Repealing Obamacare will create harm for millions
By Gene Bishop, M.D.
The Philadelphia Inquirer, Letters, Feb. 16, 2017
How can a physician oppose people getting health care? It's a puzzle to me.
The nomination and confirmation of Dr. Tom Price - widely described in the media as a fierce Obamacare critic - as secretary of Health and Human Services set my physician mind to thinking how two people (Price and I) both trained as physicians, yet have come to dramatically different conclusions on what Americans want and need as patients.
Price once ran the orthopedic clinic at Emory Hospital in Atlanta. I once ran a primary care clinic at a Philadelphia hospital. Patients in both these settings are usually low-income - uninsured, if the clinic will take them, or insured by Medicaid. Before the Affordable Care Act - or "Obamacare," as it has come to be known - low-income working adults were not eligible for Medicaid.
Without Medicaid either for the individual patients, or under a program of support to hospitals serving low-income populations, there is no care for these folks. The Affordable Care Act - in states that chose to do so - expanded Medicaid to the low-income working population. Repealing Obamacare would end this insurance.
In my training as a physician, I rejoiced to see my patients able to receive care for diabetes, hypertension and cancer.
Tell me, Dr. Price: If you oppose Obamacare and Medicaid expansion, do you envision the poor of Atlanta (or Pennsylvania) letting fractures heal without medical care or anesthesia? In your world, will only those able to pay be allowed to have a new knee or a new hip?
In my primary-care practice, patients and I made decisions together about the best treatment. I can't remember a single instance - in over 30 years in practice - where the government (Medicare or Medicaid) interfered with that decision, except when a woman wanted an abortion and Medicaid did not pay. But I can think of numerous instances where private insurance companies - the very companies Price wants to strengthen - interfered with my decision-making. And most of the successful appeals were based on government regulations that safeguarded the rights of patients when private insurance ran amok.
So when Price is concerned that the government has "commandeered medical decision-making" - I ask him how? By protecting our seniors from astronomical medical bills because Medicare limits what physicians can charge? I was taught in medical school to put my patients first. Price, under the clever phrase of "empowering patients," wants to put physicians first.
In medical school, I was taught to respect all patients, to take care of all those who needed care, regardless of income. Price must have been absent that day. I can't imagine otherwise how he can propose a health-care system that discriminates against the sick, will be unaffordable for the more than 20 million people who have gained insurance under Obamacare and will favor doctors over patients.
Is there anything on which we might agree? He wants to "modernize" Medicare. But if we look closely, Price aims to replace Medicare - the most popular health-insurance plan in the country - with vouchers that will let people buy the amount of care "they need." He doesn't say whether we can all buy crystal balls, along with the vouchers, to see into the future. And me? I'd like to see improved Medicare for All - without private insurance companies, co-pays or deductibles. It would save our country, and individuals, billions of dollars. And allow all of us doctors to take care of everyone. I'd rather have that dream than the nightmare I see with Price in charge of health care.
It's too late to send Price back to medical school to learn what it means to really support patients. But the prescription I write today is for everyone to let their elected officials know that health care for all is important - that we need to improve on Obamacare, but that the health of our state and nation will not be improved with millions losing health care.
Dr. Gene Bishop is clinical professor of medicine at the Perelman School of Medicine, University of Pennsylvania. He can be reached at firstname.lastname@example.org.