Danielle Leigh: Good evening, Jacksonville, and happy Saturday. I’m Danielle Leigh, and welcome to The Conversation with Dr. Ali Kasraeian. It’s been a while, but, how are you today, Dr. Ali?
Dr. Kasraeian: I’m good. Welcome to The Conversation. How was your time away from us?
Danielle Leigh: My time away from you. It’s never … but, it was nice. It was nice. Got to celebrate the 4th of July by celebrating the 4th of July working, but that’s fine. Somebody has to do the news. The news doesn’t take a break. It seems like we do have a big show today.
Dr. Kasraeian: Today, speaking of news, we actually have an interesting thing, interesting topic to talk about that’s been all over the media it seems like for the past six, seven months. It’s basically the idea that the acid test for any nation’s healthcare reform happens with a change in the nation’s administration, which we’ve noticed over the past six months with impunity, and the year before that with the election cycle. Only when a president or a minister who has instigated the reform departs and a new regime assumes power, which we’ve noticed, can we judge the durability of any reform law or program. We’re seeing that now.
Like it or not, now is the moment for the Affordable Care Act and the era of President Donald Trump. Now is a test to see if it’s going to withstand. Over the coming months, US society will decide through the Congress which of President Barack Obama’s reforms will survive and which will not.
Danielle Leigh: Correct.
Dr. Kasraeian: That comes from a perspective article that was written in the June issue, June 29th issue, of the New England Journal of Medicine, Prospects for Health Care Reform in the US Senate. It’s coming just on the cusp of first the House and then the Senate bill looking to repeal
Obamacare. Today, we are going to discuss the ramifications of that discussion here in the studio. To have that discussion is Dr. Michael Koren, who is a wonderful guest here in The Conversation, we’ve had on for multiple different issues, and a number of times for his insight and thoughts on healthcare reform issues. He is now the president-elect of the Academy of Physicians of Clinical Research. Our congratulations.
Dr. Koren: Appreciate that. Thank you for having me.
Dr. Kasraeian: You’re a cardiologist by trade, but you are very, very involved in clinical research. It’s quite a passion for you. You’re the CEO of the Jacksonville Clinical Research Group here in Jacksonville, Florida. You’ve done some groundbreaking research, which actually we talked about on the show last year.
Dr. Koren: Thank you. Thank you for mentioning that. I’m a preventative cardiologist. We’ve had quite a bit of success here in Jacksonville developing new drugs for cholesterol problems and for hypertension and other cardiac issues.
Dr. Kasraeian: With your new role as the president-elect of the Academy of Physicians of Clinical Research, what comes with that?
Dr. Koren: I sleep one less hour a day.
Dr. Kasraeian: Usually it seems like …
Dr. Koren: Which is getting pretty tough.
Dr. Kasraeian: Someone told me years ago, and I have not yet listened to this advice, is the more things you say yes to, the more things you want to do you have to say no to. It’s an interesting avalanche that we put upon ourselves. It’s exciting. Congratulations.
Dr. Koren: Appreciate that. Thank you.
Dr. Kasraeian: Today, we’re going to talk about healthcare reform. One of the things I found interesting, and I put as a little bit of a … whether it’s a disclaimer, or basically a common denominator to the themes of my personal impression of the discussion today, regardless of anyone in the studio or in our audience’s political leanings. I find the most amazing part of what we’re seeing happen over the past eight years, and then watching what’s happening now, and the most amazing, I think, or intriguing lesson that is not learned is one that Washington seems to not pay much attention to, that implementation of legislations and the process of any major social legislation, and healthcare reform in any nation, especially one as large with such a big population as the United States, is very unlikely to succeed when it’s designed, implemented, and passed in a single-party support.
Dr. Koren: In a contentious way.
Dr. Kasraeian: Halfway. It’s done not just with the single party, but with a system that has gone through with single-party support, but a very contentious, like you’re saying, and volatile single-party support manner. When Obamacare, or the Affordable Care Act, went through this now almost a decade ago, eight, nine years ago, one of the star criticisms was that it was done in a very single-party manner in implementation. It passed with single-party support, and its implementation was heavily criticized. You saw the implications politically of what we see now.
What we’re seeing happen now, it seems like, the same process, that almost we’ve pushed the rewind button. We’re watching the same TV show play out or the same movie play out, it’s just the pendulum has now swung in the opposite direction, but it’s quicker and louder. What do you think the implication of this is going to be on the politics of this, and most importantly on our healthcare, where we see bills come out that seem to be not the greatest, whether you’re a physician or whether you’re the community or whether you’re a politician? You can’t deny that these are not profoundly impactful changes that are going to be better for our healthcare in a grand longstanding scheme.
Dr. Koren: Just to reinforce the point you made, in 2009, when the Democrats had huge majorities in both the House and Senate, there still was a lot of contention. Early on, the Republicans made a motion to try to be part of the process, and that broke down for a number of reasons. Obviously there was finger-pointing about whose fault that was. Just to remind people, in the House, the Democrats had problems amongst themselves with some of the more conservative members of the Democratic coalition, including people that were pro-life. That was a huge contention, so they lost a lot of pro-life votes in the House bill. In the Senate bill, they had, if you remember, 60 seats at one point, which was supposedly a filibuster-proof majority. Then, Scott Brown got elected in Massachusetts, in one of the most liberal states in the country, which was a big shock. That forced them to pass the bill using a trick, an administrative trick, because they felt that the bill wouldn’t even be able to be passed …
Dr. Kasraeian: Amongst themselves.
Dr. Koren: … against a filibuster that was only razor-thin. It was very, very contentious. I think another part of that that’s insightful at this point is the Republicans don’t have nearly the majorities that the Democrats had back in 2009.
Dr. Kasraeian: Especially in the Senate.
Dr. Koren: Right. They won’t have the luxury of being able to lose a lot of their members and still pass anything. One of the hopeful points about that is maybe there can be some cross-aisle communication and support, because of the fact pragmatically I’m not sure the Republicans will be able to pass anything amongst their ranks.
Dr. Kasraeian: It seems like it’s important for that to be, from a pragmatic, sensical standpoint and from a medical standpoint, it seems like that would be a very reasonable way to go, because even from a lazy standpoint it seems like it’s much easier to edit something than to create something from scratch.
Dr. Koren: I would think so. But, there are some just fundamental philosophical issues that have to be bridged, in my opinion. I’m not very optimistic that anything is going to happen, because I don’t think anybody’s really talking about these fundamental philosophical issues.
Dr. Kasraeian: Such as …
Dr. Koren: The individual mandate is probably number one. That’s still very controversial, just to remind everybody. That was looked at by the Supreme Court. Justice Roberts was the one that was the, quote, “conservative judge” that moved over to the left in order to approve the Affordable Care Act and not to find it unconstitutional, just to remind everybody. That was a five-to-four decision. A lot of people thought it would be Justice Kennedy who would be the defector from the conservative ranks, but it was actually Justice Roberts.
He wrote the opinion. His rationale, just to remind everybody, was that he did not think that the government had the right to force people to buy a product; but he did think that the government had the right to tax people. He saw this as a tax. It’s very tortured logic, because it’s a tax just on people who won’t buy a product. That was his rationale. That was so controversial that the four justices who were the conservative justices said that that’s crazy. Scalia went on and on about how cockamamie this logic was. But, on the left, three of the five people that voted for it thought his logic was wrong. They said, “Yeah. The government has a right to do this. We don’t even believe in the rationale that Justice Roberts came up with to support this legislation.” Even in the Supreme Court, though the Supreme Court allowed it to keep on moving forward as legislation and become the law of the land, they couldn’t agree on this issue.
To me, that’s really the fundamental issue. I would frame it in a way where I would challenge each of the parties. This is my personal philosophy now. We can talk about this because we’re physicians, and we’re not just politicians. We see suffering every day.
Dr. Kasraeian: We’re frankly not at all politicians.
Dr. Koren: Right. We’re horrible politicians, and I may be the worst of them. [crosstalk 00:09:25]
Dr. Kasraeian: Those of you on the Facebook Live are watching the emeritus professor of surgery at UF Health, Dr. Joseph Tepas, walking in, who is also one of the foremost leaders in the American College of Surgeons and probably one of the smartest people with regards to healthcare policy joining us in the studio. We’re very fortunate that, whether it’s me or his wife have talked him out of a little bit of a weekend vacation to join us here on The Conversation and talk about this, on this wonderful topic of healthcare policy. Dr. Tepas, thank you for joining us.