Fortune | FORTUNE 2024年11月14日
How Trump’s Agenda 47, plus Project 2025, offer clues into possible health-care policy changes
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本文探讨了唐纳德·特朗普若再次当选总统,其健康政策可能发生的变化,主要基于其顾问罗伯特·肯尼迪提出的“让美国再次健康”的承诺,以及特朗普的‘议程47’和传统基金会的‘2025项目’等文件。这些文件暗示了特朗普可能采取的措施,包括进一步限制堕胎权、限制跨性别者权利、改变医疗保险计划、打击制药行业等,这些政策可能对美国医疗保健体系产生深远影响。

🤔 **进一步限制堕胎权:**特朗普可能禁止堕胎药和所谓的“堕胎旅游”,并要求CDC停止将堕胎宣传为医疗保健,禁止使用胚胎或胎儿细胞进行研究和疫苗开发,并要求卫生与公众服务部详细记录堕胎数据。

🏳️‍⚧️ **进一步限制跨性别者权利:**特朗普可能结束对跨性别者的性别确认治疗,禁止纳税人资助变性手术,并阻止学校宣传“性别转变”理念,同时可能要求政府只承认出生时指定的男性和女性两种性别。

👴 **医疗保险可能面临更高成本:**虽然特朗普承诺不会削减医疗保险资金,但‘2025项目’提议将医疗保险优势计划设为默认计划,结束医疗保险D部分的价格谈判计划,这可能导致受益人医疗成本增加。

💊 **制药行业面临更多监管:**特朗普计划结束药品短缺,将救命药物的生产转移回美国,并追究制药行业在慢性儿童疾病和阿片类药物危机中的责任,同时‘2025项目’也建议制药公司不得故意推迟仿制药上市。

🔬 **CDC面临改革:**‘2025项目’指责CDC接受制药公司的捐款存在利益冲突,建议禁止这种行为。

Much remains to be seen, but clues aplenty can be found not only in advisor Robert F. Kennedy Jr.’s promises to help Trump “Make America Healthy Again,” but in Trump’s own Agenda 47 and in Project 2025, the Heritage Foundation’s 500-page conservative policy plan to reshape the federal government. Because while Trump has distanced himself from the latter, he shares numerous ties with its architects, many of whom worked in his last administration and on his transition team or campaign.Below, a glimpse into what might be in store for the U.S., health-wise, according to these two documents. Trump may ban abortion pills and so-called “abortion tourism”Without getting specific, the Trump administration says it “will oppose late term abortion,” according to the official GOP platform that Trump’s website links to through his brief Agenda 47 points. It will do this, it says, “while supporting mothers and policies that advance prenatal care, access to birth control, and IVF (fertility treatments).” Project 2025 goes further, suggesting that the Centers for Disease Control and Prevention should stop “promoting abortion as health care,” and that all research and vaccine-creation involving embryonic stem cells or fetal cells “be prohibited as a matter of law and policy” (several vaccines are made by growing viruses in fetal embryo cells from tissue obtained by legally aborted fetuses). It also wants the Department of Health and Human Services to accurately report “exactly how many abortions take place within its borders, at what gestational age of the child, for what reason, the mother’s state of residence, and by what method.” This, it explains, is because “liberal states have now become sanctuaries for abortion tourism,” using a conservative talking-point phrase to refer to the 171,000 women who had to cross state borders to either have an abortion or obtain abortion pills in the wake of Roe v. Wade being overturned.  Further, the document calls for the FDA to reverse its approval of abortion pills and to stop “mail-order abortions,” and to prohibit Planned Parenthood from receiving Medicaid funds, stating that “abortion is not health care.” The American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization, though, disagree, calling abortion an “essential” part of health care. Trump wants to further restrict the rights of transgender individuals “Republicans will end left-wing gender insanity,” promises Agenda 47. “We will keep men out of women’s sports,” a reference to transgender women and girls being included in sports that align with their gender identity, “ban taxpayer funding for sex change surgeries,” which would end life-saving treatment for transgender individuals who rely on the state for care, and “stop taxpayer-funded schools from promoting gender transition.” That could mean anything from allowing students to use the bathroom that aligns with their gender identity to allowing teachers or counselors to consult with children about their gender identity without alerting parents, to prevent unwanted disclosures. Trump promises to cut federal funding for any school “pushing… radical gender ideology,” which, as GLAAD explains, “is a malicious rhetorical construct that falsely asserts that LGBTQ—notably trans—people are an ideological movement rather than an intrinsic identity,” and that the term is “just one example of anti-LGBTQ online hate and disinformation.”Further, Trump says he will “reverse Biden’s radical rewrite of Title IX Education Regulations,” referring to new policy, which went into effect in August, that expands Title IX civil rights protections to LGBTQ students, expands the definition of sexual harassment at schools and colleges, and adds safeguards for victims. Agenda 47 also says Trump will ask Congress to pass a bill ensuring the U.S. government only recognizes two genders—male and female, both assigned at birth. He says he will also investigate “Big Pharma” and “big hospital networks” to see if they illegally marketed hormones and puberty blockers—both used in gender-affirming care for minors with gender dysphoria, the latter as an off-label use that’s reversible—”which are in no way licensed or approved for this use.” But, while it’s true that puberty blockers (used for decades to treat “precocious,” or early, puberty) are not approved for use in gender-affirming care, off-label uses of drugs are legal and common. Gender-affirming care for minors—despite being endorsed by the American Academy of Pediatrics, the Pediatric Endocrine Society, and the American Psychological Association—is currently banned or severely limited in 20 states.Seniors could face more expensive Medicare Trump says he “will not cut one penny from Medicare,” and will work with seniors “in order to allow them to be active and healthy.” While Project 2025 doesn’t propose cuts to Medicare, some of its proposals may increase costs for beneficiaries—including a proposal to make Medicare Advantage the default plan, ending the Medicare Part D price negotiation program and effectively privatizing the program. Critics of that plan, including the Center for Economic and Policy Research (CEPR), say there’s not sufficient evidence that Medicare Advantage delivers better outcomes for patients than traditional Medicare. (Regarding Medicaid, Project 2025 proposes cuts but doesn’t call for its full elimination.)Trump, through the GOP platform, pledges to “protect seniors” and support “increased focus on chronic disease prevention and management, long-term care, and benefit flexibility.” Further, notes the platform, “We will expand access to primary care and support policies that help seniors remain in their homes and maintain financial security, shifting resources into “at-home senior care,” support the end of care worker shortages, and support unpaid family caregivers with tax credits. Trump wants to end to drug shortages, with more accountability for “Big Pharma” and the CDCTrump, through his agenda, pledges to end pharmaceutical shortages and “return the manufacture of life-saving drugs to the United States” by restoring his 2020 Executive Order 13944. “American doctors should never have to give a patient a drug from an unapproved facility in China or India,” he notes on his website. “We can and must produce these essential medicines at home.”Further, Trump wants to hold the pharmaceutical industry accountable for chronic childhood illness—and while he does not get more specific. Trump also says he’ll hold the pharmaceutical industry responsible for drug addiction, especially the opioid crisis.Project 2025 wants to lower prescription drug costs. “Specifically,” it notes, “the FDA should prohibit pharmaceutical companies from purposely sitting on their legally available right to be the first to sell generic versions of their drugs.” This apparently refers to the practice, by brand-name pharmaceutical manufacturers, of seeking “to delay generic competitors from entering the market,” according to the Commonwealth Fund, a nonprofit that aims to improve U.S. health care. “Strategies include obtaining and listing additional patents on their drugs with the Food and Drug Administration (FDA), engaging in strategic settlements of patent litigation, and restricting generic manufacturers’ access to drug samples.”It also says it aims to disentangle the CDC from what it says has been a practice of accepting pharmaceutical contributions, since the ’90s, through the “loophole” of the nonprofit CDC Foundation.“The money started flowing immediately: From 2014 through 2018, the CDC Foundation received $79.6 million from pharmaceutical corporations like Pfizer, Biogen, and Merck,” notes the policy plan. “This practice presents a stark conflict of interest that should be banned.”More on politics and health:Subscribe to Well Adjusted, our newsletter full of simple strategies to work smarter and live better, from the Fortune Well team. Sign up for free today.

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特朗普 健康政策 堕胎 跨性别 医疗保险
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