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Despite calls to replace and repeal Obamacare, issues affecting physicians have received little attention in Cleveland.
The Republicans consider the Affordable Care Act (ACA), aka Obamacare, one of the worst laws in American history, a disaster that is derailing the economy, eliminating jobs and making patients unhealthy.
Yet during the Republican National Convention in Cleveland, speaker after speaker took to the stage and said many words about many things, but barely a word about Obamacare or any other important healthcare issue facing physicians and patients today. Even the small handful of physicians who spoke-including Ben Carson, MD, a retired neurosurgeon and former presidential caandidate-have only mentioned healthcare in passing, if at all.
Further reading: Obamacare receives a big, fat 'F' from physicians
Republican physicians who spoke to Medical Economics in Cleveland expressed some frustration with the lack of discussion of an issue important to physicians and their patients. While they agree that the GOP must focus on important issues such as national security and immigration, healthcare needs to be in the spotlight as well.
“We’ve stopped talking about the ACA, when in fact we should be talking a lot about it,” says Marci Zwelling-Aamot, MD, an internist who runs a concierge practice in Long Beach, California, who attended the RNC as a guest of Texas Rep. Pete Sessions. “It has interfered with business from the get-go. That hasn’t changed a wit. Businesses need to know that if we hire Mr. Trump [as president] to work with us that he will open up a market economy and patients will be able to afford healthcare again.”
Some speakers have discussed healthcare briefly. For example, Donald Trump, Jr., speaking on Tuesday during the RNC said his father would be “a president who will repeal and replace Obamacare without leaving our most vulnerable citizens without healthcare and who will do it without destroying Medicare.”
The official Republican platform does not ignore healthcare, but offers few concrete details about how it would work. The platform calls for repealing and replacing Obamacare, reforming Medicare by creating more choice through premium support, converting Medicaid into a block-grant program that gives states control, allowing purchase of insurance across state lines and increasing price transparency.
Furthermore, Trump has focused on seven key points for reforming healthcare, most of them mirrored in the GOP platform.
Other important issues to Republican physicians interviewed include reforming malpractice rules to eliminate defensive medicine, confronting the opioid epidemic, and creating a healthcare system that values the judgement of physicians instead of bureaucrats.
One hurdle to discussing healthcare policy at the RNC is the nature of the event, much more of a pep rally for the party and a showcase for the media and television viewers than a dissection of policy proposals. U.S. Rep. Phil Roe, MD (R-Tennessee), the co-chairman of the GOP Doctor’s Caucus and a retired OB-GYN says it’s difficult to distill complicated healthcare policy into soundbites.
Roe also believe healthcare policy will have its place in the campaign ahead, and says just because Trump and other Republican leaders don’t discuss it frequently doesn’t mean the Republicans aren’t serious about fixing healthcare issue. He says it’s up to physicians and healthcare experts to guide candidates and the party when it comes to pressing issues such whether to delay payment reforms under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
“That focus will come back to healthcare,” Roe says. “It’s a little frustrating from my standpoint. But we’ve got people like me who are focused on it like a laser beam. The fact that candidates don’t go out there and talk about it in detail like we do, that doesn’t bother me too much. They are going to have to rely on the policy wonks like me anyway to fill in the blanks. They will be the salesman.”
Ralph Alvarado, Jr., MD, an internist from Winchester, Kentucky, had a 6-minute speaking slot during the convention on Wednesday. He feels strongly about healthcare policy-as a physician who said he had to sell his medical practice to a larger medical group because of declining reimbursement and increasing government mandates-but did not discuss healthcare during his talk, instead focusing on his personal story as the first Hispanic state legislator in Kentucky.
“Right now it has taken a backseat,” Alvarado says. “But It’s still front and center. When Donald Trump goes and talks to groups, he mentions that we need to repeal and get rid of Obamacare. And I think we want to go to a free market approach. The Republicans have another option.”
It remains to be seen whether the Democratic Party focuses on healthcare at their convention in Philadelphia, July 25-28. The Democratic candidates discussed healthcare a bit more during the primary, especially Sen. Bernie Sanders (I-Vermont) who called for a single-payer healthcare plan, essentially a Medicare-for-all program. And Hillary Clinton, the presumptive Democratic nominee, has revived discussion of adding the public option to Obamacare and reducing deductibles and lowering prescription drug costs.
Others have a more pessimistic take on why healthcare gets buried as a subject by both Republicans and Democrats. Robert Maurer, DO, a retired family physician and an elected Republican delegate from New Jersey, says healthcare is much too complicated to fix, let alone discuss.
“They don’t talk about it because they have no idea,” Maurer says. “They don’t have the foggiest.”
During his speech Thursday night, Trump took to the stage and spoke for an hour and 15 minutes. He devoted two sentences to healthcare.
“We will repeal and replace disastrous Obamacare,” Trump says. “You will be able to choose your own doctor again.”