Dr. Loh: In the crosshairs — American healthcare leadership
In these unpredictable times in healthcare, it seems that an overview of where we are, how we got here, and where we go from here, might be worthwhile before going back to dealing with the implications of some of the shortsighted policies instigated by whim and ignorance by people placed into positions of great power based on fealty rather than competence.
Unfortunately, it is the public and their progeny that have to deal with the consequences. If you do not agree with these statements, remember this is an opinion article. Feel free to express yours in this forum. An informed dialogue is good for a democracy. Childish behavior, bullying, and yelling, are not.
America has traditionally led in the fields of biomedical research and technology, as well as in the basic sciences that underpin those advances. All of humanity has potentially benefited from our medical research. Yet our outcomes do not track with the quality of our medical science, e.g., maternal mortality, lifespan, etc.
Some of this is explainable by lifestyle choices. But another contributor is the well-documented problem that in the U.S., getting access to that fantastic care is inequitable and affected by one's income, social status, and zip code. This is why despite having the best biomedical science, we have third-world outcome data for some of the actual care being delivered. Having profit-driven middle-man insurance and pharmaceutical benefit manager companies placed between a human being that needs care, and a trained clinician capable of doing that care only exacerbates the disparity between what is possible and what is probable.
Some of these factors have been called the social determinants of health, and are quite unpopular now in hallways of American power, so it is quite unlikely that there will be any meaningful movement towards correcting these issues. It's easier to blame an immigrant, legal or otherwise, or a single mother, minority or otherwise, trying to care for her family, than to look in the mirror to see where the real problems are.
Those of you who have followed my columns for decades know that I recently cut back from clinical practice after 45 years, but that I have been a clinical researcher for over 50 years. Over these years, I've seen healthcare make many changes, driven by financial pressures on the federal government to deliver affordable healthcare, and to not undermine the for-profit insurance industry. Increased taxes (by many names) and decreased benefits (by many health plans) have been the 'adjustments' required to try and keep an unsustainable healthcare system functional. They did this by kicking the financial can down the road so that the next Congress and next administration would have to deal with it. This has, by the way, been going on since around WWI (one!) from the time of Woodrow Wilson.
The current administration, through DOGE, and its selection of individuals uniquely and unequivocally unfit for their healthcare positions, has embarked on a wholesale dismemberment of our healthcare system. This is not to make it more efficient as they claim, but to cut the biggest costs (healthcare) out of our federal budget so that the uber-wealthy can keep their tax cuts due to expire soon. And yet the proposed Big Beautiful Bill will jack our national debt to even more obscene levels, to be borne by our children and children's children.
We are the only allegedly civilized country that regularly drives its citizens into bankruptcy because of the cost of getting healthcare. And our Congressional and Senate leadership have been complicit in this. Indeed, the proposed cuts to Medicaid are likely, if implemented, to break the financial back of many smaller rural American hospitals that are barely getting by now and consequently exacerbating the difficulties in getting access to care. Through coarse Draconian budgetary slashes, DOGE and Congress have laid waste to the NIH, academic and myriad basic science labs in the U.S. as well as those sponsored by partner labs around the world. As a result, we are not only losing the science that has made American biomedical research the envy of the world, we are losing the next generation of scientists who have lost their funding.
Some of the best and brightest biomedical minds are being poached by academic institutions, basic science labs and pharmaceutical labs from around the world. These scientists are vulnerable since they want to continue to do the work to which they have dedicated their lives and have been trained to do. That work is what drives progress in understanding and treating the chronic diseases that MAHA purports to support, but clearly does not understand how it it done.
Many of the new investigational products I am being offered and am seeing at my research site, are the products of basic science work increasingly coming from sources outside the U.S. More clinical trials are now being done outside the U.S. than within. In the past, these developments would have been welcome as evidence of the collaboration clinical scientists have enjoyed for decades. Much of it because many of their scientists were trained here, developed their post-graduate careers here, stayed and have been immensely productive. Some inevitably return home to build labs and continue to do the science there and train new colleagues.
This is the nature of America's soft power, the intellectual and moral inculcation of the best minds into what truly made America great. Now the shift is more ominous because young foreign investigators are feeling targeted and being made to feel unwelcome. Science does not care about your gender, race, ethnicity, politics, or religious preference, if any. It is the pursuit of new knowledge, ideally for the benefit of humankind. How humans use that knowledge is another topic, and is where it intersects with political considerations. And what is going on in Washington, D.C., now is Exhibit A. And the solution to all of this tumult is in our collective hands as long as we are able to have free elections.
Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.
This article originally appeared on Ventura County Star: Dr. Loh: In the crosshairs — American healthcare leadership
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