It is no surprise that physicians are disillusioned with the current state of health-care. To make matters worse, physicians face an uncertain future led by either of the two candidates, who hold antipodean views of health-care reform.

Hillary Clinton aims to improve and expand on the ACA. The most significant change she proposes, if she’s able to achieve it, is the creation of a public option that could help to derail the corporate welfare provided to the insurance industry by the public mandate of the ACA [5,9]. 


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There is no doubt that with Hillary in office, current trends will continue, but to what end is unclear. In 2014, at the onset of ACA implementation, physician practice owners or partners decreased to 35% from 62% in 2008.  That number was further decreased to an estimated 33% in 2016. This was met with a reciprocal increase in the number of employed physicians, which increased from 38% in 2008 to 67% in 2016 [1]. 

While some practices have opted to join Accountable Care Organizations in an effort to survive future implementations of the ACA, such as Medicare’s plan to bundle payments, it’s quite clear that the survival of independent practice owners is threatened. Such is the likely result of an environment that is becoming increasingly more complex to navigate and in which it is increasingly more challenging to maintain autonomy in a world dominated by so much corporate and government oversight.

Trump, on the other hand, has provided even less detail as to what he plans to do with health care. We know that he wants to repeal and replace the ACA with health savings accounts and tax breaks, which hardly seems to be an equitable solution. The New York Times pointed out that his tax breaks are unlikely to mean much for low-income families, who already pay little in federal income tax [10], and health savings accounts depend on extra income, which most Americans do not have [11]. 

The truth is, Trump doesn’t have a health-care plan. For example, he wants to maintain the consumer protections that prevent insurance companies from denying coverage due to pre-existing conditions, but doesn’t appear to realize that if he repeals ACA, those consumer protections will be gone—unless he offers a replacement, and he hasn’t so far [12]. Without a viable alternative health-care plan, under Trump access to care would plummet and the uninsured rate would increase from a projected 27 million in 2018 to 49 million [13]. Instead of having an improved health-care system, Americans would roll back to one riddled with problems and on the brink of collapse.

Despite this seemingly bleak outlook for physicians, a refreshing 71% still feel that patient relationships and intellectual challenges continue to make medicine a rewarding field. Nevertheless, approximately 58% of them feel that the imposition of regulatory requirements and the increased paperwork is the biggest drain on their satisfaction, followed by the loss of autonomy (38%) [1]. Allowing physicians, the people who directly care for patients, to participate in the legislative process without the adverse influence of corporation-backed patient-advocacy groups would allow Congress to better assess the real needs of patients.

While some physicians may be entrepreneurs, most are not. They’re physicians at heart—and they want to provide the best care possible. Offering them an opportunity to improve the health of their patients by taking part in national discussions about health policy, not only as concerned citizens but as stakeholders in those policies, is the only chance that either candidate has in building a sustainable and high quality health-care system.

References

1. “The Physicians Foundation 2016 Survey of America’s Physicians: Practice Patterns and Perspectives.” The Physicians Foundation. Updated September 2016. Available at: http://www.physiciansfoundation.org/.

2. “20 Million People Have Gained Health Insurance Coverage Because of the Affordable Care Act, New Estimates Show.” HHS.gov. Updated March 3, 2016. Available at: http://www.hhs.gov/about/news/ 2016/03/03/20-million-people-have-gained-health-insurance-coverage-because-affordable-care-act-new-estimates.

3. Phillips JP, Wilbanks DM, Salinas DF, and Doberneck DM. “Educational Debt in the Context of Career Planning: A Qualitative Exploration of Medical Student Perceptions.” Teaching And Learning In Medicine. 2016. 28(3): 243-251.

4. Rose SL. “Patient Advocacy Organizations: Institutional Conflicts of Interest, Trust, and Trustworthiness.” The Journal of Law, Medicine & Ethics. 2013. 41(3): 680-687.

5. Young K and Schwartz M.Healthy, Wealthy, and Wise: How Corporate Power Shaped the Affordable Care Act.” New Labor Forum. 2014. 23(2): 30-40.

6. Camillo CA.The US Healthcare System: Complex and Unequal.” Global Social Welfare. 2016. 3(3): 151-160.

7. Murray CJL and Frenk J. “Ranking 37th — Measuring the Performance of the U.S. Health Care System.” The New England Journal of Medicine. 2010. 362(1): 98-99.

8. Picker L and Abelson R. “US Sues to Block Anthem-Cigna and Aetna-Humana Mergers.” The New York Times. 2016. 7(21).

9. Clinton H.My Vision for Universal, Quality, Affordable Health Care.” New England Journal of Medicine. 2016. 9(28).

10. Pear R and Haberman M. “Donald Trump’s Health Care Ideas Bewilder Republican Experts.” The New York Times. 2016. 4(8).

11. Sabadish N and Morrissey M. “Retirement Inequality Chartbook: How the 401(k) Revolution Created a Few Big Winners and Many Losers.” Economic Policy Institute. 2013. 9(6).

12. Sullivan P. “Trump’s Healthcare Plans Trouble GOP.” The Hill. 2016. 6(8).

13. “Analysis of Donald Trump’s Health Care Plan.” Committee for a Responsible Federal Budget. 2016. 5(9).

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