My take on "Trumpcare"​

Our friends at MedPage Today published an excellent interview about the GOP health reform bill known as the American Health Care Act (AHCA, not Trumpcare or Obamacare Lite, the Administration implores)  with Donald Berwick, MD, a former high ranking healthcare official in the Obama Administration.

The preponderance of physician anti-ACA commentary on the post may not reflect the view of the medical profession as a whole.  The AMA and several specialty societies SUPPORT Obamacare. 

Berwick defends Obamacare with intelligent compassion. Good intentions don't redeem bad policy and ACA was, like all legislation and legislators, imperfect, perhaps by design to create the good crisis prerequisite to the single payer destination of all Democratic health reform roads. Nonetheless, reasonable physicians should agree the serious status quo problems must be solved for favor enhanced value sparing them from financial suicide.

Berwick's Reaganesquely asserts there must be a pony in there somewhere. He should bring the hoofbeats he hears to POTUS’s attention. AHCA won’t repeal ACA due to lack of votes. Trump is no ideologue (despite common misperception). He’s a pragmatic deal maker who wants to resolve healthcare at maximum warp for minimal political capital to pivot quickly to his economic agenda. Many of the benefits Berwick cites align with Trump's business sense that prices are too high and value is too low in healthcare. Should he convince The Donald, he might find executive orders being issued to enforce the "good" parts of the legs and regs in question.

Seasoned healthcare reform observers know politicians prize their political health above all, and their most vital of vital signs are their poll numbers. Thus, these two press reports are tea leaves to be read most closely.

  • Speaker Ryan informed his caucus that the impending AHCA vote is a binary event, their one and only shot to repeal ACA, or not;

  • President Trump signaled interest in amending the bill to include filibuster bait, a tell that he may want nothing more than to dodge responsibility for rebuilding the Obamacare plane inflight while shifting blame for its unlikely maintained altitude to the obstructionist opposition.  

Will the status quo prevail, or be repealed and replaced? Stay tuned. But in the end, the Federal government might do better by leading, not micromanaging, working with the pantheon of power centers in the medical matrix to persuade healthcare to embrace reforms proven to achieve sound objectives as allies, rather than fighting them as bitter enemies.