Elections 2010: Physicians on the ballot
■ An Iowa ophthalmologist and a Pennsylvania internist epitomize the health reform choices offered by the two major parties.
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More Americans -- and physicians -- are running for Congress this year than in any other election in recent decades.
At least 47 physicians filed the paperwork necessary to run for a congressional seat, according to AMPAC, the American Medical Association's nonpartisan political action committee. In addition, 15 physicians are running for re-election to Congress, increasing the prospect for more doctors to take House and Senate seats in the November midterm elections. However, some physician candidates were defeated in primary elections, and others still face late primaries.
Two of the new physician candidates who will be on the November ballot -- Democrat Manan Trivedi, MD, of Pennsylvania and Republican Mariannette Miller-Meeks, MD, of Iowa -- share some common ground. Both served in the military, both like and dislike parts of the national health reform law enacted in March, and both are concerned about the ever-increasing cost of health care. Dr. Miller-Meeks received the maximum contribution from AMPAC for her successful primary bid.
But the two candidates also represent the fundamental differences their parties have on the national health reform law.
Dr. Trivedi is an internist who advised President Obama on health care during the 2008 presidential campaign. While he says the new health reform law has flaws, he cheers the fact that estimates project it will cover tens of millions of uninsured people.
Dr. Miller-Meeks is an ophthalmologist who began her medical career as a nurse. She sees the steady expansion of government-sponsored health care as a threat to people's choices of health care and health insurance.
In the next two years, the reform law will hit key implementation milestones as it keeps facing threats from opponents. Both physician candidates hope to be in the House to help influence the outcome of that struggle.
From patient to physician
Dr. Miller-Meeks learned the value of good health care at an early age.
When she was 15 and her family lived in Dayton, Ohio, a large snowfall canceled school. Her younger brother missed lunch because he was out playing in the snow, so he tried cooking bacon in a skillet, starting a fire that left her with second- and third-degree burns.
A physical therapist helped her recover. The care she received left a deep impression, so she decided to try to help others in the same way.
As the fourth child of a military family of eight, Dr. Miller-Meeks said she didn't think she could afford medical school. She left home at 16 to get a nursing degree, with assistance from a military program. She followed her father's footsteps into the military and became an Army nurse at 20. Six years later, she entered medical school, eventually specializing in ophthalmology because it offered the challenge of surgery but allowed time to raise a family. She became the first woman president of the Iowa Medical Society in 2006.
Dr. Miller-Meeks said she is running for Congress for a second time to preserve the best parts of medicine and to make the health system more consumer-friendly. She faces Rep. Dave Loebsack (D, Iowa), who defeated her in 2008, 57% to 39%.
Much of the health reform law is moving the system in the wrong direction, Dr. Miller-Meeks said. She warned that insulating patients from the true cost of health care -- by reducing cost-sharing, for instance -- will increase utilization and drive up premiums.
She also opposes requiring individuals to obtain a minimum level of insurance, as the reform law will starting in 2014. Many people need only catastrophic coverage, she said.
"For people to say a marketplace will not work in health care, they're wrong," said Dr. Miller-Meeks, who performed laser eye surgery at a private practice for 12 years in Ottumwa, in southeastern Iowa.
But Dr. Miller-Meeks does agree that health insurers needed stricter regulation. Preexisting condition exclusions and other loopholes, being phased out by the health reform law, needed to be closed, she said. She suggested that health plans should be required to justify their profits the way utility companies must -- to an independent regulatory board.
Hospitals also need relief from a federal requirement to treat anyone who shows up, she said. She suggested that requirement -- part of the Emergency Medical Treatment and Labor Act -- be restricted to people with real medical emergencies.
Physicians also need the government to provide medical liability relief, Dr. Miller-Meeks said. She suggested that Congress consider a system in which noneconomic damages are limited and the loser of a court case pays the winner's legal costs. But if patients are truly harmed by medical errors, they should be compensated, she said.
Her opponent in the general election did not respond to repeated American Medical News requests for an interview. Loebsack voted for the health reform law and promotes it on his website, including its tighter regulation of the health plan industry.
Fighting for a better system
Dr. Trivedi considered many different careers in medicine, including emergency medicine, but he settled on internal medicine because it addressed the widest array of health problems.
He grew up in Fleetwood, Pa., about 60 miles northwest of Philadelphia. His Indian immigrant parents worked in an apple juice factory.
Dr. Trivedi became a military surgeon in the U.S. Marine Corps. The first U.S. serviceman to die in combat in Iraq in 2003 was in his battalion. He was a few miles away when the statue of Saddam Hussein was toppled in Baghdad's main square the same year.
"My time as a battalion surgeon for one of the first units to enter Iraq is a major factor in why I'm running for office," Dr. Trivedi said. "I think it is a perspective that is clearly needed in Washington and the type of real-world experience that is lacking in Congress."
Dr. Trivedi said the health reform law includes some positive steps and that more work remains. For example, he wants regulators to make sure that insurers follow its bans on preexisting condition exclusions and caps on coverage. "We have to make sure this thing is airtight."
But he also said the package didn't do enough to limit increases in health care costs.
He said developing best practices in health care and aligning pay with quality and efficiency would produce significant savings, as demonstrated by such groups as Geisinger Health System in Pennsylvania and Intermountain Healthcare in Utah. He acknowledged that the health reform law starts moving in that direction by giving the Dept. of Health and Human Services secretary leeway to implement innovative payment reform pilot projects.
"Those are the kinds of things that I think are the future of health care," said Dr. Trivedi, a self-described "data person." But he said incentive pay should consider the influence of patient mix on quality to make sure physicians aren't punished for having sicker patients to start.
He supports the health reform law's coverage expansion to an estimated 32 million people, half of whom will gain coverage through Medicaid. But millions of Americans still will be uninsured, which should not be the case, Dr. Trivedi said. And he said Medicaid rates -- and primary care pay in general -- are often inadequate.
Medical liability reform would reduce wasteful spending in the health system, Dr. Trivedi said. He cited a Michigan model that limits damage claims against physicians who voluntarily disclose medical errors for further study.
Dr. Trivedi said he doesn't have any illusions that a freshman representative would be able to change the partisan nature of the House. But he said Congress needs more people who won't always vote along party lines. "We need more evidenced-based policies in D.C."
His opponent -- four-term Rep. Jim Gerlach (R, Pa.) -- is much less of a fan of the health reform law than Dr. Trivedi. Gerlach supports provisions to allow generic versions of biologic drugs and curb waste, fraud and abuse in public programs. But he said the law has too many mandates, taxes, boards and commissions and no significant medical liability reform.
Gerlach suspects that business owners will opt to pay the law's penalty rather than provide mandated coverage if health insurance premiums increase significantly. And the extent to which the law goes after health plans ignores the fact that insurer profits are not all that large when expenses are taken into account, he said.
Democrats on the defense
The spike in congressional candidates comes as Republicans are making a concerted effort to take back control of the House and derail implementation of the health reform law.
Voter dissatisfaction with Congress and President Obama has grown. The percentage of Americans who disapproved of Obama's performance reached nearly 51% in late August -- a record high for his presidency, according to a compilation of national polls by Pollster.com.
Congress is even less popular. The percentage of Americans who disapproved of lawmakers' performance reached 69% in late August, a level not seen since before the November 2008 elections. In late August, 46% of Americans said they planned to support Republican House candidates on Nov. 2, compared with nearly 42% who said they would support Democrats.
Some polls showed that Republicans were gaining in popularity, but Democrats could reverse the trend before Election Day. Many voters probably won't commit to candidates until the fall, said Robert Blendon, ScD, a professor of health policy and political analysis at the Harvard School of Public Health in Boston. "There's a share of people who are very soft in their beliefs."
The economy is largely driving voters' attitudes, Blendon said. Many people don't believe that the stimulus act, health reform law and other actions by the Democratic-controlled Congress have helped reduce unemployment.
Still, the GOP has an uphill battle to regain the House, and Democrats will be competitive in terms of the choices they offer, said Democratic pollster Celinda Lake, president of Lake Research Partners in Washington, D.C. "It isn't like voters are any happier with Republicans."