July 12, 2024
Dear Interested Readers,
Democracy, Women’s Reproductive Rights, Healthcare, And Perhaps Joe Biden’s Age Are On the Ballot This November
I suspect that I am more focused on politics than many healthcare professionals. Maybe my focus and concern are because during the run-up to the ACA in 2009 and early 2010, I made several trips to Washington to meet directly with key members of the House and the Senate and was able to watch up close how the sausage was being made. I observed that most members of Congress were intelligent and focused on the work even though many seemed to have little or no passion for what they were doing. Few were more informed about the problems we faced in healthcare than most of the attendees at meetings of GPIN or the IHI. What they knew seemed to be a function of what their staffers told them. I felt that many were doing a job that President Obama wanted done as his top priority, but was an effort for which many of them had little or no enthusiasm.
I made several more trips to Washington after Don Berwick became the Administrator of CMS in July 2010 against the will of most Republicans who feared he was a “socialist.” President Obama’s willingness to use a recess appointment to make Don the administrator of CMS despite the resistance of the majority of Republicans was further evidence of Obama’s commitment to the battle for universal access to healthcare. The appointment rightfully drew the applause of the progressives who believed in both Don’s and Obama’s commitment to the Triple Aim.
On my first visit to see Don in his new office at the Hubert Humphrey Building, he walked me down the hall to the office of Rick Gilfillan whom he had appointed to lead CMMI, the innovation center at CMS. That introduction led to Atrius Health being one of the original thirty-two participants in the Pioneer ACO. I have witnessed how hard it is to pass meaningful new healthcare programs even when one party holds the presidency and controls both houses of Congress. I have also experienced how hard it is to translate new healthcare laws into programs that can overcome the resistance of the status quo and our deep political divide. We saw the momentum of 2010 to 2016 come to a screaming halt when President Trump took control of the presidency in 2017.
Looking back over the last ninety years of efforts to improve the experience of healthcare and the social determinants of health for all Americans one can see a back-and-forth pattern of a forward step followed by organized resistance which leads to a loss of momentum but the retention of some of the progress. Between moments of advance, there can be decades of cooptation and some decline in what has been achieved as the forces of the status quo and the “market” seek to translate their previous advantages into the new paradigm. This back-and-forth process has been the dance since Roosevelt’s “New Deal.” Not many know that FDR wanted to offer healthcare coverage as a part of the New Deal, but Dr. Harvey Cushing a neurosurgeon at the Peter Bent Brigham Hospital in Boston, who was one of the most politically powerful doctors in America and the AMA, and also the father-in-law of FDR’s son, convinced FDR to leave out healthcare. It has always seemed strange to me that the AMA which was organized against quackery in medicine has frequently worked at least as vigorously to defend the financial health of its members as it has to improve the health of the nation. I fear that a second Trump presidency will be better for the business of medicine than for the health of our most vulnerable citizens.
My fears and worries about the possibility of a second Trump presidency have been heightened in the aftermath of President Biden’s shockingly poor debate performance on June 27. As I began to write this letter on Wednesday, I heard that George Clooney, who is not as influential as Taylor Swift with younger voters, is reporting that his friend the president is not as sharp as he was in 2020 and should drop out.
Nancy Pelosi is also definitely concerned, but not willing to try to pull the rug out from under the president on her own. It is reported that House Minority Leader Hakim Jefferies will be visiting the White House today to give the president an update on the growing concerns from Democratic members of the House who fear that as Joe goes down so will all of those down the ballot from him. In other developments, it has been reported that in surveys pitting Vice President Kamala Harris against Trump, she leads 49 to 46. Despite President Biden’s disastrous debate performance, he remains in a virtual tie with Trump even after his performance on June 27, and his refusal to step aside for a younger Democrat like Vice President Harris or Governor Gretchen Whitmer of Michigan.
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Like many concerned Americans, I tuned in yesterday evening to watch President Biden’s news conference following the NATO meetings. His speech was again less forceful than it was four years ago. He had a few gaffs, but he gave a reasonable answer to most of the many questions he was asked. At one point he referred to Vice President Trump when he meant to say Vice President Harris. He was full of arguments about why he should remain a candidate for reelection. He forcefully defended his accomplishments over the past three and a half years and gave a mini-course on world affairs in response to dozens of questions from reporters from America and European NATO nations. What was not discussed was his durability over the course of the next four years although he asserted that today he was still energetic and up to long days. There were references to physical exams and tests from his neurologist, and he acknowledged an injury-related gait problem. Overall, I thought he did well and would give him a good grade. There is no doubt that Trump could not have done better because he has very limited foreign policy knowledge even after four years in office. He recently said that when he became president he was not sure of the purpose of NATO. The New York Times reported a stunning quote from a Trump rally earlier this week:
Indeed, he acknowledged that he had been largely ignorant about the organization [NATO] until he became president. But he then boasted about how he berated the allies as deadbeats.
At a rally away from the NATO summit, former President Donald J. Trump denigrated the alliance and boasted of berating allied nations as deadbeats.
“I didn’t know what the hell NATO was too much before,” Mr. Trump told cheering supporters. “But it didn’t take me long to figure it out, like about two minutes. And the first thing I figured out was they were not paying. We were paying, we were paying almost fully for NATO. And I said that’s unfair.”
There is more certainty in “Trump World.” Besides knowing that if his lips are moving there is a high likelihood that he is not telling the truth, we do know that the Republican Convention begins on Monday in Milwaukee. The Republicans published a “CliffNotes” like platform this week in advance of the convention. That represents a change since there was no published Republican Platform in 2020.
Pundits have compared the 2024 effort to present a platform to a typical Trump stump speech. There are whole sections printed in capital letters. Click here to peruse an annotated version of the platform, courtesy of CNN, and assure yourself that there are no complicated policy recommendations that you need to understand. As you might imagine, the document is heavy on the grief coming for illegal immigrants and pretty light on healthcare. CNN didn’t bother to annotate the few sentences about healthcare. Healthcare is also not included in the “Trumpesque” “all caps” list of promises and objectives.
To make clear our commitment, we offer to the American people the 2024 GOP Platform to Make America Great Again! It is a forward-looking Agenda that begins with the following twenty promises that we will accomplish very quickly when we win the White House and Republican Majorities in the House and Senate.
- SEAL THE BORDER, AND STOP THE MIGRANT INVASION
- CARRY OUT THE LARGEST DEPORTATION OPERATION IN AMERICAN HISTORY
- END INFLATION, AND MAKE AMERICA AFFORDABLE AGAIN
- MAKE AMERICA THE DOMINANT ENERGY PRODUCER IN THE WORLD, BY FAR!
- STOP OUTSOURCING, AND TURN THE UNITED STATES INTO A MANUFACTURING SUPERPOWER
- LARGE TAX CUTS FOR WORKERS, AND NO TAX ON TIPS!
- DEFEND OUR CONSTITUTION, OUR BILL OF RIGHTS, AND OUR FUNDAMENTAL FREEDOMS, INCLUDING FREEDOM OF SPEECH, FREEDOM OF RELIGION, AND THE RIGHT TO KEEP AND BEAR ARMS
- PREVENT WORLD WAR THREE, RESTORE PEACE IN EUROPE AND IN THE MIDDLE EAST, AND BUILD A GREAT IRON DOME MISSILE DEFENSE SHIELD OVER OUR ENTIRE COUNTRY — ALL MADE IN AMERICA
- END THE WEAPONIZATION OF GOVERNMENT AGAINST THE AMERICAN PEOPLE
- STOP THE MIGRANT CRIME EPIDEMIC, DEMOLISH THE FOREIGN DRUG CARTELS, CRUSH GANG VIOLENCE, AND LOCK UP VIOLENT OFFENDERS
- REBUILD OUR CITIES, INCLUDING WASHINGTON DC, MAKING THEM SAFE, CLEAN, AND BEAUTIFUL AGAIN.
- STRENGTHEN AND MODERNIZE OUR MILITARY, MAKING IT, WITHOUT QUESTION, THE STRONGEST AND MOST POWERFUL IN THE WORLD
- KEEP THE U.S. DOLLAR AS THE WORLD’S RESERVE CURRENCY
- FIGHT FOR AND PROTECT SOCIAL SECURITY AND MEDICARE WITH NO CUTS, INCLUDING NO CHANGES TO THE RETIREMENT AGE
- CANCEL THE ELECTRIC VEHICLE MANDATE AND CUT COSTLY AND BURDENSOME REGULATIONS
- CUT FEDERAL FUNDING FOR ANY SCHOOL PUSHING CRITICAL RACE THEORY, RADICAL GENDER IDEOLOGY, AND OTHER INAPPROPRIATE RACIAL, SEXUAL, OR POLITICAL CONTENT ON OUR CHILDREN
- KEEP MEN OUT OF WOMEN’S SPORTS
- DEPORT PRO-HAMAS RADICALS AND MAKE OUR COLLEGE CAMPUSES SAFE AND PATRIOTIC AGAIN
- SECURE OUR ELECTIONS, INCLUDING SAME DAY VOTING, VOTER IDENTIFICATION, PAPER BALLOTS, AND PROOF OF CITIZENSHIP
- UNITE OUR COUNTRY BY BRINGING IT TO NEW AND RECORD LEVELS OF SUCCESS
Healthcare makes a cameo appearance as the third item in “Chapter 4” of the platform which is entitled BRING BACK THE AMERICAN DREAM AND MAKE IT AFFORDABLE AGAIN FOR FAMILIES, YOUNG PEOPLE, AND EVERYONE.
- Affordable Healthcare
Healthcare and prescription drug costs are out of control. Republicans will increase Transparency, promote Choice and Competition, and expand access to new Affordable Healthcare and prescription drug options. We will protect Medicare, and ensure Seniors receive the care they need without being burdened by excessive costs.
I wasn’t surprised by the lack of attention to healthcare so I asked Chat GPT what it thought about Trump’s healthcare platform. I was surprised that Chat GPT gave the references it used to formulate its response, but the references predated the published platform. I have bolded the “bottom line.” I asked:
Please discuss the comments about healthcare in the Republican platform for the 2024 election.
ChatGPT
Searched 3 sites
The Republican platform for the 2024 election includes several key proposals aimed at reforming healthcare in the United States. These proposals emphasize reducing federal involvement, increasing market-based solutions, and promoting individual responsibility. Here are some of the primary components of their healthcare platform:
- Repeal and Replace the Affordable Care Act (ACA): The Republican platform seeks to dismantle the ACA and replace it with a system that gives more control to states and individuals. This includes eliminating the individual mandate and reducing federal subsidies for health insurance (KFF) (FierceHealthcare).
- High-Risk Pools: The platform proposes the creation of high-risk pools to provide coverage for individuals with pre-existing conditions. These pools would be funded by repackaging the funds currently used for ACA subsidies and Medicaid expansion. However, there is some concern about whether the proposed funding levels will be sufficient to make these high-risk pools viable (FierceHealthcare).
- Health Savings Accounts (HSAs): Republicans plan to expand the use and contribution limits of HSAs. They propose increasing the annual contribution limit to $9,000 for individuals and $18,000 for families. This measure is designed to encourage people to save more money for their healthcare expenses on a tax-advantaged basis (FierceHealthcare).
- Medicaid Reform: The platform includes a proposal to replace the current Medicaid expansion with block grants to states. This would allow states more flexibility in how they use federal funds but would also likely result in reduced funding compared to current levels (FierceHealthcare).
- Reducing Prescription Drug Prices: The Republican platform emphasizes the need to address the high cost of prescription drugs. Past efforts included capping monthly co-pays for insulin and exploring the importation of lower-cost drugs from other countries. However, the implementation of these policies has faced significant legal and logistical challenges (KFF).
- Abortion and Reproductive Health: The platform takes a strong stance on abortion, advocating for policies that restrict access to abortion services. This includes support for state-level regulations and opposition to federal funding for organizations that provide or refer for abortion services (KFF).
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.
It may be a while before we see the Democratic platform and know for sure who their candidate for president will be, but for balance, I still asked Chat GPT to discuss what President Biden has recently said about healthcare. Again, I have bolded “the bottom line.”
Please discuss what President Biden has said recently about healthcare
ChatGPT
Searched 5 sites
Recently, President Joe Biden has made several key statements and announcements regarding healthcare, emphasizing efforts to lower healthcare costs and improve accessibility. Here are some of the highlights:
- Medicare Drug Price Negotiation: One of Biden’s major initiatives is expanding Medicare’s ability to negotiate drug prices. This includes the introduction of a $2,000 annual cap on out-of-pocket costs for prescription drugs for Medicare beneficiaries and a $35 monthly cap on insulin. These measures are expected to significantly reduce the financial burden on seniors and other Medicare recipients (Politico) (The White House).
- Mental Health Care: Biden is also focused on expanding access to mental health care, an area that has bipartisan support. He has proposed new rules to enforce mental health parity, ensuring that mental health care is covered comparably to physical health care under insurance plans (Politico).
- Surprise Medical Billing: The administration is taking steps to combat surprise medical billing, which can occur when patients unknowingly receive care from out-of-network providers. The No Surprises Act has been implemented to protect millions of Americans from unexpected and exorbitant medical bills, and new guidance is being issued to close loopholes that some providers have exploited to continue surprise billing practices (The White House).
- Protection Against Junk Insurance Plans: Biden has announced measures to crack down on so-called “junk insurance” plans. These plans often fail to provide comprehensive coverage and leave consumers with significant out-of-pocket expenses. The proposed rules would limit the duration of short-term plans and ensure that fixed indemnity plans do not mimic comprehensive health insurance, thereby preventing consumers from being misled about the extent of their coverage (The White House).
- Addressing Medical Debt: In collaboration with the Consumer Financial Protection Bureau (CFPB), the Department of Health and Human Services (HHS), and the Treasury, the Biden administration is exploring ways to protect consumers from unfair medical debt practices. This includes scrutinizing medical credit cards and loans that often lead to higher costs without adequate consumer protection (The White House).
- Covid-19 Vaccination and Preparedness: Biden continues to emphasize the importance of vaccination and preparedness in the fight against Covid-19. With new variants emerging, the administration is ensuring that updated vaccines are available and accessible, particularly to vulnerable populations (Politico).
- Reproductive Rights and Abortion Access: Biden has also highlighted the importance of protecting reproductive rights, especially in the face of restrictive state laws. He continues to advocate for federal protections to ensure access to abortion services and reproductive healthcare (Becker’s Hospital Review).
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.
Based on its analysis, I think Chat GPT would vote for Biden.
I wish I could say that I have confidence in President Biden’s ability to defeat former President Trump. I have great affection for President Biden. He has worked hard and accomplished a lot. He has been a wonderful public servant over a very long career, and he has been a very good president for complicated times. I know from personal experience how hard it is to “hang it up,” though it is presumptuous of me to compare my responsibilities as a healthcare CEO to the awesome responsibilities of the presidency with all of its domestic and international responsibilities. I am just very concerned that a good press conference at age 81 does not predict performance at age 84 or 86.
In a New York Times report written by Nicholas Nehamas shortly after the news conference, there was continuing evidence that my concerns are shared by a growing number of House and Senate Democrats.
More Democrats may defect on Friday, now that members of Congress no longer have to worry about embarrassing the president during the NATO summit that took place in Washington this week. But other Democrats said Mr. Biden’s deft grasp of policy — and the fact that he answered questions for nearly an hour — was heartening, despite awkward moments like a flub in which he referred to Vice President Kamala Harris as “Vice President Trump.”
I feel momentum is building for President Biden to withdraw, perhaps in favor of Kamala Harris. The story isn’t over and no matter what happens between now and the Democratic Convention in August, the earliest we might know anything about the future will be on election night, November 5. We must remember that the outcomes of our elections in 2000 and 2020 were not known until days and weeks later. No matter what happens Democracy, Women’s Reproductive Rights, Healthcare, And Perhaps Joe Biden’s Age Are On the Ballot This November.
If Joe is still on the ballot in November, I will vote for him and I will be reassured that Kamala Harris could move into the presidency if he falters in office. If he is replaced, I will vote for the Democratic standard-bearer because Donald Trump would be a disaster for healthcare, democracy, women’s reproductive rights, America, and the free world. I know the outcome of the election will remain uncertain for a long time. One thing healthcare professionals know is how to live with uncertainty.
It Has Been So Hot and Humid
I have spent a lot of time trying to keep cool in the lake this week with my two older grandsons, ages 10 and 6. We don’t have air conditioning. In years past our ceiling fans have been more than enough to keep us cool on the few days the temperature was above 85. This year is different. The lake temp is now moving toward 80!
My neighbor Peter Bloch keeps turning out gorgeous videos of his underwater photography. This week he had some scenes looking up from underwater to the shore above the waterline. I have shared one of those shots with you in today’s header. Click here to see the whole video.
I hope that you will be able to stay cool.
Be well,
Gene
PS: I fear that over the last few weeks, many readers who have a G-mail email address did not get this letter. Google made some changes that blocked “Get Response’s” ability to notify you that the letter was available. I hope the problem is fixed. Please remember that even if you don’t get an email announcement the letter is always on the Internet at 3 PM on Friday. Just go to strategyhealthcare.com.
