President Trump or Clinton: Help Us as a Nation of Patients and Healers

Heartfelt with Dr Melissa Walton-Shirley
COMMENTARY
President Trump or Clinton: Help Us as a Nation of Patients and Healers

Melissa Walton-Shirley
Disclosures | October 06, 2015


When our presidential candidates speak on the topic of healthcare, I wonder who has their ear? Are they practitioners? Are they academicians? Are they just friends who run in the same circles? Do their confidants have their finger on the pulse of the frail, the elderly, our children, or the mentally ill? Will they encourage the future leader of the free world to pick up the mantras of prevention and detection for the first time in the history of the US? Or will we continue to dwell in the self-perpetuating palindromic cycle of sickness, treatment, and more sickness?

In this country, we lament on an hourly basis both the over- and underutilization of emergency services, yet we allow our high school graduates to go out into the world with not one clue as to what constitutes a normal blood pressure or what type of food to avoid if they develop heart failure. This is a completely preventable turn of events.

To date, no president has rolled up his sleeves on the basics or specifics of healthcare. Although our nation's history has produced admirable attempts at reaching the sick and the poor with everything from soup kitchens to websites, the common effect of these attempts is merely temporary.

The two presidential front-runners have varying opinions on how to approach the healthcare debacle. I like Mrs Clinton's plan,[1] which does include a few specifics:

A $250 monthly cap on prescription drugs for patients with chronic or serious health conditions.

Families ineligible for Medicare will be eligible to receive up to $5000 in tax credits for out-of-pocket healthcare expenses.

She would keep Obamacare.

She would like to block insurance rate hikes.

Mr Trump has admirable but broader, more general goals[2]:

To separate the influence of the insurance companies from politicians.

Universal coverage without state boundaries.

To abolish Obamacare.

He says he can amass the money required to implement these changes by bringing back jobs from foreign countries and by taxing foreign products. He says he will "take care of existing hospitals so they can take care of people." He wants the people to be able to negotiate great plans with great companies.

I have no argument with either candidate's ideas. Without agreeing on a few basics, though, we are doomed to fail again. Here are but a few of the necessary changes that will be required to right what is wrong with US healthcare today:

By the time the first term ends, insist that 100% of American workers and patrons are protected from secondhand smoke. These would require statewide mandates that start on the local level. Enticements would be required that link federal funding for local projects and public works. You pick, Mr or Madam President, as to what programs you'd like to link to that achievement.

Offer tax breaks for work places that can prove employees are participating in exercise and wellness program. Make bonuses available for those corporations that demonstrate improvement in average body mass indexes of their workers. (Think LEGACY[3] outcomes—the greatest gift our nation could give itself.)

Revamp our nation's education curriculum to make health literacy a number-one priority. Structure a progressive program for grades K–12 such that every high school graduate starts their adult life armed with more information than the average licensed practical nurse. Utilize the massive task force of retired physicians and nurses who could advise on the structuring and implementation of these programs.

Target the nation's most expensive DRG, congestive heart failure, and all of its drivers, as a focus for education, detection, and therapy. Leverage impactful data on simple measures such as the study[4] showing that placing blood-pressure cuffs in barbershops was associated with a reduction in systolic blood-pressure among patrons. There are numerous other examples of grassroots changes in our communities that will work.

Make Medicare pay for calcium scoring for appropriate patients so we may advise patients of their risk for developing angina and MI. It might also decrease expenditures for unnecessary lipid therapies. An 80-year-old without coronary calcium likely doesn't need a statin unless they have peripheral vascular disease.

Drive culture change by having an open and honest conversation about the true impact alcohol use has on our nation's trauma expenditures. Deglamorize its use in political and social circles. Send a message that reverses our permissiveness toward alcohol so we can decrease America's burden of atrial fibrillation, cirrhosis, cardiomyopathy, cancer, stroke, lost wages, and divorce.

Examine disability rolls and find work for those who might not be well enough to stand on their feet but are intelligent and vital enough to do other things like staff phone lines to help the elderly remember to take their meds, drive the elderly and disabled to appointments, and work as mentors in education systems.

Stop driving the development of a hodgepodge of electronic health record (EHR) systems that don't communicate with each other. Let me just be a physician, not a scribe, not a coder, and not a lawyer. Use EHR as an archiving tool only. Consider using the nation's only universal server (ie, the Veteran's Administration) model so that all EHRs have the capability to communicate through a central archive. Make changes that allow me to dictate my history and perform my exam unimpeded. Let me have time to look my patient in the eye and place my stethoscope and my hands on my patient without ever having to consider anything about a code. Let us have the capability to hire someone else to archive or scribe. Those tasks aren't and should never be in my job description.

Mandate access to healthcare for every single man, woman, and child in our nation. I don't care what you call it but make it coverage worth having.

Deny insurance companies the opportunity to change medication regimens in patients who are stable on current meds.

Demand that all pharmaceutical companies score all pills, stamp the name of the meds or abbreviations on the pills, and maintain the stance that once generic, always generic. Stop the daily barrage of communications from pharmaceutical companies that line our "to be shredded" bins.

Champion reimbursement for mental-health therapy, detection, and counseling. Increase in-patient treatment programs for psychiatric illnesses as well as dual addiction treatment.

Fund "Go to Grocery" programs that place nutritionists in local community food markets several hours per week to help our citizens purchase fuel that powers our bodies and protects us from illness instead of junk that weakens us, causes us to retain fluid, increases heart-failure admissions, and drives up the cost of healthcare. Fund nutrition counseling and availability in every community. Make the Mediterranean diet and the DASH diet part of every discussion.

Not everyone will agree on the specifics here, but everyone will agree there are specifics in these recommendations. We cannot build an elite nation of humans without specifics. We can't be an elite nation of citizens by waiting until illness strikes before we act. We can't change detection and time-to-treatment patterns if we don't educate our children from kindergarten about how our bodies work, how they should be fueled, and what it takes to maintain our youthfulness. If our next president ignores prevention, detection, or education, we are doomed for another 4 to 8 years of wallowing in the very expensive quagmire of obesity, diabetes, smoke exposure, mental illness, and addiction.

Please Mr or Madam President, be specific, practical, kind, caring, and informed. Help your fellow Americans to be the best we can be, but to do that, you must help us as a nation of both patients and healers.