing government intervention and promoting policies that are believed to foster personal and economic freedom, rather than on addressing the broader social factors that contribute to health disparities.

Summary:

• Democratic Platform: Explicitly focuses on addressing SDOH as central to improving health equity and outcomes, advocating for systemic changes and investments in communities.

• Republican Platform and Project 2025: Generally do not emphasize SDOH, focusing instead on market-based solutions, individual responsibility, and reducing federal involvement in healthcare.

This divergence reflects the broader ideological differences between the parties, with Democrats advocating for a more holistic approach to health that includes social factors, and Republicans focusing more on market-driven healthcare and personal responsibility.

 

Over the next two months, we will see just how much the candidates chose to discuss their healthcare policies. My guess is that unless they are questioned, perhaps in the debates, we won’t hear much about healthcare. I would also guess that since most voters don’t connect the issues that we refer to as the Social Determinants of Health to healthcare per se, the politicians will keep it simple and stick to discussing subjects like the cost of drugs and the future of Medicare and Medicaid. If Donald Trump is elected, I expect that he won’t spend much time developing policies that will improve the Social Determinants of Health. On the other hand, I have great confidence, assuming that Democrats have control of both Congress and the Presidency, that we will see many programs directed at improving the health of the nation with a focus on policies and programs that will improve the Social Determinants of Health. 

 

Healthcare policy is an important election issue. Yes, democracy is on the ballot, but so is the health of the nation. The differences in the approaches to healthcare policy mirror the deep political divide in the country. No matter who wins progress toward the Triple Aim and a healthier nation is not guaranteed. That said, I have no doubt that if the Trump/Vance ticket prevails we will see no progress or even backsliding away from the effort to improve the health of the nation. A Harris/Walz victory allows us to maintain previous gains and have a chance for progress toward more equitable and effective healthcare.

 

Sailing While I Can

 

It’s been a while since 1979 when Christopher Cross came out with his big hit “Sailing.” It hit number one on the charts on August 30, 1980. Do you remember the tune and its words? The song is pure poetry. Click here to hear it. Often, when I am out on the lake in my sailboat, the melody and some of the words drift through my mind. 

 

Well, it’s not far down to paradise

At least it’s not for me

And if the wind is right you can sail away

And find tranquility

Oh, the canvas can do miracles

Just you wait and see, believe me

It’s not far to never never land

No reason to pretend

And if the wind is right you can find the joy

Of innocence again

Oh, the canvas can do miracles

Just you wait and see, believe me

Sailing

Takes me away to where I’ve always heard it could be

Just a dream and the wind to carry me

Soon I will be free

Fantasy

It gets the best of me

When I’m sailing

All caught up in the reverie

Every word is a symphony

Won’t you believe me?

Sailing

Takes me away to where I’ve always heard it could be

Just a dream and the wind to carry me

And soon I will be free

Well, it’s not far back to sanity

At least it’s not for me

And if the wind is right you can sail away

And find serenity

Oh, the canvas can do miracles

Just you wait and see, really, believe me

Sailing

Takes me away to where I’ve always heard it could be

Just a dream and the wind to carry me

And soon I will be free

 

This is the last week of “psychological” summer even though the autumnal equinox is still three weeks away. It has not been a great summer for sailing. Some days there is no wind. On other days there is too much wind. Some days it has been raining, but this last Monday was perfect. My biggest problem has been that most of the time I sail by myself. I need sailing buddies because I am stressed managing the jib and the mainsail by myself.

 

The header on today’s letter was taken on Monday which may have been the best sailing day for me of the summer. It doesn’t show much. You can see the shoreline, the beautiful sky, and a little bit of my new bright yellow mainsail. I was too busy trying to manage the process of sailing to get a better picture. I have high hopes for good sailing weather in September.

 

I hope that you have a terrific Labor Day weekend!

Be well,

Gene