By MATTHEW HOLT
The Democratic conference wrapped with a positive speech from Kamala Harris, star energy from the Obamas and Clintons, and a bunch of Republicans telling their ideological brethren that it was higher to be a Democrat than a Trumper. Extra importantly no Beyonce/Taylor Swift duet–as we have been promised by Mitt Romney.
There was a number of speak about some points of well being care. However total if Harris wins, don’t count on a lot change to the present well being care system.
Why not?
First there’s the pure politics. The Dems have to win again the Home (possible however not sure) and maintain the Senate to go laws. Proper now they’ve a 51-49 edge within the Senate. Almost certainly that goes to 50-50 because the Republicans will certainly choose up Joe Manchin’s seat in West Virginia. There’s a collection of seats the Dems presently maintain in shut races (Montana, Ohio, MIchigan, Nevada, Arizona) that they’ll have to hold to keep up it at 50-50, and it’s laborious to see any pickups from Republicans (maybe Florida or Texas if you happen to squint actually laborious). The excellent news is that Manchin (WV) and Sinema (AZ) will quickly each be gone, so the Dems that will likely be there received’t be as tough to steer to observe a Presidential agenda. However that can nonetheless depart Walz as VP to do what Harris did and go a bunch of deciding votes underneath reconciliation, which massively limits what the laws can do–it must be “finances associated.”
Which leads us to what we’ve been listening to from Harris and her marketing campaign about well being care? We’ve heard rather a lot about points which have impacts on well being, particularly creating reasonably priced housing and combating baby poverty, however little that’s straight associated to well being care itself. Actually solely two points stand out. Abortion and reproductive rights, and drug costs.
Clearly Harris will take a swing at reversing Dobbs and passing a nationwide proper to abortion. It will want both a packing of the Supreme Court docket (my favourite) or ending the filibuster or each. Both of those will likely be extremely robust to drag off constitutionally and politically and can take big quantities of political oxygen. After all the cynics would say, the Democrats are higher off leaving this as a difficulty to make use of to beat up the Republicans on. However if it will get completed, womens’ and reproductive rights will solely be again the place they have been in 2022.
Relating to the price of medication, there’ll proceed to be a lot justified bashing of massive pharma, however the extension of insulin worth controls is one thing that (ultimately) the market by way of CivicaRX and others is attending to anyway. In the meantime the IRA gave Medicare the precise to barter drug costs and the outcomes aren’t precisely earth shattering. For instance, CMS says it’s negotiated the price of blood thinner Eliquis from about $6,000 a 12 months to underneath $3,000 This sounds good till you notice that the worth is just that top due to patent video games the producer BMS performs within the US, and the worth in the remainder of the world is underneath $1,000. We’ll hear extra about this as the worth cuts come into impact, (though not until 2026!) and extra medication get negotiated, however total this isn’t precisely an earth-shattering change.
Lastly there’s already a assured combat about extending the premium subsidies for ACA plans. These have been first within the pandemic American Rescue Act, then prolonged within the IRA, however they presently are scheduled to finish in 2025. It’s laborious to think about them not being prolonged additional regardless of the make-up of the Senate, assuming a Democratic Home of Representatives. (A Marjorie Taylor Greene speakership does give me pause!). However once more there’s nothing new right here and the general taste of pricey premiums and excessive deductibles within the present ACA market received’t change.
So what’s not going to occur? Just about all of the attention-grabbing stuff we have been promised by Harris and for that matter Biden in 2020. You could have missed the one precise “policy-first” speech on the conference which got here from Bernie Sanders. To be honest a number of his agenda was already within the Biden laws. That was no accident as Biden intentionally reached out to him in 2020 and 2021 and enacted a reasonably radical agenda on infrastructure, local weather, industrial coverage and extra. And after I say radical I imply milquetoast social democrat by European requirements! However what wasn’t in that agenda? No Medicare for all, which Bernie ran on in 2019/20 and introduced up once more on the conference. Who else proposed that in 2019? Why, a sure Kamala Harris. That by no means made it into the Biden agenda. We didn’t even get laws launched about decreasing the Medicare age to 60, which was a marketing campaign promise. There’s been no dialog about any of this from Harris or from Biden earlier than he withdrew. It’s only a bridge too far.
Which results in the stuff that will get debated about in THCB and elsewhere as to how the system truly works. There’s been nothing about Medicaid growth (or its continued contraction). No speak about reining in hospital consolidation. No point out even of insurers gaming Medicare Benefit or non-public fairness shopping for up doctor practices. Nothing in regards to the growth of value-based care.
What we are able to count on in a Harris administration is extra of the identical from CMS and doubtlessly a barely extra aggressive FTC. That may imply continued efforts to veer barely away from fee-for-service in Medicare, a couple of extra constraints on the worst conduct in Medicare Benefit, and probably some warning pictures from the FTC about hospital monopolies. However the developments we’ve seen in recent times will largely proceed. We’re not getting a primary-care primarily based capitated system rising from the wreckage of what we’ve now, and in contrast to the Clinton and even Obama administrations, there’s not even any rhetoric from Harris or Biden about how that may be a good suggestion.
So politically I don’t suppose the Harris administration will likely be very thrilling for well being care. And if the opposite man wins, as Jeff Goldsmith wrote on THCB final month, count on even much less.
