In our hyperpolarized and political society, it seems everything has a political angle, including health care. I think that some of this conflict is unnecessarily but intentionally introduced by special interest groups to force a point, a change in policy, or the acceptance of societal positions that are controversial for many and not universally accepted. Examples include LGBT issues, gender changing or affirming care, abortion access, birth control, health care of non-citizens, immigration policy, public health preventative measures including for viral epidemics, health care for veterans, end-of-life policies, universal access to treatment for tuberculosis and chronic kidney disease on dialysis, those infected with HIV virus, and COVID. Reducing the influence of politics in health care, in my opinion, is a necessary but certainly not a straightforward task, but it can be achieved through a few key steps:
Strengthening trust in science. The scientific method is inherently apolitical. It values evidence, data, and logical reasoning. One way to reduce politics in health care is to strengthen public trust in science and to consistently communicate the importance of evidence-based decision-making. The problem is when the scientists abandon science. Trust in science is not the same as trust in scientists. Indeed, it is in the nature of science to trust nothing that is not empirically provable, replicable, and falsifiable. Let us return to science.
Promoting transparency. Transparency in decision-making processes can help to minimize the influence of politics. This includes openly sharing data, making methods and processes accessible, and clearly communicating how decisions are reached. This includes openly sharing interpretations of that open data that are at variance with politically established and media-enforced norms.
Establishing clear guidelines for decision-making. Having clear, established guidelines for decision-making can help to guard against political influence. These guidelines should prioritize evidence and data over politics and religion and should be followed consistently. Yet, this implies an “expert class” of decision-makers, following some agreed-upon methodology, aloof from politics and religion. In an open society, viewpoints and interpretations of politics and religion should be measured by evidence. As it has been said, beliefs should not form your facts, and if you are lucky, then facts should guide your beliefs. It is through a vigorous political process and reference to (and debate among) core human/divine values, both informed by reason and the best dialectics, that the best decisions are made.
Limiting conflicts of interest. Conflicts of interest can introduce political bias into health care. The lobby industry complex, organized religion, and the health care industrial pharma complex are to blame for a great deal of special interest influence on health care decisions. Policies should be in place to limit these conflicts, and any that do exist should be openly disclosed. Again, the problem is the closed, money-driven monopoly structure of the lobbying industry and health care pharma industrial complex. In a world of competing politics, where there is no extreme consolidation of power into the hands of a few entities, vying interests are healthy.
Encouraging open dialogue. Open dialogue and respectful debate are important for reducing politics in health care. Diverse perspectives should be welcomed and considered, but ultimately, decisions should be based on evidence and data, not political agendas and restrictions of opposing viewpoints.
Fostering a culture of integrity and professionalism. In health care, the well-being of patients should always be the paramount concern. Ideally, creating a culture that values integrity, professionalism, and a commitment to patient care can help keep politics in check.
Remember that while we can strive to minimize the influence of politics in health care, it is an inherently complex field with many stakeholders. There will always be some level of political influence, but our goal should be to ensure that it does not interfere with the equitable quality or accessibility of care.
Overall, these proposals should minimize the influence of politics and introduce a more platonic form of politics similar to Bacon’s The New Atlantis. This may even lead to the opposite of the stated intent, and indeed, it seems to me that we are living the consequences of it at this moment.
As a medical professional, I often see how state and national regulations influence many aspects of my medical practice. One way that I monitor current and proposed regulations is through the AARP Public Policy Institute and through the public advocacy center of my professional society: The American College of Physicians. These allow practical means to reach out to, communicate and influence those with legal and regulatory power. I think that all citizens, and especially those in health care, should exercise in thoughtful and responsible ways their civic responsibilities to give their input to those making the changes.
Donald H. Marks is an internal medicine physician.
