GOP’s Oddest Obamacare Rejection: “Patient-Centered Healthcare”

The reason that Republicans shut down the federal government, it turns out, was to “restore patient-centered healthcare in America.”


As the lead author of a policy paper entitled, “Will the Affordable Care Act Move Patient-Centeredness to Center Stage?” I admit to a certain guilty thrill when I read this precise demand coming as the climax of a letter sent by 80 hard-right representatives to House Speaker John Boehner (R-OH). You don’t get much more “center stage” than shutting off the federal money spigot, which is what the letter – discussed in a recent article in The New Yorker – threatened unless the ACA was defunded.

Having said that, patient-centeredness was a truly odd choice to occupy a central role in the conservative casus belli that ended up disrupting the entire U.S. economy until the right wing finally caved.

To begin with, the term is a minor piece of jargon likely to draw blank stares from pretty much the entire American public. Even for us health policy mavens, the GOP letter linking James Madison on the redress of grievances to defunding Obamacare to a “restoration” of patient-centeredness required major mental gymnastics.

Then there’s the unintentional linguistic irony. The term “patient-centered medicine” originated after World War II with a psychoanalyst who urged physicians to relate to patients as people with physical and psychological needs, not just a bundle of symptoms. “Patient-centered care” further defined itself as exploring “patients’ needs and concerns as patients themselves define them,” according to a book by the Picker/Commonwealth Program for Patient-Centered Care, which coined the term in 1987. Patient-centered care was adopted as a “goal” by the Institute of Medicine, which added its own definition, in 2001.

But here’s where the irony kicks in. Obamacare opponents assert that the ACA undermines the traditional doctor-patient relationship – although I suspect that being able to pay your doctor because you have health insurance actually improves it quite a bit.

Yet in calling for “patient-centered healthcare” instead of the more common “patient-centered care” or even patient-centered medicine, conservatives unwittingly abandoned doctor-patient language in favor of business-speak.

“Healthcare” as one word was pioneered by Modern Healthcare, a business magazine for hospital executives. The one-word version has become a business standard, whether used by the “healthcare” systems that own hospitals, like Tenet Healthcare, or by corporate entities such as GE Healthcare.

Doctors, on the other hand, “care for” patients. It is that rootedness in caring that explains why major medical journals spell “health care” as two words and professional societies focus on “patient-centered care,” not “healthcare.” In other words, those hard-right House Republicans putatively working to “restore” the traditional doctor-patient relationship are talking in language whose corporate overtones would make a traditional doctor bristle. “Patient-centered care,” the language of patients, is the term employed in the ACA.

However, what is oddest about the conservative demand for “patient-centered healthcare” is neither its obscurity nor its spelling, but its substance. The ACA can be fairly accused of many failures, but there has never been any major law anywhere that focuses so explicitly on patient-centeredness.

A simple search of “patient-centered” in the final version of the ACA on the GovTrack.us website turned up 43 mentions. Among the most prominent was a mandate to establish a national strategy for quality improvement that includes “patient-centeredness of health care for all populations, including children and vulnerable populations.” As my co-author Juliana Macri and I wrote in our Urban Institute paper: “The law repeatedly refers to patient-centeredness, patient satisfaction, patient experience of care, patient engagement and shared decision-making in its provisions.”

We even listed specific programs where the ACA requires use of “patient-centered” quality measures, including Medicare Advantage, the favored conservative alternative to fee-for-service Medicare, and the Patient-Centered Medical Home, an effort to strengthen primary care.

In its approach to the doctor-patient relationship, Obamacare might better be seen as incorporating this piece of wisdom from a Republican with impeccable conservative credentials: “The provision of medical care has become one of the largest industries of the country…[That has] created issues from which society cannot escape merely through its own optimism or through confidence in the high character of medical practitioners.”

That was Dr. Ray Lyman Wilbur, an American Medical Association president and member of President Herbert Hoover’s cabinet, assessing why medical care costs were going up. He offered that opinion in 1933. Thinking about what patient-centeredness truly means, today’s conservatives would do well to listen.

Michael L. Millenson is president of Health Quality Advisors LLC in Highland Park, IL and the Mervin Shalowitz, MD Visiting Scholar at the Kellogg School of Management. This post originally appeared in Forbes.

15 replies »

  1. I actually believe that patient-centered care may have a negative effect on healthcare in the short-term but over a long period of time, it has proven to improve the delivery of care in our healthcare system. There are still some problems that we face with the patient-centered care movement. However, I think that if, as a nation, we don’t try to at least consider this as a possibility, we may end up with a crippled healthcare delivery system. The start of medicine was to help people feel better. I don’t think that we should lose sight of this as we continue to build insurance companies and such.

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  5. What an embarrassingly flawed analysis. The policies available on the exchanges are structurally unworkable for the middle class, and the entire piece of legislation ignores the supply side of the equation.

    The ACA is DOA.

  6. It is par for the course that Joe the Plumber doesn’t do reading comprehension. Normal people who read the article would take from it that the ACA indeed demands that the care be patient centered and that the procedures follow that precept. And it is very doubtful that the people who are making that complaint chose “healthcare” by accident. Their whole orientation is to the business world, and it is very likely that “healthcare” is the only way they’ve ever seen the concept expressed.

    As for Linda’s complaint, it is irrelevant for the ACA because it is a problem of the medical profession/politics, not the insurance industry. As a matter of fact, part of the problem here in TX is that Gov. Goodhair and his merry band of kleptos made it all but impossible for someone who has been the victim of malpractice to sue for redress. This was all done in the name of Tort Reform™, and it resulted in TX becoming a haven for incompetents running from their home states before they got booted. It also resulted in incompetents not caring whether or not they did a good job because there were no consequences.

  7. “the title of the law– the affordable care act — which, it turns out, is absolutely not for many more than it will help”

    And, you know this accurately already precisely HOW?

    “Joe.” Whoever you are.

  8. First of all, the GOP objections to the law focus almost exclusively on the insurance mechanism. The contention that it will hurt patient-centered care is not supported by any evidence from the law itself. The hackery about quackery comes from opponents. There are legitimate concerns, but they are not cited.

    Second, conservatives like, say, William Safire, as opposed to radicals, like, say Ted Cruz, know that words have meaning. There are real, substantive improvements to patient-centered care in the ACA that have a long history of bipartisan support.

    Finally, I’m not talking about affordability or any other aspect of the law. This is what’s known as changing the subject.

    People who make accusations without reading the law are…well, I won’t say stupid, but…it’s embarrassing to see on a website like this one.

  9. So what are we going to do about Insurance companies. Doctors and
    Hospital that lie and cover up botch surgeries and deny proper medical
    review for those patients, I’m sure their are those in the medical system
    that know what I’m talking about. Like this one, (((( Robert W Robinson vs
    Cigna Health Care , Dr Gary Gartsman of the Fondren Orthopedic Group , The Texas Medical Board , Dr Angela McCain , Aetna Health Care , The Texas Insurance Board. ))) Now these people can deny this all they
    want and like they always have been. But this one thing they can never do is to prove Robert wrong by challenging Robert in public over his complaints.What is worse than cancer? Doctors and Hospitals and Insurance companies that will lie and cover up medical mistakes. How sad it is to know that this sick way of thinking still goes on with are so called elite in our health care system, the very ones that advertise how great and caring they are.

  10. Michael- I am embarrassed for you… Making a political case to effectively say Republicans are stupid because of the number of mentions of patient centered care in the law???

    So, the title of the law– the affordable care act — which, it turns out, is absolutely not for many more than it will help — is also true because it is there on paper?

    Hackery… and rather embarrassing hackery, at that.