RNC: Young Internist Rallies Docs Against Trump

No matter what Trump says or does, he still manages to maintain 38% support in voter opinion surveys, Bryan Hambley, MD, co-founder of Stand Together Against Trump (STAT) told MedPage Today. Hambley completed his internal medicine residency at University Hospitals and is now a fellow in critical care medicine.

In this interview he tells Shannon Firth, MedPage Today’s Washington Correspondent, that he was spurred to action by Trump’s call to ban Muslim refugees, noting that he works daily side-by-side with Muslim doctors.

Protesters will convene Thursday afternoon for a march and later that evening for a rally in Public Square.

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RNC: Docs Protest as Trump Takes Stage

CLEVELAND — In the semi-darkness of Cleveland’s Public Square, activists Thursday night held signs glowing with tiny fluorescent bulbs that read S-T-A-T for “Stand Together Against Trump.”

It was nearly 10 p.m. and the group was just a few minutes walk from the stage where Donald Trump would formally accept the nomination at the Republican National Convention. They sang and chanted and waved and gave speeches, determined not to leave until he did.

STAT, a group of physicians, nurses and other professionals, first began publicly protesting the Trump campaign in March ahead of the Ohio primaries. It does not endorse a candidate and does not represent a single party.

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Aside from voting, Fatima Fadlalla, MD, a resident in internal medicine in Cleveland, said she’s never been active politically, but this time was different. She stepped away from the 30 or 40 people chanting on the marble steps in a grassy corner of the square — home to the iconic Cuyahoga County Soldiers and Sailors Monument.

“When the language that you hear in the election … when the leader of an entire party is, you know, spouting such language and using such divisive words and framing things in such a way that is so skewed and so against what you inherently believe, it is absolutely your responsibility to say something and to stand out, because you don’t want to look back in time and look back in history and think I had a moment and I didn’t seize it, and I didn’t say what I should have.”

As a physician, Fadlalla is concerned about Trump’s impact on her patients and the state of healthcare in the country. “It’s amazing how far he’s managed to come without actually making any specific policy remarks. But when you have somebody who frames certain arguments in such a way that is so narrow and so alienating, it’s hard to imagine that that type of individual will then be able to see some of the greater issues that are surrounding our patients and the population that we deal with, whether they’re inner-city or rural people.”

She said she worries about the social determinants of health — poverty, violence, lack of education — and thinks Trump is someone who won’t understand “that there are broader things going on that impact health. That in itself is going to have a negative impact on any sort of positive policies that would help my patients,” she said.

“I worry what a Donald Trump presidency would look like for myself as someone who is muslim and has lived here all of her life. … I worry what that looks like for my parents who immigrated here, and my friends and I worry about what that looks like for minorities.”

But she was clear about her purpose. “I’m here more than just as, like, a Muslim or just as a black person or as a woman. I’m here because I grew up believing in what I was taught about America, and about the values that we have as a country about equality, about justice, and I think that we seem to be getting further and further away from where we started in 1776, and that’s sad and that’s terrifying.”

“I just hope that people, you know, who are claiming to want to ‘make America great again’,” she said, steadying her voice, “will just take a moment and really look at what the founding fathers were talking about. I mean they weren’t perfect, but what they aspired or what they dreamed was far bigger and far better.”

Fadlalla’s sister Sara came with her to the protest. Sara Fadlalla is a post-baccalaureate student at Cleveland State University. She is applying to dental schools.

“She’s younger, I think, more energetic and very hopeful,” said Fatima Fadlalla of her sister. “I think having somebody that you’re used to taking care of, part of you wants to reassure them that things will be okay and that the future is better than the days before. And so that’s kind of what we’re holding to. … ” she said, her brown eyes starting to glisten. She apologized as she wiped at the corners of her eyes with her headscarf.

“I just hope that that’s actually the truth.”

RNC: Former CBO Director on Trump-Pence

CLEVELAND — MedPage Today caught up with Douglas “Doug” Holtz-Eakin, PhD, president of the American Action Forum, a center-right Washington-based think tank and a former director of the Congressional Budget Office, about his views on the Trump-Pence ticket, and whether Donald Trump would adopt Paul Ryan’s blueprint for health reform.

“When Ryan started the task force projects. I thought he would fail,” Holtz-Eakin said. Holtz-Eakin expected that, because it’s an election year, [House] members would be skittish about laying out too many specifics in policy areas, including healthcare, that a presidential nominee could then ignore.

“I’m not so sure now,” he said.

“You could easily see Trump as president saying, ‘Okay, see what kind of a deal you can get out of the House and Senate. We’ll work on the deal.’ And that’s what he likes. Cutting the deal. I don’t think he cares about the substance and the starting points.”

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RNC: Cruz Disses Trump, Ryan Hedges

CLEVELAND — Ted Cruz enraged an arena full of Trump fans by failing to endorse the confirmed billionaire nominee, instead seeming to take the opportunity to relaunch his own brand.

And GOP nominee Donald Trump returned the favor by disrupting Cruz’s speech by entering the back of the hall giving his blessing to the jeering crowd.

Cruz started his prime time remarks with a conciliatory note by formally congratulating Trump on his nomination. He then paid homage to a slain Dallas police officer, criticized the “corrupt” Democratic establishment, slammed Obamacare, and then — at the point where most convention speakers would endorse the nominee — he went in a different direction.

“And to those listening, please don’t stay home in November. If you love your country and love your children as much as I know that you do, stand and speak and vote your conscience, vote for candidates up and down the ticket, who you trust to defend our party.”

The audience responded by booing Cruz off stage.

The jumbo screens above fizzed and crackled and eventually sputtered out for a period, but not before playing another family-focused video. Donald Trump’s son, Eric, spoke next, but it was former House Speaker Newt Gingrich who managed to restore order at least temporarily.

“I think you misunderstood one paragraph that Ted Cruz, who’s a superb orator, said,” Gingrich told the crowd.

“In this election there is only one candidate who will uphold the constitution,” he said, and that is Trump-Pence.

Later in the night, House Speaker Paul Ryan (R-Wis.) introduced Indiana Gov. Mike Pence as a”Reagan conservative.”

“He’s a man of faith, a man of conviction, a man you can trust,” he said.

And while Ryan reserved his praises for the vice presidential nominee, he spoke of sending “him and Donald Trump straight to the White House.”

Pence, billed as the headline attraction for the evening, then introduced himself.

“I’m a Christian, a conservative and a Republican, in that order.”

Pence introduced his mother in the audience, who blew him a kiss, and then the rest of his family.

Trump tapped Pence, a social conservative and born-again evangelical Christian, as his running mate last week.

He negotiated a compromise to expand Medicaid in Indiana, an action which even some liberal policy experts say they were gratified to see, but as recently as this past Saturday has promised to repeal Obamacare. In his remarks Wednesday, he took a poke at Hillary Clinton’s role in health reform during her husband Bill’s administration, saying, “She planted the seeds of the disaster we now know as Obamacare.”

The core of Thursday’s speeches centered around law and order and defeating terrorism, but the speakers spent considerable time bashing Clinton, the former Secretary of State and presumptive Democratic nominee.

And Pence fell in line with that theme calling her “America’s secretary of the status quo”

“It’s change versus the status quo … and when Donald Trump is elected president of the United States of America the change will be huuuuuge,” he said, playing to the audience. While the crowd interrupted Pence several times with chants of “Trump” and “USA” he waited them out.

During the day, there were a number of protests in the public square outside the Quicken Loans Arena, site of the convention — including a flag-burning protest that involved 17 arrests. Leah Wolfe, who was working as a volunteer”street medic” treating injured protesters, said she had mostly been taking care of minor injuries such as blisters, sunburns, and dehydration.

The street medics haven’t had much contact with regular emergency medical services (EMS) staff as of yet, she noted. “We’re trained to identify real emergencies, so if a real emergency happens behind police lines, EMS is not allowed to go back there because they have to wait for police to clear the scene, whereas a lot of street medics are willing to be back there so they can help people, and get them out to the ambulance if it’s necessary.

“We’re a collective effort of volunteers from all over the country,” added Wolfe, who was interviewed prior to the flag-burning protest. “For me it’s practice in disaster preparedness … [although] so far it seems like it’s been pretty calm.”

When GOP presidential nominee Donald Trump takes the stage tomorrow night, physicians, nurses, and other health professionals will be joining the ranks of protesters outside the arena.

Protesters will convene Thursday afternoon for a march and later that evening for a rally in Public Square.

RNC: And Now for a Different Take on Obamacare ACA

CLEVELAND — Could a Republican administration repeal Obamacare? That was the topic up for discussion at a briefing Tuesday, held outside the Republican National Convention.

“I do not believe … that my political party is going to be able to put together a complete repeal, and I don’t think it should,” said Tommy Thompson, JD, a fellow of the Council on Foreign Relations, who served as Secretary of Health and Human Services under President George W. Bush, and four terms as governor of Wisconsin.

Thompson was the keynote guest at the briefing hosted by RealClear Politics, and sponsored by Walgreens, the American Association of Nurse Anesthetists, the American Nurses Association, and the American Podiatric Medical Association.

He said attempting full repeal would create “real chaos. The Affordable Care Act has got lots of problems, but there’s some good parts of it, and most Republicans will recognize the good parts,” he told reporters after the briefing.

Republicans should focus on fixing Obamacare, by reducing its taxes, lowering premiums, and giving people an incentive to buy health insurance, he said.

“Why is it that you and I don’t get a tax deduction when we pay for health insurance, but the company that employs us does?” he said at the briefing.

Thompson argued for giving everyone a refundable tax credit to incentivize more people to buy into plans. He also said that the government should maintain parity laws, so that sick people aren’t charged more or kicked off their health plans — he called the latter move “un-American.”

When asked who the best person would be to navigate these “meaningful changes”, Thompson didn’t hesitate: “Without a doubt, Donald Trump.”

Policy analysts and journalists speaking on a separate panel were more skeptical, given Trump’s unpredictable nature and his changing opinions on healthcare reform.

“Donald Trump would be well-advised to outsource the making of policy to [Speaker] Paul Ryan (R-Wisc.),” said Lanhee Chen, PhD, JD, a research fellow at the conservative think tank, the Hoover Institution at Stanford University in Stanford, Calif. Chen was also the policy director for the Romney-Ryan 2012 campaign.

“Presumably, that’s what would happen,” he said, and then clarified “In an ideal world for conservatives, I think that’s what would happen.”

“I think we are in a phase of the conversation now, where we’re trying to do our best to imagine what a Trump administration would look like, when in reality, none of us really knows. This is like a freak wild card,” he stated.

Chen told MedPage Today, that full repeal would be “tough” but “a large amount of repeal” could happen through the budget reconciliations process, which requires fewer votes — a path that has already been tested.

If Trump wins the election, Chen anticipates a Republican administration would attempt repeal.

“It’s important for him to realize that just saying you’re going to repeal Obamacare alone is not enough, that there has to be a coherent plan to replace it,” he said, which is where turning to Ryan’s blueprint makes sense. “Otherwise, politically I think he’s in very dangerous water.”

If repeal weren’t achieved, Chen argued for developing more tailored plans to fit people’s needs that cost less, made possible by loosening some of the essential benefits requirements; paring back subsidies; developing a more “open architecture” to create a more competitive marketplace; and giving states more flexibility around Medicaid expansion on the front-end, instead of relying on the back-door 1115 waiver process.

If Secretary Hillary Clinton wins the presidency and Republicans maintain a majority in Congress, “they’ll want to try to work together,” Chen said. “It will be incumbent on [Senate Majority Leader] Mitch McConnell (R-Ky.) and Paul Ryan to lead that negotiation with her.”

RNC Day One: A Dust-up, But No Derailments

CLEVELAND — The Republican National Convention here kicked off calmly Monday, but then descended into chaos, if only temporarily.

Business began as usual with the Pledge of Allegiance and the other standard opening procedures. Delegates even danced to the music, some wearing cowboy hats as many two-stepped in the aisles to the tune of “Happy Together,” “Come Join the Party,” and “How Sweet it is to be Loved by You.”

Despite that amicable beginning, things got rowdy inside the Quicken Loans Arena when the chair of the Republican National Committee’s rules committee moved that the convention rules be adopted.

A voice vote was taken but because both sides were shouting very loudly it was unclear whether the Aye or Nay votes had prevailed. A lot of chanting followed, including voices saying “USA!” and others yelling “We want Trump!”

The convention chair then asked for another voice vote. He declared that the rules committee report had been adopted. A delegate from Utah requested a voice vote but his request was denied, with the chair saying there was not enough support for one. The convention business resumed shortly thereafter, although shouts of “Roll call vote!” erupted periodically.

That dissension was emblematic of disagreements about Donald Trump, the party’s presumed nominee, that were going on behind the scenes, even though Paul Manafort, Trump’s acting campaign manager, had presented unity as one of the convention’s core themes during a press briefing Monday morning.

As one example of some prominent party members’ dissatisfaction with Trump, John Kasich, Ohio’s own Republican governor, will not be speaking at the convention and has thus far failed to endorse the candidate.

“He’s embarrassing his party,” Manafort said of Kasich at a media breakfast.

The theme for the opening day was “Make America Safe Again,” with a focus on national security, but a few speakers did make comments about healthcare issues.

Rep. Greg Walden (R- Ore.) slammed the Affordable Care Act (ACA). “Under this flawed law, healthcare has become anything but affordable,” he said. “Insurance premiums and healthcare costs, they’ve skyrocketed. Another round of double-digit rate hikes are set to hit consumers this November. Obamacare is what happens when a president cares more about securing a political win than setting good policy for our country.”

Walden drew comparisons between Obamacare and the “patient-centered” replacement plan touted by House Republicans, including House Speaker Paul Ryan (R-Wisc.). “We’re offering a real alternative and showing voters that Republicans are the party of new and good ideas, while Democrats are clearly the party of the failed status quo, especially on healthcare … Donald Trump will be our partner in this effort and together we will replace Obamacare with healthcare that works for all Americans.”

The orthopedic surgeon who chairs the party’s platform committee,Sen. John Barrasso, MD, (R-Wyo.), also criticized the ACA.”The president … dismantled the American system of healthcare and replaced it with a costly, complicated scheme that takes away our freedom,” he said.

Outside the “Q” second tier activities included a forum on the future of health information technology, sponsored by the Health Information and Management Systems Society (HIMSS).

Martin Harris, MD, chief information officer at the Cleveland Clinic, discussed his facility’s use of a patient portal that gives patients most test results at the same time as their physicians receive them.

“It creates a continuous relationship with physician that’s sustainable over time,” he said of the portal, which patients can access on their smartphones. “Now patients have access to exact same information that their provider has.” Certain test results, such as pathology results for suspected cancers, are delayed before being posted in the patient portal until the physician has time to discuss them with the patient, he added.

Warren Selman, MD, neurosurgeon-in-chief at University Hospitals of Cleveland, discussed the benefits of using a 3-D virtual reality system to analyze neurosurgery patients. One advantage is that it makes consultation with far-away colleagues easier.

“It’s not enough for me to make a decision by myself [in some cases] … Wouldn’t it be great to get a couple of colleagues on the same surgical theater and say, ‘Would you take a look at this? Take a look in 3D and tell me what you think,” he said. “Virtual reality has a very strong place in improving healthcare.”

In addition, Selman said, being able to see, for example, what their own brain aneurysm looks like and how the neurosurgeon is planning to approach the surgery “gives patients a greater sense of trust.”