PART 2
TRUMP REPORT
DRAINING THE MEDICAL SWAMP
Although the AMA is firmly in control of the administrative policies on Capitol Hill with its lobbying efforts and in control of the governmental bureaucracy within the Health and Human Service (HHS) that controls 13 healthcare agencies in the federal government,[1] there has been push-back recently by the Trump Administration to end government regulations in healthcare to create a free enterprise environment. Imagine that—instituting the principles of a free market in healthcare.
Get government out and let markets work in health care by former Sen. Tom Coburn (R-OK):
“Put simply: the American health care system is broken. Decades of government mismanagement and over-regulation have encouraged waste, fraud, and inefficiency, which may benefit the healthcare industrial complex, but harms patients and taxpayers in the long run. To fix this, we need policies that encourage competition and transparency, allowing markets to function freely and lower costs across the board.
“Fortunately, this idea has begun to gather widespread support. A recent study by Martin Gaynor from Carnegie Mellon University and the Brookings Institution, Making Health Care Markets Work: Competition Policy For Health Care Actionable Policy Proposals For The Executive Branch, Congress, And The States, April 2017, argues that the way to really lower health care costs is to address anticompetitive regulations and practices.
“The study also argues for federal and state authorities to more actively enforce antitrust laws in the health care industry, which is one of the most important steps that can be taken towards real health care reform. Without real competition, hospital systems, like all monopolies, are free to charge high prices for a subpar product — which is, in this case, your medical care.”
Whether or not this will be accomplished is a question mark, but it does make for interesting reading since the medical-industrial complex has no interest in reform just as the NRA has no interest in gun control. With 20% of the GDP at stake, the AMA will protect its turf at all costs, and as the leading lobbyist on Capitol Hill, they have plenty of money to bribe legislators.
For example, when medical anticompetitive activity was proven in the Wilk v. AMA antitrust trial, there was no major incorporation of chiropractic into the healthcare services after the verdict found in favor of the chiropractic-plaintiffs. The medical boycott went from an overt attack to a covert subterfuge with insidious gerrymandering in every government mandated program such as Medicare, TRICARE, workers comp as well as private group health insurances such as BCBS.
Even Judge Susan Getzendanner wrote in her Opinion a fact that remains to this day, “Note: The AMA also tried to persuade insurers, especially BCBS plans, not to cover chiropractic.”
While calls to break up the high-tech monopolies such as Amazon and Facebook grow louder, there is relatively little said about breaking up the medical-industrial complex, but there are a few, such as the Executive Summary of the Gaynor Report:
“The U.S. health care system does not work as well as it could or should. Prices are high and vary in seemingly incoherent ways, yet quality of care is uneven, and the system lacks the innovation and dynamism that characterizes much of the rest of our economy. The dearth of competition in our health care markets is a key reason for this dysfunction.”
The Gaynor report is not alone in its call to increase competition. On October 12, 2017, Executive Order 13813 directed the Trump Administration to facilitate the development and operation of a health care system that provides high-quality care at affordable prices for the American people by promoting choice and competition.[2]
The Trump’s administration produced a report that was remarkable despite the lack of media attention.[3] In fact, it may have been the most disruptive treatise on healthcare since the Affordable Care Act.
The 119-page Trump Administration Report, Reforming America’s Healthcare System Through Choice and Competition, was written by Cabinet members Alex M. Azar II, Secretary U.S. Department of Health and Human Services, Steven T. Mnuchin, Secretary U.S. Department of the Treasury, and Alexander Acosta, Secretary U.S. Department of Labor.
Their summation was spot on concerning issues we chiropractors can certainly attest, such as the barriers to market competition:
“We know the United States health care system too often fails to deliver the value it should. This report identifies barriers on the federal and state levels to market competition that stifle innovation, lead to higher prices, and do not incentivize improvements in quality. It recommends policies that will foster a health care system that delivers high-quality care at affordable prices through greater choice, competition, and consumer-directed health care spending.”[4]
The Trump Report is a candid analysis of the present healthcare system that commented on the many anticompetitive barriers like those issues chiropractors have always faced from an illegal medical boycott forcing them to practice on the margins of medicine with our hands tied by nonsensical scope of practice limitations.
The Trump Report on healthcare reform highlighted many of the same solutions echoed by President Obama at his 2013 inaugural speech, such as, “Together, we discovered that a free market only thrives when there are rules to ensure competition and fair play.”[5]
This is an issue both Presidents Obama and Trump agree on — fixing our healthcare system requires re-instituting what made America’s economic strength the envy of the world — the free enterprise system built on innovation, choice and competition.
The Trump Report speaks of the lack of consumer choice, reduced competition among providers, and government policies that suppress competition:
“Reduced competition among clinicians leads to higher prices for health care services, reduces choice, and negatively impacts overall health care quality and the efficient allocation of resources. Government policies have suppressed competition by reducing the available supply of providers and restricting the range of services that they can offer.”[6]
This aptly describes the situation DCs face in most workers’ comp programs[7], Medicare[8] and TRICARE[9] when patients have little, if any, access to our brand of conservative care despite the litany of evidence-based guidelines supporting our care as the initial treatment for the majority of spine-related disorders.
The Trump Report also spoke of the resistance to reform by the entrenched medical status quo:
“While American consumers and many providers would significantly benefit from the reforms laid out in this report, there are entrenched and powerful special interest groups that reap large profits from the status quo. It will take bold leadership to confront these incumbents and implement reforms…”[10]
This summary reads as if it were written by an articulate chiropractic scholar, but alas, we don’t have such talent among our academicians.[11] Perhaps this profound analysis added to the shock made by the Trump Report considering the enormity of the medical lobby. Indeed, draining the swamp of the medical special interests will be a huge political battle, if not impossible, as nine former presidents found who attempted healthcare reform.[12]
The Trump Report summarized this situation well:
“In particular, this report aims to address these issues as crystallized in the following problem statement: Many government laws, regulations, guidance, requirements and policies, at both the federal and state level, have reduced incentives for price- and non-price competition, increased barriers to entry, promoted and allowed excessive consolidation, and resulted in healthcare markets that lack the benefits of vigorous competition. Increasing competition and innovation in the healthcare sector will reduce costs and increase quality of care—improving the lives of Americans.”[13]
The problem remains very much alive when patients do not have direct access to chiropractors due to the market dominance by the medical profession and the suppression of competition due to the misguided policy to exclude or restrain patient access to DCs as we see with insurance coverage managed by for-profit companies like ASHN whose policy is to “squeeze care to expand profits.”
We also experience this anticompetitive policy in “cost-plus” workers comp programs where “they more they pay, the more they charge in premiums, so there’s more money for everyone.” In other words, being the “cheaper mousetrap” is a bad idea in for-profit monopolistic healthcare.
Indeed, the unreasonable and illegal restraint of trade against chiropractors remains a problem for injured patients and a huge expense for taxpayers and business owners who foot the bill when patients are railroaded to expensive and ineffective medical spine care.
Again, these for-profit folks don’t follow the guidelines, they follow the money.
[1] HHS OFFICES AND AGENCIES: HHS Offices and Agencies (Often referred to as Operating Divisions [OPDIVs]) in which Commissioned Corps officers serve
- Agency for Healthcare Research and Quality
- Agency for Toxic Substances and Disease Registry
- Centers for Disease Control and Prevention
- Food and Drug Administration
- Health Resources and Services Administration
- Centers for Medicare and Medicaid Services
- Indian Health Service
- National Institutes of Health
- Office of the Assistant Secretary of Health
- Office of the Secretary
- Program Support Center
- Substance Abuse and Mental Health Services Administration
- Office of the Assistant Secretary for Preparedness and Response
[2] Reforming America’s Healthcare System Through Choice and Competition, pp. 1.
[3] For those who know my skepticism of Donald J. Trump, this is quite an admission!
[4] Trump Report, pp.4
[5] Obama: ‘It is now our generation’s task to carry on what … pioneers began’, Obama’s Inaugural Speech, Posted by CNN Political Unit , January 21st, 2013
[6] Trump Report, pp. 3
[7] Reforming Georgia’s Workers’ Compensation Program Through Choice, Competition, & Chiropractic Care
[10] Trump Report, pp. 4
[11] Some within our chiropractic leadership prefer to gaslight the concept of vitalism as our big problem instead of pushing-back on the medical monopoly and a biased media.
[12] 1. Franklin Pierce. 2. Theodore Roosevelt. 3. Franklin Roosevelt. 4. Harry Truman. 5. Lyndon Johnson. 6. Richard Nixon. 7. Jimmy Carter. 8. Bill Clinton. 9. Barack Obama. “From 1853 to 2014: How 9 presidents changed healthcare,” Ayla Ellison, Becker’s Review, September 19, 2014
[13] Trump Report, pp. 16