Outlook for healthcare under a President Trump
Dr Lockwood, editor in chief, is Senior Vice President, USF Health, and Dean, Morsani College of Medicine, University of South Florida, Tampa. He can be reached at [email protected].
How will the recent election of Donald J Trump affect your practice? What will be the fate of the Affordable Care Act (ACA), the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and Medicare value-based payments? Will we see radical change or will intramural Republican conflicts and obdurate Senate Democrats conspire to sustain the gridlock that has paralyzed our federal government for the past 6 years?
Before answering these questions perhaps we need a bit of detached perspective. To start with, while the recent US general election was by all criteria divisive, inflammatory and, at times, vile, by historical standards it paled in comparison to the vitriol hurled when Andrew Jackson challenged John Quincy Adams, or when Reagan stunned Carter; and in each case our nation emerged none the worse for wear.
Polls and pundits simply failed to account for the American habit of cyclical rejection of ruling parties, a legacy of Thomas Jefferson, who himself had 2 extraordinarily vituperative campaigns against another founding father, John Adams. The polls also missed long-simmering frustrations among rural and exurban white working-class voters over the perception that both parties—but especially the Clinton wing of the Democratic Party—had consistently focused on urban poor and minorities but paradoxically also on Wall Street and the professional classes, all at their expense (eg, why Sanders voters turned to Trump).1 Moreover, such class resentments were exacerbated by disparate regional economic growth.
Then there is the unique American tendency to elect the opposite persona of the last president. But mostly, the pollsters missed the far greater enthusiasm for Trump compared with Clinton voters fed by Mr Trump’s pitch-perfect channeling of their fears over economic consequences of globalization, immigration, and multiculturalism.