ear Mr. Trump,
We are a group of doctors who saw in your presidential campaign a threat to the health and well-being of the country. We wrote an open letter sharing our concerns, which more than 600 doctors signed.
You were not our candidate. But now you will be our president and, more important, our patients’ president. And so we write again.
First, we ask that you do no harm.
Second, we respect that your campaign ran on changing a system that you and your supporters said was corrupt and that neglected millions. In many ways we agree. To improve the health of all Americans, we urge you to do the following:
Improve primary care. You spoke about forgotten Americans. We see them all the time — young, old, and in-between — fighting complex conditions that require constant help from physicians and others but struggling with a system that can be hard to get into. In many ways it is deeply unfair, missing whole segments of the population because they don’t fall into convenient revenue streams. This help should take place close to their homes through stronger primary care. Not only does such care focus on the often forgotten, it is a smarter way to use the country’s resources.
Invest in public health. Public health measures make the biggest impact on improving the quality and length of life. We are seeing the absence of sound public health policies in the rise of opioid deaths. This is a crisis that demands bold action and leadership. In addition, please focus on improving nutrition, disease surveillance, consumer safety, and fighting stress, obesity, and inactivity.
Provide affordable health insurance. We agree with you that the Affordable Care Act has its flaws. But ending it abruptly would be a harmful setback, and millions are now insured through the ACA. You compassionately stated that we won’t have people dying in the streets. We recommend focusing on the ACA’s biggest weakness and addressing the premium increases. Whatever you choose, please do not go forward without a plan to support the millions for whom the ACA is a lifeline. You have previously expressed support for a public insurance option, which we agree is a worthy alternative.
Negotiate drug prices. Both the Medicare Prescription Drug, Improvement, and Modernization Act and the ACA allowed the pharmaceutical lobby to set the terms for drug pricing, essentially allowing the industry to siphon money from Medicare without allowing the government any power to negotiate. Please use your negotiating skills to stop this burden on our seniors.
Protect our veterans. The US Department of Veterans Affairs is an ideal proving ground for improving health care in America. Like all Americans, our veterans deserve better support for mental health, addiction, and chronic disease. Combating these challenges requires well-functioning organizations of health care professionals, but also systems that support stronger social ties. The VA knows that investments in housing, food, employment, education will all be essential.
Aim for quality care. You ran for president as someone who understands business. The business of health care in America is growing larger each year, but being sick, needing care, and suffering with illness is not a simple matter of dollars and cents. Many have called ours a sick-care system — the more sickness there is, the more money can be made. In fact, by giving patients tests and treatments that don’t help and only harm, spending more on health care can actually make people more sick rather than less. We ask you to use your business savvy to help patients get the quality care that they pay for, nothing more and nothing less.
Health care in this country is in desperate need of improvement. We applaud you for shining a light on the millions for whom it has failed. In working for them, and for all Americans, we urge you to be thoughtful. The field of health care workers, researchers, and policymakers is filled with hardworking, dedicated, and decent people who care for all Americans, including marginalized groups like women, minorities, and the poor. We all need compassionate and informed leadership that listens to patient needs and to those who have committed their lives to this calling.
Aaron Stupple, MD, is an internal medicine physician practicing hospital medicine in Boston. Andrew Goldstein, MD, is a primary care physician and postdoctoral public health researcher in New York City. Stephen Martin, MD, is a primary care physician in Massachusetts.