Tom Price, President Trump’s new Secretary of Health and Human Services (HHS) strode to the podium to the sound of applause. The two thousand medical administrators and physicians at the annual meeting of CAPG, a trade organization representing physician groups, heard him described as the most influential person affecting the 300+ participating groups that provide care for millions. Only the third physician to lead HHS, many hoped that the orthopedist and six term GOP congressman would bring new sophistication to the federal government’s healthcare programs.
The perfectly coiffed Secretary looked every bit the new man in charge of healthcare. Sadly, his resonant voice soon dashed any hope for substance. He might have commented on the essential U.S. healthcare quandary: A country with average household income of $56,000 can’t afford the $15,000 annual cost of health insurance for a family of four. Neither Republicans nor Democrats can conjure up inexpensive insurance that covers unaffordable healthcare services. What does the Secretary think? He sidestepped the issue, twice patting his audience on the back by touting the American health system as “the finest in the world.” Seriously? If Price had attended the morning session he would have heard that the U.S. spends about 6% more of its GDP on healthcare than average developed country. That extra $1.2 trillion amounts to more than twice the defense budget. Yet U.S. health outcomes for crucial measures like infant mortality and lifespan rank average or even worse. Yes, U.S. medical technology leads the world and foreign dignitaries still travel here for world class, high tech care. But shouldn’t the secretary of HHS understand that the measure of a healthcare system is the quality and accessibility of care provided to average citizens?
Perhaps more surprisingly, Price failed even to comment on the GOP-sized elephant in the room: The proposed House and Senate healthcare measures, supported by the administration, then awaiting action. The non-partisan Congressional Budget Office estimated that the measures would cause millions to lose coverage. Price’s Hippocratic Oath had no sunset provision. If allowing millions to face loss of their coverage under the Affordable Care Act (ACA) would somehow “do no harm” why not explain the thinking to those on the front line?
Despite Price’s silence, the now fading proposals reveal a strategy of shifting national healthcare priorities toward an individualist rather than a collective approach. This shift can be seen most readily in the GOP opposition to the standard benefit package, an ACA provision that requires insurance to cover specific services. Advocates for repeal note that eliminating standard benefit would reduce the cost of plans. Although true, the savings occur only because enrollees play “benefit roulette,” hoping that that the omitted services don’t turn out to be needed in the future. And if they do? Dr. Price and the GOP would just leave that problem to the individual selecting the plan.
Similarly, the proposed rollback of the mandate to purchase insurance allows individuals to opt out of the system entirely. GOP proponents promote the change as enhancing individual liberty. They ignore the fact that when uninsured individuals get sick and arrive at emergency rooms, they no longer opt out. The costs of their care get covered by those paying into the system. Those opting out become “free riders,” enjoying catastrophic coverage paid for by others. Price and other advocates of repeal seem unconcerned about balancing individual liberty versus personal responsibility and social consciousness. They also fail to appreciate that insurance—the pooling of community resources to cover risk—is inherently collective and rewards individuals with financial and healthcare security in return for the their support of others. Secretary Price should stop promoting the illusory benefits of healthcare libertarianism and advocate instead for the health security of all the American people.
The Secretary’s CAPG photo-op resembled a prince’s foray to a rebellious provincial outpost. He did not brook questions from the assembled nor deign to meet the organization’s board. He granted permission for four questions that were submitted and approved in advance. The attendees might have been reminded of the Bourbon monarchs, who on their restoration to the throne of France to were said to “have forgotten nothing and learned nothing.” The Republicans in Washington have certainly not forgotten their years of opposition to the ACA. Their willingness and capacity to adapt and to learn more about U.S. healthcare needs in the post-ACA era remains uncertain. Secretary Price’s recent visit to CAPG provided little cause for optimism.