Health Policy

Doctors Will Vote With Their Patients

By MIKE MAGEE, MD

As Robert Muller’s testimony before Congress made clear, we owe President Trump a debt of gratitude on two counts. First, his unlawful and predatory actions have clearly exposed the fault lines in our still young Democracy. As the Founders well realized, the road would be rocky on our way to “a more perfect union”, and checks and balances would, sooner or later, be counter-checked and thrown out of balance.

On the second count, Trump has most effectively revealed weaknesses that are neither structural nor easily repaired with the wave of the wand. Those weaknesses are cultural and deeply embedded in a portion of our citizenry. The weakness he has so easily exposed is within us. It is reflected in our stubborn embrace of prejudice, our tolerance of family separations at the border, our penchant for violence and romanticism of firearms, our suspicion of “good government”, and –unlike any other developed nation – our historic desire to withhold access to health services to our fellow Americans.

In the dust-up that followed the New York Times publication of Ross Douthat’s May 16, 2017 article, “The 25th Amendment Solution for Removing Trump”, Dahlia Lithwick wrote in SLATE, “Donald Trump isn’t the disease that plagues modern America, he’s the symptom. Let’s stop calling it a disability and call it what it is: What we are now.”

Recently a long-time health advocate from California told me she did not believe that the majority of doctors would support a universal health care system in some form due to their conservative bend. I disagreed.

It is true that, to become a physician involves significant investment of time and effort, and deferring a decade worth of earnings to pursue a training program that, at times, resembles war-zone conditions can create an ultra-focus on future earnings. But it is also true that these individuals, increasingly salaried and employed within organizations struggling to improve their collective performance, deliver (most of the time) three critical virtues in our society.

First is the patient-physician relationship marked by compassion, understanding and partnership, committed to individualized care without prejudice.

Second, in the normal course of care, though inclusion, involvement and planning, doctors reinforce important bonds between individuals, families and society.

Finally, doctors allay fear and worry, which, in their absence would accumulate and eventually undermine safety and security in our society.

In a short two decades of this new century, technology, global markets, and climate change have left the American experiment in all manner of disarray. Justice, tranquility, defense, welfare, and liberty itself have been undermined. Our prime-age workers in the bottom 60% have seen no real income growth in four decades. During this span, the income of the top 10% has doubled, and the income for the top 1% has tripled.

Our nation has not figured out how to get along economically with our market equal, China. New York Times columnist Thomas Friedman says we have no “rules, norms, or laws” to protect trust and truth in a world of social networks, cybertools, and cyberbullies. We have moved from a “work, learn, retire” model to a “learn, work, learn, work, learn, work” survival mode.

We need to listen to our own Preamble and our own history. It states:  “We the people of the United States, in order to form a more perfect union, establish justice, insure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity, do ordain and establish this Constitution for the United States of America.”

It suggests that, in establishing our Constitution, we continually must determine how best to promote and maintain a healthy nation filled with healthy citizens – mind, body and soul.

The 2020 election is an opportunity to reclaim self-governance, to plan, to work, to build together. Universal health coverage is not the only platform from which to launch a recommitment to our common future, but I would argue, it is a logical starting point to pursue “a more perfect union” during these turbulent times.

Excluding moments of self-doubt and discouragement, I believe most doctors know they are appreciated, and even loved by most of their patients. They also know that the current system is highly variable, inefficient, and wasteful.  They have spent enough time idled on insurance pre-approval lines, seen enough Pharma ads imploring their patients to “Ask your doctor”, and witnessed enough lives shortened by human error to know we can do better than this.

When push comes to shove, doctors will vote with their patients.

Mike Magee is a Medical Historian and author of “Code Blue: Inside the Medical Industrial Complex” (Grove Atlantic/June, 2019).

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Peter
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Peter

“Doctors Will Vote With Their Patients”

Which ones, those with good insurance and above average incomes/job benefits, or the patients who struggle to pay premiums/deductibles/co-pays as well as the uninsured?

Bobby Gladd
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Peter, I’d encourage you to read his book.

Peter
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Peter

My post was a cynical rhetorical question, not intended to promote a blog. Docs, as a group, have never advocated for “affordable” health care – quit the opposite.

mike magee
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Thanks, Peter. It’s a good question. When we developed the Empathy Scale at Jefferson in Philadelphia in the late 1990’s, we felt that our Medical School Admissions got it right about 2/3 of the time – high in empathy. We also noted that levels consistently declined beginning in the 3rd year of Med School and extending thru residency. My own bias is that most (but not all) physicians will support universal coverage on behalf of their most vulnerable patients.

Bobby Gladd
Member

Great post, thank you. Your book looks fascinating. I can see I’ll be falling even further behind on my reading list for my KHIT.org blog. Just finished up Louise Aronson’s “Elderhood,” which was outa the park.

“You’re going to have such great health care, at a tiny fraction of the cost—and it’s going to be so easy.” – Donald Trump, Oct 2016 rally in Florida