Friday, April 7, 2017

Trump's "bad doctors": mostly greedy and bad for the public's health

My recent post, Doctors and health reform: maybe they do stand for health!, March 25, 2017, lauded the positions of many medical organizations, including the American Medical Association (AMA) for their positions in opposition to the American Health Care Act (AHCA), the Trump-Ryan bill that never even got to a vote, and apparently was never even available to House members to read before the vote was scheduled.  But I also pointed out some “bad” doctors, defined as those who advocate policies that are bad for the health of the American people. They argue that they are really for health, but this means mostly health care, especially medical care, for those who can afford it. There is no small tinge of racism as well as classism in these positions, because poor people and minorities are those most likely to be left out, and because, well, these perpetrators don’t care.

The prime example I cited was Secretary of Health and Human Services Tom Price, who, as a representative from a wealthy suburban Atlanta House district, continuously railed against the Affordable Care Act (ACA), as well as, in fact, Medicare. Dr. Price is an orthopedic surgeon, and my essay noted that this specialty is over-represented in the cohort of opponents of expansion of access, possibly because their high average income puts them in an elite economic group, and many are more concerned with their self-interest than the health of the overall population. Price was not the only bad doctor I mentioned; I also cited the “tone-deaf” comments of Rep. Roger Marshall of Kansas, an obstetrician-gynecologist. “Tone deaf”, of course, is a mild and polite term for his racist, classist comments, summarized as “the poor just don’t want health care”. Tone deaf, by the way, is also the term commonly used to describe the demeaning commercialization of the Black Lives Matter protest movement evident in Pepsi’s commercial featuring Kendall Jenner, now mercifully withdrawn. That was a result of the strong and sustained protest of a large number of people, especially on social media.

Price and Marshall are abetted by the non-physician politicians in Congress and the administration who also would deny health care to a lot of people, and even, through changes in Medicare and Medicaid, make the coverage of many people who now feel moderately secure in their insurance status greatly at risk and much more expensive. Speaker of the House Paul Ryan and Vice President Mike Pence met with the “Freedom” Caucus of the House to discuss just how regressive a health care bill would have to be to get their support. Pretty bad, it turns out. Its chairman, Rep. Mark Meadows of NC, is quoted by the NY Times as saying “Lower premiums have to be our first and only priority. By repealing community rating and the essential health benefits, it allows for lower premiums across the board.” Well, lower premiums are something everyone wants (except probably insurance companies) but there are different ways to get there. “Repealing community rating” means that insurers would no longer have to cover people who have chronic disease and are often older (and, ironically, often Trump and Freedom Caucus voters) at the same rates as less sick people. Those people would not have lower premiums; their premiums would either be fantastically higher, as they were before the ACA passed (and when many of them were without coverage) or be altogether unavailable. This is not something that the vast majority of Americans want. Similarly, “essential health benefits” are, well, essential. Like, for example, maternity care, and preventive health care. The fact that Rep. Meadows used that word and didn’t replace it with some euphemism, illustrates how tone-deaf he is.

But not all doctors who I would characterize as “bad” are reactionaries who are trying to figure out how to deny health care to the American people. Some are just traditionally greedy, seeking to fill their own pockets with as much money as possible. This is not a problem limited to the right; even folks who are progressive on social policies can be guilty of “going where the money is”. An excellent example is Trump’s nominee to head the FDA, Dr. Scott Gottlieb. Gottlieb, like many researchers, has been highly paid (at least on the order of hundreds of thousands of dollars) by drug manufacturers. Gottlieb assures us that this will not affect his decision making at FDA, and that he can be trusted, as in the title of the NY Times article of April 5, 2017, in which he “deflected” criticism. While some Democrats, like Sen. Patty Murray of Washington, noted that he had ‘“unprecedented financial entanglements with the industries he would regulate,”’ Republicans like Lamar Alexander of Tennessee agreed with Dr. Gottlieb that “his experience with the pharmaceutical industry would be an asset in regulating it.” This is terrific tortured fox-guarding-the-henhouse logic, like having Goldman Sachs financiers regulating Wall Street, or petroleum company flaks running EPA (which we, in fact, have). This concept worked fine on “It Takes a Thief”, but not so much in real life.

Taking huge amounts of money from drug companies may be morally reprehensible (or not, depending on your view; in mine it is), but more concerning are the positions that Gottlieb has taken. While he is open (he says now) to lowering drug prices by importing drugs from Canada, something Trump has occasionally voiced support for, he has previously written against it (when he was in the pay of the drug companies). The issue is what the policies pursued by the FDA, HHS, CMS, and the overall Trump administration and Congress regarding the people’s health will be. Disrespect for preventive care (“essential services”) and environmental pollution bodes very poorly for public health, as the core principle of “cut benefits” does for medical care. And, as always, the most vulnerable – from poverty, age, illness, geographic region – will suffer the most.  It would be really good if we could count on doctors like Price, Marshall and Gottlieb to protect the health of the people, but don’t count on it. We are going to need huge public protest, at least as big as those that ending up canceling the Pepsi commercial.

Well, it could be worse. Another physician, Dr. Bashar al-Assad, is gassing his own people with chemical weapons. And there was also Dr. Josef Mengele. So far, none of Trump’s nominees are in that league.

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