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.
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.
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.