Health care shouldn’t be a political issue

This post deserves a caveat — health care shouldn’t be a political issue. When someone comes into my office because they have chest pain, I don’t ask them, “What’s your political leaning?” before administering care. And now after reading about the recent delay of ICD-10 in Congress, I realized that my choice in practicing direct care was the most political and least political thing I could have done.

According to Politico, in neck-breaking fashion, GOP leadership took to the House floor in March and voice-voted a one-year patch to the sustainable growth rate (SGR is the pricey formula that determines how much the government pays doctors who treat Medicare patients).

It was a team effort, though. Republican leaders worked with their Democratic counterparts to orchestrate the ploy. As members were returning to the floor as the House came into session, they realized that the bill had already passed.

Nearly all of them were surprised. That’s because no one had the chance to vote no. And no one had a chance to vote yes.

The maneuver came after a long delay amid opposition that threatened to kill the bill and had GOP leaders trying to chart a course to pass it. It was a slick move, to say the least, for a Republican leadership team that for years was obsessed with operating the House under regular order. Even before the delay, GOP leadership was considering a voice vote. They asked Democrats about the tactic. Democrats were initially skeptical but later agreed.

But this time, Republican leaders were constrained: They would have had to find upwards of 270 yes votes to pass the bill under the fast-track mechanism they set up. They could have waited until next week to lower that threshold to 218 votes but decided to move ahead that Thursday.

And now let’s make this long line of crises even more dramatic: Fee-for-service physicians were faced with a 24 percent pay cut under Medicare on April 1 if Congress didn’t act. And they didn’t. But the president did, signing a new bill that would delay the cuts by another year.

And that right there is what’s so disheartening about the prospects of entering medicine today. That a practice might be made or broken by something happening in a room in Washington. That lack of control was one of the main drivers for me starting a practice that operated outside of the insurance system.

On one hand, that might make me a very political doctor. But on the other hand, I really am an apolitcal doctor. I’m here to do two things: provide high quality care and make high quality care more affordable.

Yes, it’s my personal belief that by pushing healthcare closer to a free market model, overall costs will fall. Although, technically this isn’t just opinion. My patients are a testament to the potential savings offered by the direct care model.

In the end, though, I just want the opportunity to practice good medicine, and make a good living for doing exactly that. For me, the less Washington has to do with that, the better. I don’t want to waste time riding someone else’s roller coaster. I just want to practice medicine to the best of my ability.

Josh Umbehr is founder, Atlas.md.

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  • Patient Kit

    On Nov 6, 2012 (Election Day), while I was in the exam room in stirrups, the private practice OB/GYN who initially found my suspicious ovarian tumor, told me two things: (1) It was likely that I had cancer and I needed surgery asap and (2) If I voted for Obama, I would get what I deserved.

    Needless to say, she is no longer my doctor and did not perform my surgery and I am never ever going to make a doctor’s appointment on Election Day again. I don’t deny her right as an individual citizen to voice what she believes politically, but her behavior as a doctor inside her exam room that day was inappropriate and unprofessional and political. It wasn’t the time or place for a political rant, regardless of how strongly she felt about Obama and the ACA. There are plenty of places for doctors to be politically active outside of the exam room.

    Healthcare clearly is a hot button issue that many of us feel passionately about. The stakes are very high for everybody. As we grapple with making the biggest changes in our healthcare system since 1965, I don’t see how we can keep politics out of it. Frustrating as it can be, for better or worse, that’s how things get done (and don’t get done in this country). I don’t see why healthcare should be immune from politics any more than any of the equally important issues that we must deal with as a country. How else are we going to work out such polar opposite opinions such as whether our healthcare system should be a business or not?

    There is little doubt that, at the Washington level, politics are often corrupt, sleazy, dirty, self-serving and power driven.
    But to me, that is why it is so important for the ordinary American people to be politically active and engaged. Vote, speak out, take action, participate. Otherwise, we leave our fates totally in the hands of career politicians, who have their own personal agendas.

    I don’t think doctors should let their politics get in the way of how they treat their individual patients. But I think it is important for docs to be politically active, maybe even now more than ever.

    • LeoHolmMD

      I agree, the exam room should be free of politics. That time belongs to the patient. But what forum is there otherwise?

      • Lisa

        Your professional organizations and your elected representatives and your vote, the same as everyone else.

        • LeoHolmMD

          To discuss with patients?
          The paths you mention do not lead to a dialogue with patients.

          • Lisa

            I do not want my doctors to engage in political dialogue with me while I am in the treatment room. Think of the implications – if I didn’t agree with them would they engage in some sort of retaliatory behavior? Are they concentrating on politics instead of my treatment?

            If you want to convince patients (and everyone is a patient, at one time or another) of your political point of view there are many other forums besides an exam room, as Kit suggested.

          • Dr. Josh, AtlasMD

            This doctor held town halls with her patients to help find a way that worked great for them.

            https://www.youtube.com/watch?v=5cvHgGM-cRI

      • Dr. Josh, AtlasMD

        I think the falls back on the patients and the doctors to find a situation that actually works, rather that weight things down with red tape. We’ve done that and there is plenty of proof that it is not working.

    • Lisa

      Kit, the story of your ob gyn behavior makes me mad, especially as she dropped you as a patient once you didn’t have insurance.

      • Patient Kit

        Not to mention that she told me that I needed to “find the money” somewhere for surgery, sent me out docterless with a new cancer dx and no advice about where I might find help and, worst of all, didn’t even wish me good luck. Definitely my worst doctor experience ever. Needless to say, I will never recommend her to anyone. Patient unsatisfied. If only she had just wished me good luck before she sent me out onto the street in shock.

        Even so, after my successful surgery, I wrote her a note thanking her for finding the tumor and for impressing on me the urgency of my situation and letting her know that I ended up in excellent hands, had surgery, cancer was confirmed and that I was doing well.

        And my story has a happy ending because, from there, an angel on my shoulder brought me to the best doctor I’ve ever had — my current GYN oncologist at the teaching hospital where he performed my surgery and who I now see regularly.

        In general, I try not to hang onto negativity. But I’m never going to shake that image of myself in stirrups on Election Day being told by a doctor that I have cancer and that, if I voted for Obama I was going to get what I deserved. That image is permanent, like a scar.

        • EmilyAnon

          Well, maybe your old gyn was right in her prediction. Assuming you voted for Obama, you got what you deserved, a great doctor and optimistic prognosis.

          • Patient Kit

            Thank you, Emily. That is actually a really good way for me to think about it. :-D. It will probably come as no surprise to anyone who has read my posts here that I did vote for President Obama. In fact, I worked on his first campaign.

  • QQQ

    The IRS is now going to be involved in your healthcare! Isn’t that swell?

    Ever been to an IRS office? It doesn’t take a genius to recognize incompetence!

    • Lisa

      I’d rather have the IRS enforcing the tax aspects of the ACA than creating a new agency to enforce those aspects. What really bothers me is that the IRS doesn’t have the ability to enforce the law and collect penalties from those who choose not to buy insurance.

      I don’t think the IRS is incompetent; they get tasked with enforcing confusing, convoluted laws and unpopular laws. Over the years, I’ve been auditied or had things on my tax returns questioned. My dealing with the IRS have been relatively painless; furthermore once I supplied a complete explanation or backup I prevailed.

      • Dr. Josh, AtlasMD

        Ummm? did you just say you WANT the IRS to be involved in healthcare? Ok….thats a new one.

        • Lisa

          No, what I said is I’d rather have the IRS enforcing the tax aspects of the ACA than creating a new agency to enforce those aspects of the law. Big difference from saying that I want the IRS to be involved with health care.

          • Dr. Josh, AtlasMD

            So you just want a gov’t body, new or otherwise, to be enforcing penalties…you call them taxes…on people based on their healthcare…I’ll go ahead and disagree with that.

          • Patient Kit

            So, if you want government out of healthcare and I want a tax-funded government single payer system and many people agree with each of us, how do you propose that we keep politics out of it?

          • Dr. Josh, AtlasMD

            By fixing it.

          • Patient Kit

            Who should fix it? Should doctors alone decide how our healthcare system needs to be “fixed”? From what I can tell, one of your main “fixes” is widespread DPC. And, as I’ve said in other current threads on KMD, two areas of healthcare that are largely direct pay — psychiatry and dentistry — are major bright red flags to me about what might happen if the majority of primary care ever became direct pay/cash only. Do you have any idea how many Americans do not get the dental and mental health care they need because insurance doesn’t cover it? I do not want to see that happen in primary care.

            So, no, I do not see your main thing to be a “fix” for our healthcare system or most patients. I do see how it would benefit DPC doctors if most primary care docs stopped taking insurance: because right now, most patients will choose a primary care doc who does accept insurance over a doc who doesn’t take insurance. Therefore, if you could get every doc to switch to your model, your competition from docs who take insurance would be gone.

            I don’t think you answered my serious question about a complex problem with “By fixing it.”

          • QQQ

            And I agree with Dr.Josh Enforcing penalties is not my idea of freedom and more about control!

          • Dr. Josh, AtlasMD

            Exactly.

    • Dr. Josh, AtlasMD

      I agree, we don’t need more people involved in the doctor patient relationship. We especially don’t need the IRS or Uncle Sam :)

  • ninguem

    Healthcare shouldn’t be a political issue.

    Do you know of any place on the planet where it is NOT a political issue?

    • Dr. Josh, AtlasMD

      Sure, but that doesn’t mean that we can take it out of the arena of politics where it will be kicked back and forth w/o being fixed. Lets take it into our own hands and fix it ourselves b/c our pts need it.