Newest doctor on the Hill hopes to boost focus on the uninsured

Washington -- Rep. Steve Kagen, MD (D, Wis.), may have left his practice for the nation's capital, but he's still on call.

The 58-year-old allergist and immunologist is speaking with a reporter one morning when a desktop speaker in his office emits a high-pitched beep. It's his voting pager. The voice of a clerk calls him and other Democratic members to the House floor to approve the record of the previous day's proceedings. It's one small part of the daily legislative process.

"God bless America," says Dr. Kagen, who is in the midst of a re-election campaign. "I had [posttraumatic stress disorder] from my medical beeper. I thought I got away from beepers. Now look at this," he jokes.

In 2006, the physician narrowly won election in the 8th Congressional District in northeast Wisconsin, making him the newest of 12 physician lawmakers in Congress. The first-time candidate, an opponent of socialized medicine, made health system change a central part of his 2006 campaign against Republican John Gard, then speaker of the Wisconsin Assembly.

To emphasize the importance of his mission, Dr. Kagen has declined congressional health benefits until all citizens have access to affordable care. So far, he hasn't had any major medical issues. "If every congressman and woman would not have health care coverage, there would be a great deal more interest in their minds in solving this problem."

Since arriving in Congress in January 2007, Dr. Kagen has been trying to advance his health care platform, specifically his five No Patient Left Behind principles. They are: requiring open disclosure of health care prices, ending health plan exclusions for preexisting conditions, not varying prices for health care products and services based on insurance status, creating a 3% tax deduction per household for health care spending, and calling for government to cover the overhead costs of providing necessary health care to the needy.

But some of those concepts were too broad to be practical or to fit into one bill. So in February, Dr. Kagen introduced the No Discrimination in Health Insurance Act of 2008, his first attempt to advance some of his principles. The measure would end health plan exclusions based on preexisting conditions, require insurers to charge the same premium for the same coverage on a local basis, and mandate health plans to disclose that price. The legislation calls for federal regulations to keep people from gaming the system by waiting to enroll in a health plan until they get sick.

"We need to establish a basic insurance policy that becomes a standard policy that each and every insurance company must offer to every citizen or legal resident," Dr. Kagen said. This would foster competition and drive down prices.

Rep. Frank Pallone (D, N.J.) is interested in Dr. Kagen's ideas. Pallone chairs the House Energy and Commerce Committee's health subcommittee. "We're going to do some hearings in the next couple of months on the whole issue of the cost of health insurance. So in the context of that, I certainly want to include discussions about this bill," he said.

The family calling

Dr. Kagen's family has been in health care for the last seven generations. An eighth is preparing to enter the field. Of his four children, his two daughters are training to be nurses, and one son is in medical school. "It's sort of what the Kagens do," the Wisconsin congressman said.

His paternal grandfather emigrated from Russia in 1905 at the age of 16. He had worked at a pharmacy in Russia, and eventually landed a job at one in Chicago. Dr. Kagen and his brother and sister grew up across the street from the pharmacy. Dr. Kagen was helping out at the store when he was 12 or 13 years old, said his father, Marvin Kagen, MD, a 90-year-old dermatologist who retired six months ago. His maternal grandfather was an ear, nose and throat specialist.

But the Kagens are not entirely new to politics. The family hosted small group chats at their house with late Sens. William Proxmire and Gaylord Nelson, both Wisconsin Democrats. When the younger Dr. Kagen was 16 in 1966, his father ran for Congress. The elder Dr. Kagen lost.

"That left a real impression on Steve. It was clearly in the back of his mind from then on," said his friend Paul Sondel, MD, PhD, professor and head of pediatric oncology at the University of Wisconsin. The two met in 1961 when they were kids. They were later roommates at the University of Wisconsin-Madison.

Dr. Sondel said Dr. Kagen had been talking about running for Congress for about 20 years, but he wasn't sure how serious his former roommate was until Dr. Kagen announced his candidacy. Dr. Sondel didn't doubt Dr. Kagen's ability to do the job, but he wasn't sure if his friend had picked the right race. "I had some wonder as to whether a forward-thinking, progressive Democrat would be able to win in a region that has been historically very largely Republican."

Familiar foes

In his re-election bid, Dr. Kagen once again faces Gard, whom he beat by just two percentage points in 2006. Gard said Dr. Kagen and the Democratic Congress began 2007 with momentum to advance health system reform, but they have nothing to show for it. "Congress, by and large, has overpromised and underdelivered on the issue of health care," Gard said.

Vetoes and veto threats by President Bush have hampered some of lawmakers' efforts, particularly State Children's Health Insurance Program expansion, Dr. Kagen countered.

While it might appear that Congress isn't doing much, that's not true, Dr. Kagen said. It takes a lot of discussions and negotiations to advance legislation, and that work has been happening. "The government we have is very glacial in its movement. It is not rapid. But there are some very positive changes taking place."

Gard said he is well known for protecting Wisconsin's medical liability fund from being siphoned off for other uses. "Over the course of this campaign, you're going to see tremendous medical community support on my behalf," Gard said.

The AMA and its bipartisan political action committee do not endorse candidates, but the PAC has contributed to Dr. Kagen's re-election campaign. The Wisconsin Medical Society also doesn't make endorsements, but its PAC will do so by fall, said Vice Chair John Hartmann, MD.