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Doctors of Science and Medicine Must Become Doctors of Policy

In the 2016 election cycle, millions of Americans elected a president who had never before held public office, believing they had “rejected the political establishment.” While the underlying idea of this perspective has its merits, there is now a group even less represented — and more desperately needed — in the federal government than businessmen: scientists and physicians.

In 2011, eight out of China’s nine top government officials held a degree in the sciences, medicine or engineering, and although the proportion has since gone down, it still makes the United States pale in comparison. Of our current 535 members of  Congress, only 11 are scientists or engineers, and another 18 are physicians. President Trump recently sparked controversy by nominating a non-scientist Sam Clovis, to head science at the USDA. Meanwhile, the current President of China, Xi Jingping, is a former chemical engineer (as is, incidentally, Angela Merkel, Chancellor of Germany). China continues to outperform the United States in research investmentnew patents granted, advancements in supercomputingspace expeditionclean energy and even health care improvement. China is currently building two highly efficient, meltdown-proof nuclear reactors based off a design from the United States which we abruptly abandoned over 60 years ago — not because of any design failure, but because no one in our government understood how it worked.

Don’t get me wrong: China is no “City Upon a Hill” when it comes to personal liberties. But in the areas of daily life where government does have a legitimate role, among which research and health policy take precedence, China is running laps around us. Despite having a population that comprises 20% of the world, China accounts for only five percent of global health expenditure and can still offer basic comprehensive care for everyone and private care (often superior to the average in the United States) for those who can afford it. Undeniably, China still suffers from fatal gaps in care in rural areas and for impoverished populations. But keeping in mind the sequential evolution of societies, China, as a developing country, has far outpaced the United States of the 19th and 20th centuries in a matter of decades, along with all of its current rival developing countries. When it comes to health care, China’s advantage is straightforward: learning from the mistakes of its communist founders, China bucked a major global trend and jettisoned universal health care for a free market system. Inequality ensued — though, ironically, to a lesser degree than all other communist and socialist developing nations — but the standard of living was raised for everyone. A country like the United States with greater social mobility and less institutionalized cronyism could learn from and expand upon China’s approach to produce more efficient and equitable results.

The central question of how a country could emulate China’s efficiency in health care delivery lies not in China’s health care organization but in those who organized it in the first place. The trend in which different professions compose the United States government has shifted from a representative conglomerate of various professionals to a nearly homogeneous group of lawyers, businessmen and, above all others, career politicians. Without a doubt, there have been numerous exemplary representatives from all fields who have made valuable and unique contributions, but such a governing majority poses hidden dangers. Lawyers, by virtue of their professional skills, have a propensity towards codified language, which partly explains why our laws have gotten longer and more complex. Businessmen, like our “outsider, anti-establishment” president, can be wrought with hidden special interests, while career politicians, living off of small Congressional salaries, lack the funding for increasingly costly political campaigns and are thus more desperate for donations and receptive to lobbying by said business interests. All of these incentives and ulterior motives amalgamated may help in part to explain why, as our tax code has gotten longer (now 74,608 pages, a 150-times increase over the past century), the share of federal tax revenue that corporations contribute has fallen by 70 percent — a decrease compensated for by higher personal income tax obligations of the middle class. No wonder there are more accountants in Congress than scientists — their industry depends upon a deliberately and unnecessarily complex tax system designed by and for corporations. Similarly, as lobbying by insurance and pharmaceutical companies has ballooned, — along with the number of executives from these industries in office — the length, complexity and, arguably, inefficacy of health policy has followed in step. For example, take the Affordable Care Act, which is nearly 2000 pages long. Meanwhile, the number of physicians and nurses — those on the front lines, interacting with, treating and comforting the infirmed daily who know that a human life has no price, though a procedure or medication does — has fallen in Congress.

The issues concerning Americans the most today (aside from the aforementioned blatant over-taxation) include health care, energy and employment prospects. Perhaps, rather than seeking out those who have experience making policies more complex and corporation-friendly, we should turn our focus to the everyday laborers in those fields who could do the exact opposite. When Senate Republicans sparked outrage for failing to have single woman working on their Affordable Care Act replacement bill (dubbed the American Health Care Act), I noticed a different flaw: there was only a single doctor. The health care policies of today are being written by politicians and lawyers who have never spent a day in a clinic or by business executives who stand more to gain from saving special interests than saving lives.

There is a silver lining: Tom Price, President Trump’s Health and Human Services Secretary and one of the original authors of the Republican replacement plan, is a lifelong orthopedic surgeon. Who better to legislate health policy than someone who works tirelessly towards providing health services every single day? The downside, faced by him and the rest of the Trump administration, is that, because so many officials have spent their entire lives producing in the free market, they lack the fine subtleties which our establishment politicians use to maintain their grip on Washington. Time and time again, the media, political party establishment and intelligence departments have aligned to use the controversies surrounding Trump (fabricated and legitimate) to undermine and stall desperately needed efforts by professionals in Congress to reform health care, taxation, research investment and the budget. While the few physicians and scientists we have attempt to deliver on their promises by reforming the sectors they know best, the political machine has struck back, holding the fate of our health care, and even our nation, hostage.

China ditched communism for a free-market health care system and, despite minor setbacks, has flourished into a world power set to overtake us in most sectors in the coming decades. Meanwhile, our system has drifted farther into the realm of government intervention at the hands of lawyers, businessmen and careers politicians who stand to gain from passing policies the rest of us cannot understand but will end up paying for in some way. Our future physicians have an unprecedented burden on their shoulders because they must learn not only how to save lives, but also how to save entire health care systems. Without one, we as physicians will not be able to effectively do the other. The time has come for physicians, scientists and leaders across all industries who may lack the nuance of Washington but understand the humdrum and struggle of quotidian life to step in to fix a government led astray by its own self-perpetuating culture and collapsing under its own weight.

Adam Barsouk Adam Barsouk (8 Posts)

Contributing Writer

Sidney Kimmel Medical College

Adam Barsouk is currently a medical student at Sidney Kimmel Medical College at Jefferson University. He studied pre-medicine, health policy and anthropology at Pennsylvania State University. As a son of Soviet Jewish escapees, Adam values the opportunity and freedom that America has provided his family, and as a current cancer researcher at the University of Pittsburgh and an aspiring physician, hopes to share this commitment by liberating the infirm from the chains of chronic disease and suffering. Adam speaks 6 languages, has visited over 30 countries, and enjoys recounting his experiences while also learning anything he can from the people and places around him.