Dr. Jason WestinIn the earlier post about the Ryan ACA repeal today we promised to introduce you to a doctor running for Congress in Harris County, Texas. TX-07 is one of those gerrymandered, traditionally Republican Texas districts where well-educated voters don't like Trump. Romney beat Obama there by a daunting 59.9% to 38.6% in 2012. But with Trump spewing his ignorance and bluster all year, the district gave Hillary a 48.5% to 47.1% win in November. The DCCC has never considered getting involved in TX-07 before. That's changed now and with Jared Polis (D-CO) as the new regional vice-chair for the area including Texas, we can expect a real fight for a change.Jason Westin is a father of 3 young children, a husband, and a doctor who fights cancer by working to find cures every single day. He will be 41 years old during the 2018 election season. After graduating college in 3 years with a degree in Microbiology and minors in History and Chemistry, Jason moved to Washington to serve as an intern in the Senate where he worked for Florida Democrat Bob Graham on health care policy. It was during the Great Tobacco Debates of 1998 that he told us he saw "the true power of politics for good first-hand."He says he was tempted to remain in politics, but he felt he "could accomplish more for more people in Medicine, graduating from Medical School with Honors before being recruited to his first academic medical job as a college professor at age 28. After cofounding a new hospital department, he decided to focus his career on treating patients with cancer.He and his wife Shannon moved to Houston, Texas to train at one of the top cancer hospitals in the world, where they both remain on faculty as Oncologists. Jason now leads a large research team that focuses of finding cures for the most common cancer of the immune system.So... why is Dr. Westin running for US House District TX07? He told us that he's long considered himself an "armchair politician, informed by not involved." During the 2016 campaign, he was stunned when an entire party, and then an electoral college majority was "taken over by a reality TV host who was uniformed and uninterested, vulgar and vindictive, and who wouldn’t be believable as a political candidate in a movie, let alone be qualified in real life."He told us that when his kids have setbacks in sports, he tells them that "complaining accomplishes very little, that the only way to fix a problem is to get up, dust yourself off, and come up with a plan." After the election, like many people he spent a lot of time complaining about the results, but felt like a hypocrite for not taking the advice he gives to his own kids. He resolved to work hard to fix what went wrong, and the best way he can accomplish this goal is to be elected to Congress.How will his background translate to his new job? Every patient who comes to see Dr. Westin has a life threatening illness. His job is “high stakes” personified. Each patient requires a detailed and personalized problem solving approach, cutting to core of complicated information, which must be communicated clearly and in a way that his patient’s can easily understand. Dr. Westin must listen to the needs of his patients, work in a collaborative way with many groups to ensure the needs of his patient are addressed, and think strategically to ensure an achievable plan exists for all contingencies. These skills would directly translate into what is needed in an effective Congressperson. The ability to listen to concerns, communicate complex ideas clearly, and work across disciplines to achieve his goals would serve those he represents well. Dr. Westin thrives under pressure and is used to multitasking successfully. In short, his medical and research career provide him the skills to be an excellent member of Congress and serve his constituents well.Trump Is Flat Out Wrong About The US Health Care System-by Dr. Jason Westin
Nobody knew that health care could be so complicated.”-President Trump, February 27, 2017
Not surprisingly, Mr. Trump is flat out wrong about the US health care system. It embodies complexity, a byzantine system of state and federal regulations, organizations, and tax codes cobbled together over time. If you tried to explain our healthcare system to a completely uninformed person, for example, someone with a background in reality television and hotels, they would likely be due for their next flu shot before you were halfway done.During our medical school training, we were taught about the amazing function of the human body and how it can break down, but we received very little education on the economics of healthcare. As a cancer-fighting doctor, when I enter the room of my patient and work with them to create a battle plan, I consider dozens of factors. These include their cancer type, overall health, previous results, social support, availability of new treatment options, and likelihood of success. It usually does not include the simple question, “who will pay for this life saving care?” With a laser focus on finding cures for my patients by designing cutting edge research, I have been intentionally oblivious to their insurance status, justified by saying that my job was to treat their cancer, not their wallet. But my eyes were opened when several of my patients, including young single mothers and beloved grandfathers, were threatened to have successful treatments stopped due to insurance issues. I could no longer claim this was someone else’s problem. Fixing the U.S. health care system is our problem, even if it's complicated.When doctors graduate from medical school, they recite the Hippocratic Oath, which compels them to “First, do no harm.” Normally, I interpret this oath to apply to how I care for my patients, but “normal” seems to be in short supply these days. Watching the current debate about the future of our nation’s health care, I feel that my oath also says that I must speak up so that American health care does no harm. I believe that health care is a right, not a privilege, and that we must work to ensure all Americans have access. In the parlance of our times, I am “woke.”The Patient Protection and Affordable Care Act (ACA), commonly known as ObamaCare, was a milestone for health care when it was enacted in 2010. At the time, nearly 50 million Americans had no health insurance and 27% of adults under age 65 were essentially uninsurable due to “pre-existing” medical conditions. Insurance companies charged substantially more or refused to insure Americans with cancer, diabetes, drug abuse, heart disease, and even pregnancy. Americans with these and other medical conditions who received insurance through their work were often reluctant to change jobs due to fear of being denied insurance with their new employer. Those who could buy insurance had no easy way to compare various policies, and many insurance plans did not cover preventative care, ranging from mammograms to vaccines, resulting in missed early detection and sicker patients. The ACA is not perfect, but it directly addressed each of these important issues by expanding coverage, increasing patient protections, and creating accessible webpages to compare plans.The ACA prevents insurance from discriminating based on pre-existing medical conditions and gender, but still allows coverage and cost differences for age, location, and tobacco usage. It requires all individual and small group plans to cover 10 essential health benefits including preventative care, prescription medications, addiction treatment, and maternity and newborn care, and allows adults up to 26 years old to remain on their parents’ insurance plan.The controversial parts of the law relate to how it expands the number of people with insurance via the creation of subsidies based upon income, the expansion of Medicaid, and the ‘individual mandate’ and other taxes. If the subsidies and Medicaid expansion (for the 32 states that adopted it) are the carrot, then the mandate is the stick. The subsidies are automatic coupons based upon income for people who make up to 4x the poverty line applied on webpages called insurance exchanges, making insurance more affordable for those who make less. The lower your income, the greater your subsidy. The expansion of Medicaid, the federal program that provides insurance to the least wealthy Americans, now allows those making up to 138% of the poverty level to qualify. The individual mandate is a penalty, or tax increase, of $695 or 2.5% of your income, whichever is greater, if you do not obtain an insurance policy that meets certain minimum standards. Other taxes created by the ACA include a 40% excise tax on premium insurance plans starting in 2018, Medicare taxes on individuals who earn at least $200,000 each year, and Medicare taxes on companies with at least 50 employees.The two main reasons to increase the number of insured Americans are improved health and reduced costs. Uninsured people rarely seek care until they are very sick, often relying on emergency rooms that provide only short-term, high-cost solutions. Increasing access to insurance should lead to earlier intervention, continual control of chronic medical problems, and preventative care. The cost reductions come from having more healthy people paying for insurance without the need for high cost treatments. The entire premise of insurance relies on the idea that the vast majority of people pay more in than they get out, with the promise that if they get sick that they will be covered. The more healthy people that sign up for insurance, the less they all have to pay.To date, the ACA has been very successful on many fronts, despite what you hear from Republicans like Speaker Paul Ryan. Due to the ACA, nearly 20 million Americans have new access to affordable high-quality health insurance. More than 3 million Americans who were previously refused insurance due to pre-existing conditions are now covered, and 2.3 million young adults are covered by their parents’ insurance until they can afford their own. Over 9 million Americans were able to afford insurance with the help of subsidies through the ACA exchanges, and 14 million more are newly covered through the Medicaid expansion. The Medicaid expansion would have had a much greater impact if 18 states had not refused the ACA funds. With these clear measures of success, the uninsured rate across America is the lowest it has ever been at 8.6%, a drop of nearly 50% from 2010. When announcing the American Health Care Act, the replacement plan for the ACA that would gut Medicaid, Speaker Ryan said that the “unified Republican government will deliver relief and peace of mind to the millions of Americans suffering under ObamaCare.” I would bet that the nearly 20 million Americans who are “suffering” by finally being able to afford insurance due to ObamaCare would reject the “peace of mind” offered by Speaker Ryan, and in return give him a “piece of their mind.”In the 7th Congressional District of Texas, where I am running against career politician John Culberson, our uninsured rate dropped from 18.6% to 15.1% since the ACA was enacted. Almost 400,000 district residents now have mandated coverage of preventative care with no copay or deductible charges as a result of the ACA. Nearly 30,000 residents purchased high quality insurance with the assistance of a subsidy, and 24,100 more could have obtained Medicaid coverage if not for the refusal of Texas to accept federal expansion funding. Even with these gains, our uninsured rate is nearly double the national average despite having a median household income of over $71,000. If Congressman Culberson votes to repeal the ACA, he should guarantee his new plan won’t hurt the newly covered and define how his new plan will help the more than 100,000 of his constituents who remain uninsured.Critics point out that insurance costs have gone up since the ACA was enacted, which is true. However, they usually fail to point out that the annual rate of increase is now 37% lower than it was pre-ACA. Congressional Republicans will make the case that the ACA is failing, in a death spiral, and that it is hurting Americans. These arguments have just about as much validity as the President’s tweets.On March 6th 2017, the Republicans in Congress, in coordination with Health and Human Services Secretary Dr. Tom Price and director of the Office of Management and Budget Mick Mulvaney, finally provided details on the American Health Care Act, a.k.a. TrumpCare, to rollback the ACA. The new TrumpCare plan will remove the individual mandate in name under the guise of “promoting freedom and personal choice”, but keep it in spirit by increasing insurance costs by 30% for one year if you allow your plan to lapse. Instead of paying a penalty for not having insurance to the federal government for re-investment in America, now penalties will be paid directly to the insurance companies and their shareholders.TrumpCare will dismantle the income-based subsidies that have allowed over 9 million Americans to finally afford insurance. In their place, new reimbursable tax credits will be created based mainly on age, with slight increases based upon income. Contrary to the ACA, these tax credits will provide a 575% greater benefit to wealthier and older Americans, many of whom happen to be reliable Republican voters. The age-based tax credits may seem like good news for older Americans, but insurances will now be able to charge them up to 5 times what they charge a young customer for the same coverage, a 67% increase over ACA practices. These tax credits will not vary by region, meaning that those who live in states with high insurance premiums will have less purchasing power. Another real problem with the TrumpCare tax credits is that they do not increase with increasing premiums over time, as ACA subsidies do. These credits will only increase if the much less volatile consumer price index goes up. This disconnect will mean that those who are the youngest and have the lowest income will slowly drop out of the insurance market when their tax credits shrink compared to their insurance costs. You will now have the freedom to not buy insurance you can no longer afford.Several Republican Senators expressed their concern about a full repeal of the Medicaid expansion that occurred in their states, and thus there are some olive branches in TrumpCare included to entice their support, but make no mistake: it will be rolled back by 2020 by defunding the federal obligation defined by the ACA. Instead, states will be given a capped amount of Medicaid dollars based upon enrollment numbers and 2016 spending, a fundamental change in this bedrock system of the American safety net. States will need to determine who and what they will be willing to cover, and what they will need to cut. Even more concerning, the ACA expansion of who is eligible for Medicaid will be repealed, preventing millions of Americans living just above the poverty level from enrolling. Remember, the ACA changes to Medicaid eligibility allowed 14 million new enrollees. Where will Americans who are now left out in the cold go after the expansion is repealed? Will the 2% TrumpCare tax credit they receive in lieu of Medicaid be sufficient to provide high quality health care to their family?For the 27% of Americans under age 65 with pre-existing conditions, TrumpCare prohibits insurance companies from returning to their old tricks of charging exorbitant fees or flat out refusing to cover these Americans. However, without the individual mandate, it remains unclear how insurance companies will remain viable if fewer healthy people maintain coverage. States will receive “Stability Funds,” euphemisms for handouts to insurance companies to help cover the most expensive patients, but these will max out at $350,000 per patient. In my clinic, the cost of many of the newest and most promising cancer fighting drugs will quickly exceed these limits. What happens beyond these limits is not defined in the law, which means that patients will be either responsible to pay out of pocket or will be required to stop receiving further care.Private insurance will still be mandated to cover the 10 essential health benefits required by the ACA, but how much coverage will be determined by each state. This will result in a piecemeal system where preventative care could be fully covered to some residents of Kansas City, but not to their neighbors a few blocks away. Lastly, the TrumpCare bill will completely defund Planned Parenthood, including all the critical preventative care provided to low-income women. In 2015, only 3% of all Planned Parenthood services were abortion-related, and no federal funds were used for abortions that were not required to protect the life of the mother or related to incest or rape.To make matters worse, some of these draconian changes aren’t steep enough for some Republicans who demand a complete and total repeal of the ACA. To put in simply, this would be a very bad idea. Without assistance, many of the newly insured Americans would immediately no longer be able to afford their insurance. The rapid withdrawal would cause premiums to increase for those who remain insured, causing even more to withdraw, and so on. This scenario is often referred to as a “death spiral,” and for many who could no longer afford insurance this term would be quite literal.Republicans will claim the above drastic changes will be needed to reduce the cost of healthcare. What they won’t tell you is that they will pay for these changes by gutting Medicare and keeping a tax on the middle class. Nearly half of all Americans receive their insurance through their employer, and under the ACA all but the most expensive plans are considered tax exempt. Starting in 2025, the TrumpCare plan will cap this exemption at the 90th percentile, which means that many hardworking families who purchased a costly plan for greater piece of mind will now regret their decision as they are slapped with a tax increase.Perhaps the most significant change planned in TrumpCare will be the complete repeal of the ACA taxes on the wealthiest Americans and large businesses. The drastic cuts in Medicaid will be used to pay for an enormous tax cut for the “job creators,” because we all know well “trickle down economics” has worked before. These tax cuts provide zero benefit to Speaker Ryan’s stated goals of “universal access to quality, (and) affordable health care,” or his desire to “move decisions away from Washington and into state programs, doctors’ offices, and family living rooms.” As someone who has worked in health care for nearly 20 years, I cannot see how a massive tax cut for the wealthiest Americans will do anything to further these worthy goals. It appears the real purpose of turning Medicaid into a ‘per capita block grant’ may be to force states to make long-term deep cuts in the health care of our most vulnerable. In short, TrumpCare is a reverse Robin Hood bill, robbing from the poor and giving to the rich.The Rice University football stadium, about two miles from my house in Houston, Texas, is where President John F. Kennedy gave his famous speech about our country going to the moon. In his speech, he said “we choose to go the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win.” As a nation, we should approach reform of our health care system with the same intensity that President Kennedy approached going to the moon. Improving our health care will be hard, but that is precisely why we must do it and do it well.What should progressive Democrats do? First, we must continue the pressure on members of Congress personified by the Indivisible and Swing Left movements. Showing up and asking polite but pointed questions at events and calling local and Washington offices will ensure our representatives understand that we are paying attention, and that we will vote. Second, we need to make sure that we have candidates who can speak intelligently on these and other critical issues. Our greatest hope to seize control of the House may be first time candidates, and we should penalize them for being newly motivated by recent events to finally get off the sidelines. We are watching the rapid erosion of the post World War II safety net both domestically and abroad, and thus we must increase our intensity beyond what was achieved in 2016, a difficult task for off year elections.What should we not do? We must avoid the temptation to hyperventilate over each distraction the President deploys. We must avoid being so focused on perfect solutions that we miss incremental improvements. And lastly, we must not lose hope that America remains the greatest force for good, and that better days will come if we work hard and keep our focus.Many on the left ask “Why don’t we create Medicare for all?” A single payer system would simplify life for those trying to compare insurance A vs. insurance B, but I worry that if rolled out as Medicare exists today that the reality could lead to a system like the VA, riddled with inefficiencies and delays in services. I strongly believe that health care is a right, an idea which meshes well with the universal coverage a single payer system provides, but I am skeptical that the bureaucracy would run as smoothly as promised. I have worked in VA hospitals, and our veterans deserve better. To truly fix healthcare, I believe that we need to have a bipartisan commission, supported by involvement from the key stakeholders including patient advocacy groups, insurers, states, and medical associations, who would review all available facts free from a partisan perspective, including multiple points of view from the brightest minds in healthcare and health policy, not from politicians and their lobbyist informed staffers. It would not surprise me if this commission recommended a single payer system, similar to that proposed by Senator Sanders, with the right reforms to the bureaucracy to make it work.I would propose this commission should dramatically increase funding for research to find cures for chronic medical conditions, not just managing them with expensive medications for life. Our current system of treating expensive chronic conditions like high blood pressure and diabetes with lifelong daily pills or shots is a great business model for pharmaceutical companies, but makes little sense for our health or our wallets. In the richest country the world has ever known, only 3% of all Americans with cancer are enrolled on a clinical trial, where all new knowledge and practice changing ideas occur. Simply put, research must be prioritized, not just provided lip service. If we can slip the surly bonds of earth and touch our moon, surely we can do better for our own health care than TrumpCare. I propose this bipartisan commission present their findings to the American people, and that their proposed legislation be brought for a vote after a new Congress is seated, ideally in 2020 when the Senate and White House will be contested again, thus giving the voters a chance to elect candidates who share their beliefs, not just their party affiliation.I’m running for Congress because I believe we can and must do better to improve our nation’s health care. The ACA is not perfect, but we should not let our attempts to obtain perfection cause us to reject the good the ACA has accomplished. In 2018, we will have an important choice. Will we continue the Republican dominance of Congress, allowing one party to have unilateral control over health care? Or will we elect representatives who will represent us and reject the special interest groups like the Koch Brothers pushing to repeal the ACA for the reverse Robin Hood TrumpCare? I’m betting the American people, including the residents of the 7th Congressional District of Texas, will make the right call.For regular updates, be sure to follow Jason on Twitter: @Westin4Congress
