Dr. Smith Goes to Washington

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.

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8 replies »

  1. Barry, again, thanks for pointing out the difference between physicians and some politicians. I suppose healthcare will not be fixed without physician input and Congressman will block physician input if they don’t donate. At least we all know where we stand. Patients are screwed.

  2. Well good. Next time I will ask someone what their party affiliation is before helping with their medical emergency. Good to know that would be considered ethical. Thanks for letting me off the hook on this one.

  3. I meet once or twice a year with our Congressman, it is not difficult to get meetings with state reps, but have had only a couple of meetings with Senators. I have rarely asked to meet alone, but help organize groups, varying from 2 (is that a group?) to about 10. I think they, pretty reasonably, are more inclined to talk with you if you represent multiple physicians. In their position, unless you are well known, I wouldn’t expect them to spend a lot of time with single docs since they have no way of knowing if that doc is just a crank or is presenting ideas common to many other docs. Just as a practical matter if you don’t have the leadership or communication skills to get others to agree with you, not sure why you should get special attention anyway. (Had to actually donate money to get to speak with Santorum. Boy did that hurt.) Some politicians won’t meet if you are not a member of their party. I suspect that is because you are not then seen as a potential donor.


  4. Politicians tend to be much more responsive to significant financial contributors whether they have any expertise on a particular issue or not. As for staffers who work on healthcare issues, it might be useful to find out what healthcare blogs, if any, they read or monitor. In the politicians’ defense, they have lots of demands for their time and are therefore time constrained.

    The big financial contributor is always going to get called back before the non-contributor. It’s just the way the game is played unfortunately. The biggest priority for them is to get re-elected and if I were in their shoes, I would probably do the same thing.

  5. Niran,
    In the last 8 years, I have sent a letter requesting a meeting 4 times to my State’s two senators and my community’s Representative. The letter was sent to each legislator, copied to the other three. On two occasions, I was given time for a conference with my senator’ staff six times, and none from the two sequential Representatives. I had a brief phone call with Senator Ben Nelson once. So be it, for accessibility. To be sure, I perceive this to be a reflection of their own view of the political accessibility exhibited by the healthcare industry, another example of its high level of internal institutional co-dependency.
    I also periodically make contact by email with journal authors regarding healthcare reform. Not only do I virtually never receive a response, but I also have never received an acknowledgement. The only person who always responds is a venerable economist at the Brookings Institute.

  6. Anish, this type of dismissive treatment of practicing physicians, who know the subject matter, is unacceptable. Legislators appear to be so consumed with taking “celebratory selfies” and acting like 2 year-olds, they can’t make time for the hard work. What do you think would happen if we started posting selfies when we closed to Medicaid patients? It is despicable. The status quo in Washington DC is part of the problem and it will not get fixed until we stand up and be counted. This is me, standing up. Whether it counts, well, we will see.

  7. I’m sure they were just busy.

    Maybe somebody should create an online service collect this feedback for them and preserve it online in perpetuity ….

    Like Wikileaks for representative democracy

    / j

  8. Hah, I’m waiting for a call back from my local representative as well.