Pericles was an Athenian statesman considered by historians to be one of the founders of Athenian democracy. His observation applies to physician—and ACP—advocacy today in our 21st-century democracy. Physicians need to be well informed on general politics. We might even say that physicians who see their business as only taking care of patients, with no interest in engaging in politics to make things better for them, have no business here at all.
Yet politics, especially in these hyperpartisan and polarized days, is a four-letter word to many physicians. Why would they want to be in such a seedy and nasty space, instead of taking the high road and just doing their best by their patients? Because politics, per Merriam-Webster, is the art or science concerned with guiding or influencing governmental policy. Because everything that physicians do to make their patients healthier, and everything patients are able to do to keep themselves healthy, is affected by politics and the decisions made by politicians.
Politics and politicians decide who will have health insurance or not and how much it will cost, as well as whether they can have access to vaccines, are able to buy and afford healthy food, are exposed to environmental threats such as lead pipes, can afford their medications, can see a physician, and are subjected to discrimination, bias, racism, and social drivers of health that deny them access to care because of who they are, where they live, and how much money they make. Politics and politicians decide how much physicians are supported or unsupported in caring for patients, including how much they are paid, how much paperwork they are subjected to, the amount of medical education debt they incur, and the hurdles they face in helping patients get needed care.
ACP advocacy, and physician advocacy through ACP, is about the art and science of guiding or influencing governmental policy for the betterment of patients, the public, and physicians. It is not about engaging in partisan politics—helping one political party or faction gain or maintain control over government—which ACP never does.
Rather, we seek to guide or influence governmental policy for the benefit of patients, the public, and the medical profession without regard to the partisan affiliation of the officeholder. On a given issue, we will sometimes align with a particular officeholder's proposed policies on a specific issue, sometimes in opposition, and often, we seek to modify the policy when it is only partially in accord with our policies.
When a president, or member of Congress, state official, or other officeholder, advocates for specific policies that we support, this is desirable, and we will say so, while trying to change their minds on other issues where we may disagree.
When they advocate for specific policies that we do not support, this is undesirable, and we will say so and try to change their minds, while seeking common ground on other issues where we may agree.
Sometimes, ACP members suggest that “ACP should stay out of politics”—usually when ACP takes a position, or expresses a view on an officeholder's policies, that they personally disagree with. While this may be understandable, consider this: Staying out of politics would mean ACP no longer would seek to influence governmental policy for the betterment of patients, the public, and the physicians who take care of them. We would not be able to advocate for higher Medicare payments. We would not be able to advocate for physician-led teams and the value of internal medicine, or for making it easier for our international medical graduates to qualify for visas and permanent residency status. We would not be able to advocate for regulatory relief. We would not be able to advocate for public health. We would not be able to advocate for affordable access and coverage. We would not be able to advocate for health equity and nondiscrimination. We would not have achieved the many successes we have had in influencing governmental policy, like Medicare payment for telehealth and audio-only phone calls at the same rate as in-person visits, or the historic increases in Medicare payments for outpatient visits that went into effect on Jan. 1 of this year. We would not be able to influence governmental policy on anything.
Pericles had another observation that is applicable to ACP and physician advocacy:
“What you leave behind is not what is engraved on stone monuments, but what is woven into the lives of others.”
Nothing is more woven into the lives of others than their own health and the health of their loved ones. By engaging in advocacy through the political process, ACP hopes to leave behind a legacy of making others' lives better.