Chapter 24: Healthcare and US Elections 2024!
Understanding the Current Political Landscape in Healthcare!
In the summer of 1783, the Newburgh Conspiracy among the frustrated officers of the continental army, who, after the Revolutionary War, felt abandoned by the congress due to the unpaid wages and broken promises. Some officers even considered Mr. Washington to become a monarch. But when he learned about the unrest, he addressed his officers, diffusing the tension, dissolving the conspiracy, and reinforcing the principles of democracy. Thus, George Washington became the first president unanimously elected by the Electoral College and served from 1789 to 1797. He later introduced two-term mandates for the presidents.
The American Revolutionary War (1775–1783) was fought primarily between the Thirteen American Colonies and Great Britain. In 1776, the colonies sought independence from British rule, ultimately forming the United States of America. The war ended with an American victory, formalized in the 1783 Treaty of Paris, which recognized the independence of the United States.
The sacrifices were many; the nation's birth involved its share of freedom struggles, which laid the essential foundation for American democracy. Every generation has faced challenges, but the nation's founding remains the ultimate struggle.
Presidential Elections 2024…
Elections are closing as the days are winding down, with the expected results in the razor-thin margin. Who will it be, Donald Trump or Harris? By now, I doubt if any undecided voters are still out there. The policy differences are stark between the candidates. In the independent US history of more than 240 years, it will be the first time if Harris wins, it will make her First Lady President of the US, and If Trump wins, it will be the oldest president ever to the White House. Politics is always fascinating; whichever aisle you are on, whichever echo chamber one has gotten, the generation of politics is changing. America is changing, and the world is changing. We are navigating these rapid changes, in this decade of pandemics to a decade of AI and the new frontier of the unknowns.
Healthcare and politics are intrinsically linked, and healthcare plays a dominant role in political campaigns. The staggering healthcare costs are a statistic and a personal issue affecting everyone. As citizens, we have the power to shape the future of healthcare through our engagement in the political process. It's important to remember the human cost behind these numbers, as they represent the struggles and sacrifices of our fellow citizens.
If we look into how we come across health policies, Harry Truman campaigned for universal healthcare insurance in 1948; however, he received stiff opposition from the American Medical Association and was sacked. During 1965, under Lyndon Johnson, in peculiar circumstances, falling short of Universal health coverage, the Medicare and Medicaid Act of 1965 was passed, dramatically decreasing the uninsured population. Later, Bill Clinton campaigned on health reform in 1992 and proposed a sweeping Health Security Act in the first of his presidency; it backlashed and went on to be defeated in both the House and Senate in the 1994 midterm elections. In 2008, once again, Barack Obama pushed for significant healthcare reform. He proposed the Affordable Care Act, or Obamacare, which eventually passed majorly with democratic votes after many twists and turns. The opposition quickly galvanized in response to health care insurance mandates losing control of the House and increased seats in the Senate in 2010.
The healthcare debate has reached a critical juncture with the alarming surge in healthcare costs. In 2024, the total healthcare budget skyrocketed to 28% of GDP and continues to climb. This staggering figure of 4.8 trillion dollars, equivalent to Germany's entire economy, underscores the significant impact of healthcare costs on our economy. The trajectory of these costs is a cause for concern, and we must take immediate steps to control spending to ensure Medicare's future solvency.
I am a proud American who understands the importance of voting. I firmly believe that democracy is not just the cornerstone of our nation but also the force that shapes our future. The First Amendment has been instrumental in our progress and has propelled us into the future. Despite facing numerous adversities, from civil war to economic turmoil, America has always emerged stronger due to its resilience and positive outlook. Our forefathers designed a robust system to ensure that democracy prevails, and it's our responsibility to uphold it by exercising our right to vote.
As an independent Internal Medicine Physician practicing just outside the DC, the politics of healthcare is unavoidable. ACA, or Obamacare, has changed the landscape of medicine and practice. In pre-Obama care, the burnout among physicians was much smaller as most physicians were independent practitioners, and minimal corporation was involved. However, fast forward to now, most practices have taken over the big corporations, and smaller practices are closing down and joining hospital systems for better pay and less burnout. Instead of quality healthcare, it has, in fact, become quantity care. As more and more business administrators come into medicine, there is an exponential increase in the cost of medicine. When the pie is so big, it's tough to avoid; for example, everyone wants a piece of it in technology, business, economics, and politics.
We currently have a sick care medicine model. If a patient gets sick, insurances pay exorbitant amounts to the hospital for the visit. But the outpatient visit trying to prevent diseases like obesity or diabetes in the first place, zero dollars. As the sick care medicine model increases, this trend will happen. The Above graph is startling, causing the business of medicine to reach new heights. The number of physicians is not growing, but there are 10 administrators for every physician. The growth has been almost 5000% (woah) since 1980. I don't think any other department comes close to this. Medicare or the federal government spends less than 5 % on preventive care. I hope more robust laws are needed to improve overall health, especially preventive health, not just the sick care in this country. I hope the next generation of politicians will look into this problem and become proactive rather than reactive.
Healthcare Policies…
Abortion has become a major contentious political issue since Roe vs Wade was overturned; the majority of women feel there is too much government involved in personal decisions. Trump's administration took significant steps, like appointing conservative justices to the Supreme Court, resulting in the Court's eventual overturning of Roe v. Wade in 2022, which ended federal protection for abortion and returned the issue to the states. Harris strongly supports abortion rights, advocating the right to abortion at the federal level to counter state-level restrictions.
Drug Pricing(especially for seniors): Both candidates support lowering drug prices, but Harris and Trump take different routes. Harris backs Medicare drug price negotiations under the Inflation Reduction Act, which caps insulin costs at $35 per month and aims to make medications more affordable for Medicare beneficiaries. Trump, however, has previously supported a model that would import drugs from countries with lower prices, like Canada, and emphasized cost reductions through marketplace competition, which he may prioritize over expanding government-negotiated drug pricing.
The Affordable Care Act, or Obamacare, has changed the landscape of US health care since 2010. Since the law passed, more than 50 million people have used the Affordable Care Act. Yes, there are positives about being able to afford insurance. Still, there are also negatives, as it can cost an arm and a leg to get care, especially with chronic conditions and significantly high deductibles. Harris wants to expand the ACA. However, Trump would like to repeal it. However, he currently doesn't have a plan.
Opioid Overdose and border crises this is rampant and are causing significant effects in the neighborhoods. The addiction treatment should be enhanced. The criminal justice system must be much more robust in the fight to help and protect the vulnerable. It is linked with border crises, and more drugs snake through the border towns into the mainland. Unfortunately, this topic has been on the back burner for the current administration.
Medical Economics is changing, and politics is playing a pivotal role. The quality of patient care suffers as too many players in the corporization of medicine. The physicians becomes the stooge of the big corporation and then gets stuck in a hamster's wheel.
Politically speaking, either candidate comes with different aspects; Strong on economy vs strong on women's health, strong on immigration vs strong on climate change, etc. Many families have been torn apart by their differing political allegiances throughout this political season. Social media brings out our most primal instincts and tribalism—an age-old problem significantly amplified by its vast reach. Regardless of the specific issues debated during the campaign, the outcome of the 2024 election and the subsequent control of the White House and Congress will have far-reaching implications for the future of US healthcare. So, you must exercise your right to vote.
Suman Manchireddy MD