It has been more than a year since Donald Trump ascended to the presidency, promising the very best of everything. I was among a small minority in healthcare that cheered the arrival of a different administration because it brought with it the hope of a new direction. Suffice it to say, my problems with the direction the prior administration took were legion.
Without re-litigating the myriad issues that arose in the last eight years, most can comfortably agree that at the end of the era of enlightened planning from the center, healthcare is more expensive, more regulated, and more inefficient.
It is the fashion of late to not just disagree with Trump, his cabinet, and his policies, but to find them all immoral people who hate (in no particular order): children, poor people, women, and any persons of color. I find it striking that most of these characters were relative unknowns toiling away in their former lives who garnered no special attention prior to joining the Trump team, and finally being outed as Voldemort-worshiping death eaters.
The members of the #RESISTANCE need not, therefore, have to worry their heads about actual policy positions, but I will attempt to summarize the stance of these apostles of Satan.
Tom Price: C
Tom Price, MD, a former orthopedic surgeon, was brought in as head of the Department of Health and Human Services. The move was applauded by most rank-and-file physicians because he spoke the language of physicians suffering under the weight of the prior administration’s good intentions.
In his Senate confirmation hearing, Price bemoaned the rules and regulations related to Meaningful Use that had pushed physicians into retirement, but did nothing to increase value to patients. He signaled a lighter touch may be on the horizon when it came to EHRs by noting that the role of the federal government was to ensure interoperability rather than micromanaging the collection of useless data points from data entry clerks formerly known as doctors.
Unfortunately, the former congressman was gone before he could effect any change, felled by the stellar journalists at Politico who uncovered evidence of travel via a charter plane for personal matters.
I must profess to being incredibly annoyed at the development. The penalty seemed entirely too great given how hopeful I was at having a physician voice speaking to physician concerns at the head of the policy making table. Regardless, the reign of Price was an ineffectual one.
Seema Verma: B-
Appointing Seema Verma to head the Centers for Medicare and Medicaid Services was another move applauded by many in the trenches. Little known to most, she had garnered attention in Indiana with an innovative approach to the state’s Medicaid program. She seemed to understand that poor access in Medicaid patients was driven in large part by inordinately poor reimbursement for a population that can be very complex to manage.
A key component to Indiana Medicaid was using tobacco tax dollars to raise Medicaid reimbursement rates to at least equal Medicare rates—a move that made her popular among physicians whose charge it was to take care of these patients.
Unfortunately, it is the charge of the director of CMS to administer, rather than make, laws. There has been little of substance to report from Verma other than some nice words about putting patients before paperwork. She has also been remarkably ineffective in making a case for what she believes in publicly.
Those of us who believe that solutions in healthcare lie with physician-patient partnerships that make a wide berth around third-party payers, need an effective and vocal salesperson. While there are glimmers of what could be as a recent fiery address at the HIMSS conference attests to, Verma has unfortunately mostly relegated herself to staid positions that inch the ball forward.
Evidence of this can be seen in her approach to the framework of value-based care that is mostly indistinguishable from its predecessors. There are some more exclusions for low-volume providers, but the meaningless system that transfers healthcare dollars from those unable to comply with regulations to those that can comply remains largely in place. It is still early, but a lack of bold action has marked the Verma reign so far.