Right Care for all in the Trump Era
Dr. Vikas Saini
President, Lown Institute
With Donald Trump in office, a new chapter has opened in the saga of American health care. Amidst the uproar of the new administration it is well to remember some important truths. Trump’s criticism of Obamacare helped propel him to his surprise electoral victory. Yet health care is one of Mr. Trump’s biggest weaknesses.
Millions of people gave him their vote because they believed they had a lousy deal with the ACA. Forced to purchase inadequate insurance with a gun to their heads, and then enduring rising copays and deductibles and rocketing costs of medicines, they decided to gamble on him despite their reservations. Now they’re waiting for him to deliver.
Trump promised to give the American people better coverage that’s less expensive, but like all politicians, he’s been long on rhetoric and short on details. Let’s be clear: Millions of people, including Trump voters, benefited from the ACA and don’t want Obamacare repealed. And of the millions more who want it replaced, a plurality actually want more coverage: A truly universal coverage system like Medicare for all.
In a few short weeks it’s become obvious that a simplistic repeal would be political suicide, and that fact has forced Congress to revisit its calculus. In other words, while Obamacare was far from perfect, more and more people are seeing that what comes next could well be worse. Just yesterday Trump indicated that repeal of the ACA may have to wait until 2018.
The situation remains remarkably fluid. It’s hard not to get distracted by the noisy news flow that passes for “debate”. The Trump administration and their allies in Congress seem to have settled on a renewed faith in market fundamentalism and even more deregulation, while out-of-power liberals and their media allies are looking for any advantage and trying to avoid confronting why they lost. This is almost certainly not going to serve the public. In fact, over the past 40 years neither liberal Democrats nor conservative Republicans have delivered what people want and need: Universal programs that provide concrete material benefits, especially to a majority of working people. Their conditions of work have been changing like quicksand for decades, and with robot cars and artificial intelligence coming, that’s only going to get worse.
In this historical moment, we have an opportunity to write a compelling new narrative about health care and to transform the zeitgeist. That’s because those of us in health care have a bedrock understanding that sustains our our worldview and approach to people: We put our common humanity first. To put it another way, there’s no technical reason why delivering the right care should be a “progressive” or a “conservative” idea.
But to get there, we’ve got a lot of work to do.
We certainly have a responsibility to our patients and communities to mitigate against the potentially devastating consequences of a repeal of the ACA but we must do more than defend the status quo. The country desperately needs a new narrative about health and about health care, and we in the Right Care Alliance are well positioned to develop it. Every day we see how the system fails so many. We’ve seen parents, grandparents, and children stricken with the pain of injury and illness compounded by a pile-up of poor access, unnecessary care, avoidable errors, and frightening medical bills.
We’ve seen brothers and sisters struggling with the despair and insecurity of job loss that have gone hand in hand with rising rates of opioid addiction and deaths from suicide. A society that has declining life expectancy for such a large fraction of its people, as documented by the Case-Deaton study, is a society with deep problems. That makes our work a moral imperative.
We have to raise our voices to insist that as a nation we can do better than ObamaCare or TrumpCare. We need to describe and advocate for a real health care system. A uniquely American health system where everybody is in and nobody is left out. A universal coverage system better than Medicare — because it is radically more available, more patient-centered, more responsive to local community needs, and not so horribly wasteful.
A system where co-pays or deductibles are not destroying family budgets. A system that gets clinicians out into our schools and towns and neighborhoods, so that anyone can see a doctor or nurse, ideally within walking distance of their own home. Where frail and elderly people can get the care they need, including end of life care, at home. Where that care is not tainted by the spin of drug and device companies, or the business needs of big hospital systems or huge medical groups. Where health care workers are paid fairly, but nobody gets rich from ordering unnecessary procedures or exploiting illness.
And where the real drivers of good health — healthy food, decent housing and real economic security — are recognized and promoted. Where the health of all people is embraced as a centerpiece in all policies.
The Right Care Alliance can be an important contributor to a national conversation about the kind of system we need because we know about health care. As a grassroots network of people — doctors, nurses, pharmacists, hospital workers, patients, and concerned civic leaders — from all walks of life and from different parts of the country, we can raise our voices to help create that new narrative.
It’s a narrative that voters from any party will understand. It’s a narrative that millions of health care workers will endorse, because they just want to do their jobs and take care of the people they serve. They’re waiting for the opportunity to do just that. Putting service and relationships at the center of care is part of that ideal; it’s what health care should be all about.
Now we need to start talking about how we are all going to take action!
