Ever since his election, the mainstream media has speculated about President-Elect Donald Trump’s “replace and repeal” plan for the Affordable Care Act. Like witch doctors trying to predict the future from rolling dried animal bones, the mainstream media has gone back and parsed his every utterance to date to try to predict what his plan might look like.
Sadly, some left-wing groups have made exaggerated claims as to the damage that repealing the plan would bring. Their inflammatory and unsubstantiated rhetoric can only be categorized as fear-mongering — and sometimes the only way to confront such fear tactics is with facts.
Lie #1 – 'Repealing the ACA would cause about 20 million people to lose coverage'
Wrong. Despite the talking heads' constant repetition of this, it simply isn't true.
The Heritage Foundation recently went directly to the sources for enrollment data — Medicaid and private insurers — to see what's really happened. The Obama administration has inflated the Obamacare coverage number by almost 42 percent. The actual gain in coverage between 2013 and 2015 was 14 million, Heritage found. That's consistent with the Census Bureau's estimate that the number of uninsured declined by 12.8 million between those years.
Only 2.2 million gained "private" coverage; the other 11.8 million went on Medicaid. And the 2016 enrollment data was basically unchanged from 2015.
For all the premium cost increases and disruptions in insurance markets nationwide, let alone the trillion dollars spent, the number of privately insured people increased only by 1 percent. The nearly 12 million added to Medicaid is hardly a consolation. Why? Medicaid is riddled with fraud and pays doctors so poorly that most either won't participate or won't accept new patients. Having Medicaid amounts to having catastrophic coverage paid for by the taxpayer — little more — and at quite a high price. That said, even if the ACA is repealed, those who gained Medicaid coverage aren't going to lose it. The Republican Congress and President-Elect Trump have made that clear.
Lie #2 — 'Repealing the ACA could be a nightmare for mental health care'
More click bait. A recent Huffington Post article implies just this — suggesting that 4 million Americans might lose mental health coverage they had recently acquired due to the ACA. The drop in the uninsured rate of those with serious mental illness occurred among the patients in the Medicaid expansion. Again, this fact is not something likely to change. And the ACA did not solve the difficulty that these patients have in finding providers or obtaining medications.
Lie #3 — 'Cutting drug prices will lower the quality of American health care'
Trump's presidential transition website initially omitted any mention of pharmaceutical price-cutting measures, such as re-importation.
Trump has since suggested that "drug companies are getting away with murder" and that he will vigorously address pricing. The response from much of the mainstream media and think tanks is that any price "controls" will "kill innovation" and "the government shouldn't pick winners or losers." I actually heard this on a Fox Business segment hosted by a libertarian.
Capitalism only works when it actually exists. When it comes to drug pricing in the U.S., monopolists are holding us hostage.
What does the real world tell us? If you look at cosmetic or Lasik surgery — both of which are not covered by most health insurance plans — you see lower cost and higher quality over the last 10 to 15 years. Isn't that what we want to see?
As a cardiologist, I often order cardiac calcium scoring CT scans. These scans can reveal early coronary artery plaque and may be helpful in deciding when and if to initiate cholesterol-lowering drugs. The cost has dropped from $400 to $99 in the last five years and here is why: It has never been covered by insurance, but that price drop and the potential of avoiding unnecessary medications means that almost every patient gets the test when I order it.
True free markets do work in health care. But drug prices are artificially inflated in the U.S. — there is no reason drugs here cost four to 10 times more than in Canada. Does anyone believe Canadians are less rigorous in their assessment of drug safety? No. It is pharma lobbyists who have persuaded our Congress of this lie while funding their campaigns. A simple fix is for President Trump to insist on "most favored nation" status for drug pricing, then use consumer protection acts to criminally prosecute the drug companies that continue to abuse Americans. Capitalism only works when it actually exists. When it comes to drug pricing in the U.S., monopolists are holding us hostage and have for years.
Let's wait and see the details of TrumpCare.
Given past legislative history, change will not be immediate. When that plan comes, we can debate the pros and cons of how Medicare and Medicaid might become fiscally solvent yet clinically effective programs — and how drug prices might be brought into line with other developed countries. Obamacare was ill-conceived and incomplete. We need to do this quickly and definitively this time. Until then, let's not try to meet the devil halfway.
Dr. Ramin Oskoui, a cardiologist in the Washington, D.C., area, is CEO of Foxhall Cardiology PC and a regular contributor to LifeZette.
Last Modified: May 7, 2017, 7:43 pm