Donald Trump: Boon or Threat to Nation's Health?

Alicia Ault

November 25, 2016

A group of physicians is stepping into what it calls a leadership vacuum by speaking out against President-elect Donald Trump, calling him a threat to the nation's health, whereas others said they were hopeful that the new administration might curb what they view as regulatory excess.

Some 600 physicians signed an open letter to Trump before the election; they have since struck a more conciliatory tone, but still consider him to be an ongoing threat, said Aaron Stupple, MD, a hospitalist in Boston who is spearheading the effort to highlight concerns about the president-elect.

Noting both a reported surge in hate crimes and the large number of people who feel offended, insecure, and threatened by Trump's perceived racist and misogynistic statements during the campaign, Dr Stupple told Medscape Medical News that Trump has "already unleashed a large degree of damage."

"This is emotional harm to our patients," he said. "We see these people in clinic all the time — the vulnerable, who are destabilized by this guy's rhetoric."

Big Names Would Not Sign On

In the original letter to the President-elect, the 634 signatories stated, "Mr. Trump has consistently demonstrated himself to be an unstable, discriminatory, and anti-science candidate, and we fear he will deliver a setback to our current progress in healthcare, impair our ability to tackle new issues, demean our patients, and potentially prove catastrophic to health and wellbeing."

The postelection missive to Trump was basically a wish list, asking him to improve primary care, negotiate drug prices, invest in public health, provide affordable health insurance, protect veterans, and aim for quality care.

The letters were created because organized medicine had not spoken out about the potential harms with a Trump administration, said Dr Stupple. He said he understood that nonprofits could not appear to be supporting a particular candidate, but said he was miffed that more big-name physicians would not join his efforts to shine a light on Trump's behavior.

"Physicians have a duty to the public good, as well as the individual good," Dr Stupple told Medscape Medical News, also noting that the American Medical Association "calls on doctors to advocate for political changes that ameliorate suffering and contribute to human well-being." He asked many prominent physicians to put their names in bold face on his letter, but he was frequently turned down. "No one really wanted to lead the charge," he said.

Dr Stupple took matters into his own hands and began contacting news organizations with his open letters; some of these organizations have published them.

He cannot purport to represent all of medicine, especially as it is not clear how physicians, as a group, voted. In a November 17 letter to its membership, American College of Physicians (ACP) President Nitin S. Damle, MD, noted, "The election has evoked strong reactions from ACP members, both within the U.S. and abroad. Like the public, ACP members have divergent views."

He said the organization would try to work with the president-elect, but also noted many areas where ACP's objectives differed from Trump's — and the Congress' — professed policy goals, including a repeal of the Affordable Care Act, a rollback of climate change agreements, and less-restrictive firearms policies.

In a postelection poll conducted by Medscape, 63% of more than 5500 overall respondents and 59% of nearly 1500 physicians were very dissatisfied with Trump's election. Only 26% of all respondents and 27% of physicians who voted said they had selected Trump. Forty-four percent and 42% of all respondents and physicians, respectively, said they strongly oppose repeal of the ACA.

What's So Bad About Trump?

Some physicians say they welcome a Trump administration, which could roll back some regulations and perhaps fix a still-broken healthcare system.

Marc Siegel, MD, an internist and columnist for Fox News, was an active supporter of Trump throughout 2016. In a column written after the election, he said a repeal, even if only a partial one, of the Affordable Care Act could be beneficial. "There will likely be more competition, more choice and more out-of-pocket payments, with less regulation," wrote Dr Siegel.

He said it could also lead to more price transparency as patients moved to high-deductible plans that would make price more of an issue, and that high-risk patients could be moved to a pool that would provide heavily subsidized plans to help them afford their insurance.

Anish Koka, MD, a cardiologist in private practice in Philadelphia, said he was looking forward to a Trump administration, as it might reverse the rush to integration. "Incentives aren't aligned with patient outcomes" in many vertically integrated care models, Dr Koka told Medscape Medical News.

He noted, for instance, that recently discharged patients with heart failure who visit the emergency department are often kept from being admitted to the hospital, in part to reduce readmission rates. "There is growing evidence suggesting that hospitals with the lowest heart failure admit rates also have the highest mortality for heart failure," said Dr Koka.

The current policies have "prioritized readmissions over mortality," he said, adding that "Mrs. Clinton promised more of the same."

His hope is that Trump and Congress will come up with alternative payment models that are friendlier toward small, independent physicians, which would also benefit patients, he said. He thinks the Center for Medicare & Medicaid Innovation, which has been charged with creating value-based payment models, might be shut down or severely gutted under the Trump Administration.

Dr Koka, an immigrant and a self-professed liberal who always voted Democrat, said he was not happy with many of Trump's pronouncements. "Some of the comments he makes are crude and offensive and unfortunate," he said, adding, "I have trouble reconciling these things."

Even so, he voted for Trump, hopeful for better policies.

Dr Stupple and Dr Koka have disclosed no relevant financial relationships.

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