The Republicans have a well defined strategy. President Trump and House and Senate leaders do not want to craft legislation that requires a single Democratic vote. All executive orders from Mr. Trump move the country in a direction contrary to Democratic Party values, and Congressional leaders have made no attempt to involve Democratic members in lawmaking.
Even though President Trump received only 45.9% of the vote in November and the voters reduced their majority in both chambers of Congress, Republican leaders are operating as an oligarchy. They are using strong arm measures to ensure that the policies of the leaders are the only ones that see the light of day. The closest the Democrats have been to the legislative process in the 115th Congress was when the President blamed them for the failure of the first attempt to pass the American Health Care Act (AHCA), even though no effort had been made to secure their votes.
This Republican game plan causes a great deal of distress for centrists and left leaning professionals. Their values have no voice in two branches of the federal government, or at least no voice that has any power. Actions already taken by this president and Congress permit more pollution and fewer consumer protections. There is real fear that health care may become unaffordable. Other proposals such as Trump’s tax plan seem geared solely for the benefit of the wealthy with an unrealistic growth projection to make it palatable to the electorate.
Doctors are chief among those professionals feeling under attack, and they are smart enough to recognize the smoke and mirrors proposals coming out of the Trump Administration and Republican leadership.
Most doctors are concerned about the proposed plans to repeal and replace the Affordable Care Act (ACA). In a January poll, just 15% of primary care physicians wanted the ACA repealed; even in doctors who voted for Trump, only 38% want the law repealed. The AHCA passed by the House of Representatives on May 4, is highly unpopular among both the general population and physicians. In recent polls, the public considered the AHCA to be a bad idea (48% “bad” vs. 23% “good” in NBC News/Wall Street Journal poll conducted May 11-13) while doctors had an unfavorable opinion of the legislation (66% negative vs. 28% positive in a Merritt Hawkins poll released May 11).
Many physicians are also concerned with the Senate plan. No details have been released other than it is being written in secret by a 13-member panel (all male) and that the Senate will use budget reconciliation procedures so they do not have to cooperate with Democratic senators and can even lose two Republican ones. This cloak and dagger process is highly stressful to many doctors.
And those doctors are already stressed. A study at the Mayo Clinic found that more than half of American physicians are physically and emotionally exhausted and losing their sense of purpose. And that is where the Republican policy of pushing through legislation that benefits only wealthy and conservative constituents without regard for the rest of the country may lead to a healthcare crisis and recession.
It’s painful to have your expertise ignored and your beliefs continually under attack. A change may be in order for many physicians and with a little help from 1960s counterculture icon Timothy Leary, perhaps it’s time to “turn on, tune in, drop out.”
As explained in his 1983 book Flashbacks, for Leary, “’Turn on’ meant to go within to activate your neural and genetic equipment. Become sensitive to the many and various levels of consciousness and the specific triggers that engage them. ‘Tune in’ meant interact harmoniously with the world around you – externalize, materialize, express your new internal perspectives. ‘Drop out’ suggested an elective, selective, graceful process of detachment from involuntary or unconscious commitments. ‘Drop Out’ meant self-reliance, a discovery of one’s singularity, a commitment to mobility, choice, and change.”
For many overworked doctors, that description may seem pretty good right about now.
Not all doctors have this opportunity to drop out, but many do. Doctors who have put away enough retirement money, are 50+ years old, don’t have small children at home, have saved enough for their kids’ college education, and probably have no mortgage and certainly no student loans can consider it. Desperate times sometimes call for desperate measures.
How appealing for many doctors in this stage of life to give their 6 month notice, sell their house and buy a modest one in Napa, Sedona or Boulder. They would be able to hike or ski every day, do some writing or painting, or learn to play the guitar. Annual passes for golf or skiing are a good value when you have the opportunity to use them.
But doctors are lifelong high achievers, and that is not likely to change in retirement. These professionals will likely lead the next wave of innovation in medicine and they can always pick up some money with locum tenens work, if needed.
There should be plenty of locums work available if this move to early retirement occurs because it will produce a doctor shortage. That is where the healthcare crisis and economic slowdown will begin. The Republican plan to pass legislation that only benefits the wealthy and leaves tens of millions without medical insurance will drive some physicians out of the workforce. In retirement, these doctors will cut their spending and that will be a drag on the economy.
Spending on medical care has been a main driver in the U.S. economy for years and that will likely change under whatever plan the Republicans pass. In post-ACA America, emergency room visits will increase – a substantial portion of the cost not collectible – and people will likely be less healthy. Rural hospitals will probably close as a result of that economic blow and rural Americans will become even sicker. Unhealthy people are less productive so there will be a further drag on the economy.
When physicians with the means to choose early retirement weigh the options, retirement may look pretty good. They may feel uncomfortable leaving a work environment in which they are highly respected for the uncertainty of early retirement, but when you feel you are under attack for simply doing your job or having the beliefs you have, the decision gets easier. And many will find that while they are highly respected in their field, it may have been a long time since they were truly happy.
And in that way they can probably relate to Abd-ar-Rahman III, a 10th century ruler in what is now Spain:
“I have now reigned above fifty years in victory or peace; beloved by my subjects, dreaded by my enemies, and respected by my allies. Riches and honors, power and pleasure, have waited on my call, nor does any earthly blessing appear to have been wanting to my felicity. In this situation, I have diligently numbered the days of pure and genuine happiness which have fallen to my lot: they amount to Fourteen: – O man! place not thy confidence in this present world!”
For physicians, this may be interpreted as “O doctor! Place not thy confidence in this present job!” Choose early retirement and you may find true happiness.