'Putting Patients Above Politics': Tennessee Hospitalist Running for House Seat

Dr. Dawn Barlow, the current director of hospital medicine at Livingston Regional Hospital, is seeking to represent Tennessee's sixth congressional district.

Healthcare is the main platform Dr. Dawn Barlow is running on to represent Tennessee's sixth congressional district.

As director of hospital medicine at Livingston Regional Hospital, a rural facility in central Tennessee, Barlow said her experience with treating patients who struggle to afford necessary care has inspired her candidacy.

In an interview with HealthLeaders, Barlow discussed how Congress should implement healthcare fixes that will benefit American consumers, what aspects of the Affordable Care Act should be preserved, and how her time spent as a hospitalist gives her perspective on the current discussions regarding health policy.

The following transcript has been lightly edited.

HL: What are changes you would like to see in healthcare policy to make healthcare better for Americans across this country?

Barlow: I believe that we have to preserve the 10 essential benefits of the ACA. In Tennessee, we have companies that are selling non ACA-compliant plans. That means that they're able to deny people coverage simply because they're too sick or because they're older. In Tennessee, we have not expanded Medicaid, which is a state issue that I'm hopeful our next governor and state legislature will remedy. And then I believe that we have to go further and work toward a single-payer system.

I believe that we need to look at all of our options and think about what are the long-term outcomes and what our legislation is going to do. I would support Medicare-for-all, and I believe that we need to get a little bit more detailed into that. We need people in healthcare writing legislation so that we understand how it affects the patient, the nursing staff, and the primary care doctors in rural America.

HL: Would you be in favor of bringing back the individual mandate that got stripped away in the tax bill last year?

Barlow: No, not really. The problem with the ACA is that a lot of people were priced out of the market. Since we didn't expand state Medicaid, we have a lot of working families who are priced out of the healthcare market, and those people are already living paycheck to paycheck.

I think it's going to hurt the working poor. I believe that people who can afford to pay for their health insurance and healthcare need to contribute. My concern with the individual mandate is it's going to hit too many working family that just cannot afford it.

HL: If you were elected to Congress, how do you think you can influence the conversation at the federal level to help hospitals pursue the push for value-based care?

Barlow: I believe that we need to be doing everything that we can to make sure that we have legislation that supports patient-centered, evidence-based care that is effective and efficient. That's our goal as a hospital, and that's my goal on a daily basis. That's what I'm going to be looking at when [reviewing] or writing legislation—that's what I'll be focused on. Is it patient-centered, cost-conscious, effective, and efficient? And is it evidence-based; that's the way I think as a hospitalist on a day-to-day basis. I'm taking that thinking to Washington, D.C.

HL: Do you think that the Trump administration's drug pricing measures have been effective so far? And do you have any ideas or recommendations for HHS?

Barlow: The first thing is Medicare needs to directly negotiate with the pharmaceutical industry. I believe that the pharmaceutical industry has spent so much money directly marketing to the patient, so we need to stem that in some way. They're also marketing to the physicians. I mean, how many ACE inhibitors do we have, and how many statins? We're taking old drugs, tweaking them a little bit, and then marketing them as new and novel medications when they're really not. At the same time, we have problems, at times, getting basic medications at our hospital.

There are shortages all the time of basic medication and drugs that we do need like antibiotics to treat multidrug resistant organisms. The pharmaceutical industry doesn't have enough of an incentive to start making these drugs because that's not a drug we're going to use on a frequent basis. We need to give the pharmaceutical industry some incentives to make the drugs that we need, to be on the cutting edge of healthcare and stop doing all the things that are just lining their pockets. I'll be honest with you, I'm not a fan of the insurance industry. I'm not a fan of the pharmaceutical industry. I believe they have taken advantage of us for way too long, and we're going to start putting our patients and their needs above those of the pharmaceutical industry.

HL: What is your response to people that say Medicare For All is a practical option?

Barlow: I want to look at the numbers. I looked at the Medicare-For-All bill, and I see where there is concern. That's why I think [Congress needs] to sit down together and come up with a plan. We need to look at what it's going to cost us. I'm OK with a hybrid system as well. I'm not going to shoot down something that is good, that gives the vast majority of Americans coverage.

If we can come to a consensus that covers most Americans, I'm good. If we can get to a Medicare-For-All or hybrid system, where we still have catastrophic health insurance for every man, woman, and child in America, but still have room for a private insurance industry to cover other things. I'm OK with that as well. We just have to work on getting people the care they need at a cost they can afford, and however we do that, I'm OK with it. We're have to start putting our people above politics.

And I'll say this: Everybody says, 'How are you going to afford it?' but if we stop subsidizing the insurance industry, which is what we're doing with ACA now, that's going to contribute a lot to paying for this outright. And if we start preventing illnesses, that's also going to help with the cost.

HL: What should hospital executives and health system leaders take away from your candidacy?

Barlow: In Tennessee, we have hospitals closing and we have patients suffering. The reason our hospitals are closing and the reason our patients are suffering is because of the people that we have in state office, the governor's office, the House of Representatives, the Senate, and in the White House. I would recommend [that] the people who care about healthcare [should] start getting behind candidates who understand healthcare.

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.