Implications of presidential election for health-care

Implications of presidential election for health-care

The presidential election gives me an opportunity to comment about the future of our country, and it is my hope that you will read this even though it might differ from some Republican and from some Democratic perceptions. We might have different perceptions and perspectives, but I don’t think we differ in our goals. Let me introduce myself and then, if you choose to read further, you will see what my solution to our society problems are.

When I was 15, I followed the case of Caryl Chessman in California. When he was executed in 1960, I vowed to never support the death penalty for anyone for any reason.

I have hated and abhorred racism and bigotry all of my life; when I was in college in Louisiana, the KKK threatened me for my acts of kindness toward African Americans. It was my father, who did not agree with me, who defended me. In 1964, I returned from three months in Africa and addressed 2,000 students in a Louisiana State student conference. I spoke about civil rights and racial equality. At the end of that address, not one person spoke to me. It was 30 years before I was ever asked to speak in Louisiana again.

In 1994, I was asked to speak to a pro-life rally – as I am against the death penalty, I am also against abortion, but I do not try to impose my belief upon others. At that rally, I asked all who favored abortion to raise their hands. None did. I then asked those who opposed abortion to raise their hands. All did. I then said, “We have settled the issue of abortion for ourselves; let’s talk about something we may not have settled.” 

I then said the blood brother, the fellow kinsman, the fellow traveler with the abortionist is the racist, the bigot, the prejudiced person. I gave a one-hour speech on bigotry and have to date never been asked to speak in the state again.

I favor the Dream Act – I love children and would never want to dash any child’s dreams — and I support a path to citizenship for all who live in America. Neither position is popular with conservatives, but I would not refuse a college education to any child, and we have millions of Hispanic residents in this country who are contributing to our lives every day.

I support health care for all citizens and residents (however they may be categorized by others) of this country. I am not sure yet how to pay for this, but as a physician, I have never refused care to anyone and could not do so now.

The above are positions of a classic social liberal, but I am also a classic fiscal conservative. I stand against the death penalty, abortion, racism, bigotry and isolationism, and I stand for health, nutrition, safety, protection and education for all children. My positions are internally and externally consistent with my belief in the dignity, value and personhood of all people. I stand for the freedom of all to exercise their choices, even when those choices radically differ from my own principles, beliefs and convictions. It is not an accident that I have founded and that I lead a multi-ethnic, multi-national, multi-cultural, multi-faith practice in both patients and providers. And it is no accident that that practice has eliminated ethnic disparities in the treatment of diabetes and hypertension (see

On the SETMA website, you’ll find a link to my address upon receiving the Distinguished Alumnus Award from my school of medicine in October. The greatness of this country did not come from conservatism or from liberalism; it came from the balance of the two. The entrepreneurism of conservatism and the humanitarianism of liberalism created the greatness of the United States. And while we often act as if these positions are mutually exclusive, it is also reality that many Democrat humanitarians are also entrepreneurs, and that many Republican entrepreneurs are also humanitarians. I am tired of two sides just yelling at one another. In the Bible, Proverbs advocates a balance between “mercy” (liberalism) and “truth” (conservatism). That is what is needed in America today.

The president won

Acting like a winner is conciliatory

The reason I place the burden for reconciliation among the citizens of this country at the feet of the president is that he is the ONLY one who can take the initiative to change the conversation and hopefully move this country back toward its historical, dynamic equilibrium between liberalism and conservatism. If all I wanted to do is shout at the darkness, I could. I chose to solve the problem, or at least to try and solve it. If the president takes the bold move I would recommend, he would win, even if Republicans rejected his overture and refused to work with him; and if they do work with him, then we all win. If the president wants to be a modern-day Lincoln, this is the only way for him to do so.

I don’t ask that anyone agree with my premise that the president can be “great president” by acting courageously; however, I believe my observations about the lack of statesmanship by both presidential candidates is correct. I once had a pastor who was moving to a new church. He told one evening that he had been confronted about a difficult issue and that, “I had nothing to lose so I told them the truth.” I asked, “If you had had something to lose, would you have lied?”

The president has won, as he told everyone the first month of his first term – when discussing compromise and bipartisanship, he rejected both, declaring, “I won.” A statesman looks to the welfare of all, not to the election outcome. The president can die on the hill of his success, or he can rise to the summit as a statesman and boldly and courageously take steps to bridge the gap between liberalism and conservatism and solve our problems. He has nothing to lose, so he can tell the truth.

Response to an academic

Shortly after the election, I wrote an academic who had a negative response to my assessment of the President’s conduct in the recent election. I said: “Thank you for responding. I had hoped you would.” The academic was interested in my opinion of the Accountable Care Act. I said:

1. I have always supported the ACA. I have misgivings about the financing of it but not because of concern for my own economic interest. My practice ( is debt free, as I am personally. I don’t need much to fund my lifestyle other than I wish to support my eight grandchildren’s college careers. Also, my wife and I have endowed a Distinguished Professorship in Patient Centered Medical Home at the University of Texas Health Science Center in San Antonio, a Distinguished Lecture Series in patient centered medical home and a primary care institute there. All are interdepartmental and interdisciplinary programs. We would like to continue to support the transformation of health care in my practice and in my school of medicine. In that we are not independently wealthy, we must work and earn income.

2. I subscribe to and promote Hubert Humphrey’s “Moral Test” for a government, which he enunciated in November 1977. By the way, I voted for him for president. He said, “The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.”

3. I subscribe to and promote IHI’s Triple Aim. I also was disappointed that Don Berwick could not get confirmed as the head of CMS.

4. The SETMA Foundation has received $2 million over the past four year from the partners of SETMA with which we pay for the care of our patients who cannot afford it. None of that money can profit SETMA. An uninsured patient who was admitted to our service (we take care of 25 percent of all indigents and uninsured patients admitted to the hospital) needs a gastric bypass. She has no money, no insurance and no hope. We are negotiating a price (probably $24,000 global cost) and we (SETMA and SETMA’s partners) will pay it.

5. CMS commissioned a study of 623 medical practices in January 2011. Half were medical home; half were not. SETMA’s result was that our global cost for Medicare Fee-for-Service beneficiaries was 37.4 percent below the practice benchmarked against us.

I don’t know if any good will come from my proposal, but I am willing to risk others’ objection in order to “light a candle” rather than cursing the darkness. If I fail, then I will have failed trying valiantly.

I repeat my affirmation that the genius of America has always been a balance between conservatism and liberalism. That balance should be a dynamic tension – dynamic because it is active and establish by dialogue rather then two simultaneous monologues and a tension because it respects the rights of both “sides” to hold their beliefs and to have those beliefs respected even though they are not embraced. The fault for the lack of such a dialogue is both Democrat and Republican, but it is principally the president’s. It is the president’s job to be led by his personal convictions and then to form a consensus with those who agree with him and with those who disagree with him.

Modest proposal for a president

My proposal that President Barack Obama invite Gov. Mitt Romney into his cabinet and to co-author a solution to our fiscal crisis has been echoed by many. In his closing paragraph of his piece titled, “2012 Election: How to Rebuild Trust and Infrastructure,” CNN commentator, Fareed Zakaria said, “Is there a special tactic that might help bring Republicans along? Well, in his gracious speech on Wednesday morning after his re-election, Obama noted that he hoped to talk to Romney about ways they might work together. Why not ask Romney if he would be willing to spearhead this project? It would be an act of bipartisanship in the service of a national interest — and it might just begin to change the tenor of Washington for the next four years.”

I thought this was interesting because it is exactly what I proposed the day before. I don’t think the president will ask and I think if he does Romney will not accept because neither are statesmen but appear to be base politicians, more focused on personal advancement than the good of America.

I couched my proposal in terms of the president acting presidential and statesman-like with an opening, sincere gambit of humility and contrition. Again, unlikely to be done but powerful if it were. The amazing thing to me is greatness is in the hands of the president, and healing for this nation is there, also. Someone has to take the first step. Humility is so seldom seen in American political and public life, but when it is, it is seductive and attractive.

A Democrat legislator offered to get my original article to the president, and I said, “Thank you, sir. As you know, I am not a supporter of the president, but for the sake of America, I want him to be a great president. Our land needs to be healed and not further divided. The president has nothing to lose except his legacy. That legacy can be great, but only if he takes steps to bring people together. That will not be done by his demanding that others always see things his way. Nor will it be done by his being required to always accept someone else’s way. It will be done by mutual respect and the crafting of a ‘dynamic’ solution that does not require the resolution of the ‘tension’ or of the ‘dynamic tension.’”


I wish the president well, and I hope he will become a statesman instead of just a politician. We have precious few statesmen and too many politicians. I hope he will at least listen and consider the path I have recommended. For the dyed-in-the-wool Democratic president to reach out to the dyed-in-the-wool Republican challenger is counterintuitive, but it is also the greatest hope we have as a nation in the short and long run.


Dr. James L. Holly is CEO of Southeast Texas Medical Associates, LLP (SETMA) in Beaumont.