How repeal and replace will affect patients

by Rishi Manchanda, MD

As a primary care doctor for working families, I am interested in anything that can tangibly address my patients’ health problems. But how do I prescribe repeal?

The House effort to repeal and replace last year’s health care law is not just an untested placebo with major potential side effects, like increasing the number of Americans without health coverage. For those of us on the frontlines of health care, it’s opportunity lost. Instead of repeal and replace, my patients would be better served if our legislators pursued other more effective remedies.

Rx: Protect real health improvements

The first remedy is to secure and build on tangible improvements under last year’s law. Whether one believes last year’s health care law went too far or not far enough, it is hard to deny that many Americans who have already benefited from the Patient Protection and Affordable Care Act will suffer if the law is repealed. Thanks to the law, my 13-year-old patient with severe scoliosis, whose lungs and breathing are restricted by the curvature of her spine, will never be denied health insurance simply because of her condition.

Millions of patients are already benefiting from similar overdue remedies, like the end of rescissions and prohibitive co-pays for preventive care. Many more will soon benefit as health care is modernized through innovations such as electronic health records, which have been spurred on by recent federal incentives. For many health professionals in America, these improvements, however incomplete or imperfect, are as cherished and vital as my teenage patient’s freedom to breathe a little easier. Instead of repeal, lawmakers should preserve that freedom, and extend it to 23 million others who were left out of last year’s health care law.

Rx: Help Americans prevent disease

Beyond securing improvements in access and coverage, lawmakers have the opportunity to help Americans address the primary factors that shape their health. The cumulative research of the last thirty years has unequivocally demonstrated that where we live, work, learn, eat and play has more of an impact on health than the health care we receive. Yet, outside the exam room, communities face an anemic prevention infrastructure, a segregation of civic and economic opportunity, and unhealthy social conditions that lead to costly health disparities. These disparities were recently described in detail in a national report by the Centers for Disease Control and Prevention (CDC). And the Joint Center for Political and Economic Studies calculated that, over a four year period, these health disparities cost the nation $1.24 trillion, which is roughly equivalent to last year’s federal deficit.

Smart prevention remedies which address these health disparities and the conditions that shape health in practical, measurable ways do exist. These include the Prevention and Public Health Fund and the Communities Putting Prevention to Work initiatives, created under last year’s health care law and the recovery act. Instead of destroying these tools as Senator Coburn and others have recently threatened, lawmakers should expand these investment opportunities and create new ones by incentivizing clinicians to prescribe community-based early intervention and prevention as well as we prescribe aspirin.

Rx: Strengthen health and democracy

Lastly, given recent events, Congress should consider remedies that can strengthen America’s civic health let alone patients’ health. Evidence indicates that the nation’s health depends on whether individuals have the opportunities and civic abilities to influence the conditions and decisions that impact their health. Simply put, having a voice in your health care, in your community, and in the democratic process can improve your health. Health, in turn, is a resource for democracy. In 2008, wounded veterans were permitted to exercise their right to register and vote while in VA hospitals, without violating their privacy or their right to health care. Legislators can help remedy some of what ails our health and our democracy by extending the same opportunity to eligible Americans in all health care settings receiving federal support, from teaching hospitals to public clinics. Rather than hamstringing health care through repeal, Congress should increase health care’s ability to strengthen democracy by making it as easy to register to vote in a doctor’s office as it is at the DMV.

Like members of the new Congress, America’s health professionals are increasingly aware of the opportunities before them to improve the nation’s health. Legislators can use this session to better equip clinicians, their patients, and our communities with effective prescriptions, like those described above. Congress should build on last year’s improvements to health access and coverage, increase opportunities to improve health where it begins, or at least offer viable remedies that appropriately address the nation’s other ailments.

As it stands, however, ‘Repeal and Replace’ is a costly placebo distracting us from opportunities and work at hand. As my patients will tell you, that’s a prescription America can’t afford to take.

Rishi Manchanda is a primary care physician and founder of Rx Democracy!, a nationwide nonpartisan network of health care providers who increase voter and civic engagement and, in turn, improve people’s ability to improve their health.

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