When I was doing my medical training at St. Vincent’s Hospital in New York City (a proud and fine hospital that has sadly closed), the official word was that we could not counsel patients to use condoms to prevent HIV transmission. Like many other doctors in training, I was bothered by this edict but kept in mind that St. Vincent’s had been at the forefront of providing compassionate care to people with AIDS since the very beginning of the epidemic. I went right ahead and counseled patients at risk for HIV infection to use condoms without suffering any consequences.
That kind of interference between doctor and patient, easily sidestepped, seems quaint today. We are experiencing a dangerous and increasingly successful power grab by many politicians to pass legislation controlling how medical providers are allowed to practice medicine. How could this be happening? It may have started with abortion restrictions and access to family planning care, but political ideology is now being used to affect general medical practice in ways that will have consequences for every single American. Every time I talk to colleagues about how politics is creeping into our profession, I see that they share my outrage. We all know how much blood, sweat, tears, and time are necessary to become a competent medical practitioner. The idea that politicians without a shred of medical training are writing laws that restrict what prescriptions we can write and what procedures we can perform is unfathomable.
It is common knowledge that politicians in many states have by now enacted laws that only permit abortion when a woman’s life is in danger. And we have seen elected officials argue with obstetricians about whether a woman’s life is truly in danger. Women have now died because they could not get a court order for an abortion in time. We all know that many states have now taken away parents’ rights to allow gender-affirming care in their children. And there are strong forces that have IVF in their crosshairs. But are you aware that politicians such as state attorneys general have joined lawsuits that would force the FDA to rescind the licensing of a safe and effective medication because it is used for medical abortion, among other things? And that they are making efforts, which have been successful in the courts, that will affect whether insurance companies pay for preventive care such as mammograms, colonoscopies, and lung CTs for long-term smokers.
Most people have never heard of the United States Preventive Services Task Force. This panel makes recommendations about preventive health care measures and cancer screenings, and their guidelines are followed by Medicare, Medicaid, and private insurance companies to decide whether to cover tests like mammograms or bone density scans.
It is no exaggeration to say that the USPSTF is universally respected and continuously consulted by American medical providers. Their recommendations are always evidence-based. Up to now, insurance companies that participate in the Affordable Care Act have been mandated to follow the USPSTF’s’ Grade A and B recommendations to cover screening tests. That mandate has been stricken from the ACA by a three-member panel of the Fifth Circuit Court of Appeals. Not only did they declare that insurance companies can ignore the USPSTF’s guidelines, but they went further and questioned the constitutionality of using their guidelines at all. This decision is being appealed but is already in effect in states covered by the Fifth Circuit; in those states, ACA-participating insurance plans are now free to charge co-pays for screening tests and to deny coverage of some preventive medications on religious grounds. Originally dreamed up to limit access to medications that prevent HIV infection (“PrEP”), this lawsuit, likely to reach the Supreme Court, will have real-life effects on coverage of expensive screening tests such as mammograms, breast MRIs, and colonoscopies.
I am old enough to remember a time when politicians across the political spectrum agreed that the government had no role in personal medical decisions. That principle has weakened in recent years, with far-reaching consequences that most Americans have not considered. As you cast your ballot next week, think about which candidates are committed to keeping government out of the exam room, leaving medical decisions to patients and their health care providers.
Kevin Armington is an internal medicine physician at Mount Sinai Beth Israel and Robert Wood Johnson. AIDS activism in the 1980s guided him toward a career in medicine. He is board-certified in internal medicine and addiction medicine and is an HIV specialist. He currently practices on telemedicine platforms.
