JamesLHollyMD.com

	James L. Holly, M.D.

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Letters - Letter to Senator Ted Cruz May 20, 2015

May 20, 2015

Senator Ted Cruz:

Last night, my wife, Carolyn, and I attended your meeting in Beaumont, Texas. In my seventy-one years plus, this was the fourth political meeting I have attended. The first was a political rally for Senator Hubert Humphrey in Waco, Texas in 1966. (See below) At the conclusion of your meeting, Carolyn and I contributed to your campaign the maximum allowed by Federal regulation. We did not do this because we think you will win the Republican Presidential nomination or that you will be elected President. We did not do this because we desire or expect to receive any consideration for an idea or project we are supporting. We did not do this because we are endorsing your candidacy, although I can vote for you. That is not an idle comment because I have never failed to go to the polls but upon occasion there was no candidate for president that I could or would vote for.

Dershowitz and Cruz

We did give your campaign the legal limit of financial support because we are endorsing your character, your ideas and your life-story. We did it because we do expect the favor of you personally reading this note. I will ask your staff to forward it to you. I awoke at 2 AM this morning thinking about your presentation and the future. I agree we are at a pivotal time in the history of our country. Finally, at 3:00 AM I dressed and came to my office to think through this note. I hope it is helpful to you.

While we do not worship at the altar of the Assyrian and Babylonian god, Nebo, who was the god of “wisdom and writing - education,” we do appreciate Alan Dershowitz’ affirmation of your God-given intellectual gifts. In a series of reminisces about former students, Harvard Professor Alan Dershowitz said of you: “U.S. Sen. Ted Cruz (R., Texas): ‘Off-the-charts brilliant. And you know, liberals make the terrible mistake, including some of my friends and colleagues, of thinking that all conservatives are dumb. And I think one of the reasons that conservatives have been beating liberals in the courts and in public debates is because we underestimate them. Never underestimate Ted Cruz. He is off-the-chart brilliantâ€¦’” http://www.philly.com/philly/columnists/20140406_The_Pulse__Dershowitz_and_his_life_at_Harvard_Law.html It is our prayer and hope that you will continue to use these enormous gifts as you already have for the good of your fellow man.

The following two quotations give context to what I wish to say about your campaign. First, Goethe said, “Knowing is not enough; we must apply. Willing is not enough; we must do.” (Johann Wolfgang von Goethe) The Institute of Medicine used this quote in admonishing healthcare providers that it is not enough simply to know what is right; we must do what is right.

The Moral Test

My admiration for Senator Hubert Humphrey - I voted for him for President - stems from his address to the 1948 Democratic National Convention where he courageously addressed civil rights before it was politically correct. The response to his address was that the Dixicrats walked out of the Convention in opposition to civil and human rights for African Americans. In 1977, Senator Humphrey enunciated what has come to be called the “moral test of a government” and which now adorns the lobby of the Health and Human Services building in Washington, D.C. He said, ““The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.” (Hubert Humphrey Source/Notes: Remarks at the dedication of the Hubert H. Humphrey Building, November 1, 1977, Congressional Record, November 4, 1977, vol 123, p. 37287.) I ascribe to this test.

It is in the context of the above that I offer the following observations. And, my observations are offered in the context of what I know best which is healthcare delivery and policy. You may not remember but I asked you the question, “How can we prevent the republican nomination process from resulting in the election of the democrat nominee.” The context of this questions is that if twelve good men and women tear each other apart out of personal political ambition, it may result in the democrat nominee winning the election. The other dilemma you face and one which you know you face is that in winning the Republican nomination, you may position yourself such that it is not possible for you to win the general election and the presidency. Remember, it is possible to be true to your principles and to make your tent large enough to include people who don’t agree with everything you say but they welcome your forthrightness, your character and your willingness to listen to those who disagree with you without ridiculing them.

I appreciate and admire that you believe that “telling the truth as you see it” is the way to political success, but I remind you that you are not running to be the president of republicans but you are running to be the president of the republic. Let me explain. I am not a politician because I cannot compromise. That is not said arrogantly as compromise is the “coin of the realm in a democratic republic” and my inability to compromise disqualifies me from running for office. For instance, I have deeply held, religiously-based beliefs. I often describe myself as a social liberal, a fiscal conservative and a theological fundamentalist. This means that I think everyone has the right to live as they personally chose and that even if I have the electoral power, I do not have the right to impose my views upon others, as they do not have the right to demand that I affirm things with which I disagree. I have the responsibility to support a society in which each person can chose their own way and that society has the responsibility to respect my beliefs when peacefully, respectfully and compassionately practiced.

Personal Belief and Public Policy

Illustrative of this is that I believe that homosexuality violates my personal religious beliefs. But, I have publicly opposed prejudice and violence against homosexuals. Once a friend came to me and told me that he is a homosexual. I already knew that and I told my friend, I love you and I receive you - this word means “to make room in your heart for someone.” I affirmed my personal belief about homosexuality. I told my friend, “My responsibility is to receive you as you are; your responsibility is to receive me as I am. If it comes to a confrontation, I will publicly support you, but if you or others demand that I affirm or endorse your life-style, I will not.”

At your event last night, I applauded at all the appropriate points consistent with everything I have said above. For anyone that was not there, I add that you did not address the issue of same-sex marriage or homosexuality. However, there is one issue you raised at which point I did not applaud, which was your comments about “Obama Care,” the somewhat derisive manner in which many refer to the “Patient Protection and Affordable Care Act.” (ACA) I did not applaud because, while there are elements of the ACA with which I disagree, your principle description of the Act was that you do not want the government to get between the doctor and the patient.

The Republican Alternative to the ACA

To my knowledge and I have read the entire behemoth, there is nothing in the ACA which interferes with the patient/provider relationship. Before you say, what about “You can keep your doctor, if you want to,” I agree that was a deception. However, for at least the last fifty years and in some cases for over 100 years, patients have accepted the requirement to chose a doctor who is in their health plan or who is in their clinic. Consistent with what I say, once the patient/doctor relationship is established in the context of this financial arrangement, only the doctor and patient decide on the care. If a health-plan contract limits care or excludes a particular treatment, it does not dictate what care is to be given but only what care the health plan will pay for. Furthermore, your comments and those of other Republican candidates are symptomatic of the recurring deficiency of Republican politicians: they are keen to tell you what is wrong and with what they disagree but there is little discussion of what they are for. The ACA was passed in March, 2010 and other than the House of Representatives voting 54 times to overturn the ACA, I have not seen one bill or proposal from the Republicans to replace the ACA with a comprehensive, workable alternative. While opposing “Obama Care” will get great applause from Republicans, it does nothing to tell us what Republicans would do if they control the White House and both chambers of the Congress.

Senator Cruz, I came away from your session appreciating you greatly. I liked the idea of the simplification of the tax code, but the dirty, little secret is that you and I know that it will not happen, not because of the evil democrats but because there is no grit among Republicans to do it. We’re not going to get rid of the Department of Education for the same reason. I also came away knowing that you are against the ACA but having no idea what you are for. If I were you - and you and America are glad that I am not - I would never mention Hillary Clinton again. I would never mention the ACA again. I would loudly, clearly, simply declare what my healthcare transformation will look like. Re-read Goethe’s and Humphrey’s statements; see their application. And, if your first step is to remove the ACA, your simultaneous, second step should be to vote in your health plan which is simultaneously presented to the Congress.

Tell us what you’re for, not in generalizations and particularly not in opposing Democrats, but what you propose, what you will do and what you have put into the pubic arena for discussion. A comedian once said, “Tell me something you believe in; I’ve got enough doubts of my own.” Imagine, if rather than your audience last night having walked away knowing that you’re against the ACA, they had walked away knowing that you are for:

Healthcare for children, the poor and the elderly
Healthcare transformation which comes from the internalized passions and ideals of healthcare providers which passions and ideals are guided by evidenced-based literature rather than healthcare reform which is based on rules, regulations, and requirements which come from external pressure applied by government oversight.
Healthcare which promotes quality and safety in care.
Electronic patient management rather than simply electronic patient records
Etc.

If you are going to attract independents, Reagan Democrats and to energize Republicans, it will have to be done with content and ideas. This will not be done with what you are against but with the substance of what you are for.

I have added below my signature, links to my thoughts on pubic healthcare policy and healthcare transformation. If it should be valuable to your campaign I would be happy, at my expense, to dialogue with your staff and advisors about a healthcare policy which could attract the vision and passion of the nation. It would never mention the ACA.

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family& Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

PS: For the past 17 years, I have written a weekly newspaper column on health affairs. All of those articles can be found at www.jameslhollymd.com. In addition there are over 250 articles written about SETMA which are posted under Your Life Your Health. Below are the links to articles about public health policy which you may find interesting. The following link gives you an introduction to SETMA

The following link gives some information about SETMA: http://jameslhollymd.com/in-the-news/vital-signs-examiner-publication

SETMA is the only practice in America which possess all of the following:

SETMA’s Recognitions and Accreditations

NCQA - PC-MH Tier III	2010-2016
NCQA -- Diabetes Recognition	2010-2016
NCQA -- Heart And Stroke Recognition	2010-2016
NCQA -- Distinction in Patient Experience Reporting	2014-2015
AAAHC -- PC-MH	2010-2017
AAAHC -- Ambulatory Care	2010-2017
URAC -- PC-MH Advance Certification with EMR	2014-2017
The Joint Commission -- PC-MH	2014-2017
The Joint Commission -- Ambulatory Care	2014-2017
The Joint Commission -- Clinical Laboratory Services	2014-2016
Texas Medical Foundation, CMS’ Texas QIO -- The Texas Practice Quality Improvement Award	2012-2014

Public Policy and Healthcare Transformation links:

Your Life Your Health - Healthcare Reform: Public Policy

Abraham Lincoln and Modern Healthcare - 02/15/2013
An Analysis and Response to President Obama's Health Care Reform Address to the American Medical Association: Part I - 06/18/2009
An Analysis and Response to President Obama's Health Care Reform Address to the American Medical Association: Part II - 06/25/2009
An Analysis and Response to President Obama's Health Care Reform Address to the American Medical Association: Part III - 07/02/2009
An Analysis and Response to President Obama's Health Care Reform Address to the American Medical Association: Part IV - My Healthcare Reform - 07/09/2009
Can More Care Provide Less Health? - 05/14/2009
County Health Rankings - Part I - Jefferson County’s Results and what it means - 02/26/2010
County Health Rankings - Part II - Quality of Care - What Will Be Gained by Public Reporting - 03/04/2010
Entrepreneurism versus Professionalism Part II: Republicans and Democrats Both Have it Wrong - 04/22/2010
Entrepreneurship vs Professionalism Part I: Drivers of Healthcare Cost - 04/15/2010
Framing the Discussion of How to Solve the Nation's Health Care Problems - 11/29/2007
Health Care Reform: What is in the bill? - 04/01/2010
Healthcare Change - Foundational Ideas - 11/12/2009
Healthcare Change and the Uninsured - Part I: Hope, Value, Virtue - 08/16/2012
Healthcare Policy and Hope - 06/21/2007
Healthcare Policy and Hope Part II - 06/28/2007
Healthcare Policy Issues Part II - Reality, Responsibility and Rights - 08/13/2009
Healthcare Policy Issues Part III - Reforming or Transforming Healthcare - 08/20/2009
Healthcare Policy Myths - 03/19/2010
Healthcare Reform: What Must Be Involved? - 02/04/2010
Healthcare Reform: What Must Be Involved? Part II -- Honesty - 02/11/2010
Healthcare Reform: What Must Be Involved? Part III - Hard Choices; Personal Choice - 02/18/2010
Pursuing Excellence in Healthcare Delivery:Personal Mastery and Electronic Medical Records as Tools of Excellence - 01/08/2009
Quality of Care and Healthcare Reform - 06/10/2010
Rationing Health Care vs. Rational Healthcare - 08/06/2009
Response to Week at Harvard Kennedy School of Government: Shaping Healthcare Delivery Policy - 02/09/2013
The Implications of the Presidential Election for Healthcare Policy - 11/15/2012
Your Healthcare Found in Your Caring for Others - 09/11/2008

Your Life Your Health - Medical Records

A Health IT Academy at Texas A&M - 07/03/2014
A New Day in Healthcare for You and for Us - Part V - Certified Electronic Health Records (EHRs) - 08/26/2010
A New Day in Healthcare for You and For Us - Part VI - Meaningful Use - 09/23/2010
A Review of 2010 and a Projection for 2011 - 12/30/2010
A Texas A&M Health IT Academy Part 2 of 5 - 07/10/2014
Abraham Lincoln and Modern Healthcare - 02/15/2013
Address to the Beaumont Chamber of Commerce August 2000 Part I - 01/06/2011
Address to the Beaumont Chamber of Commerce August 2000 Part II - 01/13/2011
Case Study: Laboratory Information Systems on ADVANCE for Administrators of the Laboratory - 10/01/2011
Designing an EMR Guided by The Fifth Discipline by Peter Senge, PhD - 01/27/2007
Don't Load Both Barrels - The Story of SETMA's Implementation of NextGen EMR and EPM - 12/08/2005
Electronic Health Records (EHR) and Quality Improvement: If You Make a Change will it Make a Difference? - 02/03/2011
Healthcare and Numbers: Making the Switch to ICD-10 - 09/25/2014
Healthcare Quality Award 2012 Part I - Priorities for Performance Improvement - 12/01/2011
Healthcare Quality Award 2012 Part II - Dashboard to Measure and Manage Whole System Performance - 12/08/2011
Healthcare Quality Award 2012 Part IV - Data-Driven Improvement in the National Quality Strategy Priority Goal Areas - 12/23/2011
Healthcare: Metanoia -- A Shift of Mind - 02/06/2003
Healthcare: EMR only distantly related to 'real' electronic patient management - 02/20/2003
Healthcare: Improving Health -- Overcoming Organizational Learning Disabilities - 02/13/2003
Is Your SETMA Medical Record Secure?: Part I - 09/27/2012
Is Your SETMA Medical Record Secure?: Part II - 10/04/2012
Managed Care and Electronic Patient Records - 05/11/2000
March 30, 1998 - March 30, 2012: SETMA's Journey Toward Electronic Health Records - 03/29/2012
Medical Records: Beyond Electronic Medical Records - 06/01/2003
Medical Records: Evolving into Electronic Patient Management - 06/13/2003
Medical Records: Is it Secure? - 01/24/2001
Medical Records: What Should it Contain? - 01/18/2001
More Than a Transcription Service: Revolutionizing the Practice of Medicine: And Meeting the Challenge of Managed Care With Electronic Medical Records (EMR) which Evolves into Electronic Patient Management - 05/01/1999
Patient-Centered Medical Home and Care Transitions: Part I - 04/21/2011
Patient-Centered Medical Home: The Power of Data in Designing the future of healthcare - 05/20/2010
Pilgrimage to a Patient-Centered Medical Home - 02/17/2011
Principles of Change Agents: If you are going to make a change, it had better make a difference - 08/09/2012
Pursuing Excellence in Healthcare Delivery:Personal Mastery and Electronic Medical Records as Tools of Excellence - 01/08/2009
SETMA -- HIMSS Stories of Success:Part I -- Improving Population Healthcare and Safety Through Real-time Data access, Auditing and Reporting - 02/24/2011
SETMA and Meaningful Use: Outline of SETMA's Deployment Part II - 08/21/2014
SETMA HIMSS Stories of Success: Part II -- Improving Population Healthcare and Safety Through Real-time Data access, Auditing and Reporting - 03/04/2011
SETMA’s Response to the Robert Wood Johnson Foundation: Part III The Primary Care Team Learning from Effective Ambulatory Practices - 06/14/2012
Texas A&M Health IT Academy Part 3 of 5 - 07/17/2014
Texas A&M Health IT Academy Part 4 of 5 - 07/24/2014
Texas A&M Health IT Academy Part 5 of 5 - 07/31/2014
The Place of Patient-Centered Medical Home in the Future of Healthcare Delivery - 07/23/2009
The Titanic: Technology, Temerity and Tradition - What Healthcare Can Learn From the Titanic

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

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