A Letter from Your Doctor
The broadcast above features a conversation about this letter with Dr. Charles McGowen on The Public Square®. Here are the additional resources mentioned in this broadcast.)
Donald J. Trump
President of the United States of America
1600 Pennsylvania Avenue
Washington, D.C. 20500
Dear President Trump:
I am writing to you as an 81-year old practicing physician, a patriotic conservative and one who is deeply concerned about the welfare of my seven grandchildren and seventeen great grandchildren with regard to their access to affordable healthcare in the coming years. My support for you, from the day you first announced your candidacy, has been stubbornly consistent and unwavering, despite the marked skepticism within my circle of friends, my acquaintances at church and even my own family members. Before election night I had convinced the majority of them that you were the only person running who could preserve our nation and in particular eliminate “Obamacare” and replace it with a system that had been time tested and one of which I had been an active part. Having read The Art of the Deal, I knew that it was time for a successful businessperson to begin the process of balancing the books in our bankrupt Washington-based, political system. My friends and the media pundits argued that in our country’s tradition no non-politician had ever taken up residency at 1600 Pennsylvania Avenue. Knowing your prowess in closing the deal, and knowing that we desperately needed another “new deal” (FDR), for another “new generation of Americans” (JFK) I was certain that you were God’s man to close that deal for that generation.
I graduated from The Ohio State University-College of Medicine in 1961. I then served as a rotating intern for one year in a 1,000-bed teaching hospital in my hometown of Youngstown, Ohio. Due to the “doctor draft,” imposed by a coming war in Southeast Asia, I volunteered to serve as a Flight Surgeon in the USAF. I spent two years on active duty (1962-64) and five years in the active reserve (1964-1969); being the only Flight Surgeon at the U.S. Air Reserve Base in Vienna, Ohio. It was during that time that I also completed a three year residency in internal medicine; again at that same 1,000-bed hospital; comprised of two units, separated by three miles. Each unit had a very active outpatient clinic that successfully served the indigent members of the community who could not afford a private physician. This service was totally free and the clinics were run by interns and residents and overseen by a rotating list of private physicians who served without monetary remuneration.
That facility was run like a Swiss watch by one administrator, a businessman who did not have an education in hospital administration, and one medical director; they shared the same secretary. Those three spent mornings at one unit and afternoons at the other. That was the sum total of the administrative guidance at what was then known as the Youngstown Hospital Administration. The practice of medicine within the doors of the hospital and out in the community was strictly based upon a gentleman’s agreement between a physician and his or her patients. Thus, I had the privilege of working in a free market system, driven by the will and needs of a free people, and where I hardly ever heard anyone complain about the cost of medical care. That all began to change following the 1965 intrusion of the Federal and State governments into our medical care by means of Medicare and Medicaid imposed by the Johnson administration.
With the new rules and regulations placed upon all hospitals, our one administrator had to be replaced by two, one at each unit, and a secretary for each. In addition, each administrator had to have an assistant administrator and they also needed their own staff. This compliment of administrators and sub-heads of various departments subsequently grew at such a rate that the hospital could no longer afford to treat clinic patients. Those large clinics eventually closed. The distance between the physician staff and nursing staff from the administrative staff widened and the previous cordial oneness enjoyed under our one administrator and one medical director eventually vanished. As a result, when employee contracts came up and first developed an extreme disharmony between the nurses and their administrators, union organizers saw an opportunity to step in, the first ever nurse’s union came into existence and the Youngstown Hospital Administration became infamous for being the site of the first strike by a nursing staff against a hospital in U.S. history. This resulted in further widening the gap between the administrators and the physician staff, most of whom supported their close associates, the nurses. Ultimately all hospital employees became unionized.
Without taking too much more of your time, let me summarize my long experience in the field of medicine by simply saying that I have practiced clinical medicine through four pivotal phases in our nation’s history. In 1961-1965 it was a free market, patient/doctor driven system. Hospitalization insurance was low cost, basically catastrophic in nature, and did not pay for any outpatient services. Between 1965-1980 those patients over 65 and those whose income was sufficiently low, had full access to health care from our offices and our hospitals with little financial burden of their own. As a result every request that they made regarding their sundry complaints had to be met with extensive workups. That obviously imposed a major fiscal problem, previously yet ignorantly unforeseen, for both the Federal and state government balance sheets. Given that we physicians had been blamed for that rise in the cost of medical care, the Nixon Administration devised what was later imposed upon us; the Kaiser Permanente genre of Preferred Provider Organizations and ultimately Health Maintenance Organizations; which came on board during the Ford administration. Those formulations came with further regulations being imposed upon hospitals, requiring the addition of further ancillary administrative staff. Now too, we private physicians also had to add new staff members to handle all of the paperwork imposed by the newly formed 3rd party organizations. The PPOs and HMOs gradually imposed so many restrictions on the practice of medicine that the decisions regarding a patient’s healthcare fell not between her and her physician but instead to the employees of a 3rd party; Medicare, Medicaid or private insurance companies. As a result those 3rd parties grew, reimbursement to physicians fell and the cost of medical care shifted from physicians to the 3rd parties. Thus began the early retirement, or moving to other venues, of America’s physicians. I left my private primary care practice in an affluent suburban community in 1999 and moved into a consulting, independent contractor genre; also continuing my twenty year role as an Assistant Clinical Professor of Internal Medicine at our local Medical School (NEOMED). During the months leading up to the 2008 election I spoke at numerous Tea Party gatherings warning about Senator Obama’s pledge to bring about the so-called Affordable Care Act, and showing the need to return to the really affordable system of free enterprise that all American citizens enjoyed prior to 1965 and the intrusion of governments into a private practice, in which they had no right nor knowledge to enter.
In 2010 I longed to get back into clinical medicine and joined the staff of a consortium of five inner city clinics, serving 20,000 people in northeastern Ohio. In addition to my capacity as a primary care physician I am also the clinical coordinator for several nurse practitioners. I have been working full time there ever since and despite the promises made by the proponents of the AFA; I see first hand that those who need it most are finding it extremely unaffordable. So, Mr. President, you see that I have experienced medical care from a variety of venues; inside a hospital for four years, under the eyes and regulations of the federal government in the USAF for seven years; in a suburban private practice for thirty-two years and through an inner city clinic for the past seven years. At the age of 81 I have no desire to retire but I do long to see a return to the system that benefited everyone and one that we all enjoyed prior to 1965. I have many ideas as to how that can work and I would consider it a privilege and honor to share those ideas with some of your administrative and or legislative staff. I have lived longer than most of them and humbly say that by the grace of God I have an experience in healthcare that can be equaled by very few living Americans who are still actively engaged in the health and welfare of our people.
In 1964 the total federal government spending for healthcare was $6.7 billion out of a total budget of $189.1 billion, or 3.5%. In 2015 healthcare cost the federal government $3.2 trillion or 17.8% of the total. I can assure you that the exorbitant rise in the cost of healthcare during those 51 years was not due to a concurrent rise in the income or net worth of one’s primary care physician.
Thank you Mr. President for taking your valuable time to read and consider what I have said and I wish you great success in your sincere, heartfelt efforts to “make America great again.” I would only add, with all due respect, that the accomplishment of your wonderful desire can only eventuate by making the delivery of a free market of healthcare a reality again. The budget can ill afford to continue on as we are. My prayers for you are repeated frequently and I know that our Lord has you safely in His care.
Cordially and dutifully yours,
Charles McGowen, M.D.