Dear 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.

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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.

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  • In response to your request that Trump, first do no harm and invest in public health, I couldn’t be more surprised that you didn’t mention climate change, which is considered one of the biggest global public health threats of this century. Trump is a well known climate denier and has referred to climate change as a “hoax invented by the Chinese”. He has promised to withdraw the US from the historic Paris Climate Agreement, undo the Clean Power Plan, dismantle US environmental rules around coal, increase our dependence on fossil fuels and is a stated skeptic of renewable energy sources. It is critical that Trump not reverse the tremendous progress the Obama administration has made on climate change and that his administration continue to act on climate in the interest of public health. Please know that many US professional medical organizations have position statements on climate change. I would be happy to share any of the many position statements with you (American College of Physicians, American Academy of Physicians, American College of Obstetrics and Gynecology and so many more. Please also know that the Medical Society Consortium on Climate and Health has recently formed – a group of 8 medical societies, whose mission is to educate policymakers, the public and our patients about the harmful health effects of climate change and health benefits of decreasing greenhouse gas emissions. I invite you to tune in for the launch of this organization https://www.eventbrite.com/e/launch-of-the-medical-society-consortium-on-climate-health-registration-29288324166.

    Finally, I think any discussion about the public health impacts of a Trump administration should include mention about the role of physicians for advocating for common sense gun control.

    Amy Collins MD, Senior Clinical Advisor Health Care Without Harm https://noharm.org

  • Please continue with a Universal medical plan that we all contribute to Obama’s would work if everyone paid up. Even if you are healthy today, you never know when an accident or bad health will hit. I’m 74 and have conditions that mean I have to have medication, 3 heart medicines, blood thinner and a few other I was in the doughnut by June and now I’m in the Catastrophy. It’s so horribly expensive I have difficulty paying for these meds Thank you!

  • I fully support to message and tone of every word in this letter. I wish I had signed. I hereby sign.
    My Rx for the healing of the nation: Weep deeply: There is a time for grieving. An alarming number of my patients and friends told me that their children had wept at the news that Trump had won. They wept not because they saw their parents’ sadness but because they are scared and sad, as they should be. This has never happened in an American election before. This tells all. Young children are crying over an election result. So weep deeply. I vomited for the fourth time this mourning (ha ha, good misspell), and I hope my visceral purge is done.
    Turn off the Noise: After the weeping, do not harm yourself further by watching the hysterical reactions play out on social media and the pseudo-news. This will only intensifying your sadness, fear, and mistrust in America. This is contraindicated. The glowing screens cause harm. Turn them off; even if just for a week. Engage in the life you lived before you became an internet addict. Internet addiction is harmful to your health. Abstinence is best. At minimum, cut back, a lot. You will feel much better…and you will need to feel much better, because it’s a hard road we have to travel for the next 30 years.
    EVERYTHING is to blame for the calamity that is a Trump presidency:
    –A constitution whose spirit has been fully violated, morphing our checks and balances system into a ‘gum and wrenches system’
    –A two Party system based on unholy alliances that give us candidates who do not fulfill the popular will on anything (guns, healthcare, military interventions, immigration…)
    –A media that focuses the camera only on the most morally challenged and cruel characters and creates false equivalencies making it impossible for the average American to know what is true outside of their non-reality bubble.
    –An American electorate that is ill-informed and hard pressed to be otherwise, seething with ill directed anger, disgust and oft race based fear stoked unabashedly by right wing groups including the RNC, and now our President elect.
    Eat, Move, Chill Well: Weep, pray, love each other, hang out in actuality with your actual friends. Stop agonizing over your mythological Facebook friends–this is what we are in social media; we are myths; we are what we want ourselves to be and what our social bubbles tell us to be. Turn it off and like somebody who is actually there. Go outside and play, meditate, listen to and play music, pray if that moves your soul, eat delicious food, love the ones you’re with. Be thankful for the release from the black noise of things that are not really there. If bad things happen, and; unfortunately, they probably will, you will not be better off having imagined it with your social media bubble months to years before it happens. Chill y’all. It’s bad, but spinning out about how bad it is will not help. If we are all going down, let’s go down dancing.
    To the healing of the nation

  • Can we get beyond the baseless assumption from 15 years ago that better access to primary care will somehow have a major impact on the cost and quality of care in this country? Rational, sure. Evidence based, no. I was a believer once, too. Now, anyone who considers it a meaningful strategy for improving care based on the realities of US healthcare simply doesn’t have any meaningful experience worth considering. Show me The evidence. In other words, it is a talk track from a generation ago. Try again. Ugh. This is the problem with healthcare. Filled with shallow ideas and cherry picked data. And no, I’m not avTrump supporter. I just can’t stand trite doctor shit.

  • 59,523,714 HIDDEN AMERICANS DECIDED THIS ELECTION !

    Americans had 2 choices for president – pro-lifers had 1 CHOICE !!!!!!!!

    All the media are asking how Trump won. It was not because of HIM !!!!!

    There were 59,523,714 American Citizens that may have decided this election — the unborn aborted babies that have NO VOICE and CANNOT VOTE !!!!! This is how many AMERICAN CITIZENS that have been killed since Roe vs Wade in 1973.

    WE PRO-LIFERS SPOKE FOR THEM !!!!!

    Please encourage Donald Trump to be humble and recognize the authority higher than himself — GOD !

    America cannot kill its unborn citizens and expect God to bless our land !!!!!

    TOTAL AMERICAN DEATHS BY WAR 1,449,071
    ABORTED AMERICANS SINCE 1973 59,523,714

    Total American Deaths by War
    Civil War 750,000
    World War II 405,399
    World War I 116,516
    Vietnam 58,209
    Korean War 54,246
    Revolutionary 25,000
    War of 1812 15,000
    Mexican American 13,283
    Iraq/Afghanistran Wars* present 7,222
    Philippine–American War

  • He was not your candidate! We, the voters, take note. Yet, you now, faced with reality are making demands that ultimately assure your financial gain from such demands.

    Its unfortunate that your group, albeit one of the most formidable at self protection/selfishness, are and have been the most contributing factors in millions of people not being able to afford health care.

    Thereby, nesscitating the movement towards a healthcare system that truly respects the need for access to appropriate health care.

    How about you expressing a desire to truly enable a price competitive market? If you did this then it would support an economy that is mindful of the needs of many rather than the exorbitant profits you continue to support.

    Compromise by expressing a willingness to cooperate in moving the health care industry that is affordable to all.

    As a consumer of health care this is what a lot of us wuld respect and support.

    • What you’re saying is true. However, they outline fee-for-service as an issue in this article. Additionally, thinking of health care as a consumer good is far off the mark. Health care is like electricity or shelter; the demand doesn’t just go away when the price goes up. That’s been shown to be true all over. When costs rise, there are no fewer people enrolling in coverage.

      I completely agree with your overall point. Physicians and their autonomy are certainly a big part of the problem here.

  • The cost of medications is so high that most patients are forced to choose between their daily good or their medications. The cost of medications need to be negotiated down if there is going to be mean a meaningful improvement.

  • U may hv 600 fellow Socialist Liberal Physicians that signed your Letter, but the reality is there are likely 600,000 plus Physicians that would thoroughly disagree with you. The ACA is an abomination of care act! You 600 Physicians must be Government /Hospital Corp.employed or Academics because the REAL PHYSICIANS that own and run small practices are being put out of Business or taken over thnks to ACA!! I am an AAPS member and I dare you to read their in depth analysis of the ACA and how its destroying the Practice of Medicine and turning it into the Application of Healthcare Dirrctives from ACA and Insurance Corps. I sure hope PEOTUS Trump put your letter where it belongs, with the ACA in the trash heap of History! You may advocate only one thing and that is “First Do No Harm”! Well, the ACA has done nothing but Harm!!! Businesses have laid off or reduced staff to Part Time to avoid the absolutely ridiculously high mandatory Medical coverage costs! This is DOING HARM!!! Real Physicians believe in the Hipocratic Oath and follow it rather than the simplified and P.C. “First Do No Harm”! Sincerely, Deplorable Joseph F Kasper MD.

  • I would add that to advance these goals investment in the science of healthcare by expanding funding for AHRQ is essential to avoid waste.

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