Politics as Usual—Not!

Margaret Tempero
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As I write, President Trump has been in office for about 2 months. And frankly, I'm exhausted! For a while, I tried to keep track of everything, relying on my usual news sources, CNN, or The New York Times. But just when I think things are settling down, out comes another zinger and we're in a tailspin again. Now, I know it is not my role here to express my political opinion, and I won't since I love my job! But I do think I have the right to weigh in on the Affordable Care Act (ACA) in jeopardy. Plans afoot on Capitol Hill could affect you and me and our patients in a big way.

President Trump ran in part on a platform calling for repeal of the ACA. Was there a basis for discontent? Sure. The ACA had become unaffordable for many. In some states, provider choices have become extremely limited as many insurers pulled out of state-run plans. Not only did this affect choice, it caused hardship when patients suddenly had to travel long distances to get the specialty care they needed. So, in many parts of the United States, lots of folks have become disillusioned and angry. I get it.

At the end of March, Paul Ryan, Speaker of the House of Representatives, put forward a new bill to replace the ACA. Analysis of this bill suggested that, under it, 24 million Americans would lose coverage. For a variety of reasons, all Democrats and many Republicans refused to support it, and the bill was pulled in the final hour before a scheduled vote. President Trump announced afterward that our health system was destined to crash and burn. Most of the rest of us just breathed a sigh of relief that this hastily prepared bill to replace the ACA was no longer on the table.

Every new initiative has unintended consequences. You probably have to expect that. Did you ever remodel your house and find out that some features were too expensive or impractical? Of course you did. So you worked with your contractor and changed the plan to make it workable and within budget or you raised the budget because you liked a feature and decided it was worth the extra expense. Why can't that happen with the ACA? I agree there are some fundamental philosophical differences with factors, such as being forced to buy health insurance or pay a fine and getting subsidies or tax breaks so you can afford insurance if you want it. Beyond those differences, though, it seems like simple economics; we ought to be able to find common ground and just fix it.

My concern right now is that nothing will happen. That the feuding and debate will continue to the point that we have neither a reasonable replacement for the ACA or legislation to reform it. And that means a significant number of our fellow citizens will continue to struggle with adequate access to care.

My mother once taught me a very valuable lesson. I knew that she wanted a new car and that my father was reluctant to agree. Then, one day a new car was in the driveway. When I asked her how that happened, she replied, “Well, dear, I just made your dad think it was his idea.”

I think that's what we need: leaders on both side of the aisle who can put aside their political aspirations and give others ownership so that something useful gets done. I know I'm dreaming and that Washington doesn't work that way. But I can still dream.

What do you think? Please e-mail correspondence (include contact information) to JNCCN@nccn.org or log into www.editiorialmanager.com/JNCCN to submit a Letter to the Editor.

Margaret Tempero, MD, is a Professor of Medicine and Director of the UCSF Pancreas Center and editor-in-chief of JNCCN. Her research career has focused on pancreatic ductal adenocarcinoma, especially in the area of investigational therapeutics. Dr. Tempero has served on the ASCO Board of Directors and as ASCO President. She currently serves on the ASCO Conquer Cancer Foundation Board. She codirected the AACR/ASCO Methods in Clinical Cancer Research and taught this course and similar courses in Europe and Australia. She was founding Chair of the NCI Clinical Oncology Study Section and served as a member and Chair of the NCI Board of Scientific Counselors Subcommittee A. She is a member of the Scientific Steering Committee and Chair of the Clinical and Translational Study Section for the Cancer Prevention & Research Institute of Texas. She is or has been on the Scientific Advisory Boards of the Lustgarten Foundation, the Pancreatic Cancer Action Network, the V Foundation, The Alberta Canada Cancer Board, and the EORTC. She served as a member of the Oncology Drug Advisory Committee for the FDA. She has served as Deputy Director and Interim Director for the UNMC Eppley Cancer Center. She is Chief Emeritus of the Division of Medical Oncology at UCSF and served as the founding Deputy Director and Director of Research Programs at the UCSF Helen Diller Family Comprehensive Cancer Center.

The ideas and viewpoints expressed in this editorial are those of the author and do not necessarily represent any policy, position, or program of NCCN.

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