Dear Mr. President

March 31, 2017

An open letter about the recent healthcare legislation.

First off, you have my sympathies for what must have been a supremely frustrating experience recently, trying to extricate us all from the healthcare mess your administration inherited. One does not practice medicine for long in this country without painful knowledge of what it’s like, trying to herd cats…evidently felines run for Congress, as well as go to medical school. Hearing more than a bit of chatter from others “in the trenches” of providing healthcare to the populace, I sensed no overall consensus of support for or resistance against the recent bill. What does seem clear is a healthy majority is disappointed nothing ultimately changed, and we’re left with the status quo. It seems paradoxical: If the current state of affairs is unpalatable, why would there not be a groundswell of support for some sort of change-even if said change was less than perfect?One reason that comes to mind: Only a small minority of docs seemed at all familiar with the terms of the bill. And, none had any sense of input into the new healthcare plan. If that sounds familiar, it should-because, about seven years ago, the same state of affairs had an awful lot of docs feeling demoralized about how PPACA (Obamacare) had been written up and unilaterally pushed into law. The Omnibus Bill, let alone the infinite subsequent regulatory verbiage to follow, was massive enough to defy reading or comprehension by any one person. Small wonder one of its key supporters noted it had to be passed before we’d find out what was in it. Oh, there was a token gesture or two of having physicians on board. A White House photo-op with a few people in lab coats, for instance, and a statement of support from the AMA (which doesn’t represent the vast majority of doctors and had some of its own axes to grind-but, that’s a subject for another blog). I have yet to make the acquaintance of a single individual who had input into word one of the law. It does not, as you might imagine, give a doctor a sense of representation, or indeed any illusion of control over his own profession. To say nothing of a typical citizen’s sense of control over his healthcare. This time around, I had higher hopes since Tom Price was involved. At last, an actual physician, central to the process! Many (I’d say most) of us remain encouraged that he’s in the mix.Still, the most recurrent theme I’ve encountered among docs who were either opposed to the recent bill or uncertain about it, has been that it didn’t address many of their greatest concerns. Not exactly surprising, since there was also no sense of outreach beforehand to find out what those concerns were, let alone how those docs actually providing the healthcare felt about what changes would be most beneficial. So, again, my condolences for your recent ordeal. Not because I think it’s a huge setback: You’re barely into your term of office, with Congressional majorities in your favor; You’ll get it done, and much more besides. I just imagine it’s annoying beyond belief to have a bunch of armchair quarterbacks, especially your buddies in the press, trying to gin this up into a bigger deal than it has been. What I would suggest is taking this opportunity to succeed where the previous administration failed so horribly: Get the healthcare workers on board with your next move. Not lame, hollow gestures like those trotted out seven years ago, but actual outreach to working docs, nurses, and PAs who keep the system functioning 24-7-365. Find out what they think they need, what’s holding them back, and how they’d want things to run differently. Maybe even involve some of them in writing up the new rules. If you have their clear backing during future efforts to fix what has been broken, I have little doubt that ample support from Congress, and indeed the citizenry, will follow.