By MATTHEW HOLT

The Democratic conference closed with a lovely speech by Kamala Harris, star energy from the Obamas and Clintons, and a bunch of Republicans telling their ideological brothers that it was higher to be a Democrat than a Trumper. And most significantly, no Beyonce and Taylor Swift duet, as Mitt Romney had promised us.

There was numerous speak about sure facets of well being care. However total, if Harris wins, you don't count on a lot change within the present well being care system.

Why not?

First, there’s the pure politics. The Democrats must win again the Home (most likely however not actually) and maintain the Senate to cross laws. Proper now, they’ve a 51-49 benefit within the Senate. That may doubtless change into 50-50, because the Republicans will certainly choose up Joe Manchin’s seat in West Virginia. There are a selection of seats that the Democrats at present maintain in shut races (Montana, Ohio, Michigan, Nevada, Arizona) that they should maintain to take care of 50-50, and it’s onerous to see the Republicans selecting them up (possibly Florida or Texas in the event you look carefully). The excellent news is that Manchin (WV) and Sinema (AZ) will each be gone quickly, so the Democrats which can be there received’t be too onerous to persuade to observe a presidential agenda. However that might nonetheless give Walz, as vice chairman, the chance to do what Harris did and cross some key votes underneath reconciliation, which vastly limits what the laws can do — it should be “budget-related.”

Which brings us to what we’ve heard from Harris and her marketing campaign on well being care? We’ve heard quite a bit about points that impression well being, significantly creating reasonably priced housing and combating baby poverty, however little or no that instantly pertains to well being care itself. The truth is, solely two points stand out. Abortion and reproductive rights, and drug costs.

It’s clear that Harris will try to show Dobbs round and nationwide proper to abortion. This could require both packing the Supreme Court docket (my favourite) or ending the filibuster, or each. Each can be constitutionally and politically extremely troublesome to tug off, and would take up an infinite quantity of political oxygen. After all, the cynics would say that the Democrats can be higher off leaving this as a difficulty to bash the Republicans with. However as If profitable, ladies's rights and reproductive rights is not going to return to earlier ranges till 2022.

With regard to the price of medicinesThere’ll nonetheless be numerous justified bashing on large pharma, however the enlargement of insulin worth controls is one thing the market is (finally) prepared for anyway by way of CivicaRX and others. In the meantime, the IRA gave Medicare the suitable to barter drug costs, and the outcomes aren’t precisely earth-shattering. For instance, CMS says it has negotiated the price of blood thinner Eliquis from about $6,000 a yr to lower than $3,000. That sounds good till you notice that the value is barely that top due to patent video games that producer BMS is enjoying within the US, and the value is underneath $1,000 in every single place else on the earth. We’ll hear extra about this as the value cuts go into impact (although not till 2026!) and extra medication come underneath negotiation, however total it’s not precisely a world-shattering change.

Lastly there may be already a assured battle about Extension of premium subsidies for ACA plans. These had been first included within the Pandemic American Rescue Act, then expanded into the IRA, however are actually scheduled to run out in 2025. It’s onerous to think about they received’t be expanded additional, whatever the make-up of the Senate, assuming there’s a Democratic Home of Representatives. (A Marjorie Taylor Greene presidency does make me pause!). However once more, there’s nothing new right here, and the general vibe of excessive premiums and excessive deductibles within the present ACA market isn’t going to alter.

So what’s not taking place? Just about all of the fascinating issues that Harris and Biden promised us in 2020. You might have missed the one actual “coverage first” speech on the conference, which got here from Bernie Sanders. To be honest, a lot of his agenda was already within the Biden laws. That’s no coincidence, as a result of Biden got here at it with a vengeance in 2020 and 2021, pushing a fairly radical agenda on infrastructure, local weather, industrial coverage, and extra. And after I say radical, I imply a mushy social democrat by European requirements! However what wasn’t in that agenda? No Medicare for All, which Bernie campaigned on in 2019/20 and introduced up once more on the conference. Who else proposed that in 2019? A sure Kamala Harris. That by no means made it into the Biden agenda. We didn’t even introduce laws to decrease the Medicare age to 60, which was a marketing campaign promise. There was no dialog about any of this from Harris or Biden earlier than he pulled out. It’s only a bridge too far.

Which ends up in the issues which can be being debated in THCB and elsewhere about how the system really works. There isn’t any point out of Medicaid enlargement (or continued shrinkage). There isn’t any point out of curbing hospital consolidation. There’s not even point out of insurers abusing Medicare Benefit or non-public fairness shopping for up docs’ practices. There isn’t any point out of increasing value-based care.

What we are able to count on from a Harris administration is extra of the identical from CMS and probably a barely extra aggressive FTC. Meaning continued efforts to maneuver away from fee-for-service in Medicare, some further restrictions on the worst conduct in Medicare Benefit, and probably a number of warning pictures from the FTC about hospital monopolies. However the tendencies we’ve seen lately will largely proceed. We’re not going to have a major care-based, capitated system constructed out of the mess now we 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 might be a good suggestion.

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