Doctors on Hill seek voice in reform debate

Washington -- Last November, U.S. voters elected four new physician-representatives, putting more physicians in Congress now than in at least the past 20 years. The 16 doctors in Congress find themselves on the job in a year when health care expertise is a hot commodity on Capitol Hill.

Most of the physicians voters sent -- or re-elected -- to Washington are conservative Republicans. Many are family physicians or ob-gyns, and most are from southern states.

"Every one of them are there for their own personal reasons," said Rep. Jim McDermott, MD (D, Wash.), the longest-serving physician in Congress. "They all have something they want to change."

Dr. McDermott, a psychiatrist, was one of two physicians voted into Congress in 1988. The number of doctors working on the Hill has grown relatively steadily ever since.

But physicians' influence over national health system reform in today's Democratic Congress may be limited. Eleven of the 16 are Republicans, and few are on committees with primary jurisdiction over health care.

Nevertheless, the nine Republican physicians in the House are trying to increase their influence. They formed the GOP Doctors Caucus in March to present a united voice against some of the health reforms backed by Democrats and the administration -- such as creating a public health plan to compete with private insurers.

"These ideas on the Republican side should logically be led by those men and woman who have the professional expertise before they came to this body," said Rep. Phil Gingrey, MD (Ga.), co-chair of the GOP Doctors Caucus. Rep. Tim Murphy (Pa.), a psychologist, is the other co-chair. Two dentists and an optometrist also are caucus members.

Also, five of the physician caucus members are part of the 21-member Health Care Solutions Group, a GOP leadership alliance designed to counter Democratic proposals. And GOP Doctors Caucus member Rep. Michael Burgess, MD (Texas), is chair of the Congressional Health Care Caucus, a Republican strategy group.

Seeking a doctor's opinion

Physicians are influencing Congress in other ways, too. Rep. Charles Boustany Jr., MD (R, La.), said he is often asked about how legislation would affect physicians and patients. "I get the sense that my voice is well-respected on both sides of the aisle."

Rep. Frank Pallone Jr., (D, N.J.) said having three physicians on the House Energy and Commerce health subcommittee he chairs is helpful. "They're able to look at a lot of these issues in a practical sense." Drs. Burgess and Gingrey are subcommittee members, as is Democrat Donna Christensen, MD, delegate from the Virgin Islands.

Sixteen doctors in Congress is not an all-time record. From 12 to 18 doctors served in the first Congresses, according to Threads of Greatness: A Bicentennial Tribute to Physician-Statesmen, a 1976 publication of AMPAC -- the American Medical Association Political Action Committee. Physician representation ebbed in the late 19th century to an average of seven to 15, then declined further in the 20th century to between two and five.

Today, physicians also hold sway in the executive branch, said Chris Jennings, a Democratic strategist and former health care adviser to President Clinton. Four physicians working in the Obama administration -- including Zeke Emanuel, MD, brother of White House Chief of Staff Rahm Emanuel -- helped moderate a 90-minute health care discussion on May 27 with more than 30 physician leaders. The group widely agreed on the need to address the shortage of primary care physicians and the need to emphasize personal responsibility in health care, according to a White House summary of the event.

Still, Dr. Gingrey said in early June that House Democrats have not invited Republicans to write a bipartisan health reform bill.

Dr. McDermott said House Republicans won't be left out of the process. The House committee chairs have been deciding the direction of the legislation before opening it up to scrutiny. "I don't think there's any question [Republicans are] going to be involved as soon as possible."

Partisanship still plays a key role

Rep. John Fleming, MD (R, La.), said the political divide between Republicans and Democrats is having much more of an impact on the legislative process than the physicians are. Democrats favor a larger government role in health care and Republicans favor a more private system. "It's very polar."

But political bridges can be built, Dr. Boustany suggested. He said he often agrees on health reform issues with Rep. Parker Griffith, MD (D, Ala.), a member of the conservative Democrat Blue Dog Coalition.

The GOP Doctors Caucus is going to be organized and very vocal, Dr. Boustany said.

"It would be a big mistake for the Democrats and the Obama administration to ram through legislative proposals without heeding some of the advice we have."