Political divisiveness in health care

Learning to work together

By Ed Weisbart, M.D.
Minnesota Physician, November 2016

You wouldn’t know it by looking at the health care debate in America today, but one of our nation’s foundational pillars used to be political collaboration. Although the 2009 passage of the Affordable Care Act was intensely partisan, we have a proud, centuries-old legacy of collaboratively solving our problems despite our differences, and many of our past solutions were made stronger because of our differences.

I have had the honor of testifying on a variety of topics in a number of state legislatures across the nation. My experiences make me wonder how our noble national history led to political statements such as these that were said directly to me:

• From a cattle rancher serving as a state representative: “As a former embryo, I have expertise about women’s reproductive choices.” This was the basis for his ignoring medical evidence about conception, embryology, and the guidance of the American College of Obstetrics and Gynecology. It’s difficult to build an evidence-based strategy with a legislator who believes his personal history as an embryo gives him as much information about reproductive issues as being board-certified in ob-gyn.

• From an attorney serving as a state representative: “I oppose raising the tax on cigarettes because you can’t assure me the money won’t be used to clone humans.” It’s hard to determine the best strategy to prevent adolescent tobacco addiction without also having to weigh the risks and merits of stem cell research.

• From a psychiatrist serving as a state senator: “I think about all 12 antidepressants, and I think about my patient, and something inside me moves and tells me which one to prescribe.” I was a bit worried about what might be moving inside of him, but held my tongue in the interest of finding common ground.

• Finally, from another attorney serving as a state senator: “I acknowledge your evidence that expanding Medicaid would save many lives, but as a state senator I’m still going to block it for political reasons.” Rigorous analysis of the emerging clinical and economic data from expansion states has no place in a policy discussion when the decision has already been made based on political goals. At least this senator was willing to be open and direct.

How did we get to the point where reproducible evidence is valued as highly as uninformed conjecture, where attitude and philosophy are considered as independent truths, and politics trumps science even for professionals? And how do we get back to building public policies on evidence, reason, and collaboration? There is a body of science that can help us find our way back. The imperative is stronger, especially when it comes to health care.

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Ed Weisbart, M.D., is a family physician in St. Louis, MO. He volunteers in a variety of safety net clinics, and chairs the Missouri chapter of Physicians for a National Health Program.