Last November, we wrote an op-ed for STAT, as medical students, lamenting how politicized our future profession has become in recent years. In the aftermath of a divisive election that we argued may well have been a “referendum on the Affordable Care Act,” we implored policymakers and other stakeholders to take politics out of health care before attempting to reform it. We believe that partisanship has infected health policy in devastating ways, weakening the level of scrutiny, paralyzing the rigor of debate, and ultimately preventing much-needed progress on issues of cost, access, and quality in American health care. Over the last few months, we saw this infection run its latest course in the halls of our Congress.
As if a testament to our analysis, the partisan mechanisms by which health reform was pushed through the House failed to achieve the passage of any bill in the Senate, and here we are, eight months later, with the same, exacerbated problems we identified in November: sky-high deductibles, increasing premiums, and insurers pulling of marketplaces. Yet, even after months of political teamsmanship yielded nothing for the American people, the first impulse of some has been to retreat back into partisan corners. Conservatives on the right, like Rand Paul and Mark Meadows, are pushing for a total repeal of the ACA, while liberals on the left, like Bernie Sanders and Elizabeth Warren, are fighting for a transition to a single-payer system.
Both of these approaches are inherently divisive, and, for better or worse, have come to be driven by scorched-earth ideology, rather than pragmatism. They presuppose a simple, correct answer to a question that, as President Trump realized a few months ago, is rather complicated. Clearly, a pure, free-market approach to health care would leave millions behind, unable to afford good insurance for a variety of reasons. But at the same time, it is difficult to ignore the realities of single-payer systems around the world today, such as in the UK, battling back against new challenges related to the cost of their services.
This polarization doesn’t bode well for the country, especially the low income working families who bear the brunt of the inability of Washington and our state capitols to implement policy fixes for the ACA. It may even be toxic for the attitudes of future physicians. While passing a Merck research laboratory just the other day, one of our classmates launched into a diatribe about the evil, profit-seeking pharmaceutical companies, asserting that scientists who work for them have “sold out.” His unwillingness to listen to arguments from peers about the countless life-saving medications that American biopharma has produced (and the many examples of generosity on the part of companies like Merck, such as their efforts for river blindness) precluded any chance of a rational discussion about what aspects of drug pricing, for instance, we ought to reform. All too often, it becomes tempting to frame health reform as a struggle between good and evil, rather than as a competition of ideas.
In our last essay, we pointed out that major health policy reforms — like Medicare, Medicaid, CHIP, and MACRA — have historically been supported by both sides of the aisle. The vision forward for health care should also be bipartisan. We’re encouraged by recent signs in this direction, like Senator Lamar Alexander’s announcement of September hearings on how to stabilize the individual insurance market. And as students of health policy and medicine, we know there are smart solutions worth discussing out there, not only to patch the ACA — like a federal reinsurance fund, a public option for marketplaces lacking insurer competition, and cost-sharing subsidies — but also to tackle other issues in health care, like supporting the role of paid caregivers to relieve nursing home costs for families sliding from the middle-class into Medicaid, reforming Medicare policies for dialysis, and ensuring parity for mental health treatment. Many of these fixes have been introduced by members of Congress, but few have been discussed by their colleagues as meaningful components of health reform. They should be. Bipartisanship, diving into the weeds of policy, may lack the glamour of a single-payer solution or a campaign slogan to repeal Obamacare. But it creates policies which lawmakers are not afraid to fix, if needed, in the future.
We’ve been close observers of the health policy debates this year because we understand their deep impact on our future ability to take care of patients and advocate for their best interest. We’re sick of health care being the political football of choice in Washington. We’re sick of speculating about the fate of our profession and our patients as lawmakers meet behind closed doors, presenting bills hours before a roll-call vote, or in a quick PowerPoint presentation, if we’re lucky. We’re sick of feeling like much of the knowledge we’re gathering about our roles in the health system won’t even matter if and when that system breaks down after another swing election. And more than anything else, we’re sick of blind partisanship, and so are many of our classmates in Providence, in Boston, and around the country. Our country, and our patients, deserve better.
Suhas Gondi and Vishal Khetpal are medical students.
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