I taught medical ethics — Trumpcare would fail

The Republican alternative to Obamacare leaves too many behind

Meeting with providers at Falls Church Healthcare Center

In medical school, students are immersed in the realm of medical ethics. It’s where new doctors study, learn right and wrong, ask tough questions, and discuss things like end of life care, genetic testing, and patients’ rights. In lots of ways, it’s the most important part of being a compassionate and competent doctor.

For 25 years, I was an assistant professor teaching pediatrics, neurology, pathophysiology, and ethics at my alma mater, Eastern Virginia Medical School. It’s been great training for my legislative work — we get in some debates in the classroom that would rival the General Assembly! But it also makes me think — really think — about the morality of our healthcare system.

In the AMA Code of Medical Ethics, doctors are taught that healthcare is a fundamental human good and that society has an obligation to make care available to everyone — regardless of ability to pay.

As physicians, we’re asked to always consider the following principles of good healthcare, and get this: By my estimation, Trumpcare doesn’t meet a single one.

1. Healthcare should be transparent.

President Trump and congressional Republicans’ healthcare plan is as convoluted as they come. In fact — it was actually kept locked up in a room, where not even lawmakers could access it. Details about the actual coverage it would provide are obscured, and there’s even confusion amongst Republicans about what the plan would or would not do.

2. Healthcare decisions should include input from all stakeholders — including the public.

The GOP’s had seven years to work with Democrats to come up with a viable alternative to (or improvements for) the Affordable Care Act — and they flat-out refused to work across the aisle. Now that they’re the party in charge, they’re still refusing to include constructive feedback from Democrats or even moderate Republicans. Not only are they playing politics with people’s health, they’re refusing to meet with constituents to discuss the bill. Leaders like Barbara Comstock haven’t held a single in-person town hall to answer questions about the repeal of the Affordable Care Act.

3. Healthcare should protect the most vulnerable, with special attention to historically disadvantaged groups

We don’t know a lot about Trumpcare — but we do know it puts a lot of our most vulnerable communities at risk. Women, children, folks with low incomes or disabilities, people of color, and older Americans will all suffer under the new law. In fact, it’s estimated that people between the ages of 50 and 64 would see a dramatic rise in the cost of their healthcare — all while giving a tax break to people making over half a million dollars a year.

4. Good healthcare considers the best available scientific data about the efficacy and safety of healthcare services.

Democrats have been willing to make improvements to the ACA since its inception. In fact, even President Obama has said, “If you can put a plan together that is demonstrably better than what Obamacare is doing, I will publicly support [it].” But here’s the thing: experts agree that the ACA is working and the GOP plan not only wouldn’t improve the ACA — it would make things much, much worse.

5. Healthcare seeks to improve health outcomes to the greatest extent possible.

Our healthcare system should seek to improve the health of the most people possible. By cutting millions out of the system, Trumpcare will do the opposite. It’s that simple.

6. Physicians should ensure that basic care does not discriminate.

Trumpcare will make it harder for poorer folks to get healthcare — and redirect benefits to the wealthiest among us. Who will be able to easily get coverage in this new system? Wealthy, mostly white, individuals. Who will lose out? Women, children, seniors, people of color, folks with disabilities, and more.

7. Healthcare systems should provide for ongoing review and adjustment to consider medical innovation to ensure continued, broad public support

Medicine is constantly evolving and changing. That’s why we call it a practice — we’re constantly trying to improve. The Affordable Care Act is more popular than ever before. We should continue to build on its progress to get more Americans quality, affordable care. Trumpcare would only take us back.

When people don’t have access to providers and preventive and ongoing care, they receive treatment in emergency rooms, hospital intensive care units, and jails, if mentally ill. This is morally wrong, and it flies in the face of the Hippocratic Oath, which guides our practice of medicine.

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