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Four Themes of 2016 Republican Convention

Well, it’s one convention down, and one to go.  All in all,  the four themes worked.  Republicans had a positive convention.  Now we shall see what the Democratics convention have to offer.  

Trump missed the boat on one issue.  It was failing to talk more about  the future of ObamaCare and the  positive role of physicians in providing that care and giving them the respect they deserve.  

Not About ObamaCare

This blog is not  about whether ObamaCare is repealed or replaced.  

Whoever is elected,  elements of ObamaCare will be changed.

- Individual and employer mandates and how health exchange subsidies are paid will be modified. 

-- Provisions for not excluding those with pre-existing conditions and for covering young people under 26 will be retained. 

--The Public Option will not be passed. 

--Decline in the number of uninsured under ObamaCare  from 16% to 9% will be celebrated. 

--Number remaining uninsured (29 million) will be lamented.

--Merits of government-based  coercion  coverage versus market-based choice  coverage will continue to be debated.

Loss of Respect for Doctors

What  the Trump campaign failed to mention was the loss of respect for doctors in providing that care.   Doctors feel under siege from  critics, the media,  lawyers, regulators,  and government officials who insist physicians be responsible  for installing  and maintaining  electronic health records to collect data the government says it needs to dictate how physicians practice.   It comes down to: who decides – government or doctors .  It comes down to whether doctors should be treated as trained professionals or data-entry clerks  or regulated serfs for government.

Coburn and Krauthammer

As Tom Coburn, MD, the Oklahoma senator remarked in 2009 – “The idea that a bureaucrats somewhere will make decisions about health care and coverage  I think is untenable to most Americans.” 

Or as Charles Krauthammer  observed in a 2015 Washington Post piece after attending his 40^th Harvard Medical School reunion,” My colleagues have left practice all say they still love patient care, being a doctor.   They just couldn’t stand everything else….the never-ending attack on the profession from government,  insurance companies, and lawyers,,, Progressively intrusive and usually unproductive rules and regulations, topped by an electronic health records mandate that produces nothing more than billing  and legal documents, that have degraded medicine.”    In other words, documenting had replaced doctors as the main mission of clinicians.

Collective Paranoia

As a consequence of this loss of respect and misguide mission, a collective paranoia has set in among physicians.   Physician burnout and suicides are mounting.   Practitioners  are abandoning private practice.  Two-thirds of doctors feel the quality of medicine is deteriorating.  Physician shortages , now 50,000, are expected to grow to 100,000 by 2020.

In his acceptance speech,  Trump should have defended doctors  just as  he so effectively defended the police.  The police help maintain law and order and protect  people again crime.   Physicians help maintain health  and protect people against disease.

Yet seldom is heard an encouraging word.  We need to be told so we can again take pride in our profession.  Peter Pronovost, MD, head of the Johns Hopkins Patient Safety Institute, advanced this novel proposal in the July 21 Health Care Blog,  "Let's trust our doctors." It's worth a try, and it would make doctors feel better.