Obamacare dramatically changed the financing and control of health care, and thus the remuneration of physicians.  Doctors are now deeply engaged in politics to increase their remuneration and dictate medical policies which affect their practices.  This article holds COVID-19 responsible for the new level of physician political activism, but that is not true.  It is all about the Benjamins and the BMWs::

https://www.politico.com/news/2024/09/21/doctors-harris-support-public-health-00179165

Doctors ‘fight like hell’ against a second Trump admin: ‘Elections do matter for your health’
Some see the politicking as a moral obligation, but others see a threat to the doctor-patient relationship.
By Daniel Payne - September 21, 2024

Doctors are giving nearly twice as much to Democrats as Republicans this cycle, teaming with Kamala Harris’ campaign and broadcasting the hazards they see in a second Trump administration on social media.

Some of their colleagues worry all the politicking will further erode trust in public health, but the Harris supporters say they see it as a moral obligation.

“Elections do matter for your health,” Dr. Suhas Gondi, an internal medicine resident at Brigham and Women’s Hospital in Boston who’s involved with the organizing, told POLITICO. “It’s hard for me to not be engaged in politics.”

Doctors’ strong support for Harris is the culmination of a political shift that started with the battles over patients’ rights and HMOs in the early 2000s and gained speed with Donald Trump’s 2016 run — which drove educated professionals into the Democratic Party.

Until then, physicians, as individuals and the organizations representing them, gave more to GOP candidates in every election cycle since the 1990s, save 2008.

Doctors skeptical of their colleagues’ public display of partisanship say they’re worried about how it’s playing in the exam room and what it means for their profession as another aspect of American life succumbs to polarization. They see conservative patients losing faith in their doctors — and a threat to public health, exemplified in everything from missed vaccinations to forgone cancer screenings.

They’re making the case that it would be better for their colleagues to keep their views closer to their white coats. “What matters in the clinic is that I build a rapport with the patient, learn their problem and preferences and find a therapy that fits with their preferences,” Dr. John Mandrola, a Kentucky cardiologist wrote on his Substack site last month. “You can’t do that if they don’t trust you. Or if they view you as a biased partisan.”

The day before, Mandrola’s post on X calling on doctors “to stay apolitical in the public sphere” had prompted a backlash from physicians who disagreed.

They said the stakes of the election are too high to worry about how their advocacy plays with the MAGA faithful. Pushing for science-based policies and freedom to practice medicine as they see fit is more important, many doctors said, than trying to be apolitical.

Harris is urging her physician supporters on, encouraging doctors to take advantage of their role as trusted messengers. Nearly 1,600 people signed up for a recent call for Health Care Providers for Harris, hosted by her campaign, which raised more than $100,000.

The skeptics note that the trust Harris is banking on isn’t what it used to be. A survey published in July found trust in doctors and hospitals dropped from more than 70 percent at the pandemic’s outset to just above 40 percent — with declines in every sociodemographic group.

Nonetheless, doctors who have long felt compelled to advocate on progressive policy issues appreciate the new allies.

“American medicine has changed profoundly,” said Dr. Ed Weisbart, national board secretary of Physicians for a National Health Program, which advocates for a single-payer health care system. He said doctors are “starting to realize that their advocacy for their patients doesn’t end within the exam room but actually has to go into broader political work.”

Democrats see an opening to keep that trend going: appealing to doctors’ sense of responsibility for their patients.

“You put that love for your patient into action by advocating for them day-in and day-out,” California Democratic Rep. Raul Ruiz, a doctor himself, said on the call with Health Care Providers for Harris. “That is the type of dedication and effort that Kamala Harris will have for the American people and the type of energy that we need — to go fight like hell to make her the next president.”

Shifting left

Covid-19 was a turning point for many doctors.

The Trump administration’s response, which many saw as focused more on politics than public health, prompted more of them to speak out.

As the 2020 election approached, a glut of campaign contributions to Democrats followed, the most individual contributions from doctors in history, according to OpenSecrets, a group that tracks money in politics.

Doctors donated nearly $129 million to Democrats and $62 million to Republicans (compared with $46 million and $33 million in the 2016 cycle, respectively).

Two years later, the Supreme Court overturned Roe v. Wade, ending federal protections for abortion. That has allowed states across the country to limit what reproductive health professionals are allowed to do for patients, causing some to move.

It was another driver of political activism, doctors said.

“We need to ensure that Democrats are elected up and down the ballot,” Dr. Anna Igler, an obstetrician-gynecologist in Wisconsin, said on the Health Care Providers for Harris call. “Our message should be clear: Reproductive rights and access are all on the line. The stakes in this election could not be higher.”

The battle over gender-affirming care, in which many Republican-led states have restricted treatments despite the recommendations of major medical associations, has had a similar galvanizing effect.

Republicans still have plenty of physician supporters, of course, including opponents of abortion and gender-affirming care. And several GOP doctors serve in the House and Senate.

Rep. Greg Murphy (R-N.C.), a urologist and co-chair of the GOP Doctors Caucus in the House, said fellow physicians “must be careful not to undermine the integrity of our profession by infusing politics into the sacrosanct doctor-patient relationship.”

And the Trump campaign fired back at doctors who’ve signed on with the Harris campaign.

“The only candidate who ‘serves as a threat to public health’ is Kamala Harris,” Karoline Leavitt, the Trump campaign’s national press secretary said in an email asking about the charge Harris-supporting doctors are making.

Leavitt cited Harris’ support for abortion rights and “economic policies that have increased healthcare costs for struggling American families” as examples of the threat she poses.

‘You’re either with us or you’re not’

There’s ample evidence that doctors, as with other highly educated professionals, have shifted toward the Democrats. A Pew Research Center report in April found that 61 percent of voters with a postgraduate degree now favor Democrats.

Most doctors POLITICO spoke with agreed that they shouldn’t espouse their political views inside exam rooms. But some believe they have a responsibility to publicly oppose restrictions on their ability to practice as well as policies they think harm patients.

“Trust is something that creates an enormous responsibility but also lends some political power and power that I’m pleased we’re trying to start using,” said Gondi, the internal medicine resident in Boston.

Some doctors disagree because they think engaging in politics poses a high risk of alienating patients and eroding trust in medical expertise — without much upside.

“It’s better for patients if doctors keep their political views to themselves,” Dr. Mary Braun Bates, an internist in New Hampshire who sees mostly older patients, said.

Even her views on health policies such as abortion legislation, for example, are “irrelevant for whether or not I can treat heart failure.”

Bates has seen the effects of patients’ political sensitivities firsthand.

After mentioning she had spoken to the governor of New Hampshire, who had visited her clinic, a patient said: “That’s not my governor.”

“That was the last time that patient saw me,” Bates said.

Other patients have become angry with her when she suggested, particularly after Trump won the presidency in 2016, that patients engage less with the news to lower their rising blood pressure.

Other doctors see a middle ground. Dr. Adam Cifu, an internist in Chicago, said he thinks it’s reasonable that physicians speak out when they have specialized knowledge, or on matters directly related to their practices.

But he acknowledged the risk even those comments can bring to the doctor-patient relationship, which he considers his “greatest responsibility.” And he suggested it could have implications for trust in the health system broadly.

“I think that physicians take for granted, a little bit, the respect that we’re still held in,” Cifu said. “That’s on shakier and shakier ground. And with how polarized the country is, almost anything you say can be held against you by half the people you see.”

Cifu acknowledged that many of his colleagues have a different calculus — one that’s playing out inside the groups that represent them.

The American Medical Association, once the conservative voice of the country club physician and still the nation’s leading doctors’ group, called this year for peace in Palestine and Israel. Its members also voted to call for drug use to be decriminalized, and to end the death penalty.

In a statement, a spokesperson for the group said that “physicians — like any group of Americans — span the ideological spectrum,” adding that the AMA works with both parties to achieve bipartisan solutions to problems facing doctors and patients.

The votes on Palestine and Israel, drug use and the death penalty came after months of planning by a growing, diverse group of mostly young doctors coordinating across AMA factions to make the organization more progressive.

“This is where our AMA is going,” said Dr. Luis Seija, advocacy committee chair of the group’s Minority Affairs Section. “We are committed to doing what’s right. You’re either with us or you’re not.”