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Tuesday Aug 29, 2017

Health Care Debates Don't Have to Be Heated

"So let us begin anew -- remembering on both sides that civility is not a sign of weakness, and sincerity is always subject to proof. Let us never negotiate out of fear. But let us never fear to negotiate."

-- President John F. Kennedy, Inaugural Address, Jan. 20, 1961

A few weeks ago, I had the opportunity to debate the merits of the direct primary care (DPC) model at the AAFP's National Conference of Family Medicine Residents and Medical Students in Kansas City, Mo. My counterpart in the workshop was Ed Weisbart, M.D., a DPC skeptic and proponent of a single-payer national health plan.

[Ryan Neuhofel, D.O., with Ed Weisbart, M.D., discussing pros and cons of DPC]

Here I am debating the merits of direct primary care with Ed Weisbart, M.D., right, during the 2017 National Conference of Family Medicine Residents and Medical Students in Kansas City, Mo.

I didn't know Dr. Weisbart well when I invited him to debate DPC, but he had written about the downsides of the model last year in an article titled "Is Direct Primary Care the Solution to Our Health Care Crisis?" After reading Dr. Weisbart's criticisms, I was initially both baffled and incensed. Similar strong reactions from other DPC physicians were reflected in the comments on that article, to which Dr. Weisbart graciously responded by clarifying many of his concerns.

Having been an early adopter of the DPC model, this was not the first time I had heard these criticisms. I have tried to dispel misconceptions about DPC on this blog and in other places. However, it has become clear that many of these misunderstandings persist.

National Conference has offered students and residents workshops about DPC in recent years (including presentations I have given). Although these workshops have been educational, they didn't give attendees a great opportunity to publicly discuss the potential drawbacks of DPC. I wanted to give skeptics and critics a chance to fully air those ideas in an open and public venue. So I reached out to Dr. Weisbart to see if he would participate in such a discussion.

Dr. Weisbart advocates for a national single-payer health plan. He is chair of the Missouri chapter of Physicians for a National Health Program(www.pnhp.org), and he has called for Medicare for all(www.kansascity.com). Based on these views and his harsh critique of DPC, I presumed we would be at extreme odds on nearly all matters related to health policy.

Leading up to National Conference, our nation had been fiercely debating health care bills for months. The drama and partisanship in Congress regarding health policy had reached yet another crescendo. In this context, I expected passionate audiences of residents and students for our two sessions.

We took frequent detours from our basic discussion outline to talk about the history of our health care system, comparisons of DPC to HMOs, administrative and regulatory burdens, nuances of running a DPC practice, patient protections and "cherry picking," the primary care physician shortage, promoting evidence-based and quality care, and the root causes of high health care costs, to name just a few topics.

Dr. Weisbart and I were certainly approaching the issues from different perspectives, but we agreed on many problems and sometimes on their causes. He acknowledged that DPC is a practical workaround that can improve many aspects of primary care practice, but he had major concerns about the implications if it were widely adopted. His main concerns were how to achieve universal access (especially for lower-income or medically complicated people) and ensuring standards of care.

Toward the end of both sessions, we discussed how DPC might fit within larger, systemic health reforms. Dr. Weisbart believed that if DPC truly reduces downstream health care costs, then his movement and mine might be allies. Although strange bedfellows on the surface, we both believed such a marriage of ideas could be possible if appropriately structured.

Although there were points of fierce contention about how to improve the health care system, we both tried our darndest to understand each other's perspective and shared some laughs along the way. I hope our banter compelled the next generation of family physicians to think outside of the usual boxes.

As we've all learned, changing virtually any part of the health care system is met with vehement opposition from political and business interests. Nearly every proposal, no matter how small or large, is labeled as severely harmful -- and often malicious -- by the opposing side. For decades, this political theater has mostly led to preserving a fundamentally broken system.

It has become a persistent exercise in déjà vu, and the next round is surely just around the corner.

Despite the increasingly high stakes, we must tone down our reflexive political natures. If there is any hope of creating a productive dialogue around health care reform, we must speak with, and listen to, people of different views in a civil and non-accusatory manner. We can and must find common ground before we can move forward with big ideas.

Dr. Weisbart and I proved that is possible. I hope Washington, D.C., can do better next time around.

Ryan Neuhofel, D.O., M.P.H., owns a direct primary care practice in Lawrence, Kan. You can follow him on Twitter @NeuCare(twitter.com) 

Posted at 06:05PM Aug 29, 2017 by Ryan Neuhofel

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