Why Are the Doctors in Congress So Terrible?

Sen. Rand Paul speaks about Obamacare repeal and
replacement in March 2017. Mark Wilson/Getty Images

In September of last year, American Medical Association CEO
James Madara wrote a
letter
to Mitch McConnell and Chuck Schumer, urging them to
abandon the efforts to repeal the Affordable Care Act. It

wasn’t
his
first
such letter.

The Republicans’ latest attempt at repeal—this time it was the

Graham-Cassidy Amendment
—“violates the precept of ‘first
do no harm,’” Madara wrote, because it would kick millions of
people off their insurance and decrease access to healthcare.
Of course, that precept, with origins in the Hippocratic oath,
doesn’t apply to McConnell and Schumer. It theoretically does,
however, apply to one of the authors of that amendment, Dr.
Bill Cassidy, a senator from Louisiana, along with the other
handful of physicians currently serving in the United States
Congress. Most of them didn’t care about Madara’s warning.

At the moment there are 14 doctors on Capitol Hill (and a few
dentists). Twelve of those are Republicans. All of them are
men. The only two who are not white are the only two Democrats.
On the Republican side, these healers have taken positions and
supported policies that, by any reasonable measure, do absurd
amounts of harm. The makeup of this group of physicians does
not remotely reflect the demographics of America’s doctors (of
which
about one third are women
, and
fewer than half identify as white
), and their voting record
is sharply at odds with the collective views of their
colleagues outside of Congress.

Once you start thinking about this dynamic, you can see it
everywhere. Witness Kentucky senator Dr. Rand Paul throw out
some
anti-vaccine nonsense
(not to mention
anti-basic scientific research nonsense
), and Dr. Andy
Harris, a representative from Maryland,
stump for pro-gun bills
, and the whole host of them support
the ObamaCare repeals in spite of ample evidence of the danger,
and wonder: How did we get here? What is it that drives more
conservative than liberal doctors toward elected office? And
how do we explain, once they have arrived, an apparent disdain
for the principles baked into their training?


Howard Rosenthal, a professor of politics at NYU who has
studied the political polarization of doctors, thinks the
answer to why doctors are usually conservative lies in the
types of doctors these men are. “If you look at
Congress, I think you’ll find that these Republican members all
come from higher-paying specialties,” he said.

There are exceptions, of course: Louisiana congressman Ralph
Abraham was a family physician, as was Tennessee congressman
Scott DesJarlais. The two Democrats, Ami Bera and Raul Ruiz,
both of California, are respectively a general practitioner,
which sits at the bottom of the pay scale, and an emergency
medicine specialist, which earns a middling salary.

But mostly Rosenthal is right: Senator John Barrasso of Wyoming
was an orthopedic surgeon, and Indiana congressman Larry
Bucshon a thoracic surgeon. Florida congressman Neal Dunn was
trained as a urologist, Harris as an anesthesiologist, and
Cassidy as a gastroenterologist. Those are consistently among
the
highest paid specialties
.

Nothing motivates political
awakenings like a threat to one’s wallet.

The earning power of these doctors is relevant for a few
reasons. First of all, an orthopedic surgeon who has been
making close to $500,000 a year for a while likely has the
resources to set aside his practice in order to run for office.
A pediatrician making far less than half that amount may not.
The doctors pulling in all that cash might also be more
inclined to maintain the status quo—a status quo threatened by
the left’s halting dubstep dance in the general direction of
universal coverage.

Those specialists “may be particularly threatened
professionally by healthcare reform in terms of salary
limitations,” said Matthew Goldenberg, a psychiatrist at Yale
who has also done research on the space where politics and
medicine cross. “Primary care physicians get paid less in the
current system than specialists, and it may be that if we were
to move toward a more nationalized health system, that
subspecialists’ income potential might be under some threat.”
Nothing motivates political awakenings like a threat to one’s
wallet, and there is
ample evidence
that richer people tend to lean more
conservative in general.

Rosenthal also suggested the surgeon-legislator pipeline might
be driven by late-life crises: The skills they need tend to
atrophy at a younger age than in other specialties. “You’re
feeling, well, your hands aren’t so good for cutting people up
anymore,” Rosenthal said. “Let’s try a different career path.”

If all that’s true, then it would follow that we might get more
Republican than Democrat doctor-legislators.
Research
from Goldenberg and Tufts political science
professor Eitan Hersh has found that about two-thirds of
surgeons out in the non-Congressional wild are Republicans,
while more than three-quarters of psychiatrists and infectious
disease doctors are Democrats. There is a spectrum covering the
rest of the specialties, with anesthesia, urology, and
ophthalmology (Rand Paul!) leaning red, and pediatrics,
geriatrics, and endocrinology leaning blue. But importantly,
the handful of MDs we have governing the country don’t remotely
reflect the overall breakdown: Goldenberg and Hersh found that
54 percent of doctors overall are Democrats—and that was in the
pre-Trump era.

Once these doctors make it to Congress and start to actually
legislate, maybe the best explanation for their seemingly
hypocritical agendas is partisanship: Nearly every remotely
controversial vote happens along party lines at this point, so
if you arrived a Republican, you’re probably going to vote like
one. Still, it is hard to see how someone goes from taking care
of patients on a daily basis to kicking millions of them off
their insurance.

“I was worried that we were
taking the wrong path toward single payer, which I think is not a
system that will work.”

In April of last year, the House narrowly voted for its own
Obamacare repeal attempt.
The vote had 20 Republican defectors
—not one of those
doctors among them.

I asked all the doctors in Congress to speak with me for this
story, and one agreed: Andy Harris, the Republican congressman
from Maryland. He cited the ACA and government meddling in
healthcare as among the motivating factors for running for
Congress (he was first elected in 2010, after serving in the
Maryland state legislature since 1998). “Part of the problem
with the ACA, I thought, was that it of course had an expansion
of Medicaid,” Harris told me. “And having taken care of many
Medicaid patients in my practice, and heard the stories about
the difficulties that patients on Medicaid had in obtaining
care and sometimes the quality of the care, I was worried that
we were taking the wrong path, honestly, toward a single payer,
which I think is not a system that will work.”

Harris’ feelings on Medicaid and single payer aren’t exactly
universal, even among conservatives.
Recent polling
found
more than half
of the U.S. is in favor of a single payer
system, and other countries including the United Kingdom,
Sweden, and others manage with it just fine—in fact,
you’ll live longer
in those countries than in the U.S., and
you are
far less likely to die in childbirth
. Meanwhile,
three-quarters of this country (and 61 percent of Republicans),

according to polling
, holds favorable views of Medicaid.

Harris said he disagreed with the AMA’s CEO on the violation of
“first do no harm,” instead arguing that the ACA itself was
harming people. He also noted that the AMA represents a “small
minority” of all physicians. Depending on your definitions,

he’s not wrong
: It has more 200,000 members, but some are
students, and there are nearly a million doctors in the
country. Still, the nonpartisan Congressional Budget Office
found that the ACA repeal bill that all those doctors voted for

would leave 14 million more people uninsured
the very next
year, and 23 million by 2026.

He also claimed that “many medical societies” were in favor of
the ACA repeal attempts. I asked him if he could name any of
those, off the top of his head. A short pause. “No,” he said.
“I just know, there are many of them that did not take the same
position the AMA did.”

I have not done a full survey of every medical professional
society in the country, but back in September,
others put together
 long
lists of such societies
that did not, in fact, agree with
Andy Harris. The American Society of Anesthesiologists,
representing Harris’s specialty, took no hard position, but
released
a set of provisions
it said “must be included” in any
reform effort. Among these were continued coverage for
preexisting conditions, and the preservation of current levels
of insurance coverage. A
survey of doctors
across specialties in early 2017 found
that only 15 percent wanted a full ACA repeal; 32 percent of
Republicans, and a robust zero percent of Democrats, were in
favor.

Of course, doctors in Congress don’t just weigh in on
healthcare reform. These healers have
supported
extreme anti-gun control measures that
research shows
 could
increase violent crime
. They stump for ever-increasing
abortion restrictions, and though
Republicans have long argued
that abortions themselves are
the serious threat to women, reproductive rights advocates
argue it’s actually the restrictions
doing harm
in a
variety of ways
. They vote in and support the Scott Pruitts
of the world, now engaged in a day-and-night blitzkrieg aimed
at dismantling every bit of environmental public health
protection the country has built up over the last 50 years.


But maybe this isn’t that complicated: Pick any profession, and
you’ll be able to find a variety of opinions, political and
otherwise. Fourteen doctors is a small sample size. It just
feels, on some level, like doctors should know better.
Harris said as much, explaining that the training physicians
undergo makes them well-suited for work in the legislature.

“We are trained to actually gather information, assimilate
information, and make a decision,” he said. Caring for a
patient requires keeping up with the latest research,
incorporating all available data, making a diagnosis and
selecting the best possible treatment. “When you’re looking at
the legislature, or policies, that’s our training: our training
is to gather all the information and make the best decisions,
so in that way it can come naturally to you,” he said.

This is all dark and unsettling, but perhaps it is an artifact
of what is already a past era, when some small subset of
doctors were annoyed with government meddling. There is a
chance that a shift is happening: More doctors are running for
office now, likely with very different views of healthcare,
among other issues. A number of physicians have launched
Congressional campaigns, including
eight women supported
by a group called
Physician Women for Democratic Principles
. Other groups,
like
314 Action
, are supporting candidates with scientific and
medical backgrounds. The AMA’s own political action committee
is holding its latest version of a
candidate workshop
in early March.

So there is a chance that the next Congress’s collection of
doctors might better reflect their profession—in demographics,
and in empathy.

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