Neither political party truly represents doctors or their patients

When you walked into the voting booth on Tuesday, November 6, did you do so with a feeling of calm certainty that the man who would get your vote for President was unquestionably the best choice, or even the only possible choice?  Did you feel confident that your candidate’s political party fully supports your political views as well as your personal values?

For many physicians, I suspect that the answer to those questions was not a resounding “yes”.  Perhaps more so than in any previous election that I can recall, there were elements in each party’s platform that many thoughtful physicians might have a hard time accepting.  The extreme left and right wing contingents within the Democratic and Republican parties argue for wildly different policies, but does either of them truly represent the best interests of our profession or our patients?

First, the Democrats

To take a closer look at this question, let’s start with the Democratic Party. Many physicians greeted the passage of the Affordable Care Act (ACA) with at least some sense of optimism.  After all, none of us want to deny care to patients who need it.  All of us have endured capricious and unjust denials of payment by insurance companies, and everyone understands the calamity that can result to a patient from the loss of a job and insurance coverage.

But even while the ink was still damp on the thousands of pages of fine print within the ACA, it became clear that it contained far more of a threat to the practice of medicine than many anticipated.  In essence, it aims to make health care cheaper by allowing non-physicians to practice medicine.  A secondary aim is to devalue physicians’ judgment by imposing “standards” and “protocols” of unproven merit.  This philosophy was perfectly summed up in a recent address by AMA President Jeremy Lazarus, who said, “It once made sense for physicians to value autonomy, independence, and self-sufficiency. But the game has changed.”  Another ACA apologist, Dr. Ezekiel Emanuel, advocates shortening medical education so that new physicians will “become comfortable with group decision making, standardization of practices, task shifting to non-physician providers”—in other words, making sure new physicians won’t have the scientific background to inform their decisions, and will seek the protection of group-think.

If all this wasn’t bad enough, many physicians failed to appreciate the critical moment when President Obama chose not to appoint a physician to succeed Dr. Donald Berwick as acting head of the Centers for Medicare and Medicaid Services (CMS), and instead appointed a nurse administrator, Marilyn Tavenner.  It should come as no surprise that CMS recently gave nurse anesthetists the right to bill Medicare directly for pain management services, over the strenuous objections of the ASA. Nationwide independent practice for nurse anesthetists and nurse practitioners is fast becoming a done deal.  A vote for President Obama implicitly endorsed this agenda.

Next, the Republicans

Yet there are so many reasons why a physician, male or female, might have been embarrassed to disclose to friends an intention to vote Republican in this election.

Sarah Palin and her equally ill-informed colleague in Congress, Michele Bachmann:  You’ll remember Mrs. Bachmann, at one point a GOP presidential candidate, who stated that the HPV vaccine causes mental retardation, and that “The Lion King” could influence children as propaganda for gay rights.

Todd Akin, the Missouri Congressman and unsuccessful Senate candidate, who opposes abortion in nearly all circumstances, and stated that rape rarely causes pregnancy because “the female body has ways to try and shut that whole thing down.”

Rick Santorum, another erstwhile GOP presidential candidate, who believes contraception is “harmful to women” because “it’s a license to do things in the sexual realm that is counter to how things are supposed to be.”

I could go on. But even setting aside the obvious targets, it’s all too easy to find reasons why many physicians were unable to support the Republican cause.  Certainly staunch Republican physicians like Maryland’s Representative Andy Harris, the first anesthesiologist in Congress, and ASA President John Zerwas, who serves in the Texas State Legislature, support physician interests tirelessly.  But it’s hard for their influence to outweigh the negative impact of the Tea Party zealots who tolerate no compromise on contentious social issues.

Here’s where I’m still confused.  I thought that conservatives and the Republican Party believed in fiscal stewardship, limited government, and the freedom of each individual American to chart his or her own destiny.  Yet the Republican candidates of 2012 seemed all too eager to have their influence extend into the most personal and intimate matters in people’s lives, issues that might better involve the counsel of a physician or a member of the clergy than a politician.

In fact, the Republicans didn’t conceal their disdain for a lot of different groups of people in America.  But it wasn’t a clever move to alienate anyone with sympathy for feminism, for immigration reform, or for people who lack health insurance, and it certainly didn’t end well for the GOP.

I’m no expert on immigration policy, but weren’t nearly all of us immigrants at some point?  As the granddaughter of Polish immigrants and the great-granddaughter of an O’Sullivan who (according to family lore) left Ireland one step ahead of the hangman’s noose, I can only be grateful that my ancestors got here before anyone started talking about building a wall to keep immigrants out.  Governor Romney’s talk of “self-deportation” of illegal immigrants was annoying and irrelevant, and it’s hard to understand why he didn’t make better use of New Mexico’s Governor Susana Martinez and Florida Senator Marco Rubio in his campaign.

When we look around our hospitals, it becomes clear how much immigration has benefited American medicine.  The doctors’ lounge and nursing stations look like the United Nations, and it’s lucky that we have physicians and staff who can speak Spanish, Farsi, Chinese, Russian, Armenian, and Tagalog with our patients from around the world.  Can we really criticize people of Hispanic or Asian descent, or anyone else for that matter, who didn’t vote Republican?

Do we need a new American political party?

Here’s my wish list.  I’d like to be able to vote for a candidate who truly believes in limited government and free enterprise.  I believe that there is a role for government in the coverage of trauma and catastrophic illness, but that patients should expect to budget for routine health care, pay their physicians, and pay for routine medications just as they pay for food, shelter, cell phones, automobiles, and legal advice.  I wish everyone would simply let Roe v. Wade stand as settled law, and leave the rest to individual conscience. I support civil unions for consenting adults with rights and responsibilities to be defined by state government, and marriage as a sacrament to be defined privately by religious institutions according to their traditions.  I’d like to keep on practicing medicine as an honorable profession with a proud history, and not live in fear of violating “protocols” set in place by federal government administrators who know little of what we do.

Is that too much to ask?  Can either political party reinvent itself to be a party that physicians could enthusiastically support, maintaining loyalty to the profession as well as to their personal values?  Or do we need a new American political party altogether?  We have just under four years to figure it out.

Karen S. Sibert is an Associate Professor of Anesthesiology, Cedars-Sinai Medical Center.  She blogs at A Penned Point.

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  • http://twitter.com/wellmike15 Michael McNeil

    I understand your busy and a doctor, but to be this woefully misinformed about what each candidate represents is shocking. Next time you vote, you may want to look at what each candidate has done, its also called a record. Do you vote with your head or your heart? For someone who wants limited government, how is Obamacare and the Stimulus limited?

    • http://www.twitter.com/alicearobertson Alice Robertson

      It clearly wasn’t unbiased though pains were taken to appear so. How could the writer have even studied the reproductive issue unbiasedly…and continued to write so much on it without considering the whole gist of the matter. That’s a bad diagnosis:) Surely, you can see it as a “rights” matter, not a feminist or anti-feminist agenda. It’s bothersome to read more, and more agenda driver matter under the guise of supposedly helping patients (the altruist bent in these articles starts to get nauseated). No one is stopping women from paying $4 a month for their birth control. Gosh…you need another soapbox! There are hurting people out there, and doctors are getting blamed for problems they didn’t even create, and then there are articles like this which are more about a feminist agenda than truly a bird’s view of the medical system (where I think men matter too:). I, honestly, think writings like this are purposefully slanted and very unhelpful to the vast majority of patients….and doctors. It just needs cleaned up a bit and resubmitted:)

  • ninguem

    The word “politics” comes from the ancient Greek.

    “poly” = “many”

    “tics” = “blood-sucking vermin”

    Doctors come to learn that neither side is on the doctor’s side, or the patient’s side.

  • http://www.capko.com Laurie Morgan

    Dr. Sibert, I enjoyed your thoughtful column. Did you consider voting for Gary Johnson? I think there was quite a bit of overlap between his platform and your wish list. A libertarian candidate can’t yet get equal standing with the democrats and republicans, but support has grown substantially in recent years — making a third party less of a pipe dream than it once was.

    • http://www.twitter.com/alicearobertson Alice Robertson

      Considering Gary Johnson’s strong views on personal rights, could you write a quick summation on how he would have handled the healthcare debate? What his answers are? If they are similar to Dr. Ron Paul’s answers the article would be pretty short as far as a reflection on third party hat in the healthcare ring.

  • Robert Luedecke

    As a fellow anesthesiologist I commend you on noting problems with both political parties and your beliefs. At least in this last election, both you and I are politically independent, just picking one of the two major candidates that best represent our views. I believe that makes you a thinking individual rather than one who always votes for the same party, no matter who they run or what their platform is. I believe our country would be much better off if there were more thinking voters and the politicians knew they would absolutely lose your vote if they got too far right or left. Bravo for being brave enough to tell us what you truly believe! Obamacare is certainly not perfect, but are we the only industrialized country in the world who can’t figure out some way to insure all citizens? In Texas, the Republican party is the party that goes into our exam room and comes between us and our patients. How does that make sense?

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