Health-care Reform: Conservative Style

Ophthalmologist Kris Held has key role in American Doctors 4 Truth

By Bill Kekevian, Associate Editor

Kris Story Held, MD, arrived for her first live television appearance early in the evening of March 23, 2012. It was the second anniversary of President Obama signing his signature piece of legislation, the Affordable Care Act, and Fox News host Neil Cavuto had tapped her to appear on his “Your World” program for comment. She had long since earned the description “media savvy.” Dr. Held, a 57-year-old ophthalmologist and mother of four, was still recovering from a recent surgical procedure herself: a mastectomy.

Back home, in San Antonio, Dr. Held, along with colleague in ophthalmology Dr. Jane Lindell Hughes, would occasionally guest host a local talk radio hour. But it was the pair's founding of a 501(c)4 organization called American Doctors 4 Truth and their production of a controversial television commercial that catapulted them into the national spotlight.

Dr. Kris Held of American Doctors 4 Truth

“We made this ad to be in-your-face,” she says. “Maybe it's because we're from Texas.”

At the Edge of a Cliff

Although she never had strong political feelings, Dr. Held says, her ear perked up when President Obama started introducing health care reform.

“We know we have got to have health-care reform, all physicians know that. The status quo was a disaster,” she says. “That's why a lot of physicians initially supported Obama.”

But, she says, the disappointment set in when “it became apparent in '09 that the type of reform we were going to get was not patient-centered reform.”

She wasn't the only one with reservations and soon she and Dr. Hughes were collecting funds to build American Doctors 4 Truth. With the initial $50,000 Dr. Held says they raised, the group decided to invest their money into a commercial and it was a doozey. They even enlisted a director who had worked for the History Channel and is one of Dr. Held's patients. Held says there was a lot of discussion about how to remain respectful while still making an impact.

The result, a direct parody of a previous ad critical of Rep. Paul Ryan, was a four-minute web video, cut to 30 seconds for television, in which an actor playing the president shoves an elderly woman in a wheelchair off a cliff.

From a Patient Point of View

Two thousand twelve was already set to be a whirlwind year for Dr. Held when, in February, she was diagnosed with breast cancer. She blames her tireless fight against the Affordable Care Act.

“I almost wonder if this stress is why I got sick,” she bemoans, recalling her schedule in the months leading up to her diagnosis. “I got almost six hours of sleep a night. I had two kids at home last year and this is all we did. My 2009 vacation was spent reading the bill.”

High on her list of complaints is ObamaCare's electronic records mandate. Back in early March, while in her hospital bed recovering, Dr. Held became suspicious about medication she was being given. She's hesitant to go into details, but as a physician herself, she says she was able to identify mistakes being made. When she asked about it, the hospital staff confirmed her records had been confused with another patient. They chalked up the error to their electronic records system. While this anecdote may not be reason enough, according to Dr. Held, it's symptomatic of a larger issue: The limiting of choice.

“I can tell you, it's not better quality. People shouldn't be mandated to use electronic records,” she says. “These things have got to be tested.”

“Worse than Nothing”

Dr. Held has made the trip from her home and private practice to Washington D.C., eight times since 2009 to meet with legislators and advocate for repealing the legislation, pejoratively known as ObamaCare.

And American Doctors for Truth does employ the pejorative. As a part of the group's 12-point program outlining their health-care reform proposals, they write, “The status quo prior to ObamaCare is the place to momentarily return as we start to begin the process of constructive change. ObamaCare is far worse than doing nothing. It is an unworkable and financially ruinous course for our country.”

To say Drs. Held and Hughes have harsh rhetoric to describe ObamaCare's impact on their field would be an understatement, but if they sound defensive, Held says, it's with good reason.

“This is about patient choice,” she says “We [doctors] have let the government take over our profession.”

It's not just the government she says let her down. The American Medical Association, she emphatically says, “sold doctors out.” Although just 11% of American physicians are members, the AMA was awarded an exclusive billing revenue stream by the Obama administration.

“They misled us,” Dr. Held says of the AMA.

American Doctors for Truth isn't a political organization, she says, it's about the issue of patient rights. That's an issue that's becoming more and more political. With limited resources and limited people, Dr. Held says, the group's goal isn't to recruit, just to educate. The commercial aired in her home state of Texas and, with the remaining funds, they were able to get it on the air in only one additional state: Florida.

“We wanted to pick a swing state,” she says.

Uploading the clips to the Internet has helped bring in more than 9 million extra views.

Her activism hasn't interrupted her practice, though. Back in Texas, she reports, her patients are thanking her, especially ones on Medicare, who she says will face rationing.

A Different Kind of Reform

“They'll deny surgery to people over 80 or people not working,” she predicts, “There will be rationing. There are not enough doctors. The quality of care will go down. The cost of treatment is going to be weighed against patients' age, not on medical evidence.”

As an ophthalmologist, Dr. Held is particularly worried about what she refers to as the legistlation's inevitable “rationing problem.” Maybe, she says, ObamaCare's independent advisory board will encourage her cataract patients not to get what she calls her “number one surgery” simply because they're too old or not healthy enough. She fears it will limit her patients' quality of life.

Officially, the Obama administration hopes to expand Medicaid coverage to people younger than 65 with household incomes at or below 133% of the federal poverty level. And as for the Independent Payment Advisory Board, defenders insist it's designed to reduce congressional micromanagement.

American Doctors for Truth, along with sister groups Docs4PatientCare, the Association of Physicians and Surgeons and Physicians Council for Responsible Reform (all of which include Drs. Hughes and Held as members) have their own vision of health-care reform. They're hoping to inspire a political and intellectual shift that includes removing employers from the health-care business and allowing purchase and portability across state lines.

One of their 12 points seems to sum up the group's view of intellectual change. It reads:

“The notion that insurance is a pre-payment for routine health and preventative care must be replaced with a major medical shared risk model where insurance is for unanticipated medical and surgical expenses after a certain deductable is met. Routine care would not be covered, but would contribute to the deductable.”

According to Dr. Held, this is an issue of patient choice, which will remain in the hands of others until this sort of market-based change is enacted.

Until then, Dr. Held says, she'll “pray to God ObamaCare will be thrown out.”

In late June, the Supreme Court confirmed the constitutionality of the ACA, effectively upholding the law in full. However, with a presidential election just around the corner, the full legislation may still never see the light of day.

If the ACA does go into effect and Obama wins a second term, Dr. Held plans to take a page out of Sarah Palin's book and go “rogue.”

“I will implement, in my own practice, what I believe. One of the major aspects of our plan is absolute transparency. That's how I want to run my practice. I should be able to choose to take care of patients for nothing if I want,” she says.

Whatever happens with the ACA and the election in November, Dr. Held says, “I will spend all of my energy getting true, patient-driven, market-centered health care reform in place without the government.” OM