Physicians Grade the Trump Administration

A year ago, it would have been hard to predict how much of an impact the first year of the Trump administration would have on healthcare policy. Physicians Practice wrote in October of 2016: "After being of primary importance in 2012, healthcare is almost an afterthought in the 2016 election."

After being the top issue for the 2012 campaign, Gallup ranked healthcare the fourth most important issue for Republicans, third for Democrats. "I don't think healthcare has been discussed much; there has been some talk on what could be done with the Affordable Care Act," Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association, told Physicians Practice last year.

Instead, health policy was thrust into the spotlight for the first six months under the Trump administration. Republican congressmen and influential members of Trump's Cabinet, including Vice President Mike Pence and HHS Secretary Tom Price, MD, as well as the president himself, were all engaged in months-long efforts to repeal and replace the Affordable Care Act (ACA).

How has the Trump administration done thus far on healthcare policy? Not great, according to the respondents to the Physicians Practice 2017 Great American Physician Survey. When asked to grade his administration on healthcare policy thus far, 40.4 percent said the administration deserved an “F” - the most popular grade percentage by far; 20.53 percent said the administration deserved a “C”; 18.4 percent gave it a “B”; 11.6 percent gave it an D; and only 9.07 percent gave it an A.

We spoke to physicians across the country- from those who say leadership in Washington, D.C., has failed thus far, to one doc who gave Trump an A.

Grade: F

Carolyn Eaton, MD, a family physician in San Antonio, can't separate Trump, the man who campaigned for president, and Trump, the president who oversees an administration. The reason she gave Trump and his administration an “F” on healthcare comes down to one basic reason. "On the campaign trail, [Trump] would go on about having a great healthcare plan…he out-politicked the politicians is what he did. He figured someone else would figure this out later. And so of course he had nothing and presented nothing. That's a failure; don't promise what you don't have," Eaton says.

While some can separate Trump from Congress, Eaton places the blame on both. She was unimpressed with their efforts to repeal and replace the ACA. She says it was a huge step back and would have resulted in 8 million people losing insurance. She defends high-deductible plans and says they are better than no insurance at all, which would have been the case under the Republican plan. Instead, she says she'd like to see bipartisan efforts to fix the ACA, but says Trump put the kibosh on that.

One positive she has seen from the Trump administration, due to the failed efforts to repeal the ACA, is more physicians accepting and advocating for universal healthcare. A recent survey from Merritt Hawkins confirmed this, indicating that 56 percent of doctors were found to support a single-payer system. Eaton would rather deal with one set of rules, such as that under the “Medicare for all” plan, than 18 sets of rules, which she deals with through government and commercial payers.

Rebecca Fox, MD, a pediatrician in Loudon County, Va., is among the physicians advocating for universal coverage. Her reasoning is that healthcare dollars are getting spent one way or another. She says she would like to mirror other countries' health systems to get a better idea for covering people. Rather than tearing down the ACA, Fox says she wants to see it improved. "The ACA is a framework; just because the floor isn't level doesn't mean you have to tear down the entire structure of the house," says Fox, who also gave the Trump administration a failing grade. She was particularly bewildered when President Trump said, "Who knew healthcare could be so hard?"

Similar to Eaton, Arvin Nanda, DO, a family physician in Dayton, Ohio, gave the Trump administration an “F” for broken campaign promises as a so-called dealmaker. "With a Republican Congress, a Republican Senate, and a Republican President, it's rather shameful they can't get something done. The president isn't interested in what passes for healthcare, he just wants anything to pass, so he can go back to the voters and say, 'I did it,'" he says.

Nanda says letting the ACA fail, as Trump has claimed he might do, isn't the answer. Instead he is looking for a bipartisan bill to fix the health law. He notes that lack of bipartisanship is why Obamacare didn't succeed and now Republicans are making the same mistakes the Democrats did eight years ago. Besides fixes to the ACA, Nanda says he'd like to see the Trump administration and Congress focus on an issue that hits close to home for him: education on opioids and other drugs.

Fox is in agreement with Nanda about the lack of bipartisanship. "Since when did cooperation become a four-letter dirty word? It's going to take all of us - Democrats, Republicans, Independents, men, women, people of every conceivable color and ethnicity - [to be in] this together, because we all have healthcare needs," she says.

Grade: C

On the other side of the aisle, some physicians are more forgiving toward Trump and his administration for the failure to repeal and replace the ACA. However, their strong desires to see the law replaced, or at least amended with significant modifications, prevents them from being too generous with his grade. Such is the case of Keith Aldinger, MD, an internist in Houston. He says there was not a lot of forethought by Republicans in general in putting together something that could improve or replace the health law.

On the positive side, Aldinger gives credit because the administration and Congress are making the effort. "With time, they'll do something [to amend the ACA]." he says, "They need a lot more physician input as to what's working within the [medical] office and the patient care situation." On the whole, he believes things are moving in the right direction.

Aldinger says he would like to see both the White House and Congress address the high cost of care for patients. He specifically says deductibles are too large and forcing patients to pay out of pocket. "They're never going to use their insurance, so why are they paying for it?" he wonders.

Paul Norwood, MD, an endocrinologist from Fresno, Calif., likes the efforts from the Trump administration and Congress to cut down Medicaid costs. He says the country's debt makes this an absolute necessity. However, Norwood, who is in favor of a mostly pure market-driven system, says the Trump administration only gets a “C” because they didn't have the political capital to get people in their own party to vote for an ACA repeal.

Norwood has a few ideas he would like to see the administration tackle in the next few years. He would like “one-sized fits all mandates,” as he calls these kinds of insurance rules, to be removed and replaced with a primarily first-party payer system. One-sized fits all plans, he notes, are why premiums are so high. "I personally think everyone should be on a high-deductible [health plan]. This way they will shop for medical care and [insurance] will be used for major medical issues only," he says. He would also like to see lowered regulations for drug approval, an easier ability for people to open hospitals, and patients - not doctors -responsible for buying malpractice insurance.                                                 

Grade: A

Michael Wolff, MD, a urologist in Burlington, N.C, is giving the Trump administration an “A,” as a credit to the president himself. Wolff praises Trump's efforts to undo a regulatory climate that he says has harmed the patient-doctor relationship. As a practice owner, Wolff says this doesn't just apply to the ACA, but business regulations as well, specifically citing the corporate tax rate that Trump has been trying to cut. He opines that the over-regulated climate is why physicians who want to open their own practice have limited options nowadays.

Wolff says Trump is trying to bring a pro-business attitude to Washington, D.C. He blames the failure thus far to repeal the ACA on HHS Secretary Price and Congress. On Price, Wolff says, "He hasn't taken care of patients for a long time, he has been [in Congress]. He's part of the Washington elite."

Wolff has even harsher words for Congress, whose members, he says, are entrenched in the nation’s capital and not living in the real world. "This Congress doesn't want to do anything….Most Congressmen have never owned or run a business. Mr. Trump has, so I think he has an understanding of what it takes to be a productive citizen. These congressmen don't and they live in an igloo. They don't understand what it's like to make a payroll, pay taxes, etc.," he says.

The only optimism Wolff has for the next year is if entrenched members of Congress are replaced by outsiders, similar to President Trump. "All the incumbents need to be thrown out [of office]. I think that's what it's going to take…Americans don't want the status quo, they want change," he says.