By MATTHEW HOLT

The Democratic conference wrapped with a fantastic speech from Kamala Harris, star energy from the Obamas and Clintons, and a bunch of Republicans telling their ideological brethren that it was higher to be a Democrat than a Trumper. Extra importantly no Beyonce/Taylor Swift duet–as we have been promised by Mitt Romney.

There was a whole lot of speak about some features of well being care. However general if Harris wins, don’t count on a lot change to the present well being care system. 

Why not?

First there’s the pure politics. The Dems must win again the Home (possible however not sure) and maintain the Senate to go laws. Proper now they’ve a 51-49 edge within the Senate. Most probably that goes to 50-50 because the Republicans will certainly choose up Joe Manchin’s seat in West Virginia. There’s a sequence of seats the Dems at present maintain in shut races (Montana, Ohio, MIchigan, Nevada, Arizona) that they’ll must preserve to keep up it at 50-50, and it’s onerous to see any pickups from Republicans (maybe Florida or Texas when you squint actually onerous). The excellent news is that Manchin (WV) and Sinema (AZ) will quickly each be gone, so the Dems that will likely be there received’t be as tough to influence to observe a Presidential agenda. However that may nonetheless depart Walz as VP to do what Harris did and go a bunch of deciding votes beneath reconciliation, which massively limits what the laws can do–it needs to be “funds associated.”

Which leads us to what we now have been listening to from Harris and her marketing campaign about well being care? We’ve heard rather a lot about points which have impacts on well being, particularly creating reasonably priced housing and preventing baby poverty, however little that’s straight associated to well being care itself. Actually solely two points stand out. Abortion and reproductive rights, and drug costs.

Clearly Harris will take a swing at reversing Dobbs and passing a nationwide proper to abortion. This may want both a packing of the Supreme Court docket (my favourite) or ending the filibuster or each. Both of those will likely be extremely robust to tug off constitutionally and politically and can take enormous quantities of political oxygen. In fact the cynics would say, the Democrats are higher off leaving this as a problem to make use of to beat up the Republicans on. However if it will get finished, womens’ and reproductive rights will solely be again the place they have been in 2022. 

Concerning the value of medicine, there’ll proceed to be a lot justified bashing of huge pharma, however the extension of insulin value controls is one thing that (ultimately) the market through CivicaRX and others is attending to anyway. In the meantime the IRA gave Medicare the correct to barter drug costs and the outcomes should not precisely earth shattering. For instance, CMS says it’s negotiated the price of blood thinner Eliquis from about $6,000 a yr to beneath $3,000 This sounds good till you understand that the value is barely that prime due to patent video games the producer BMS performs within the US, and the value in the remainder of the world is beneath $1,000. We’ll hear extra about this as the value cuts come into impact, (though not until 2026!) and extra medication get negotiated, however general this isn’t precisely an earth-shattering change.

Lastly there’s already a assured struggle about extending the premium subsidies for ACA plans. These have been first within the pandemic American Rescue Act, then prolonged within the IRA, however they at present are scheduled to finish in 2025. It’s onerous to think about them not being prolonged additional regardless of the make-up of the Senate, assuming a Democratic Home of Representatives. (A Marjorie Taylor Greene speakership does give me pause!). However once more there’s nothing new right here and the general taste of pricey premiums and excessive deductibles within the present ACA market received’t change.

So what’s not going to occur? Nearly all of the attention-grabbing stuff we have been promised by Harris and for that matter Biden in 2020. You will have missed the one precise “policy-first” speech on the conference which got here from Bernie Sanders. To be truthful a whole lot of his agenda was already within the Biden laws. That was no accident as Biden intentionally reached out to him in 2020 and 2021 and enacted a reasonably radical agenda on infrastructure, local weather, industrial coverage and extra. And once I say radical I imply milquetoast social democrat by European requirements! However what wasn’t in that agenda? No Medicare for all, which Bernie ran on in 2019/20 and introduced up once more on the conference. Who else proposed that in 2019? Why, a sure Kamala Harris. That by no means made it into the Biden agenda. We didn’t even get laws launched about reducing the Medicare age to 60, which was a marketing campaign promise. There’s been no dialog about any of this from Harris or from Biden earlier than he withdrew. It’s only a bridge too far.

Which ends up in the stuff that will get debated about in THCB and elsewhere as to how the system truly works. There’s been nothing about Medicaid growth (or its continued contraction). No speak about reining in hospital consolidation. No point out even of insurers gaming Medicare Benefit or personal fairness shopping for up doctor practices. Nothing in regards to the growth of value-based care.

What we will count on in a Harris administration is extra of the identical from CMS and doubtlessly a barely extra aggressive FTC. That can imply continued efforts to veer barely away from fee-for-service in Medicare, a couple of extra constraints on the worst habits in Medicare Benefit, and presumably some warning pictures from the FTC about hospital monopolies. However the developments we’ve seen lately will largely proceed. We’re not getting a primary-care based mostly capitated system rising from the wreckage of what we now have now, and in contrast to the Clinton and even Obama administrations, there’s not even any rhetoric from Harris or Biden about how that will be a good suggestion.

So politically I don’t assume the Harris administration will likely be very thrilling for well being care. And if the opposite man wins, as Jeff Goldsmith wrote on THCB final month, count on even much less.