Health Reform and Primum non Nocere

Following the admonition to “First do no harm,” I will refrain from sharing a post I wrote before the Presidential Election that would not promote a productive conversation regarding the future of health reform.  Instead, I will share some immediate thoughts regarding the future President Donald Trump.

Twenty-one years ago tonight, I was installed as the President of the Iowa Academy of Family Physicians. In my President’s Address, I said that having grown up in Denison, in rural Iowa and similarly, begun my practice as a family physician in Titonka and Algona, both in rural Iowa, I was going to “dedicate my actions this year to promoting rural family physicians. Furthermore, by protecting rural medicine, I think in part, we  help to protect that which is rural in Iowa and in America, a goal worthy in and of itself.”

Donald Trump won because rural America wanted to send a message to Washington,     D. C. The flyover country–the land between the two coasts, or the “deplorables” as Secretary Clinton so crudely mocked–extracted its revenge. My efforts for health reform have always been geared to the underlying goal of protecting rural America and rural Americans who I view as “the salt of the earth.”  If Donald Trump is listening to rural America, if he cares about rural America, and if he wants to protect rural America, he needs to acknowledge the rural Americans who have obtained health care coverage through Medicaid, the Exchange, or as a child under the age of 26 through the Accountable Care Act and find an alternative way to protect their health care coverage.

If Donald Trump takes us back to a world of pre-existing conditions and significantly higher rates of uninsured people, then the massive red color that illustrated his electoral success across the national map, as well as nearly every state’s rural counties on election night will symbolize the bleeding and suffering of rural Americans’ unmet health needs.

I hope and pray that he achieves the same success in the world of public policy that he has achieved in the world of politics. I plan to offer my advice and as appropriate, my criticism in this process. My final thought for Donald Trump is “First do no harm.”