I have read Trump and the American Future: Solving the Great Problems of our Time by Newt Gingrich very closely. Mr. Gingrich is a former speaker of the House of Representatives and was a 2012 presidential candidate, author of forty books and is a Fox News contributor. He presents four extensive and detailed chapters, “Covid-19 Would Kill Medicare for All” and “America’s Healthcare Rebellions, part I, II, and III.” I will not attempt to duplicate his wonderful analysis of America’s health care problems and coming innovations, but rather attempt to summarize his studied and novel solutions as well as challenges ahead.
Throughout the China Virus crisis, “government has had a vital role to play, but it was not to run the health care system. Instead, government has served as a facilitator and coordinator. In fact, many of the most vital steps President Trump took involved getting the government out of the way.”
Government-run health plans; Bernie Sanders’ style Medicare for All, or “public option” plans like former Vice President Joe Biden’s can lead to scarcity. Instead of market-based competition, the above plans use top-down government systems to control costs. As Gingrich states, “there is simply no way that a collection of bureaucrats sitting in Washington knows enough to set the right price for anything.”
Medicare underpays, thus, about 20% of doctors don’t participate in Medicare. It graphically stifles quality improvements and other innovations.
“Single-payer healthcare, like Medicare for All plans,” according to Mr. Gingrich, “would devastate America’s hospital system.” And Biden’s plan would have a similar effect.
Most of the Obamacare policies are outrageously costly and have “extremely narrow networks of providers that exclude the best doctors.” For instance, no Obamacare plan in all of Texas covers treatment at the MD Anderson Cancer Center in Houston.
Most Americans, President Trump, Republicans, and Democrats agree that those with pre-existing conditions should be guaranteed the right to purchase affordable insurance. Actually, many states had set up guaranteed coverage pools prior to Obamacare.
Gingrich explains, “The rush among Democrats to adopt government-run health care, whether it is all at once like Sanders or through a Trojan horse like Biden’s public option plan, is an admittance of failure. It shows that even they recognize that the Affordable Care Act failed to deliver on its central promise: to make health care affordable.”
Some innovations are in place and are wonderful, but President Trump, Republican majorities in the House and Senate, as well as cooperating Democrats can and will work together to dramatically improve America’s health care.
Mr. Gingrich comments, “One of the greatest strengths of President Trump is that he goes outside of the typical Washington channels for information.” That’s a major reason that I call our President the Innovation President.
First of all, we must recognize as Mr. Gingrich states that, “Americans are empathetic people.” We consider health care “as a moral issue as much as a pocketbook one.”
Mr. Gingrich states flatly that government-run healthcare like Medicare for All, the public option, or trying to fix Obamacare are “ultimately dead ends.”
Instead, physicians, medical entrepreneurs, patient advocates, and innovative business leaders are moving forward with what works in America. So far, these rebels are “scattered and uncoordinated, but results have been amazing – enormously better health for patients at about half the costs. Previously ignored by the political system, that all changed when Donald J. Trump became President on January 20, 2017.”
One of the health care rebels’ strategy that our Innovation President is embracing in health care is “radical transparency.” Currently, America’s health care system is both extremely complex and opaque. As an example of the wide variety of costs: a Blue Cross Blue Shield study from 2015 showed that the cost paid by their insurance for a knee replacement in Dallas, Texas ranged from $16,772 to $61,584. Mr. Gingrich explains, “The result of secret prices is that in 17.7 percent of the American economy – $3.6 trillion – customers are making decisions absent of price considerations.”
What is happening is that “patients are not price insensitive, they are price blind.” Mr. Gingrich explains, “Secret pricing is the underlying dysfunction behind the skyrocketing cost of health care in America. It is responsible for the out-of-control increases in health insurance premiums as well as rising out-of-pocket costs: deductibles, copays, and coinsurance.”
While in June 2019, President Trump signed a groundbreaking executive order to at last end secret pricing and return power to the patient. It is being fought in court by hospitals. A majority of Republicans in the House and Senate with President Trump might be needed to implement this “enormous step forward in creating a genuine functional free market in health care.”
President Trump’s health care executive order also directed the Department of Health and Human Services to establish a system for quality transparency to assist patients in comprehending what they are buying. “Americans deserve to know if they are choosing the best care,” according to Mr. Gingrich and I fully agree.
Besides transparency in price and quality, Americans are adamant in wanting access to their health records. President Trump’s executive order directed the Department of Health and Human Services to develop rules that would guarantee patients immediate access to view and share their medical records.
Transparency of price and quality as well as instant access and ability to share patient information is a framework that gives a patient control of their healthcare, greater affordability, and helps Americans to get care when they need it. When providers are disclosing transparent pricing, the middlemen buried in the health system, who add negligible value as they add costs, can be removed.
Fraud in health care is a huge problem. Estimates of this plight go up to ten percent of health care spending or over $300 billion. A book, Stop Paying the Crooks by Jim Frogue delves in detail to that problem. Mr. Gingrich wrote the preface.
President Trump took a large step to allow small companies in the same industry and geographic area to join together in associations to save money in health plans.
In recent years, a good deal of heed has been directed toward physician burnout. This is an issue that I was unaware of. Mr. Gingrich points out that “the symptoms include exhaustion, cynicism, and a lack of compassion for patients.” He also explains that physicians and primary care doctors are being put in the position of spending less time with patients rather than more.
One innovation is “direct primary care.” An example is Atlas MD where employers pay a low fixed price that covers most ordinary health expenses. Noticeable is the lack of people in the waiting room. There are no receptionists, just a registered nurse and two doctors. With no insurance involved, all sorts of administrative overhead is completely avoided. Patients are seen immediately.
Roughly half of patient interaction is virtual: phone calls, video conferences, and even text messages. A doctor reveals that he only sees about four to six patients a day, while a typical primary care doctor sees about forty to fifty patients each day.
There are currently more than 1,200 “direct primary care” practices in America and the number is increasing.
Other innovations include companies that set up their own healthcare medical centers which produce better care, low employee turnover, lower costs, holistic treatment, a win-win situation all around.
Another brewing rebel approach is to consider “aging as a disease” that is treated rather than an unavoidable process of slipping into poorer and poorer health. The doctors that Gingrich cite say that their work with aging should be supported and expanded upon by officially classifying aging as a disease.
Preventative medicine is crucial and the expanding use of wearable medical devices along with further advances in this real-time area are not only innovative, but downright exciting!
Gingrich explains, “The dominant payment model in health care today is third party, pay-for-service.” A rebellion in health care is “fully integrated health care and health coverage without complex provider networks.”
About 20% of all medical care in America is unnecessary according to a study in a doctor survey.
A key part of fully integrated health care is the elimination of the third-party payer and having a provider-run health plan. Gingrich points to three such plans which are the “highest-performing health systems in the country in terms of costs and quality.” He points out that others are pointing towards this model as well.
A fully integrated plan is not simply big which tends to avoid competition, but instead invests heavily in primary care to identify health problems early and assists patients in managing problems themselves. At the same time these integrated systems have the scale and care services “that span from maturity to long-term care – literally your entire life.” Gingrich notes an important point, “fully integrated health care is particularly effective in dealing with the challenge of covering people with pre-existing conditions.”
Gingrich states, “Medicare and Medicaid patient populations are sicker than the rest of America.” President Trump and those on his team at Health and Human Services recognize the potential of these fully integrated systems. They have established a new direct contracting model for Medicare that would pay a single flat fee for handling all a patient’s health care needs. While a fully integrated health care system is not a total replacement for fee-for-service, it is an option that exists in tandem with a price-transparent fee-for-service model.
Price and quality transparency will allow patients to go to the highest-value health care providers. Savings of companies can allow higher pay for workers and their development. Because of our innovative, hard-working President Trump, these new initiatives will be “affordable and customizable to what employees need.”
Gingrich explains: “This is a vision for a truly free market in health care that provides the best possible combination of competition among health care providers to lower price and quality. It will create health coverage for financial certainty, and properly align incentives among patients, doctors, and payers to keep Americans healthy. It is the health system of the future that America’s health care rebels are building, and President Trump and Republicans are helping to make it a reality. It is a fundamentally better and more attractive vision than the government-run health care future of Vice President Biden and the radical Democratic left.”
I highly recommend Newt Gingrich’s Trump and the American Future. The entire book covers far more details than my summary above and also many more topics of tremendous interest. To be honest, his book opened my eyes to so many aspects of health care that I just was not aware of. Mr. Gingrich also encourages all to visit his website at Gingrich360.com to learn more.
I would also like to add that Senator Bill Cassidy MD is now running for re-election. We need doctors such as him to navigate these complex issues in Congress. I will certainly vote for him!
