Open letter to Rep. Liz Cheney and Sen. Mike Enzi

I am a semi-retired professor of surgery at the University of Utah. I would like to thank you very much for your letters regarding the House AHCA and the Senate “Better” plan. The CBO report is now out, and it is clear that both the House and Senate bills will hurt the American people in fundamental ways.

You both expressed the idea that Obamacare has been the cause of Wyoming’s woes regarding access to healthcare, and that repealing it will help individuals obtain insurance. This idea is misguided in fundamental ways. The idea that HSA’s (health savings accounts) will solve the problem of high deductible individual insurance plans with big co-pays ignores the fact that most Americans do not have significant savings. 

The median savings for all working age families is $5,000, and 69 percent have less than $1,000 in savings accounts of any kind. Moreover, 50 percent of Americans have zero retirement savings.

With high deductible accounts, and without subsidies, out-of-pocket costs for unexpected illness or injury have the potential to plunge even young and working families into financial catastrophe. Previous owners of our ranch had to sell for just this reason. They didn’t sell because they didn’t like ranching. They sold it to pay healthcare bills — well before Obamacare. 

Other members of our community have children on Medicaid because of congenital disabilities. These families also work multiple jobs — as most people around here do — but still are struggling to both care for their kids and to make ends meet. Reducing long-term Medicaid benefits will strain these families further, as these children will carry their problems throughout their lives into adulthood.

You expressed in your letters the idea that individuals make better choices than communities and that mandating that individuals carry health insurance is unpopular. This argument reminds me of the history of seat belt and smoking laws. They were contested for years because they challenged individual freedom — ignoring the fact that others, and communities in particular, have to pay increased costs for healthcare due to poor individual decisions. 

If each individual who makes a decision not to buy health insurance also waives the right to ambulance services, the ER, the ICU and other extremely expensive services, the argument would be consistent. But few people foresee the need for these services — until they need them, and then they believe that they have a “right” to the care. Who pays then?

You say that the people closest to the problem understand it best. I have been very close to these problems — as a doctor for almost 35 years, who has practiced in three states, and as a patient and mother of kids and grandkids. 

In Evanston, we have real problems with community health. As detailed by our public health leadership and in the local paper, Uinta County ranks third from the bottom among all Wyoming counties for health outcomes. 

The economics of access to affordable care has been addressed by multiple books and articles, and they point to the fact that healthy communities are more economically and politically stable, and that community health is not just an individual business but also the government’s business.

You seem to feel that improving the well-being of insurance companies will make them want to compete for plans with big carve-outs for certain kinds of care — like maternity care, and that this will improve the well-being of our citizens. One of the biggest problems is the fact that insurance companies, as businesses — even the nonprofit ones — are in the business to minimize their own “costs” and maximize profits. 

Doctors and hospitals are in a chronic “war” with these companies to provide and be reimbursed for healthcare service. The dysfunctional system drives up costs for everybody — the doctors must spend time and hire staff to negotiate plans and get pre-authorization; patients have to spend valuable time on the other side, trying to get the insurance to pay. It is an exhausting process that causes burn-out for doctors, who then leave the workforce early. All this does not improve service to patients. 

A good, concise article on this subject was recently published in JAMA: “Where does the health insurance premium dollar go?” (available at

I believe that our Congress and Senate can do better. Healthcare costs have been problematic well before Obamacare and will continue to be if we allow insurance companies to call the shots in an effort to “lure” them back to the individual market. Reducing health assistance to low income people and the disabled while cutting taxes for the wealthy is short-sighted and mean spirited.

The Hippocratic Oath requires doctors to “do no harm ...” The House and Senate bills would do significant harm. 

Please reconsider and put the health of Wyomingites first.


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