Your healthcare is on the 2024 ballot

Dr. Irving Kent Loh

This column has been called Second Opinion ever since I started regularly writing it in about 2000. It naturally focuses on healthcare issues, and obviously represents my perspective and thus my opinion of these topics.  

A First Opinion belongs to the reader, and, as in the healthcare environment, a second opinion represents the cogitations of another, hopefully informed, individual to help someone sort out a healthcare topic that may be a dilemma for those involved. Indeed, as I told patients for years, I would pick topics that were controversial and which I thought that the information in the media was a bit too sensationalized or confused to let even an educated observer see the core issues at hand.

Over the last several decades, like in most topics in America and the world, almost any subject has been politicized. Differences in perspective and opinion are normal, but the vitriol we have endured even in the topic of healthcare, fanned by so-called radical progressives on the left and fundamentalist conservatives on the right, have made thoughtful dialogue a nostalgic relic of the past. I mean, really, who is against healthcare?

In this wonderful, still currently free country, healthcare policy should be predicated on some general principles common to our humanity. First, healthcare should be available to all within the borders. People come to America through the front door, or through the back door. We all wish that legal immigration were the order of the day, but that’s a goal not yet achieved. As we have heard, thoughtful bipartisan efforts to make progress in our porous borders have been thwarted by political considerations. 

This has healthcare implications because immigrants, perhaps because of the arduous life that caused them seek shelter here, or the journey itself, may be ill and have communicable diseases such as tuberculosis or virus caused diseases which can seed cases here. Magically putting up 100% effective barriers that keep them out just has not worked. Once here, sick people should be treated, if at least to keep them from spreading illness and allow them to be productive. Effective border control is the answer, but demonizing immigrants is not.

The cost of healthcare, whether it be exorbitant healthcare premiums, or outrageous copays, can make healthcare unaffordable so that even middle-class U.S. citizens may not be able to afford healthcare and thus suffer the consequences of not obtaining optimal or even basic care. It truly was an embarrassment for many American physicians teaching or attending conferences abroad to try and explain how we, the wealthiest and greatest nation the world has even seen, could have so many of its own citizens uninsured and unable to get even basic healthcare, except through Scarlett O’Hara’s “kindness of others,” that is, charity care. 

Efforts to reform our healthcare “system” since the early 20th century were marked by political discord and thus stalemate. The creation of Medicaid, then Medicare, and then the Affordable Care Act has provided notable improvements in coverage of the poor, disabled, elderly, and economically challenged people in our country. If someone or members of their family get their health insurance through their employment, they know what that means if they lose that job. Sadly, and predictably, the political winds of this election cycle have again made this debate rise again. As I wrote in a recent column, the healthcare elements of Project 2025 threaten the support of these healthcare programs for vulnerable people in this country. So healthcare is clearly on the ballot next week.

And another principle themed in many of my Second Opinion columns has been the enhancement of quality of care. In general, the wealthier the population, the better the care. Not only can they see the clinicians they need, they can get the highest quality diagnostic tests, and can afford the best recommended therapies. And, of course, the opposite is true. Even assuming that there is available healthcare in less economically robust or rural areas, there may be a general drop-off in the quality metrics used to assess adequacy of care. These social determinants of health are real.  

About 25 years ago, after watching healthcare reform be foiled yet again by financial and political forces, I had an epiphany that healthcare technology could be a pathway to progress. Since I knew that venture capital would look on this as an opportunity to make money, I began to attend healthcare symposia in Silicon Valley where I learned that technocrats had little idea of how healthcare actually worked. But little by little, and with the guidance of experienced clinicians and academics who partnered with or actually joined healthcare technology companies, technology has provided useful solutions. 

That healthcare did not collapse during the COVID pandemic is a reflection of how technology in the form of telemedicine and international collaboration with a remarkable “all hands on deck” mentality that transcended institutional primacy, international barriers, and political considerations was something in which I was privileged to participate. As the pandemic waned in the public consciousness, that collaborative mentality has frayed, and the politics have again begun to throw elbows.

In my opinion, what is next for healthcare will be continued advances in technology, novel approaches validated by clinical research, applications of new therapies in evidence based disease management, and all of this operating under the aegis of regulated artificial intelligence. Those will be topics for my future Second Opinion columns and perhaps even some public lectures if there’s interest.

But first, we have an election. I hope you voted early, but if not, please make sure you do. In a functioning democracy, it’s the ultimate way in which your voice is heard. Your healthcare is on the ballot.

Irving Kent Loh, M.D., is a preventive cardiologist and the director of the Ventura Heart Institute in Thousand Oaks. Email him at drloh@venturaheart.com.

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