"Let Obamacare Explode"

Last week, the AHCA was pulled from the House floor after not enough votes could be secured in favor of its passage.  A Washington Post article reported President Trump’s thoughts on the matter.  “We couldn’t get one Democrat vote, not one. They [Democrats] own Obamacare.  So when it explodes…we make one beautiful deal for the people.”  Journalist Robert Costa asserted “there was little evidence that either Trump or House Republicans made a serious effort to reach out to Democrats.”  Well Robert, I sure did. And I did not get very far. 

In the interest of full disclosure, over the past 20+ years, I have been a Democrat, Republican, and just about everything in between.  I recently reached out to lawmakers on both sides of the aisle, yet the responses were lopsided.  A recent entry myself into the political physician realm, I gave a presentation last week on lowering Medicare drug costs to the National Physicians’ Council for Healthcare Policy (NPCHP), in the Energy and Commerce Committee Hearing Room in Washington DC.  This phenomenal group of physicians was assembled by Congressman Pete Sessions (R) from Texas; and they are innovative, engaged, and working to improve the lives of their patients and fellow physicians. 

Six weeks prior to my Washington DC visit, I reached out to three local lawmakers in the interest of discussing healthcare:  Congresswoman Cathy McMorris-Rodgers (R), Congresswoman Jaime Hererra-Beutler (R), and my own local Congressman (D), who I am not naming because of the story below.  Both Congresswomen responded and met with me briefly; they were gracious, honest, and forthright about their support or lack thereof for the AHCA.   Despite three attempts to set up a meeting with my own Representative, I have yet to receive a response. 

In my opinion, not engaging with practicing physicians on the subject of health care reform is a lost opportunity.  There was very little chance my Democratic Representative would vote in support of the AHCA (which is perfectly acceptable), but why is it not worth his time to exchange ideas with a local practicing physician? 

Eighteen months ago, my Representative and I were both in attendance with our respective extended family members at a local theatre production watching our children perform.  During the event, I responded as a Good Samaritan for a relative of my Congressman.  Without a second thought, I jumped up quickly to respond.  To qualify for Good Samaritan protection, you must meet three qualifications:  there must be an emergency, aid must be rendered outside a hospital or a place with medical equipment, and care provided must be voluntary.   In the interest of privacy, suffice it to say, this particular situation met all three criteria and I rendered all necessary and appropriate treatment. 

Partisanship has no place in the rendering of health care services and should play no role in the work of advancing health care reform.  Regardless of party affiliation, lawmakers should solicit recommendations from local practicing physicians whenever they are able.  Both Representatives McMorris-Rodgers and Herrera-Beutler set aside time to speak with a concerned physician from their home state about impending healthcare legislation.  They are both strongly committed to ensuring the populations of Washington State have timely access to healthcare.  I realize their time is precious.  So is mine.

Practicing physicians are partially to blame for not insisting our voices be heard by lawmakers.  As a group, we willingly lend our expertise assisting others in our offices, our communities, and our country, yet we accept the status quo as second class citizens when it comes to having a place at the proverbial healthcare policymaking table.  This MUST change.  Lawmakers who passed the foundering ACA and burdensome MACRA legislation consulted very few practicing physicians on the front lines, and their legislative plundering is destroying our once noble profession. 

The last independent pediatric group in my local Congressmans’ hometown was recently purchased by a hospital conglomerate as a direct result of the ACA legislation he supported. Everyone seeking pediatric care in that county will see their costs rise significantly as a result of the mandatory “facility fee” imposed by the hospital for primary care services. This is a loss of affordable access for his community.

After pulling the AHCA bill last Friday, Trump said, “As you know, I’ve been saying for years that the best thing is to let Obamacare explode and then go make a deal with the Democrats and have one unified deal. “  I agree with him.  It will ultimately result in a better healthcare plan for us all.  First and foremost, however, lawmakers responsible for ACA and MACRA legislation must be held accountable for the unanticipated consequences resulting from “coverage with no access to care;” the folly of which is unfolding before our very eyes. 

Physicians care deeply about our patients and our communities. Physicians must ensure they have input on the next healthcare go-around.  Meaningful healthcare reform will require pragmatism, diligence, compromise, and patience.  Working across the aisle is vital to developing better health care legislation for the American people. 

It is time lawmakers consider front-line doctors as the ‘industry experts’ best positioned to contribute to the development of effective and enduring health care reform rather than relying on the renderings of lobbyists who are padding their own pockets as well as those of legislators.  In response to Robert Costa at the Washington Post, I believe President Trump when he said they could not obtain one single Democratic vote.  My own Democratic Representative would not spend five minutes discussing healthcare legislation with me, a practicing physician from the district he represents in Congress.  It is time to roll up our sleeves, shake hands, and get to work.