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What do you think? Is it going to be 6 of one, half dozen of the other with politicians? Will the Republicans propose/ alter the ACA in a way that favors physicians more?
Republican House and Senate (and maybe Executive) good for the future of medicine?
- Thread starter ihopeigetit
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I think it's a lot more complicated than this. And if the republicans take the executive and keep the legislative then ACA will simply be repealed, not altered.
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As long as insurance companies right the bigger donation checks neither party will help physicians or patients. If health was important to the Republican party then the red states wouldn't be the states fighting for the most unhealthy titles.
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Before this thread falls into an unsalvagable flame war...
PLEASE, regardless of your political leanings, take the time to be aware of state/county/city level politics, which play just as big a role as the feds in terms of health policy. I've pretty much decided to turn down what would have been a good attending job in Chicago that was heavily reliant on state funding because of the budget situation in Illinoins.
It infuriates me when I see med students and residents who stay home on election day, especially in mid-terms.
PLEASE, regardless of your political leanings, take the time to be aware of state/county/city level politics, which play just as big a role as the feds in terms of health policy. I've pretty much decided to turn down what would have been a good attending job in Chicago that was heavily reliant on state funding because of the budget situation in Illinoins.
It infuriates me when I see med students and residents who stay home on election day, especially in mid-terms.
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No flaming. I'm an independent.
I was just stating that the situation is a lot more complicated than it looks with a lot of backroom politics, even within ones own party.
Democrats--> single payer.
Republicans--> private, no mandate.
ACA is some non-functional compromise between the two that creates more problems than it solves.
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No flaming. I'm an independent.
I was just stating that the situation is a lot more complicated than it looks with a lot of backroom politics, even within ones own party.
Democrats--> single payer.
Republicans--> private, no mandate.
ACA is some non-functional compromise between the two that creates more problems than it solves.
I think that last part is a bit hyperbolic. It's been kind of a wash for my program and a net positive for my patients, many of which are seeing an MD for the first time in years (helps to be in a medicaid expansion state). Most of the changes we've been dealing with (compensation/paperwork issues) that have been the biggest headache over the last 4 years have to do with policies outside the realm of the ACA (a lot of them at the state level...especially with our medicaid patients).
Note that my main hospital is probably majority medicaid. I'm also typing this from a VA clinic computer now. Despite the headaches here, the VA has been a pretty good place to work that the feds have been generous throwing $$ to lately, and they tend to treat their employees well.
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Republican government does not = good for medicine and the converse is not true as well.
As far as local government goes all that matters is CONSTITUENCY. That's it. Who is voting for them? Who is giving money towards their campaign?
In rural areas, mostly old white people vote which leads to a Republican rep for that district in the House. How does this rep vote? He votes against anything cutting social security benefits in spite of the party's platform to "end the welfare state" because his constituency benefits from it. His constituency does not like the ACA because it's thought to be a Dem policy and so the rep will do what he can to block expansion in his state (See TX and about 35% of the Union) in order to hamstring ACA implementation and keep his voters happy. What's the result? Bad for patients. Expensive practices in Texas (including MD Anderson) have not seen a dramatic rise in patients in spite of offering the best cancer care in Texas (and the country, competing with Memorial Sloan Kettering but don't quote me) because the lack of expansion and public reaction to the ACA has kept the uninsured and underinsured exactly where they are (albeit 15 million people that were not insured are now insured, nationally). So, in spite of having something offered to them, Rep constituents in rural areas of the U.S. would still rather their reps continue to oppose the ACA implementation for political reasons that paint the ACA as unsustainable welfare. In spite of this view conflicting with what I said earlier about social security (which is unsustainable welfare but untouchable by both parties because only old people vote in this country /sigh) the public will continue to support these actions. Thus, the reps will continue to act in this way.
At the Senate level the constituency is larger but inaction and the lack of compromise will probably continue until Obama's term ends in 2016. I have very strong doubts about Reps being able to elect an executive into office in 2016 and if that is the case then I fully expect the gridlock to continue into 2020 barring some explosive global event that requires our military intervention. Wars are strong periods of national unity and it allows the executive and his party to pass more legislation in their favor. That's not conjecture, that's just an observed fact and I really don't know how to explain it.
Anyways, I don't expect the Senate to do anything ACA related although I would expect a Rep House Senate combo to maybe try to block the ACA title that further subsidizes medical education and other training programs. The only thing I wouldn't be surprised at seeing is expansion of residency slots from the Senate but I wouldn't get my hopes up there either since there is no critical incentive for them to do so at this point and this Senate really only likes doing things with guns to their heads.
I would not expect the Reps to block the ACA title that expands mid-level provider training and gives them more autonomy in primary care environments because that title is very good for the healthcare and pharmaceutical business interests which play a large role in their campaigns. Mid-level providers are cheaper for big hospital corporations and the prescribe more, statistically, which is great for patient satisfaction (which the ACA gives a **** about for some reason) and pharm companies. That being said, I don't expect the Dems to do anything about these titles either though I can see them arguing for subsidizing medical education especially if they are from California, the East Coast or a Blue Mid West state where most medical training takes place and costs are exploding.
My point is that either party being in power does not mean "good or bad" for medicine. Politics is not binary. Politics is about two things: "the public opinion and how they vote" which makes it awful and "money" which makes it ****. For the voting bit, the young don't vote in local elections (this includes med students, residents, young attendings, nurses, a lot of people in healthcare) which leaves them unrepresented in their local government. The physician lobby is essentially non-existent and does not constitute a large enough quantity of money, people, or leverage to have a significant amount of sway on legislation. That's why we rely on committees and people like Ezekiel Emmanuel to say what is good for physicians instead of just asking the physician lobby - which doesn't exist. Physicians have enough money, nationally, to be a force to be reckoned with but I doubt it is spent on politics and if it is it is probably just in individual donations to specific candidates (which is not bad because that is a form of voting, in a way, but does not necessarily satisfy the needs of the physician population at large, especially poor residents who do not have the income to be represented in such a fashion). Essentially, no one on Capitol Hill really gives a **** about patients and the Republican constituencies from Rural areas don't largely seem to give a **** about their own interests other than social security and Medicare. The republican constituencies from Urban areas are younger (but not that much younger) and don't care about social security, Medicare, or Medicaid, or the ACA in general and would rather it just go away.
Here's a couple of things you should know about the ACA right off the bat:
1)It's here to stay.
2) The system we had before was way worse, unsustainable, and would have caused a national defense crisis in the future or at least a national defense SPENDING crisis. (PM me if you want to know what I mean by that, it's a tangential and unrelated discussion about the way government money is allocated).
The long and the short of it is that you should stay on top of your local and state politics and VOTE VOTE VOTE every chance you get, Rep or Dem, in order to ensure that you are represented. Your fellow med students should be encouraged to vote, physician colleagues, everyone. Young people need to vote in this country. They are far too indebted and poor to have a big sway on a political funding campaign but with enough votes and letters it's enough to at least get a bullet point on a campaign platform that will at least be heard on the news, disseminate, and maybe eventually make it to the national stage or party convention if enough politicians and voters agree it should be a thing.
Also, I beg of you to please, please, please avoid saying things like "the ACA is bad for patients and doctors" if you cannot immediately follow it with what part of the ACA is bad for patients and doctors. The ACA has a lot of problems for patients and docs, to be sure, but when you are trying to fix a system that was essentially a debacle that pretended that the 1980s would last for all of eternity you are going to have to break some eggs.
As far as local government goes all that matters is CONSTITUENCY. That's it. Who is voting for them? Who is giving money towards their campaign?
In rural areas, mostly old white people vote which leads to a Republican rep for that district in the House. How does this rep vote? He votes against anything cutting social security benefits in spite of the party's platform to "end the welfare state" because his constituency benefits from it. His constituency does not like the ACA because it's thought to be a Dem policy and so the rep will do what he can to block expansion in his state (See TX and about 35% of the Union) in order to hamstring ACA implementation and keep his voters happy. What's the result? Bad for patients. Expensive practices in Texas (including MD Anderson) have not seen a dramatic rise in patients in spite of offering the best cancer care in Texas (and the country, competing with Memorial Sloan Kettering but don't quote me) because the lack of expansion and public reaction to the ACA has kept the uninsured and underinsured exactly where they are (albeit 15 million people that were not insured are now insured, nationally). So, in spite of having something offered to them, Rep constituents in rural areas of the U.S. would still rather their reps continue to oppose the ACA implementation for political reasons that paint the ACA as unsustainable welfare. In spite of this view conflicting with what I said earlier about social security (which is unsustainable welfare but untouchable by both parties because only old people vote in this country /sigh) the public will continue to support these actions. Thus, the reps will continue to act in this way.
At the Senate level the constituency is larger but inaction and the lack of compromise will probably continue until Obama's term ends in 2016. I have very strong doubts about Reps being able to elect an executive into office in 2016 and if that is the case then I fully expect the gridlock to continue into 2020 barring some explosive global event that requires our military intervention. Wars are strong periods of national unity and it allows the executive and his party to pass more legislation in their favor. That's not conjecture, that's just an observed fact and I really don't know how to explain it.
Anyways, I don't expect the Senate to do anything ACA related although I would expect a Rep House Senate combo to maybe try to block the ACA title that further subsidizes medical education and other training programs. The only thing I wouldn't be surprised at seeing is expansion of residency slots from the Senate but I wouldn't get my hopes up there either since there is no critical incentive for them to do so at this point and this Senate really only likes doing things with guns to their heads.
I would not expect the Reps to block the ACA title that expands mid-level provider training and gives them more autonomy in primary care environments because that title is very good for the healthcare and pharmaceutical business interests which play a large role in their campaigns. Mid-level providers are cheaper for big hospital corporations and the prescribe more, statistically, which is great for patient satisfaction (which the ACA gives a **** about for some reason) and pharm companies. That being said, I don't expect the Dems to do anything about these titles either though I can see them arguing for subsidizing medical education especially if they are from California, the East Coast or a Blue Mid West state where most medical training takes place and costs are exploding.
My point is that either party being in power does not mean "good or bad" for medicine. Politics is not binary. Politics is about two things: "the public opinion and how they vote" which makes it awful and "money" which makes it ****. For the voting bit, the young don't vote in local elections (this includes med students, residents, young attendings, nurses, a lot of people in healthcare) which leaves them unrepresented in their local government. The physician lobby is essentially non-existent and does not constitute a large enough quantity of money, people, or leverage to have a significant amount of sway on legislation. That's why we rely on committees and people like Ezekiel Emmanuel to say what is good for physicians instead of just asking the physician lobby - which doesn't exist. Physicians have enough money, nationally, to be a force to be reckoned with but I doubt it is spent on politics and if it is it is probably just in individual donations to specific candidates (which is not bad because that is a form of voting, in a way, but does not necessarily satisfy the needs of the physician population at large, especially poor residents who do not have the income to be represented in such a fashion). Essentially, no one on Capitol Hill really gives a **** about patients and the Republican constituencies from Rural areas don't largely seem to give a **** about their own interests other than social security and Medicare. The republican constituencies from Urban areas are younger (but not that much younger) and don't care about social security, Medicare, or Medicaid, or the ACA in general and would rather it just go away.
Here's a couple of things you should know about the ACA right off the bat:
1)It's here to stay.
2) The system we had before was way worse, unsustainable, and would have caused a national defense crisis in the future or at least a national defense SPENDING crisis. (PM me if you want to know what I mean by that, it's a tangential and unrelated discussion about the way government money is allocated).
The long and the short of it is that you should stay on top of your local and state politics and VOTE VOTE VOTE every chance you get, Rep or Dem, in order to ensure that you are represented. Your fellow med students should be encouraged to vote, physician colleagues, everyone. Young people need to vote in this country. They are far too indebted and poor to have a big sway on a political funding campaign but with enough votes and letters it's enough to at least get a bullet point on a campaign platform that will at least be heard on the news, disseminate, and maybe eventually make it to the national stage or party convention if enough politicians and voters agree it should be a thing.
Also, I beg of you to please, please, please avoid saying things like "the ACA is bad for patients and doctors" if you cannot immediately follow it with what part of the ACA is bad for patients and doctors. The ACA has a lot of problems for patients and docs, to be sure, but when you are trying to fix a system that was essentially a debacle that pretended that the 1980s would last for all of eternity you are going to have to break some eggs.
