President-elect Donald Trump sends a strong signal he may look beyond repealing and replacing Obamacare to try to scale back Medicare and Medicaid, popular entitlements that cover roughly 130 million people, many of whom are sick, poor and vulnerable. And that’s a turnabout from Trump’s campaign pledge — still on his campaign website — that he would leave Medicare untouched.
.. His vision for health reform hinges on eliminating much of the federal government’s role in favor of a free-market framework built on privatization, state flexibility and changes to the tax code. The vast majority of the 20 million people now covered under Obamacare would have far less robust coverage — if they got anything at all.
.. “Between this nomination of an avowed Medicare opponent to serve as HHS secretary and Republicans here in Washington threatening to privatize Medicare, it’s clear that Republicans are plotting a war on seniors next year.”
.. “To put in charge of the nation’s health care system and a trillion-dollar budget someone who has never overseen anything larger than a congressional committee ought to raise eyebrows when this position has historically been reserved for an individual with significant administrative experience,” said Rep. Steny Hoyer.
.. “In general they’re trying to shift risk from the government to individuals, and particularly to low-income individuals,” said Topher Spiro, who heads health policy at the left-leaning Center for American Progress. “It’s hard to see how that’s giving them a leg up, and how that’s improving the quality of their lives.”
The Cost of “Defensive Medicine” caused by the Threat of Lawsuits
“physicians estimate[d] the cost of defensive medicine to be in the $650 to $850 billion range, or between 26 and 35 percent of annual health care costs in the U.S.”
.. The practice of defensive medicine, which squanders hundreds of billions of dollars annually, is a response to an increasingly litigious society in which one in 14 physicians faces a malpractice suit every year. This creates a strong incentive to perform additional and perhaps unnecessary tests to exhaust every potential diagnosis — no matter how improbable — to buttress a defense in court. These costs are passed on to patients or to “the system.”
Drugmakers Find Competition Doesn’t Keep a Lid on Prices
Makers of Viagra, Cialis show how rivals tend to raise prices in tandem, a reason for the surge in U.S. prescription-drug spending
Pfizer Inc. raised the list price of Viagra by 13% in June. Less than a week later, Eli Lilly & Co. pushed up the price of its competing pill Cialis by the same percentage.
.. A common six-pill prescription of Viagra or Cialis lists for around $300 today—more than double the price five years ago
.. “Not only have these pharmaceutical companies raised prices significantly—sometimes by double digits overnight—in many instances the prices have apparently increased in tandem,” the pair wrote. The FTC and Justice Department declined to comment.
Let’s Say Obamacare Is Repealed. What Then?
For years, they’ve been trying to change Medicaid funding to a block grant that they can then constrain over time. This will be enticing for them because it will allow them to reduce Medicaid spending in the future, while forcing states to make the tough decisions — and take the blame — for cuts in either beneficiaries or services.
Fixing the markets for those who are getting health insurance through the Obamacare exchanges, though, is a different story. Without some sort of market regulation, which they’ve generally been opposed to, the same problems that existed pre-A.C.A. with respect to pre-existing conditions and individual ratings will exist. Many people will become uninsured. Annual and lifetime limits could reappear. Lots of people will have problems getting insured.
.. Yes, I think Democrats would filibuster anything they could. The filibuster is not set in stone. A Senate majority can change it, and some are already calling for the G.O.P. to do so. But that doesn’t appear to be what the Senate will do — they’ll retain the filibuster. This could play to their favor, since they can propose things they like, let the Democrats filibuster them and take the blame when repeal kicks in with no replacement. Perhaps that’s another way for Republicans to get out of their political bind.