Dear Mister President

President Obama,

Let me start out by saying congratulations on winning a second term. I voted for you both times because of your promise kept on trying to reform the debacle that is the US health care system. It wasn't everything I had hoped it could be, but you did something that many presidents had tried and failed to do, so kudos. Thank you for being so dedicated to making real strides in universal access to care. It's super important.

I'm writing to you to say how disappointed I am. The law does not go far enough. It does not set up a system by which we can buy into the federal health care system. It does not offer adequate improvement to Medicaid, and does too much for Medicare recipients. I'm sure I'm one of the few that would say that, but there are many Medicare recipients who can receive, frankly, way too much care. Care that they don't need. My friends on Medicaid, however, can't access the medications they desperately need that their doctors have prescribed. Breathing medications, medications for GI problems. It is ridiculous that disabled people who are often in most need of competent care are the least likely to be able to access it. That's a huge problem.

Also, this does not solve the issue of qualified medical professionals. Why is there a primary care shortage in this country? I think it's tied to the lack of medical schools, the need for tort reform, and the expense of medical education. Often, the poorest medical students go into the primary care field because they have experienced the real need first hand, but perhaps more middle class students would go that way if it felt in some way manageable. These doctors experience huge demands and little reward for their time. There's no real "doctor paycheck" for them. They work long hours in hopes of being reimbursed a pittance for what they've done. That's why the specialty fields are so packed. You get to have banker's hours, with interesting patients that don't call you at all hours. How nice!

When patients can't get in to see their primary doctors, they rely on urgent care and emergency rooms. Is that really the system we want to build? See your primary doctor for your yearly physical, but when you actually get sick, go see a stranger doctor that has no idea what your history is like. One that does not know you. I understand the purpose of urgent care and the need for emergency medicine, but I think the ER doctors I've met would rather treat real emergencies, rather than patients who waited too long to see their family doctors when they had pneumonia... because they couldn't get an appointment. Ridiculous.

I know you can't fix all of these things, but I would like to see some additions to the ACA that could touch on at least a few of them. Or start making movements in those directions. I know you've got other things to focus on, and I know getting Congress to do anything is impossible, but I really wish we could do something about all these things together.

All the Best,

LRM