Op-Ed: Clive Fields: What does MAHA mean for America’s physicians?

With President Donald Trump’s inauguration and with the confirmation hearings for Bobby Kennedy behind us and with Mehmet Oz’s to follow, what exactly is the Make America Healthy Again (MAHA) movement and what does it mean for America’s physicians? What is clear is what it is not — it is not a single person, a single issue, or a single idea. It is a fundamental reevaluation of and reorientation of our health care system to deliver on the promise of making America healthy again.

Americans are living shorter, less healthy lives despite spending the most on health care. It shouldn’t be taboo to ask why the system doesn’t work the way we want and why it costs so much.

A career in family medicine has made me acutely aware of the burden of chronic disease and spurred me to think about how to address it. As part of that process, I’ve spoken with policymakers, including leaders in the MAHA movement, to share my experiences and hear their plans for reform. I believe MAHA has three defining pillars: intellectually, permission to be curious and challenge the status quo; clinically, prioritization of prevention, wellness, and the management of chronic disease; and economically, a focus on outcome-based reimbursement.

Most importantly, MAHA is a movement that puts patients first, respects the trusted relationship between physicians and patients, and recognizes that health care decisions are best made in exam rooms around the country, not in the cloakrooms of Washington D.C.

As a medical student and resident, I saw the negative impacts of an environment that discouraged inquiry. My fellow students and I had questions about almost everything, but traditional medical education made it difficult to ask them. It didn’t take long to realize that agreeing with the status quo was the easiest path to success. The longer we trained, the less likely we would ask why. You knew the answer: “because that’s the way it’s done here,” or “that’s the way I did it.”

MAHA gives permission to ask questions without a forgone conclusion or fear of retribution. Why do vaccine schedules differ in Western countries: is one more effective than another? Why have autism rates increased: is it changes in diagnosis, greater recognition of sex differences in presentation, or could there be another cause? Do we need fluoride in the water now that we have fluoride in our toothpaste? Why don’t we train more primary care physicians to meet the needs of an aging population? These don’t seem like irreverent questions, and they should be answered with honesty and scientific rigor, regardless of the result. Will there be room for different interpretations? Of course. That’s what drives the next set of questions, moving science forward, not holding it back.

Our current system rewards heroic care. As a result, we have seen incredible advances in the diagnosis and treatment of rare diseases, development of new technologies and a sub specialization of our health care workforce, but at what cost? Are training centers prioritizing this research over the mundane, but potentially more effective areas of prevention, wellness, and the management of chronic disease? Medical educators talk a lot about the need to engage patients in healthy lifestyles, manage disease exacerbations, and how to help patients make tough decisions about their care, but how much time do they really spend teaching in these areas? The evidence that supports the impact of exercise and nutrition as key factors in the health of an individual or a population is irrefutable, but education in these areas is still minimal in most medical schools. Why don't we teach how to integrate mental health and addictive disease into a team-based, patient-centered and holistic approach to patients’ health? Training programs, reimbursement, and recognition of these priorities have lagged. MAHA will prioritize these areas not as an afterthought, but as one of critical importance.

If there is one thing I have seen over and over in my career, it is that you get what you pay for. Fee-for-service reimbursement, weighted toward specialized and interventional treatment, gets us more specialized and interventional treatment. Patients benefit from new technologies and interventions, but if given the choice, my patients would rather not be in a hospital, not be away from family, and almost always would choose home as the preferred site of care. MAHA will value early intervention, team-based collaborative care, and most importantly, prioritize what patients want and where they want it. If that’s what an accountable health care system looks like, it is well within our reach.

MAHA will promote intellectual curiosity, drive a clinical model focused on prevention, wellness, and the management of chronic disease, and tie outcomes to an aligned economic model. These steps will ensure patients’ needs are paramount in the health care system while recognizing that decision-making lies with patients and providers.

This is the foundation of a health care system we could all be proud of, one that puts relationships and outcomes ahead of transactions and procedures while meeting the needs of patients, their families, and America’s physicians.

Clive Fields is a family physician and is a co-founder of VillageMD.