Obama wins! But do we?

It's my first AHA/US-presidential-election week. Steve Stiles, my colleague, thinks it might have happened once back in 2000, but that predates my time with theheart.org team. Rolling our meeting back a week allowed us to become a temporary part of the West Coast preelection fray. My friend Bob Harrington, a recent transplant to California, said it was "difficult to get used to all the propositions" (well, I think he meant legal propositions up for vote, but that could explain why my political hero Bill Clinton has spent so much time on the West Coast lately), and I concur. The airways here were saturated with commercials. Real teachers, actors playing teachers, teachers pretending to switch off the commercials of actors playing teachers, reps from the LAPD standing up against a guy they think is "dirty" while playing the audio from what sounds like the movie Machete, and an attorney general who said what a "nice" person his opponent i, but in the next breath how dishonest she's been under oath. Nice, but dishonest? It's mind-boggling, but no less mind-boggling than trying to figure out the impact the outcome the 2012 US presidential election will have on American cardiology.

I'll get this out of way. I am a Democrat. Four years ago, I voted for McCain. Although I liked the idea of reforming health care, I was afraid we wouldn't live to see it because I was uncertain Barack Obama had the mettle to protect us with his foreign policy. I saw mushroom clouds on the way into the voting booth in 2008. This time, I voted for Obama. I knew I'd probably go broke with his "balance-of-wealth" philosophy, but poor sick people would have access to healthcare. I also likened our country's economy to a sick patient who is told, "You'll be out of the hospital in a few days," but on day three, they spike a fever to 105 and were much "sicker" than previously thought. Instead of going home, they're going to the ICU, and there is no telling how long it's going to take to get them back on their feet. I think our country is in the ICU.

As I walked away from the voter's booth two weeks ago, after voting for Obama and a sprinkling of Republicans for other things, the angel on my shoulder said, "Great job, Melissa. You've been altruistic. God loves that." The devil on my other shoulder said, "Hey, if Gov Mitt Romney wins, your salary might go up, and you can do more good things with that salary." Obama won last night, but I'm still not sure if my devil or my angel is happy. One thing is for certain; I took that "47% speech" into the voting booth with me. If I was leaning "right," it pulled me far back to left. The "47%" is what lost the election for Romney, because it includes not only the "47%" but also those who care about them.

I admit that I did feel sorry for the Romneys last night. It was a hard-fought battle. Mitt had some good ideas, and I think he's a good person, faithful to his wife and his religion. I secretly wished the losing candidate could have an automatic cabinet position so the hopes and ideas of those millions of people who are disappointed this morning could still be fairly represented. It would be a daily catfight, but it is already anyway, and if Obama and Romney spent more time together, they might just like each other and start to work together. (Yes, again, childish magical thinking here).

I made the statement that I enjoy seeing presidents work in a second term. They develop a certain swagger, a different turn of phrase, because they don't have to give a flyin' flip about another election. Oh, they have to play by party lines somewhat, but it's gotta be liberating for a second termer. President Obama in this second term is now free to tackle tort reform. It will make his lawyer friends back in Chicago a little mad at him, but they'll get over it and be shooting hoops together again in no time. I just hope he'll give us the kind of tort reform we need instead of what we think we need. If he'll dial the folks at the University of Michigan and pattern recommendations from them for what protects patients and drives down claims, at the same time weeding out frivolous gold diggers (now I ain't sayin' everyone's a gold digger), it could be his greatest legacy and our first real shot at reforming healthcare.

There are a few other things on the cardiology plate that need addressing. Stop with the subspecialist bashing. Focus instead on saving enough money to entice kids to continue to want to be doctors. No one wants to spend $150 000 to go to med school and struggle when they get out to pay off that debt. Stop driving docs into hospital acquisition. I firmly believe that smacks down the free enterprise of the American doctor. It is a communistic approach to medicine that drives up cost by increasing the amount of reimbursement for same services that formerly cost less.

Mr President, focus on prevention, on smoking, obesity, and sedentary lifestyle. Dial up the focus on nutrition and exercise. Call a press conference. Tell Americans in your usual stilted syntax while staring intently through the lens into our living rooms and iPhones. "You got two options. Sit on the couch . . . and drive up the cost of healthcare . . . or get up, America. Lose weight and get in shape . . . and make it easier on yourself and all of us." Be a president that lives that and promotes that. Card-carrying democrats will fall in line. Hard-nosed Republicans and especially tea partiers won't want to be told what to do, but they might just listen when we create the mental image of soup lines forming downtown.

Mr president, promote smoke-free legislation that will take our entire country smoke-free. The money we're spending for preventable illness like those who smoke and develop lung cancer, COPD, heart disease, and stroke is enough to give every American a tax break and every subspecialist in America a raise and a Cadillac.

The diatribe listed above is my wish list for a footloose and fancy-free second-term President Obama. If we keep the military strong, make America healthier, and implement tort reform, our country can be the best we've ever been. Now, these are worthwhile propositions that no president should ever turn down.

Your comments

	Obama wins! But do we?
	# 1 of 17	November 7, 2012 01:29 (EST)
	ken	Tort reform, good luck!
	# 2 of 17	November 8, 2012 07:28 (EST)
	M1Manley	Sad to see that an intelligent person allowed the distorted 47% comment to be the primary decision driver for her election choice.
	# 3 of 17	November 8, 2012 07:56 (EST)
	Dr. J	Lady, You must be dreaming.  The Obama you voted for doesn't exist,just another illusion cooked up by his slick political machine.  Sorry, you are 100% wrong. Dr. J
	# 4 of 17	November 8, 2012 08:40 (EST)
	Dr. G.	You should have taken your intellect into the voting booth with you and made an intelligent decision, not one driven by emotion or who was on your shoulder.
	# 5 of 17	November 8, 2012 08:42 (EST)
	stephen pollock	first:  you lose all credibility when you voted for Palin... that woman could not run a pta, much less be in line for the white house second: the principles of Obama care: no pre existing conditions, no caps/ cancellations are excellent.. what is in the other 2,000 pages.. talk with your friends who run a business and ask them the effect of the huge complicated beaurocracy that is created.  third: why not get all the cardiologists to refuse to accept/ participate in medicare.. that is the only way reimbursements get better, and we do not have to sell ourselves to full time hospital employment fourth:  accountable care is simply managed care by another name.. pts will have to sign up with a system, and can not switch.. they lose choice.  If doctors are naive enough to sign up with every system they will then lose any leverage on their fees.. they will just be begging for pts.
	# 6 of 17	November 8, 2012 09:12 (EST)
	Dr Haas WA	So basically you voted for Obama this time because you hope Obama will do the things that Romney said Romney will do, and you feel less worried about mushroom clouds despite how Obama dealt with Lybia? Melissa, I have read your articles for a long time and I know you are a smart lady, so I am going to give you the benefit of the doubt that this nonsense you wrote is based on  female emotions, because you are clearly not applying science or logic. I love my wife dearly, but thank God she asks me who she should vote for. You should consider discussing your voting logic with your husband before casting your next ballot. Even though you voted for the wrong guy, I wouldnt have written this response if your reasoning made even an ounce of sense. Doctors are going to get paid less no matter who had won, but micare and social securities only hpoe of survival was with Ryan plan. Obama is not only going to raise your taxes, but those of even our poorest patients. Nobody in their right mind will go to medical school under Obamas policies unless they are as altruistic as they are independantly wealthy. I dont even know how to respond to your conclusion that Obama would ever consider tort reform! Basically your misguided vote helped ensure that our patients will remain unemployed, uninsured, and overtaxed, and that we will have fewer doctors with more restructions and less job satisfaction. I am three years out of my cardiology fellowship, and with results of this election now decided, my intent is to hopefully be in a new career outside of medicine before the next election.
	# 7 of 17	November 8, 2012 09:13 (EST)
	Dr. AS	Your comments are well prescribed, you voted your conscious, knowing and perceiving your thoughts. I am an independent but voted for Obama for the second time.
	# 8 of 17	November 8, 2012 09:28 (EST)
	Liliana BT Kuvlieva	Sad to see that there are people with medical degree that cannot recognize the reason behind the act. I salute you, Dr. Walton-Shirley!!! About your honesty, bravery, and mostly about your good and caring heart – something that Hypocrites would be proud of… It is sad that there are not many physicians who are passionate and concerned about their patient’s wellbeing….It is sad that physicians in US are comfortable now ,in 21 century with the fact that there are people without health care in their country  - The most Powerful, the most free and Progressive in the World….The saddest of all is that this issue had grown in the political arena so much , when in fact it is pure humane and moral in nature. And yes, we are dreaming…. But the people who were talking about going to the Moon were dreamers too…and yes, they succeeded 100%.
	# 9 of 17	November 8, 2012 09:38 (EST)
	Ken	Americans get what they voted for; unfortuntately, so will I.  Wish the Republicans would stop running democrats and run a conservative instead.  In the words of Will Rogers, "Politicians: we swear 'em in then cuss 'em out."
	# 10 of 17	November 8, 2012 09:56 (EST)
	Dr J	Paying more to a fiscally irresponsible government is and expecting better healthcare IS "childish magical thinking" and dangerous.
	# 11 of 17	November 8, 2012 10:19 (EST)
	Alain	You stated "I love my wife dearly, but thank God she asks me who she should vote for. You should consider discussing your voting logic with your husband before casting your next ballot.".  Do I read this right? Your rhetoric would have not surprised me if it was voiced from Saudi Arabia but here in the States were women gained the right to vote last century: incredible!  This line of thoughts along with the other comments of “self-deportation”, “legitimate rape”, "47%", and “gift from god”, is exactly what got Obama elected.
	# 12 of 17	November 8, 2012 11:49 (EST)
	Liliana BT Kuvlieva	Dr.J /Very interesting name?/,It is” childish medical thinking” to believe that if 25 M people do not see a doctor in their lifetime and for everything going wrong  they  visit the nearest  ER,  will be “fiscally responsible” in any means. People have to be accountable for their health and this is the global  issue in US.  For instance, people cannot drive their car without insurance, but they can leave any lifestyle they would prefer without any accountability…. And when they are very, very sick, they will go to ER and be admitted with STEMI, NSTEMI, AHF and Cardiogenic shock, which will make LOS endless in some cases….If I add LVAD or open heart surgery… Who is paying for that? You and me and millions like us, who are diligent and obsessed with calories counting and organic foods….I do not know where do you live, it is probably a  fancy big city with intelligent and well educated people, who have the responsibility /logistically/ for their own health... But here in Kentucky /and Dr. Walton knows better than me/  is different…And I am sorry to say that, but this is the majority of the country… I think it is irresponsible and dangerous to ignore this fact…This is the reason that the healthcare in the US is the most expensive one in the World! Do we have the healthiest people in the world, knowing that we are the heaviest nation and our kids are the heavies kids I wonder!?!.Yes, we are dreaming, but to be insured for your health is not an option /the way that we do not question the option to drive a car without insurance – the choice is only about the full coverage or less/.  It is not taking away your “freedom”/this will never cross my European mind, it is sound so ridiculous/, it is not about bigger government,  It is the way to make people responsible for their health, to teach them to take care of their own health  and make good choses in their lifestyle – this will be good for them, for their kids and for the whole  society, don’t you think?  I salute you, Alan! You ace it!
	# 13 of 17	November 8, 2012 11:57 (EST)
	Dr Haas	You understood me absolutely correctly. There was a single issue that mattered in this election. the economy. To vote for a candidate during this election for any other reason (social issues) is absolutely moronic. The country needs a professional CEO with experience bringing organizations back from the dead, not a "likeable" guy who we hope will change his obviously flawed philosophy. when I send a patient for cardiac surgery, I send them to the one with the best technical skills and outcomes, not the " nicest one With the expensive suit. We all know women who consistently choose poorly when it comes to selecting a mate, yet keep going back for more. Men do this too, but not nearly as Often. I am simply pointing out that Dr WS voted for the "nice guy" hoping that he would change his ways. as a consequence she and those she cares about (her patients) Are going to continue to suffer. I.e. she is living in la la land instead of the real world. her decision was based purely on emotion which is a female trait rather than logic which males tend to use in making decisions. This is simple biology. Your comments on legitimate rape, 47%, are the typical straw man arguments that get people like Dr WS to vote their emotions rather than common sense.
	# 14 of 17	November 9, 2012 11:23 (EST)
	Ellie	Dear Melissa, Have you considered emailing your article to the woman in the White House?! Maybe she can assist us emotionally driven women! Ellie
	# 15 of 17	November 9, 2012 11:57 (EST)
	Melissa	Ellie, That's very very funny! :)  If I weren't so completely confident that my vote was a valid reflection of my conscience, I'd have been offended by that cockamamie statement  about women.  That does rank right up there with the top five most ridiculous statements that ever been made on any blog or forum I've ever written or moderated.  It doesn't crank any adrenalin for me though. After being a part of the movement for  smoke free legislation in the #1 tobacco producing county, promoting PCI in a state where initially folks were more concerned about their referral base than saving myocardium, and now trying to help drive change in a health care system that's hemorraging patients because of lack of credible leadership, I eat comments like that one for breakfast! YUM!! :) Suggest we try it with yogurt, fruit and a nice walk. The nuts were already included! HA! Have a great day. Keep on keeping on! Melissa
	# 16 of 17	November 9, 2012 01:41 (EST)
	jeffrey	The pres could start by STOP SMOKING!  What an awful example of responsible health prevention.  He is in no position to ask citizens to participate in healthier activities.
	# 17 of 17	November 13, 2012 11:15 (EST)
	susie	The angel on my shoulder lead me to vote the same way..for the same reasons.  Sometimes we just have to vote not so much for ourselves but for others.  I still have confidence is the president.  Everyone should have health insurence and thats the simple truth..there comes a time when we all have to understand  we have enough and can even afford to do with a little less.

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