Same Signs and Symptoms, But Different Diagnoses and Treatment: MAHA Alternatives on the Current State of U.S. Healthcare

Although not necessarily focused on children’s health and chronic disease in the way that the MAHA commission is designed to be healthcare commentators are weighing in on what Kennedy’s and the Trump administration’s healthcare priorities should — and will — be.

Drew Altman

Drew Altman, president is president and CEO of KFF, noted in a column today that the most of Trump’s actions so far have left untouched powerful U.S. healthcare interests, which Altman listed as hospitals, doctors, the nursing home industry and managed care industry.

Altman said that will change with the large cuts to Medicaid that Republicans seem to likely advance as part of budget and tax cut legislation. More than half of Medicaid spending goes for people with disabilities or who are older, many of whom use long-term care, including in nursing homes. Altman said nursing homes have powerful lobbies at the state level. He also noted that half of all Medicaid spending flows to the managed care industry, which is dominated by big insurance companies.

“There is no significant cut in Medicaid spending that is easy or simple to pull off, and certainly not one totaling almost $900 billion dollars over 10 years,” wrote Altman.

In the February issue of Health Affairs, Mark McClellan, M.D., Ph.D., and Don Berwick, M.D., M.P.P., were the lead authors of sweeping opinion pieces on the status of U.S. health and healthcare and improvements that should be made. Full text of both commentaries is available (you can find it here and here) and not behind a paywall.

McClellan, now a professor at Duke University, was one of the FDA commissioner and CMS administrator during the George W. Bush administration. Berwick, a lecturer at Harvard and healthcare improvement expert who popularized the Triple Aim, was one of the CMS administrators during the Obama administration.

Afoul of anti-DEI

McClellan and his co-authors wrote about public health and, like the MAHA executive order, invoke declining life expectancy as one of the reason for taking action. But their focus is on funding and coordinating existing organizations and federal, state and local public health efforts. They describe funding as fragmented and the approach as neglectful of “foundational public health capabilities” and a hinderance to “blend and braid funds that would allow for a more cohesive, synergistic local infrastructure to address interlinked public health priorities.”

They pin their hopes on population health-oriented efforts by healthcare providers and value-based care payment that is supposed to encourage coordination of care and disease prevention. “Instead of viewing public health and health care as separate and competing systems, the nation must embrace opportunities for a population health approach that leverages the strengths of both professions to improve the health of all people,” they wrote,

Mark McClellan, M.D., Ph.D.

McClellan and his-coauthors also pointed to Medicaid waivers that fund efforts to address social determinants of health, specifically mentioned programs in North Carolina and Oregon.

Their laundry list of efforts that could improve public health include electronic case reporting, strengthening the public health workforce and health departments adopting data standards, such as Fast Healthcare Interoperability Resources (FHIR), to improve interoperability.

Some of their proposals run up against the Trump administration’s anti-DEI policies. For example, McClellan and his colleagues say that Centers for Disease Control and Prevention and the National Institutes of Health should “fund researchers to evaluate models for augmenting the existing public health workforce, including diversity and inclusion efforts.”

Equalizing Medicare and Medicaid payments

Berwick and his colleagues also predicate their arguments party on U.S. life expectancy lagging behind other developed countries. Their focus is on healthcare spending, which they characterized as being “out-of-control” and what they describe as a “muddled middle ground” of a public-private healthcare system that operates without too much government oversight.”

“Drug companies, health insurers and hospitals have harvested steadily increasing profits yet millions of Americans struggle to access needed care and pay healthcare pills,” they write.

In listing their eight principles for guiding transformation of the healthcare system, Berwick and his colleagues mention creating a Medicare public option; improving access for people covered by Medicaid by equalizing Medicaid and Medicare payments; centering healthcare in primary care by, among other steps, integrating behavioral health services into primary care services; and creating a national board (they propose calling it the Health System Accountability Board)that would monitor and report on transparency, access and accountability.

There is some overlap with what the McClellan- and Berwick-led teams of authors propose. The Berwick group also writes about population health and improving outcomes through outcomes by minimizing fee-for-service payment.

Don Berwick, M.D., M.P.P.

Although their diagnosis about what ails U.S. healthcare and their prescription for remedying it are almost entirely from MAHA’s, Berwick and his co-authors have an equally dim view of its current state.

“Because of the persistent failure to prioritize patient and societal well-being the United States lags far behinds its peers in key measures of health and wellness, and its healthcare spending imperils its economic future,” they wrote.