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Dr. William B. Applegate and Dr. Christopher C. Colenda: A broken system and broken promises on health care

Dr. William B. Applegate and Dr. Christopher C. Colenda: A broken system and broken promises on health care

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We have devoted our professional lives to the clinical care of older persons and have found this field richly rewarding. However, in the last few years, we have witnessed, in our older patients, a sense of rising disappointment regarding broken promises on health care.

We have all struggled with the complexity and expense of our health care system, but unrealistic, even false, promises made by President Trump since the start of his campaign and his presidency have confused and disappointed our older patients. His empty promises to provide an alternative to Medicare have resulted in frustration and resentment toward health care, which have complicated the lives of patients and doctors alike. Further, Trump’s confusing, and often false, public statements regarding the coronavirus pandemic have now tragically exacerbated this dynamic. Many of our older patients do not seem to trust us when we warn them that not following CDC guidelines could put their lives at high risk. We believe that our national leadership has confused our patients, resulting in avoidable deaths of thousands of older persons.

In 2016, our country needed leadership that could inspire while addressing and healing our fault lines. Sadly, we watched as the nation plunged into discord over health care policy, generating contradictory messaging about how to provide more and better health care for “less.” This could have been an admirable goal, but was never backed by any substantive plans or policies from the president. For instance, regulations were written to allow low-cost health insurance policies to be marketed to younger adults which were indeed less expensive, but misleading, with limited duration and limited care coverage.

Meaningful Medicare policy reform has languished. For example, over the next 15 years, Medicare enrollment will increase substantially because most baby boomers will have aged into Medicare. The Medicare Trustees project that, by 2029, there will be 2.4 workers for each Medicare beneficiary, down from 4.6 around the time of the program’s inception and 3.0 in 2018. By 2041, MEDPAC estimates that Medicare spending combined with spending on other major health care programs, Social Security and net interest on the national debt will exceed total projected federal revenues. If Trump is reelected, we predict that his solution to this quandary will be to simply cut Medicare coverage for older persons.

While Trump has actively tried to diminish Obamacare, the coronavirus epidemic has demonstrated the profound need U.S. citizens have for continued national health care coverage. Rather than trying to protect its citizens and lead the country in handling this devastating crisis, Trump actually falsely denied the pandemic’s seriousness.

The duplicity in this has been further revealed by Bob Woodward’s tapes and by the fact that Trump and several associates have recently contracted COVID. Many analysts have shown that Trump’s disastrous handling of the coronavirus crisis is directly responsible for the unnecessary deaths of countless older persons, a majority of whom have previously supported him politically. This disaster has been compounded by his continued attack on Obamacare at a time that Americans desperately need more governmental support of health care expenses.

Many of Trump’s allies and supporters have disingenuously tried to praise the job our current president has done. It is hard for us to fathom that our older patients can accept these assertions given the overwhelming evidence to the contrary. Others will attribute these sad events to “misfortune” or “bad luck.” Our interpretation is that these events, particularly for older voters who supported the current leadership, are an unprecedented betrayal.

Dr. William B. Applegate is president and Dean Emeritus of Wake Forest University Health Sciences and professor of medicine, geriatrics and gerontology at Wake Forest University School of Medicine. Dr. Christopher C. Colenda is president emeritus of West Virginia University Health System in Morgantown, W.Va., and dean emeritus of the College of Medicine, Texas A&M University Health Sciences in Bryan, Texas.

Also contributing to this column were Dr. Dan G. Blazer, a professor emeritus of the Department of Psychiatry and former dean of Medical Education at Duke University School of Medicine in Durham and Dr. Burton V. Reifler, professor emeritus and former chair of the department of Psychiatry at Wake Forest University School of Medicine.

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