Health Care Health Care Reform

Supreme ambivalence…with a sliver of optimism

With the permission of the editors at, a version of this post also appears on Trials and Fibrillations. I wasn’t going to write on this matter, but I changed my mind.

You know the news: the US Supreme Court upheld the Affordable Care Act.

As a doctor in the mix, it seems appropriate to weigh in–ever so briefly.

First, take a deep cleansing breath.

I am highly conflicted about the Supreme Court’s decision. Part of my brain tells me that I should be stomping around in an inflamed state. But I don’t feel that way. Basically, I don’t feel much. It’s not that I think the case isn’t important. It is. Make no mistake: how we, as a nation, treat the less fortunate among us says a lot about who we are.

But really, did the decision matter? If the ACA was struck down, would a better system have emerged? In this political climate? Would an alternative system effectively solve our three most pressing healthcare problems: covering everyone, controlling costs and maintaining the sanctity of the doctor-patient relationship?

I doubt it. Especially since we can’t ever talk about doctors making mistakes, or that smart medicine does not mean more medicine. Less-is-more talk gets beat down as rationing, while goals-of-care discussions bring up death panels. There’s a lot of work to be done.

That’s why I’ve decided that all I can do is show up each day and work hard to positively affect the world in which I live. For me, as an experienced physician, this means working effectively in the healthcare system chosen by the people, whether I like it or not. I have to trust that the American people will choose wisely.

I’m a doctor. And doctoring allows me to do the most good. For this I am grateful.

As far as writing about healthcare issues, I’ll keep at it, in the hope that my experience in the real world contributes constructively to the debate.

Think positive.


4 replies on “Supreme ambivalence…with a sliver of optimism”

I for one think the upholding of the Affordable Care Act is definitely good for health care and good for the country. The act is far from perfect – and its 2700 pages is 2600 more pages of legalese than I’d ever be able to get through. The “theme” of the Act I think is MOST important – that everyone can be covered – and that preexisting conditions will no longer exclude coverage of those in need. Those are the things that counts – because even relative “haves” in our society are no more than one serious illness from financial difficulty (if not loss of home and bankruptcy).

The problem as I see it is our political system. It’s not about being Democratic or Republican – but rather its about doing what is right for the country. As good as I think upholding this Act is – the “battle” has just begun, because already the “other side” (in this case Republicans) are doing all in their power to rebut the decision – with result that millions of dollars will be spent (wasted) on political effort to repeal the Act more because it was something proposed by “the other side” – than because the Act is bad. There are clearly problems with the Act – but the “theme” is good (How can it not be when it means some 30 million more Americans will now be insured – and when it means that people will not be denied insurance because of preexisting conditions?). We all should work to amend and improve whatever is problematic in the Act. Instead the goal of “the other side” will be (strictly for political purposes and for purposes of improving their own financial gain) to tear the Act apart (and in so doing make the current President of this country look bad). I used to think our governmental system of “Checks and Balances” was a good thing – and that the politicians that I elected would do the “right thing” rather than cower behind party lines without courage or concern about doing what is best for the people involved.

Bottom Line – VERY SAD what our health care system (and our country) has come to – and something that won’t be fixed until political parties (and everyone else) begin to work together to collaboratively solve problems rather than working to rebut “the other side”. Nothing will change until the lesson is learned that one should do the right thing – not the political thing ….

Final Note – Sorry Dr. John – I generally have positive feelings about Dr. Wes – but the ongoing Commentary/Debate about this topic on his web site is (my opinion) – just more manifestation about what is not right with our current system …

My view completely. This is the message I hope the public come to understand and grasp. However, in our hyper partisan poltical environment I fear our leaders will do little. The effort must come from us. We physicians should share our expertise and opinions with those who listen..

Dr. John – I wish everyone had your great attitude. We might not have these divisive issues if they did. Thanks for keeping your posts coming. I look forward to reading them. I wish you practiced in Florida!

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