Following Republicans’ many attempts to kill the Affordable Care Act this week, culminating in last night’s surprising failure of a “skinny” repeal bill, MedPage Today asked physicians outside the Beltway how they and their patients have been reacting to the drama.
“I think people sort of feel that the whole system is just an angry mess,” said Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates in New York City, and weekly blogger for MedPage Today.
In Manhattan, he sees patients of all kinds.
Throughout this process of “dredging up” different repeal bills, instead of patients being relieved that one or another didn’t pass, “there’s a lot of throwing up their hands,” he told MedPage Today in a phone call.
Even those patient who don’t like the Affordable Care Act felt this wasn’t a good process, Pelzman added.
For his own perspective, Pelzman believes that the ACA was a good start but the country should move towards Medicare-for-all (or “god forbid, socialized medicine,” he joked), but he acknowledged that it may not be realistic right now.
“My hope for the future of the healthcare system in this country is that we figure out what that baseline of access and preventive and chronic care that every member of society should have is, and then if people want some platinum policy and want to pay more for this or that, I think the private insurers would be more than happy to provide that.”
“This country needs a safety net that is a little less exclusive … You should be able to get the care you need and if you want to see the world’s greatest heart surgeon, you figure that out.”
“Why should someone who has a child with leukemia … worry that they’re going to have to give up food or their house in order to get their child treatment?” he asked.
“When you hear people like [Sen. John] McCain standing up and saying it’s time to stop making it all what the Democrats want or what the Republicans want, it’s got to be what the people who sent us to Washington want, I think that’s the right message.”
Daniel Edney, MD, an internist in Vicksburg, Miss., who characterizes his political views as “left of the Tea Party but to the right of most moderates in Washington,” said he isn’t against repealing the ACA as long it can be replaced with something better.
“In the absence of seeing something better, I personally am in favor of fixing what we have,” he said.
He was disappointed that Mississippi’s governor chose not to expand Medicaid.
“If any state in the union needed Medicaid expansion it was Mississippi,” Edney said, adding that it was “absolutely foolish” to give up $2 billion in funding over a political statement.
However, the governor did say he would accept funding through a block grant, an idea that Edney is not opposed to. “It’s not about ideologies, it’s about doing the right thing to help our folks,” he said.
The ideal is “to make healthcare decisions as local as possible,” Edney said.
He’s not hopeful about the prospects of a bipartisan agreement. However, “currently the leadership in Mississippi has a good relationship with the administration,” he said. “Maybe things will improve for us whether there’s a repeal and replace or not.”
“People have healthcare and they need healthcare. To take it away from them, that’s just cruel,” said Pamella Gronemeyer, MD, of SEMC Pathology in Highland, Ill., and co-president of her state’s chapter of Physicians for a National Health Program.
Gronemeyer said she fell asleep watching the debate last night but woke up on time to catch the vote.
“I was glad that John McCain voted no and killed it,” she said. “The majority of people I know supported the ACA and did not want it to be repealed.”
“I realize it was a ‘skinny repeal’ but once you get rid of those mandates, it will help break the system,” Gronemeyer added.
The biggest concern Gronemeyer had with repeal was its impact on the critical access hospitals in her state.
“Without the ACA those hospitals are going to close and the rural areas are going to suffer. It’s going to take people an hour or an hour-and-a-half to get to the hospital,” she said.
She also worried about repeal’s impact on Medicaid, noting that southern Illinois has been struggling economically and many people now rely on Medicaid.
Looking ahead, Gronemeyer said, “I’d like to go to single payer … but they keep telling me its not going to happen.”
So, she’s prepared to compromise for the moment.
“We need to fix the ACA. We need to make the markets more competitive, make the premium more affordable” and ensure that deductibles are within reach.