Political passions drive doctors to campaign

Washington -- Still not sure which candidate to vote for this year? Marilyn Heine, MD, and N. Thomas Connally, MD, would like a word with you.

"President Bush is clearly the best choice for medicine," said Dr. Heine, chair of Bucks County (Pa.) Physicians for Bush-Cheney.

"He is dedicated to protecting patients' access to high-quality health care in America. He's a true advocate for the doctor-patient relationship and is a champion for much-needed medical liability reform that would safeguard patients' access," she said.

On the other side of the political spectrum, Dr. Connally is just as adamant in his support for Sen. John Kerry (D, Mass.).

"It's not even close," said Dr. Connally, a Virginia physician and national coordinator for Doctors for Kerry. He favors Kerry's more comprehensive approach to dealing with the uninsured. "It's reasonable, it's doable, it builds on the current employer-based system."

All signs point to a close and contentious presidential election this year, making grassroots efforts all that much more important. Physicians are among those working locally on the candidates' behalf.

And Drs. Heine and Connally, energized by distinct differences in how the presidential opponents would approach health care issues, have thrown themselves into campaigning even more than usual for these already politically active physicians.

Dr. Heine is a board member of the Pennsylvania Medical Political Action Committee, which took the unique action this year of officially endorsing Bush for re-election.

Dr. Connally, now retired, spent 12 years on the government affairs committee of the former American Society of Internal Medicine. He has helped with presidential campaigns as far back as Robert Kennedy's bid in 1968.

They are both making the rounds of campaign events, public forums and editorial pages explaining to the public -- and other physicians -- why their candidate is the better choice.

Along the way, both physicians have had face-to-face encounters with their candidates that have only left them more secure in their choices.

"He understood health policy in great detail," Dr. Connally said of Kerry. Even during the Democratic primaries, Kerry came across as the most presidential in the crowded field of candidates, he said.

Said Dr. Heine: "I met with President Bush in a small group roundtable discussion in Scranton. I was deeply impressed with his understanding of the medical liability crisis and his commitment to resolve the issue in order to protect patients' access to high-quality health care."

The American Medical Association does not endorse candidates but works with all parties to pass legislation important to the physician community, according to a statement. "As with all election campaigns, the AMA encourages physicians to actively support the candidate of their choice."

A recent survey of physicians by Pennsylvania's Muhlenberg College shows 57% plan to vote for Bush and 39% for Kerry.

Surveys of voters show that many see physicians as honest brokers on political issues, ranking them above lawyers or businessmen on trustworthiness. Doctors also bring the legitimacy of being personally affected by many of the issues under debate.

"I volunteer at a free clinic here in Arlington and am on the Virginia state board of free clinics, and I really see the problem of the uninsured and see it as a worsening problem," Dr. Connally said. The human cost is devastating, but it is not simply a moral issue, it's an economic one, too.

"We don't get off scot-free. Those people, if they end up in the emergency room, they run up our costs. I see large, large numbers of diabetics and hypertensives, and they're going to develop end-stage renal disease sooner or later if they're not taken care of," Dr. Connally said.

Bush has taken steps to help the uninsured -- increasing community health center funding and proposing measures to make private insurance more accessible, Dr. Heine noted. But for her, liability reform is a more pressing issue.

The liability crisis has hit Pennsylvania hard, causing doctors to drop high-risk procedures, leave the state or retire early. It also has turned off new physicians. Only 17% of Pennsylvania's medical residents stayed in 2003.

"In Bucks County, we've had a loss of over a hundred physician services in the last two-plus years, while our population is aging and requiring more health care resources," she said.

"We're seeing in Pennsylvania the results of a legal system gone awry. President Bush has been saying for years that California's MICRA is an excellent model for medical liability reform," she added. Bush has pushed for the $250,000 noneconomic damages cap supported by the AMA.

Kerry is also aware of the need for liability reform, said Dr. Connally, who spoke with the candidate. "We discussed many concerns: the uninsured, health care costs and other things. But he was the one to initiate the talk that we have to work on a broad program to make the way we're handling malpractice cases much more rational," he said.

Kerry's proposal includes requiring that certified expert witnesses be obtained before filing a lawsuit and moving states toward mandatory, non-binding arbitration. His plan would bar awarding of punitive damages except in the most egregious cases of negligent or malicious conduct.

Dr. Connally has become something of an expert on Kerry's health care proposals. He has had to, in order to answer doctors' questions when speaking around the state.

"They're not rollovers. They've had some questions about things that come to any intelligent voter's mind, like: 'How are we going to pay for this health care plan?' or 'Go over the Kerry plan for malpractice again,' or 'There were some good points in the Medicare Modernization Act, why is it that Kerry voted against it?' " he said.

Dr. Heine doesn't mind answering physicians' complex policy questions either. For her, fitting in campaign events between nights in the emergency department and days at her oncology practice, the really tough question is when she'll get any sleep.