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June 27, 2019

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The US Constitution has only 4,534 words.  The instructions on how to light my gas grill had more.

So maybe it is not a surprise that Article II of the Constitution, the part that establishes the presidency and the executive branch, hinges on this rather pithy little sentence.

‘The executive Power shall be vested in a President of the United States of America.’

There is a lot in those 15 words, nine of which have only one syllable.  We notice these things.

There are far more words in Article II talking about what makes up a quorum and how to determine who actually got the majority of the electors (uh, my number is bigger than your number…I win) than that single sentence that gives the President a LOT of power.

One of the ways the executive branch executes is through the Executive Order. FDR was the king of Executive Orders, ringing in with 3,728 of these.

In these, the boss writes instructions telling people on his team what they need to do.  They are a bit more formal than firing a tweet at a cabinet secretary as they get posted on the White House website and in published in the Federal Register and printed up on fancy letterhead and things like that.

President Trump just issued one and Alex Azar, Secretary of the Department of Health and Human Services, the guy who got most of the TO DO assignments out of this one, called it ‘one of the most significant steps in the long history of American health care reform.’  All expected hyperbole from the home team aside, he is right – this is a big deal.

Trump’s order directs his team to develop regulations, generally over the next six months, to change the game in five basic ways:

  • Require hospitals to disclose negotiated commercial rates (huge transparency move).
  • Require insurance companies to provide information to patients about costs before they receive care (everyone taking a swing a surprise billing).
  • Require agencies to coordinate on quality metrics (because I guess we should keep saying this until they actually do it).
  • Require agencies to make more de-identified data available to outsiders to use in building tools to help patients (this means apps for price comparison; it is handing the market a jackhammer to break through on transparency).
  • Expand what you can do with a Health Savings Account (sounds like no big deal, but another nudge toward empowering the consumer, another market tool).

Regular readers know our bias here as we’ve not been trying to hide it – when asked to choose, we generally prefer ideas that trust the market (consumers and competition) more than bureaucrats.  We’ll see how things play out, how the regulatory rubber hits the road, but this is the administration giving healthcare policy a giant push in that direction.

Tim Coan
Tim Coan

CEO and founder

Tim Coan, ALN’s CEO, writes an insightful and witty blog weekly about a variety of topics relevant to independent physician practices.