We agree with Ms. Fisher that physicians can help steer the national health care conversation by illustrating the real-life consequences of policy decisions. We disagree, however, on two critical points.
First, Ms. Fisher questions whether expecting physicians to devote time to understanding and explaining complex policy is realistic. Her argument misses the point: We are not advocating for all physicians to study and describe every detail of health policy. However, many physicians do understand the human impact of legislation such as removing health insurance from millions of Americans. If physicians relegate this responsibility to lobbyists and policy wonks, they cede the power to shape the U.S. health care system to those who are far from the realities of providing patient care.
Furthermore, we believe that physicians should have at least a basic understanding of health care policy because of its effect on patient well-being. Improving physician knowledge of health care policy begins with more health policy education throughout medical training. Educational organizations such as the Association of American Medical Colleges (AAMC), which Ms. Fisher represents, can play a critical role in this endeavor. Physicians learn an enormous amount for the sake of patient health and safety; asking them to understand the milieu within which they put all this knowledge to practice is both sensible and realistic.
Second, Ms. Fisher suggests that the existence of physician organizations like the American Medical Association (AMA) obviates the need for individual physicians to understand or engage on issues of health care policy; however, the history of “organized medicine” demonstrates how dangerous it is to depend exclusively on these organizations to advocate for the interests of patients. The AMA initially lobbied against the creation of both Medicare and Medicaid,1 and it has successfully defeated past proposals to create a single-payer health care system.2 Organized medicine has always been an effective advocate for the financial interests of physicians, but not necessarily for the well-being of patients.
Most recently, the AMA and AAMC both strongly supported the nomination of Dr. Tom Price for Health and Human Services Secretary. Dr. Price (now resigned) has been a vocal opponent of the ACA, as well as Medicaid and Medicare in their present forms. Many physicians oppose his stances on public health issues, including gun control and women’s health. Individual physicians should not assume that their own views will be represented by these large organizations.
This year, the AMA and AAMC were united against repeal of the ACA and played a crucial role in preventing it. We commend them for their work. We also recognize that this effort was bolstered by the voices of thousands of individuals who believe, as we do, that it is the responsibility of all physicians to advocate for the best interests of their patients.
Erik A. Levinsohn
Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0003-4594-9570; e-mail: [email protected]
Priscilla Wang, MD
Internal medicine resident, Brigham and Women’s Hospital, Boston, Massachusetts.
Andi Shahu
Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut.
Matthew L. Meizlish, MPhil
Sixth-year MD/PhD student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0002-4306-5061.
Talia Robledo-Gil
Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut.
Eamon Duffy
Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut.
Juliana Berk-Krauss
Fourth-year medical student, Yale School of Medicine, New Haven, Connecticut; ORCID: http://orcid.org/0000-0001-9642-9589.
References
1. Cohen WJReflections on the enactment of Medicare and Medicaid. Health Care Financ Rev. 1985;suppl:3–11.
2. Starr PPrécis of Paul Starr’s The Social Transformation of American Medicine. 1982. J Health Polit Policy Law. 2004;29:575–620.
