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FROM THE
EXECTIVE DIRECTOR
What would a businessman do to healthcare?
By Stephen C. Fitzer, BCMS CEO/Executive Director
So the presidential election sur- legal/academic perspective. Both presidents surrounded them-
prised just about everyone. If you selves with cabinet choices that reflect their background and per-
were like me, I was up at 2:00 in the spective. That means we will likely see a 180 degree pivot on
morning listening to the results and methodology going forward. Based upon that, it is interesting to
couldn’t believe the underdog won speculate on what and how things can change. One serious dis-
the election. The new president won advantage that the new president has is that the money was all
the election by campaigning on used up by his predecessor. The United States is now about $20
many issues that will reverse the trillion in debt. Interest rates are about to go up which will mean
trends of the past 8 years, including even more interest expense to service the debt created under Pres-
social issues, military, trade, and yes, ident Obama. It means that unless President Trump can be more
healthcare. As to how it affects medicine, only time will tell. Repeal efficient or bring in more tax revenues, his ability to invest in his
and replace was the motto, but we all know it will not be that simple proposed programs will be finanically limited.
or that quick.
Significant healthcare mega trends over the past four years, at the President Trump has promised to invest more in infrastructure,
national level, have been expansion of Medicaid, paying providers military, immigration control and private sector job creation. Based
for illusive “quality” performance versus fee for service, and getting upon his promises, the places he will target to cut will be entitlement
everyone on health insurance through a wealth distribution model programs Supplemental Nutrition Assistance Program (SNAP and
(remember Jonathan Gruber). Every time the government changes welfare), healthcare, and government size. A significant question to
the location of the goal post, it takes years for providers to develop the provider community is “how will that impact the delivery of
and implement strategies that enable them to adapt and stay in busi- healthcare?” At this point, we all have our divining rods out. We lis-
ness. The cost of adapting to new models of healthcare cause finan- ten to what he has said, who he has chosen to advise him, and what
cial and care setbacks. The government healthcare dollar keeps the landscape looks like and we make our best guesses. Here are some
getting stretched to cover more and more with less and less. that seem logical to me.
The new president, at the time this article is written, has not yet
announced any specifics as to what the new healthcare plan will look President Trump will seek to turn more responsibility over to the
like. Of course, the two political parties are either totally in support states and to private enterprise. Free market economics are what he
of change or totally opposed to change, depending upon who is rec- understands and believes in. That means fewer federal government
ommending the changes. The general populace consistently asks for programs, including cost cuts, substituted by federal government
unity at the national level based upon what makes the most sense monitoring. In other words, Trump will seek to cut back the federal
and is in the best interest of the majority. But polarization is fash- government actually doing things that private enterprise can do, and
ionable in politics, and politicians generally take the position that he will let states decide what is best for their own citizens based upon
not giving ground, not negotiating anything, is the only acceptable their needs and capabilities. For healthcare, this will likely impact
position. In such a scenario, the only time anything gets done is Medicaid funding (block grants to states).
when the president’s political party also has majority control in the
house and senate. President Obama took advantage of that two-year President Trump and his advisors will re-evaluate government ex-
status to ram through the Affordable Care Act, and President Trump penses and challenge prices, terms and deliverables. Like Trump did
now has a similar edge for at least the next two years. with military suppliers, it would seem logical that he would turn his
President Trump is a businessman and will look at things very ire to pharmaceutical companies and others who have demonstrated
differently than his predecessor who came at things from a high profile price increases in recent years. Trump appointed nego-
tiators will go toe-to-toe with suppliers to try and extract the best
deals possible.
The Affordable Care Act will be assessed as to cost, fairness, and
10 San Antonio Medicine • February 2017
