This letter is in response to "Will The Health Overhaul Improve American Health Care? An Open Letter to Medical Students" by U.S. Senators John Barrasso, MD (R-WY), and Tom Coburn, MD (R-OK)
Dear Senator Barrasso and Senator Coburn,
As physicians-in-training, we appreciate your effort to provide insight into the future of medicine and your invitation to join the health care reform conversation. We write to offer a perspective on health care reform that values progress for both physicians and patients - a perspective unfettered by special interests and strengthened by the belief that the system can place people before profits. The Affordable Care Act will shape the clinical landscape and climate we will practice in for the rest of our lives. The decisions you make today will determine our ability to provide quality, affordable health care for all Americans for decades to come. The health of our nation relies on you to make these choices as physicians, not as politicians.
The health care system that we, the next generation of physicians, will inherit is in shambles. The system is dysfunctional not only for the physicians who work within it, but more importantly, for the patients whom it should serve. With more than 50 million Americans uninsured, millions more underinsured, 45,000 Americans each year sacrificing their lives for private insurers' bottom-lines, and 1.5 million bankruptcies attributable to medical costs, the physician-patient relationship already suffers as a result of bad policy. To pretend that this is not the reality facing many Americans by resisting reform violates another basic tenet of medicine - first do no harm. An overreliance on free market ideologies through the choice and competition you champion have already driven the Norman Rockwell physician out of business. The new reforms are not changing a perfect system, they are rescuing a system on the brink of collapse.
The Affordable Care Act contains numerous provisions that we sincerely hope to see implemented. Foremost is the Prevention and Public Health Fund which ensures that resources are available for community-based wellness promotion activities. Similarly, federal funding of comparative effectiveness research will provide unbiased information that clinicians can use to provide better, more efficient, and more effective care to patients.
Medicaid expansion is an element of the Affordable Care Act that should be celebrated, not condemned. Without Medicaid expansion, many of our nation's most vulnerable populations will continue to be denied access to the care they need -- until they are left with no choice but to go to an emergency room. This maldistribution of resources drives up costs for all Americans - even the insured. We agree that Medicaid reimbursement rates could and should be sufficient to cover the costs of care and incentivize greater provider participation. We look forward to your support for such federal legislation in the 112th Congress. At the end of the day, however, Medicaid expansion is not really about physicians and their reimbursement rates, it is about patients. For the vast majority of those Americans who will now be Medicaid eligible and able to seek care, the only alternative is to remain uninsured.
The Affordable Care Act also invests in our health professions workforce. The National Health Service Corps and programs such as teaching health centers have a track record of developing robust primary care clinicians. These reforms will play a vital role in ensuring that our workforce is better aligned with our nation's health care needs. Similarly, the National Health Care Workforce Commission has been charged with health professions workforce planning and should be fully funded to accomplish this monumental task.
The imperfection of the Affordable Care Act is not that it went too far, but that it did not go far enough to address profit-driven intrusions into the patient-physician relationship. The alleged solutions presented are predicated on political self-interest rather than Americans' health care needs. Your assertion of having supported reforms that would provide affordable, high-quality coverage within reach for every American is not borne out through fact or experience. For as of now, only one system has been able to achieve that goal: Medicare. Medicare provides much-coveted government funded care for millions of Americans while operating at a fraction of the administrative costs associated with private insurance. Expanding Medicare-for-all provides the best hope of realizing access to high quality care for every American while remedying the crippling burden that health care costs place on our economy.
We all agree that the health of millions of Americans can no longer serve as a political football. The overwhelming majority of physicians agree that key provisions of the Affordable Care Act will improve access to health care services for millions of Americans. Leveraging the good faith that the American people have put in physicians for your own political gain is an affront to the core tenets of medicine in which we are all trained. Act as physicians, not as politicians; prioritize health over politics. Please stop obstructing health care reform implementation.
Iyah Romm, MD Candidate
John Brockman, MD Candidate
Elizabeth Wiley JD, MPH, MD Candidate
Sylvia Thompson, MD, MPH
The authors are current or former national leaders of the American Medical Student Association (AMSA)