As the 2016 US Presidential Elections heat up, you may be interested in what the current frontrunners from both parties have to say to doctors. The following post is based on current healthcare policy stances as professed by the candidates themselves. While we all understand health care policy changes will happen through acts of congress rather than the office of the President, it is still fun to think about what would happen if the candidates end up carrying out their promises. Please note the WCM verdict is only rendered in view of the expected financial impact on physicians and does NOT represent an endorsement of the candidate. More after the jump.
The Iron Triangle of Health Care
Before we get started, I want to introduce "Iron Triangle of Health Care" which include three competing issues in health care - cost, access and quality. The current paradigm is that changing any of the three will lead to changes in the other 2 factors. For example, a new policy increasing access will lead to decreased quality and/or increased costs. It is important to realize that while this is still the dominant view of health care economics, it is not dogma. One simply need to look to their iPhone to see how quality and access can improve while lowering costs in a separate industry. Many experts think that health care is a sector ripe for technological disruption.
"I have always fought for affordable, quality health care for all Americans. As president, I will defend The Affordable Care Act . I will crack down on prescription drug prices and hold the drug companies accountable to the public health rather than profit. I will defend women's rights to reproductive health, including contraception and legal abortion. I will push to lower the cost of health insurance premiums and transform health care into a system that rewards value and quality rather than the number or tests and procedures performed."
WCM Translation: In order to achieve the things she promised, Hillary will have to push for universal coverage and single payer health care in order to bargain with the health insurance companies, Big Pharma and institutional health care providers. I suspect individual health care providers will have the least bargaining power of all players in such a system. Physician workload will increase and incomes will fall as a necessity in such a system. As a result, health care quality will likely be degraded. The only way quality can increase in such a system is the automation of most health care services - and if that happens, there will be fewer jobs for YOU!
VERDICT: BAD FOR DOCTORS
"As President, I will completely repeal Obamacare. I will increase access and lower cost by returning to the tried-and-true free market economic principles that made me the business success that I am today. I will repeal legislative barriers to health insurance companies competing across state lines. Increased competition will drive down premium. I will require price transparency from all health care providers, thus giving consumers the choice to shop around for the best bang-for-the-buck. I will block-grant Medicaid and return it to State control - the state government knows their people best and can manage Medicaid better without federal overhead. I will eliminate barriers to importing cheap, safe and dependable drugs, giving Americans more affordable options from overseas."
WCM Translation: Trump will push for a free market model of health care in which the costs of goods and services are dependent on supply and demand. However, one critical requirement for his plan to work is for the health care system to be a free market. Unfortunately, we all know that is far from the case. For example, let's take the only part where he addresses the health care providers involving price transparency. While this may sound like a great idea if there are a lot of competing providers in your community, in reality most communities only have 1 or 2 health care institutions that provide the majority of care for the local population - which means price transparency won't necessarily lower prices. On the other hand, if Trump gets his way, there will likely remain an overabundance of demand for health care and a shortage of providers, which spells out good fortune for YOU.
VERDICT: GOOD (LESS BAD) FOR DOCTORS
WCM Bottom LINE:
As usual, the political debate thrusts health care policy into the spotlight. Also as usual, the candidates are more than happy to launch lofty promises into the airwaves without detailing how to actually achieve them. Both front-runners talk up a big game - predicting their approach will increase access, improve quality and decrease costs simultaneously - albeit through different means. Unfortunately neither are tethered to the current reality we live in. In essence, both are blowing hot air.
What are your thoughts? Have I mischaracterized their views? Comment below!