Finding precedent for unprecedented times

“Unprecedented” is a term being used a lot these days, and while it may be true that we are in unprecedented times, these are certainly not the first unprecedented times I have lived through, and I do not expect them to be the last.

Looking back on 9/11 and COVID-19 as two examples, these events required some new type of thinking, resiliency, and creativity to move through them, and now is no different. The country has evolved, and there seems to be significant resistance by many Americans to what has been considered the status quo for many years. The Republican Party appears to have captured that sentiment well, which led to them sweeping the White House and both houses of Congress in the 2024 elections, while the Democratic Party seems to have become more of the old-school party that is out of touch with “regular people.” There is truth in these views that must be considered as we move forward.

The Republican Party is very different now than it was even a few years ago. The Republican Party that I remember was fiscally conservative, seeking smaller government, reducing restrictions on businesses, and cutting taxes. It was generally considered more comfortable with Wall Street than it was with the “common person.” Ronald Reagan was the standard bearer for this type of conservatism. Throughout his presidency, Mr. Reagan was extremely popular, as he had very clear goals domestically, had a strong foreign policy agenda, and was also an incredible communicator. He was very likable, even to those who fundamentally disagreed with his policies. As a result, Mr. Reagan's brand of conservatism is what has stood the test of time—until now.

Now, it seems that the Republican Party has garnered a different, perhaps more diverse, base. The exit polls did show that while White voters, particularly men, preferred the Republican candidate, as has been the case for all Republicans since Richard Nixon in 1968, President-elect Trump made some unexpected gains in votes from the Latino/Hispanic population and, to a lesser extent, the Black population. With that said, those who voted for Vice President Kamala Harris were more racially diverse overall.

Therefore, an unusual set of diverse groups seems to be making up this new Republican base. It includes big business (e.g., Elon Musk with Tesla), but not necessarily the pharmaceutical companies against whom Mr. Trump fought during his prior administration around price transparency and affordability and may tangle with now, potentially, regarding vaccination mandates.

Some voters who may previously have identified as Democrats due to environmental and social welfare causes but who also have been concerned about mandated vaccinations and government “over-regulation” of food and drugs seem to have found themselves more at home with the Republicans of late. Further, some individuals who have typically been opposed to governmental interference in their daily lives are supportive of legal roadblocks to abortion and gender-affirming care that Republican leaders are more likely to implement.

The Democratic Party has also evolved over the years. It was long known as the party of the “common person,” and this is how I recall it from growing up in Kentucky, which once was a blue state. My grandfather on my mom's side was a coal miner and then a long-time union organizer, ultimately retiring from General Motors, while my other grandfather worked for the Democratic Party in Kentucky until his retirement.

Under President Franklin D. Roosevelt, the party started to be identified by modern liberalism, including support of social welfare, labor unions, and the regulation of business. President Roosevelt was then followed by Presidents Harry S Truman, Dwight D. Eisenhower, John F. Kennedy, and Lyndon B. Johnson, who were certainly different from each other. However, all generally espoused the same liberal viewpoints. It was when the Civil Rights Movement took hold that the Southern states, including Kentucky, began to transition into red states. More recently, the Democratic Party has been labeled as too “woke” and out of touch with the working people—messaging that seemed to have a significant impact during this most recent election.

So, where are we now and where do we go from here? First and foremost, we must ensure that new and updated policies and laws are evidence-based, something that has come under severe threat following the election. As I discussed in my column in the January I.M. Matters, facts are facts and they do not waver based on one's political views. Vaccines work, plain and simple! Some can nearly eliminate diseases in our population, like polio, measles, mumps, and rubella, and others help prevent more serious illness from diseases like flu and COVID-19. We should not forget the gratitude of our recent ancestors who were first able to receive the polio vaccine after seeing so many suffer. We also know that a strong public health infrastructure overall is necessary both day to day and to ensure we respond appropriately to whatever the next outbreak or pandemic may be.

Last month I also discussed some other key issues of concern regarding the Affordable Care Act (ACA) and Medicaid, as well as areas of opportunities for moving forward, such as addressing Medicare payment reform and administrative burdens, while noting that ACP's policies and our principles will remain in place no matter what. How do we do this? How can we find the “purple” in what might be very divisive discussions between ruby red Republicans and deep blue Democrats?

ACP's senior leadership team recently engaged in training on crucial conversations such as these, and what we learned seems particularly relevant now, in the wake of this election. A conversation becomes crucial when the stakes are high, you have differing views, and strong emotions are involved. When initiating such a conversation, it is important to begin with where you are and what you are feeling, then actively work to take the emotion out of it and simply start with the facts that both parties can agree on, ideally leading to a mutual purpose.

For instance, Robert F. Kennedy Jr. is interested in improving the health of those with chronic conditions, recognizing that over 129 million Americans—over 40% of the population—have at least one. A Democrat talking to Mr. Kennedy about this issue could listen to him sharing his story about these facts and then tell him their own. The same facts can lead to very different stories, but ideally there are still some commonalities between the two. Those commonalities can be a place to start to identify solutions. )

I recognize that we are all not going to be having a crucial conversation directly with RFK Jr., but you can certainly do this with your members of Congress either in Washington, D.C., or within your districts on any number of issues. ACP is happy to help with this as well and has identified our top nine policy priorities for 2025 as a guide:

• valuing the care provided by internal medicine physicians,
• reducing administrative burden in medicine,
• ensuring access to care,
• protecting the patient-physician relationship,
• strengthening the internal medicine workforce,
• supporting and enhancing digital health,
• ensuring prescription drug access and affordability,
• investing in public health initiatives and research, and
• promoting physician-led team-based care.

The College provides one-pagers on each of these issues that include background information, ACP's position, and a call to action with any relevant active bills or regulations. ACP members can use these resources in their own visits with members of Congress and with their state legislators. Additional resources are also available on our state health policy website, such as toolkits on key issues and a questionnaire to submit requests to ACP National for advocacy assistance.

I encourage all of you to get ready to engage in crucial conversations during these unprecedented times! We must look ahead at where we want to be and take steps to get there together, no matter what party you are affiliated with and even when facing significant challenges. Please know that ACP is ready to help in any way we can.