In politics, medical and premedical students are often invoked and rarely consulted. We are the nation’s future physicians, studying for careers that will span the next half-century. We are entering medicine in a period of profound policy change, yet policymakers neither expect nor seek our input. Should states expand Medicaid coverage to the poor? How should responsibilities be shared between physicians, nurses, and social workers? What kinds of regulations should be placed on insurance companies and hospitals? If the nation’s future physicians want a voice in these and other questions, we must first understand the issues.
The Affordable Care Act (aka “Obamacare”) is both unprecedented and incremental; it promises reform while keeping the basic structure of American health care intact. In the past few months many of the law’s major provisions have come into force. While newspapers and cable outlets focus on the most immediately visible provisions—like the online exchanges—countless others are being implemented outside the public discourse. In this special issue on the ACA we hope to bring less-covered issues, particularly those affecting medical and premedical students, to the fore.
JoAnna Haugen’s feature story explores the political work of “organized medicine,” the organizations that speak for physicians and physicians-in-training. For much of the past century these groups, especially the American Medical Association, have both spurred and stifled change in America’s health care system. Avery Hurt’s feature highlights the ways in which medical education will—and will not—change with the implementation of the ACA. In this month’s Perspectives, Gabriel Edwards and David Mealiea question whether the insurance provisions of the ACA do enough to keep health bills from bankrupting patients.
As physicians, we will live and work within the provisions of the Affordable Care Act. Debates between hospitals, health insurance companies, patient and provider organizations, and activists from across the ideological spectrum continue to rage. Try as we might, we cannot avoid these political battles. To say nothing is to support the status quo; to speak up is to enter the fray. So, now more than ever, we must train ourselves in the politics of medicine.