Trump must listen to doctors before replacing Obamacare

Keith L. MartinThe Affordable Care Act as we know it is about to meet its end.

A new president, a new Congress and old political grudges mean the nation is in for another seismic shift in how it cares for its citizens, seven years after the last major upheaval. And as divided as Washington, D.C., is over the ideal approach to better healthcare, there are equally diverse perspectives across the United States.

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Just ask Paul Gordon, MD.

For just over three months, Gordon, a primary care physician and professor at the University of Arizona’s College of Medicine in Tucson, rode a bike from Washington, D.C., to Seattle, canvassing the nation’s rural communities on an Obamacare “listening tour.” He logged more than 3,200 miles and engaged in over 100 conversations during his travels.

And what he heard provides additional insight into the outcome of last November’s election.

“What I heard most was anger … fueled by misinformation,” Gordon told Medical Economics. The physician said he frequently heard “repeated sound bites” from political ads and news coverage about how bad the law was as well as the president who enacted it.

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One woman in the mid-Atlantic region, unaware of the law’s actual name, told him, “Perhaps if the law wasn’t named ‘Obamacare,’ it would be better received.” Others voiced their frustration about having to pay for others’ insurance through subsidies, painting them as lazy or undeserving of assistance. 

But rather than correct or expand on the nuances of how public and private insurance works, Gordon simply listened to what average Americans had to say about healthcare in their country. He also spoke to those thankful for the law, who were either receiving a subsidy for their coverage or able to get coverage despite a pre-existing condition. 

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Gordon logged his findings on a blog he kept during his journey (bit.ly/Gordon-ACA) as well as in an upcoming journal manuscript. He would invite President-elect Donald Trump and his administration to look deeper than online polls or phone interviews to accurately gauge American sentiment in reforming healthcare, especially in rural areas where the law has its critics, but also those whose lives are better as a result.

“The big point is that we did something different than survey data, often dichotomous, fixed-choice responses,” he said. “Those don’t give the opportunity for the richness of a conversation and that’s what we did. It makes a big difference.”

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And now that he’s resumed his academic work in Arizona, Gordon will take what he’s learned to train future physicians to do the same thing: simply stop and listen and, when needed, take the extra step he didn’t on his tour and provide accurate information to dispel misconceptions or miscommunication.

“You need to listen to your patients, because we don’t know how difficult it is for them without actually asking the questions,” he said.  “And I get that when you are in practice, particularly when you have some [quality metrics] to meet, that’s really hard. I still think, though, even opening the door to the conversation is helpful and … maybe we can at least refer them to resources that we trust for information.” 

Keith L. Martin is editorial director of Medical Economics. What would you tell the Trump administration about Obamacare ? Tell us at medec@ubm.com.