Over the days since Mitch McConnell made the super-secret Senate healthcare bill public he has witnessed a backlash that has been at least as large as the one that followed the release of the House version of their "repeal and replace" Obamacare legislation. Part of that backlash has come from some high-profile groups in the healthcare sector, such as the American Medical Association and the New England Journal Of Medicine.
But there are plenty of doctors who support the Republican effort to get rid of Obamacare, too. On Wednesday morning MSNBC's Stephanie Ruhle spoke with a group of five who voted for Trump and who now seem to be quite happy to spout the same kind of nonsense about the Affordable Care Act that we have been hearing from other Trump allies.
The first thing that was interesting about the panel was that there wasn't a single primary care physician on it. There were a couple of cardiologists, an ophthalmologist, an internal medicine specialist, even a radiologist. (Radiologists specialize in reading and interpreting x-rays, CT scans, etc, and have little if any direct contact with patients.) But not a "family doctor" in the bunch. So all five represented specialties that most patients would turn to after being referred by their regular doctor. But of course all five had strong opinions on why the Affordable Care Act is a very bad thing. And none of them had very much evidence to back up their claims.
Take Dr. Alieta Eck, an internist from New Jersey. Eck complained about the Obamacare Medicaid expansion, saying,
"Obamacare extended Medicaid, and so these people, they've got this insurance card that is worthless."
"Worthless?" Not according to the Kaiser Family Foundation, the nation's largest provider of nonpartisan information on matters of health. A February report from KFF highlighted the positive effects of Medicaid expansion:
- Coverage: Studies show that Medicaid expansion results in significant coverage gains and reductions in uninsured rates, both among the low-income population broadly and within specific vulnerable populations.
- Access to care, utilization, affordability, and health outcomes: Most research demonstrates that Medicaid expansion positively impacts access to care, utilization of services, the affordability of care, and financial security among the low-income population. Studies have also shown improved self-reported health following expansion, but additional research is needed to determine effects on health outcomes.
- Economic measures: Analyses find positive effects of expansion on multiple economic outcomes, despite Medicaid enrollment growth initially exceeding projections in many states. Studies also show that Medicaid expansions result in reductions in uncompensated care costs for hospitals and clinics as well as positive or neutral effects on employment and the labor market.
- As the Trump Administration and Congress debate ACA repeal and replacement, gains in coverage and access as well as economic benefits to states and providers are at stake if the Medicaid expansion is repealed.
Dr. Kevin Campbell, a cardiologist from North Carolina, said he has witnessed "eight years of the destruction of healthcare as I know it." Considering that the US has historically had some of the highest healthcare costs of any country in the world, yet has poorer outcomes in many areas, it seems hard to argue that "the destruction of healthcare as I know it" as a bad thing.
Ruhle brought up Trump's campaign promises about healthcare, and reminded the group that he had promised that everyone would be covered. Eck didn't think that having people lose their coverage was necessarily a bad thing.
"If you remove the mandate to buy insurance, a lot of things will happen where people will now use just their common sense and they'll spend money where it needs to be spent," Eck said.
Doctors like Eck seem to think that all of their patients, most of whom do not earn the $284,000 that the average specialist made in 2015, can make wise decisions about obtaining care, even when those patients have to make choices between things like medical care and making a mortgage payment. What will actually happen is that many patients will put off needed care, and some will die. That was exactly what was happening before Obamacare, and what will happen again if Trumpcare becomes law.
Ruhle pointed out to the group that Harvard University did a study that found that based on the Senate bill, 217,000 people could die. "When you have a headline like that, it scares people," she noted. Instead of offering a substantive response, the group, almost as one, scoffed at the notion. "That's [scare people] what it's intended to do," Dr. Campbell sneered.
Ruhle wrapped up the segment by asking the panel to offer advice to Trump about what to do. Eck was first out of the box, once again revealing her obsession with Medicaid, saying he should block grant Medicaid dollars back to the states. Healthcare consumer group Families USA says that is a terrible idea.
Once the amount is set by the federal government, it will not change, even if a state’s actual program costs are greater than the allotted amount. If a state’s costs exceed the amount of the block grant, it will have to use its own funds to make up the difference or, more likely, cut services for low income residents, including children, seniors, and people with disabilities.
Dr. Jane Hughes, the ophthalmologist, said that the Senate bill is "a good start to decentralizing our healthcare system." A strange comment, given that Obamacare gave states the ability to set up exchanges where insurers could offer policies to meet the needs of the consumers in that state. The only thing "centralized" about the ACA is that it sets down rules for insurers to follow nationwide.
Finally, the radiologist Dr. Nicole Saphier, said that it's time to forget "repeal and replace" and "reach across the aisle" to work together on a solution. You know, sort of like what Democrats attempted to do when they were working on Obamacare. That was about the only wise statement that came from this entire group.
The concerns that came from this group seemed to largely center on money -- who pays the bills and how much will they pay -- rather than patient care. After listening to what these five had to say about Obamacare vs. Trumpcare, I don't think I could be comfortable being a patient of any of them, no matter who was paying the bill.