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Don’t Mix Politics with Patient Care

By Dr. Chris Lillis
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I am a doctor who strives to keep politics out of my exam rooms.  I find that discussing religion or politics with my patients can reveal our personal differences and ruin the trust that is needed to maintain a healthy doctor-patient relationship.

With this in mind, I would like to respond to Dr Hal Scherz’ opinion piece.  He and his organization, Docs4PatientCare, seem to find their energy from opposing “Obamacare” rather than helping increase Americans’ access to health care.  He takes the step to actually encourage his patients to vote against the bill.  For me, that is going too far.  As a clinician, I advise my patients on their health, not how to vote.

I work with over 16,000 physicians who wish to improve the health of our fellow citizens by reforming our health care system.  Doctors for America and I support the Patient Protection and Affordable Care Act (PPACA), which seeks to improve lives and save costs by increasing access to care.

Dr Scherz slanders the law.  He claims that “Section 1311” of the PPACA is going to give powers to the federal government to command physicians how to practice and “…effectively makes them government employees.”  He alleges that this new law “politicizes medicine and…destroys the sanctity of the doctor-patient relationship.”

I would first ask Dr Scherz, “Have you read the PPACA?”  Clearly, section 1311 deals with the requirements for States to establish insurance exchanges, and does not mention once any requirement for doctors to conform to any standard of care.  These exchanges, which will serve as clearinghouses for private insurance companies, will serve to increase competition in the individual health insurance market that is currently priced out of reach for the average American.  Perhaps Dr Scherz should read the law prior to spreading these falsehoods.  You can search the PPACA here: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3590enr.txt.pdf

In fact, there are no provisions in any part of the PPACA that establishes care guidelines, and there is no legislative language instituting any penalties or fines for doctors providing care…unless they choose to defraud Medicare. I applaud the provisions of the PPACA that encourage comparative effectiveness research, which will help physicians learn which medical therapies are most effective, but will certainly not dictate to any physician how they should or should not practice medicine.

Dr Scherz does not stop with the fear-mongering there, however.  He states that the PPACA “badly exacerbat(es) the current doctor shortage.”  I do not understand how he seems to ignore the provisions in the PPACA that increase Graduate Medical Training positions in primary care, establish new teaching centers in rural areas, increase scholarships and loans to those choosing a career in primary care, and provide States grants to improve access to care in rural areas.   

Furthering his efforts to obscure the facts, he claims there have been “countless protests by doctors and overwhelming public opposition” to the PPACA.  There have also been countless protests by doctors in favor of the PPACA – I have attended many of them.  However, public opposition seems to rapidly disappear once proper education about the law occurs.  It is true that public opinion is roughly evenly split when asked about health reform as a whole, with 43% of respondents being in favor and 45% opposed.  However, majorities of those polled are in favor of several provisions in the law: 1) eliminating insurance companies’ ability to refuse a policy for pre-existing conditions (72%),  2) giving tax credits to small business to afford health insurance for employees (71%), 3) preventive care without co-pays (70%), 4) prohibiting rescission (68%) and 5) closing the Medicare “donut hole” (64%).   The only point Dr Scherz seems to make here is that the buzzwords used by health reform opponents such as “rationing,” “death panels,” and “government takeover” are highly effective at frightening the public.

The example of Missouri is also wildly misleading.  Dr Scherz claims that “voting by a margin of 71%-29%...” Missouri voters “reject the federal requirement that all individuals purchase health insurance.”  Dr Scherz is correct that a mandate for purchasing insurance is one of the least popular provisions.  But the case of Missouri grossly overestimates this unpopularity.    The referendum was voted on at the same time of the party primary elections in Missouri on August 3rd.  Around 17% of residents of Missouri voted on August 3rd (939,000 out of a population of 5,987,580 residents) and those voters were disproportionately represented by Republicans due to the contentious nature of that State’s GOP primary.  Performing some simple math, 71% of 939,000 voters represent around 667,000 people, or roughly 11% of the populace.  Is Dr Scherz suggesting we should shape national policy based on 11% of our population?   What if we allowed 11% of the residents of San Francisco or New York to choose our national legislation?   

I also wonder how Missouri’s citizens would feel about the individual mandate once they know its benefits.  It will prevent skyrocketing premiums and reduce uncompensated care that we all currently pay for through our taxes that reimburse hospitals.  Subsidies for health insurance will be available for up to 20 million US families so they will finally be able to afford health insurance.  I believe Americans will embrace health care reform when they learn the facts of its many benefits, instead of being scared by fear-mongering rhetoric.

I am a primary care physician.  I see a fragmented health care system that is excellent for those with health insurance and other means to pay for health care.  But I also see the consequences of a lack of access to care as I volunteer at my local Free Clinic. I disagree with Dr Scherz and his decision to introduce divisive partisan politics into his clinical practice and the practices of members of Docs4PatientCare.  I choose, through my advocacy work, to offer policy makers and the public positive suggestions to further improve our health care system.  But I base my advocacy on fact, not fiction.  For me, it is about patients, not politics.  When I care for my patients, I am their doctor, not their political advisor.

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