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    Grading the Trump administration's healthcare initiatives


    Scott Gottlieb: A

    The man appointed as commissioner of the FDA has been a bright spot that has drawn applause from many corners of the political spectrum. A conservative approach to the high price of drugs dictates using markets to lower prices, and in that vein, the FDA commissioner approved a record number of generics in 2017. The FDA also announced an expedited review of generic drugs for which there are fewer than three existing generic competitors.

    In an attempt to allow the market to push drug prices lower, the FDA approved numerous generics in 2017, and announced an expedited review of generic drugs for which there are fewer than three existing generic competitors. Gottlieb also launched a pilot program for orphan drug requests to ensure the world would create no more Martin Shkrelis.


    RELATED: 5 facts physicians need to know about Anne Schuchat


    Gottlieb also maintains an active and mature presence on Twitter, in stark contrast to the other members of the healthcare team. If he could only manage the President's Twitter account as
    well, world peace may well be within our reach.

    Healthcare Policy: B

    Health care turned out to be very complicated. Who knew? The solutions to what ails us remains comfortably far from reach after one year. There are those like me who believe the path to the best healthcare system courses through physician-led practices beholden to patients rather than systems.  A mostly non-practicing class of healthcare busybodies made up of administrators, economists, public health officials, and MBAs think the opposite. To this group, the physician is an interchangeable widget. Pushing back against this monolith is a slow process that began with the election of an outsider. The people appointed by Trump have not disappointed in changing the overall conversation in healthcare. The individual mandate is a good example. What was a good idea to ensure everyone paid their fair share turned into a $300 to $500 per month boondoggle for a 40-year-old who just wanted financial protection from a catastrophic event. Little surprise that there were few tears shed here when this non-working mandate was repealed with the recent tax bill.

    The administration has also hearteningly attempted to rein in spending for a Medicaid program that has largely been working poorly for patients because low reimbursement rates have meant poor access to primary care physicians. The reimbursement rates are particularly befuddling given the fact that the United States gave ~$500 billion to insurance companies in 2015 alone to manage Medicaid patients. One hopes that the nation’s vast wealth may be deployed in a manner that serves patients, rather than their insurance companies.

    Overall, there is ample evidence that new management has brought a different approach
    Change, though, continues to be frustratingly slow. Value-based pay-for-performance care that doesn't actually relate to value remains the law of the land, and its implementation continues to leave much to be desired. Vertically integrated networks, once formed, seem difficult to displace.

    A word of advice for the appointees facing some very tall tasks in the three years to come: Fly economy.

    Anish Koka
    Anish Koka is a cardiologist in private practice in Philadelphia trying not to read the writing on the wall. Follow him on twitter ...


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    • [email protected]
      As a full time pastor and retired physician; I feel that a response from a different set ot trench workers is needed. People in my my area are suffering from the recent healthcare policies. The hard working people in rural Southeast Oklahoma are struggling to get quality healthcare vs. surviving. Many of these people are Trump supporters it is unfortunate that the current Administration policies will not support them. As you continue to give grades I will continue to work to find quality healthcare to for all people regardless of their political affiliation. Charles A. Woodridge MD, M. Div
    • [email protected]
      Thank you, Dr. Koka, for a measured and thoughtful assessment. Of particular note, your thoughts on value-based reimbursement, EMRs, and avoidance of third-party intermediation were particularly enlightening. I would agree that the demise of Tom Price so early in the process was disheartening and that the response from 'the Resistance" was dramatically overblown. I wish Seema Verma much success but am in agreement that the built-in inertia with Medicare and Medicaid may be too much to overcome in a relatively short timeframe. A bright spot in this whole issue is how alternative practice and reimbursement models, like Direct Primary Care, may have a positive impact on improving both quality and cost of care. Time will tell.

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