I’m a Democrat physician and I’m voting for Trump
Editor’s Note: which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Anish Koka, a cardiologist in private practice in Philadelphia. The views expressed in these blogs are those of their respective contributors and do not represent the views of or UBM Medica.
As a long-standing member of the Democratic Party, I have a confession to make. I am voting for Donald Trump. The journey from a man like Obama to a man like Trump was surprisingly short, forged as I started a small independent practice three years ago in the crucible that is healthcare.
Current times mandate that I first dispense with the incoherent and tired case made to disqualify Trump as a racist, misogynist, xenophobe who is a harbinger of the apocalypse. We have come to live in an age where dissent from a very narrow norm validated by an equally narrow band of liberal elites is not to be tolerated. Dissenting opinion is vilified and deemed offensive. Saying all lives matter makes you are a racist. Arguing for more restrictive immigration makes you a xenophobe. So yes, I have trouble digesting that Donald Trump, the socially liberal, Elton John-loving recent Democrat will threaten democracy, the republic, or civilization as has been solemnly warned.
Hyperbolic threats to the republic aside, a very concrete threat to medicine exists in the form of well-intentioned administrators trying desperately to save medicine from its physicians. Sachin Jain, M.D., the former senior adviser to the Obama-appointed administrator of the Centers for Medicare & Medicaid Services (CMS), Harvard Medical School alum and current rising star in healthcare delivery notes:
“The simple image of the physician-patient relationship that draws many of us to medicine – the dedicated physician, the thankful patient—is no longer.”
Is it any surprise, then, that the innovation that has emerged over the last eight years relates to the physician as data-entry clerk, reporting on quality metrics that do not relate to actual value?
Did you see this? Internist has starring role at RNC
The patchwork of payment schemes is now to be replaced by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which in turn took the place of the prior flawed Bill Clinton-era Medicare Sustainable Growth Rate (SGR). The MACRA proposed rule has been panned almost universally by the practicing physician community due to its immense complexity. Stunningly, the messiah who was supposed to solve the healthcare cost conundrum, Barack Obama, weakly mustered a plan to reduce physician reimbursement, yet left untouched the monthly mortgage that hospitals can charge the uninsured for a pack of Band-Aids.
As a result of avoiding the pesky cost issue, the Affordable Care Act (ACA) expanded coverage effectively but costs a pretty penny to the government in the form of federal subsidies, and to the average patient in the form of high deductibles and ever-increasing premiums. The higher non-deductible cost to patients is by design as it is intended to turn patients into bargain shoppers who would, in an ideal world, exert downward pressure on healthcare costs. Unfortunately, the gentleman with the dissecting aorta for some reason does not appear to be in the best position to bargain when he needs surgery.