In his keynote address at the annual meeting of the Large Urology Group Practice Association (LUGPA) in Chicago, Illinois, former Florida governor and 2016 presidential candidate Jeb Bush opened by discussing his family, including how his brother, former President George W Bush, took up painting in his retirement and his granddaughter’s multiethnic heritage. He said that she is an example of the diversity that makes America a great nation, and commented that the divisiveness currently on display in Washington, DC, must be tempered with civility. Following the speech, Deepak Kapoor, MD, and Gary Kirsh, MD, moderated a question-and-answer session with LUGPA members that probed these political questions as well as ones closer to attendees’ hearts.

Bush responded to a question about consolidation of hospital companies and insurance companies by saying the end result is higher prices and less innovation. “It’s just how markets work,” he said. But despite Washington gridlock, he said any effort that focuses on protecting the sole practitioner, even if it is done at the expense of monopolies, should have bipartisan support.

Asked about “the literacy crisis,” Bush said that the problem is that kids who are born in poverty are not exposed to the same vocabulary as children of means. “Lots of gaps start at the earliest age,” he said. Fixing the problem would require an expansion of early childhood literacy, and ending social promotion after the third grade, he said, adding that “family literacy ought to have a higher value in our communities as well.” 

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Noting that during his speech, the message of unification resonated, Dr Kapoor asked Bush what a strategy to reform DC and break the gridlock could look like. Bush said structural changes are needed. “Maybe a system that creates more purple districts” could force politicians to work with people who don’t look like their voting base, he said. But he added that bipartisan friendships are also important, noting that while his father was in Congress, he was famously close with Mississippi Democrat Sonny Montgomery. “The friendship was not as partisan” in Congress back then, he said.

Asked if former New York mayor Michael Bloomberg, who recently announced he would seek the Democratic Party’s presidential nomination, is a viable candidate, Bush said Bloomberg is an “extraordinary” person. “He’s incredibly successful, very generous, very practical, and if you could just designate a president, you would pick someone like that,” he said. “He’s an incredible guy,” but added that he doesn’t think competency and success are enough to be “a winning strategy in a hyperpartisan Democratic primary.”

Asked about sweeping proposals such as Medicare For All, which Democratic candidates Elizabeth Warren and Bernie Sanders have championed, Bush said they are “idiotic.” Radical initiatives such as Medicare for All, the Green New Deal, and student loan forgiveness are irresponsible because they allow Trump to make a case that the Democrats are “scary,” Bush said. 

Dr Kirsh said that many in attendance do not relish the idea of Medicare payment rates being widely adopted by hospitals, and expressed concerns that House Speaker Nancy Pelosi’s push for drug pricing reform — a proposal he called “Stalinist” — would have dire consequences. He asked Bush who in the GOP “represents thought leaders for an alternative to Medicare for All and the Speaker’s frankly preposterous bill?” Bush said he didn’t know of any. “There are 100 ideas Republicans have on health care, [but] there’s not one comprehensive approach, which is a shame,” he said. He added that he would prefer to give control to states rather than have federal mandates for items such as preexisting conditions or insurance requirements.

Asked if he intended to run for office again, Bush demurred.