By Stephanie Innes
Arizona Daily Star, December 6, 2016
PNHP Note: Detailed findings from the bicycle tour mentioned in this article were published in the journal Academic Medicine. “Opposition to Obamacare: A Closer Look,” was authored by Paul R. Gordon, M.D., M.P.H.; Laurel Gray; Alex Hollingsworth, Ph.D.; Eve C. Shapiro, M.D., M.P.H., and James E. Dalen, M.D., M.P.H., Sc.D.
If President-elect Donald Trump wants to reform health care in the U.S., he might do well to consult Tucson physician Dr. Paul Gordon.
Gordon, 61, this year cycled 3,255 miles over three months, listening to Americans talk about the Affordable Care Act (ACA), which is also known by its unofficial yet popular name, āObamacare.ā
The University of Arizona College of Medicine Tucson professor expects to publish some of his findings and observations in academic journals.
A lot of people he met along the way were parroting sound bites, Gordon found. Others said they donāt want to pay for other peopleās health care. At the same time, he found the people he encountered were kind and generous with sharing their thoughts, with offers of help to fix flat tires, and to provide lodging and meals.
āWe heard stuff that was not present in the survey data,ā said Gordon, who rode through rural areas of Maryland, Pennsylvania, Ohio, Michigan, Wisconsin, Minnesota, South Dakota, Montana, Idaho and Washington state.
Some people he met liked the fact that young adults can stay on their parentsā health insurance until the age of 26; that insurance companies can no longer deny them coverage due to pre-existing conditions; and that federal subsidies are available to help people pay for insurance. But others had no idea those three things all happened as a result of the ACA and are part of the law.
Anger
āGiven what we heard, I wasnāt all that surprised with how the election went,ā said Laurel Gray, 26, medical student who accompanied Gordon on part of the āObamacare Listening Tourā to assist with research. āThe anti-ACA lobby was very effective at painting an inaccurate picture of what the legislation is.ā
A lot of people were angry, she said.
āWhen you are passing through these rural areas and seeing the reality of what life is like and what it has been like for the past 10 years, itās very different. I hadnāt realized what a bubble Iād been living in, in Tucson.ā
Gordon, who teaches and practices family medicine, and his wife, Tucson pediatrician Dr. Eve Shapiro, have long been supporters of universal health care. That means theyād like to see all Americans have equal access to health care through a single payer system.
But thatās not what the Obamacare Listening Tour was about.
āI never corrected. I just listened. By listening I quickly gained their sense of trust,ā Gordon said. āI was just there to listen, not judge.ā
Between three and eight people were riding with Gordon at any given time, including Shapiro, his two grown children and Gray, the UA student, who was a social worker before she went back to school to become a physician.
Misinformation
Gordon recalls how much a musician he met in rural Ohio disliked the individual mandate, which was part of the 2010 law, that all Americans have health insurance. The musician doesnāt mind that car insurance is mandatory because owning a car is optional. But being alive isnāt optional and thatās why mandating health insurance is unfair, he told Gordon.
Gordon also tells the story of a hotel manager he met in Knoxville, Maryland who hasnāt seen a doctor in a long time, even though he has employer-sponsored health insurance. He finds the system too complicated, so he avoids it.
And then there was Henry, the South Dakota resident who told Gordon that Obamacare āsucksā but wasnāt clear on the details of it.
āThere was so much misinformation,ā Shapiro said. āIt was sound bites. Everything was Obamaās fault.ā
She also noticed a large number of people who, āhate government telling them what to do.ā
Complicated system
Gray went through her own learning curve.
āThis was my first year needing my own health insurance. Iād always been on my parentsā plan,ā she said. āWhen I started the tour I was embarrassed by my huge gaps in knowledge. I learned a lot.ā
Some people Gray met said they could not afford health insurance. In some cases, though, she wondered whether health insurance was not their financial priority.
One certainty Gray took back to school this year, where she is a second year student, is that medical students have an obligation to be politically informed about the system in which they operate.
Gordon and Gray never set up any of their talks with people in advance. Typically they would ride for a few hours and stop at a convenience store along the way, get something to eat or drink, and talk to the people there.
The āObamacare Listening Tourā jerseys the team wore invited conversation. Gordon and Gray would then dictate and summarize what theyād heard as a voice memo, which they later transcribed.
āAt a minimum it informed me of peopleās understandings of health insurance and health in general,ā Gordon said. āAnd it helped me to be a better teacher and practitioner. A great lesson is that of listening. We need to listen to our patients. We canāt necessarily fix it, but we can at least listen.ā
Gordon himself was never a fan of Obamacare because it includes the insurance industry, and much of the insurance industry is a business that prioritizes its stockholders.
In a single payer system, physicians can still be independent but thereās not another layer of overhead and administrative costs, he explained.
āHealth care is complicated. But when you have a single payer system itās not complicated at all,ā he said.
āDamn politiciansā
Gordon recalls a 75-year-old woman he met in Spokane, Washington who had similar sentiments as she drank a beer and watched a baseball game.
āHealth care is a right,ā he recalled her saying. āItās true. Just raise taxes ā¦ But the damn politicians donāt have the balls to raise taxes.ā
At this point, no one can predict what will happen to the Affordable Care Act moving forward. But Gordon says it will be hard to remove some of the pieces people donāt like, such as the individual mandate, without increasing costs.
Next up: Gordon would like to cycle across Canada to hear from Canadians firsthand what they think of their health system. Heās interested in doing the same in Taiwan, which also has a government-run single payer system.