Is Trump good for healthcare? Not so fast
At first glance, physicians in private practice may assume Donald Trump will be good for healthcare. A businessman who does not like government intervention seems like a dream come true. Hopefully, intrusions into patient care such as Meaningful Use and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will be history and all may be better with the private practice of medicine. No so fast.
If it were an organized business, healthcare in America would be the largest enterprise in the world in terms of revenue. The $3.8 trillion healthcare industry is fueled by public dollars, mainly Medicare and Medicaid, and by commercial health insurance. The out-of-pocket payments by patients account for only about 20% of healthcare spending—a percentage that’s rising, but overall still small by comparison.
Trump wants to “Make America Great Again” by investing in infrastructure, e.g. highways and bridges, and the military. He also wants to cut taxes. Where will the revenue to pay for all this come from? I believe healthcare is a likely target.
I suspect the massive medical industrial complex is in for some reckoning and likely a recession under Trump. That is not all bad from a broad social perspective. Those of us in primary care have little sympathy for medical waste and inappropriate care. However, reduced spending in healthcare is likely to impact everyone dependent on payments from Medicare, Medicaid and private insurance. About half of physicians, including those in primary care, work for health systems likely to be impacted by decreasing revenues.