Goodbye Republicans. Helloo Democrats:
September 28, 1999
Republicans Are Feeling Feverish
As Doctors Cut Across Party Lines
By LAURIE MCGINLEY
Staff Reporter of THE WALL STREET JOURNAL
AUSTIN, Texas -- Polishing off their salad-and-pasta dinners in a
conference room here, six dozen doctors listen closely as Molly Beth
Malcolm, the chairwoman of the state Democratic Party, makes her pitch:
Democrats, not Republicans, are the true protectors of patients and
physicians, and deserve the doctors' political and financial support.
"It's the Democrats who have been with doctors on these health-care
issues," she tells the group, made up mostly of conservative Republicans.
"Your issue is our issue. Your future is our future."
She gets no argument here. For one thing, Republican Party officials, citing
scheduling conflicts, declined invitations to debate the issue at this meeting
of the Texas Medical Association's political action committee. For another,
the doctors' view of the political world has changed.
David Duffner, an orthopedic surgeon in Tyler, Texas, has spent most of
his life as a Republican and is active in the Texas GOP. But now, he says,
"I'm a lot less Republican than I used to be. Increasingly, I find myself
drawn to the Democratic Party."
'I Get Indigestion'
Joe Cunningham, a Waco, Texas, internist, agrees, saying he used to
consider himself a Republican, but now, "If I'm listening to the Republican
viewpoint on a talk show, or reading it in the newspaper, I get indigestion."
Such statements once would have been political heresy among doctors.
They were the ultimate privileged profession, and steadfastly aligned
themselves with the GOP. Prominent in their communities, they were an
important part of most Republicans' political base, often serving on
fund-raising committees.
Today, however, doctors find their incomes and decision-making authority
curbed by powerful managed-care companies and insurance firms --
which have made their own substantial investment in campaign
contributions to the Republican Party.
Aghast that the GOP leadership
hasn't brought managed care to heel, physicians are crossing party lines for
help, and rewarding Democrats with votes and political contributions.
Indeed, in the House, which is scheduled to begin debate on the
managed-care issue next week, A Republican dentist and doctor have led
efforts to work with Democrats on a sweeping bill to crack down on
managed care.
Giving to Kennedy
Exactly how many doctors are crossing party lines is unknown, but here's
one striking indication: The American Medical Association's political action
committee, Ampac, recently contributed to Democratic Sen. Edward
Kennedy of Massachusetts for the first time. Demonized for years by the
AMA as a promoter of socialized medicine, Sen. Kennedy now is a
leading champion of the patients' bill of rights endorsed by dozens of
consumer and medical groups, including the AMA. Another notable
beneficiary of Ampac largess: Democratic Rep. Lloyd Doggett of Texas,
long despised by physicians for opposing malpractice reform.
In part, the doctors' estrangement from the national GOP is a matter of
convenience. They are desperate to see legislation enacted that will curb
the growth and power of managed care, and they believe that a bill passed
by the Senate in July fails that test, partly because it omits a patient's right
to sue HMOs over denied treatment. But on other issues -- taxes and
regulation, for instance -- many still harbor GOP sympathies.
But the shift also reflects a fundamental change in the way doctors see
themselves and their place in the world. Many used to regard themselves
as small-business people, and therefore naturally drawn to the GOP as the
party most friendly to business interests. But Robert Blendon, a Harvard
University professor who studies attitudes toward the health-care system,
says many physicians, despite average net income of more than $160,000
a year, increasingly feel like besieged workers, with diminished control
over patient care and their own economic futures. That leads them to
rethink their political identity.
"Republicans represent capital, and Democrats represent labor,"
says Dr.
Duffner, the Tyler
"Physicians used to be capital, but now
we're labor in the view of managed care. We're fungible commodities. So
if they drop one doctor from a contract, they just get another, even if it
means that a family that has been coming to you for 20 years has to switch
to another doctor."
Turning to Unions?
That's why there is also growing interest among doctors in using unions to
try to counter managed care's clout in setting fees and treatment options.
The AMA is organizing a collective-bargaining unit for employed doctors,
and salaried physicians regularly attend AFL-CIO conventions. "You can't
get much more Democratic than a union," says L. Anthony Cirillo, an
emergency-care physician and Republican school-board member who
practices in Pawtucket, R.I. "If that doesn't tell you the cats are sleeping
with the dogs, I don't know what will."
Doctors have stood with the GOP in the past through some fierce political
battles. In 1965, for example, the AMA bitterly fought the creation of
Medicare, arguing that the government program would sabotage the
private health market. Ironically, the federal health program for the elderly
and disabled, pushed through by President Lyndon Johnson, turned out to
be a permanent financial boon for physicians.
Republicans have made accommodations, too, to keep the doctors on
board. In 1995, House Speaker Newt Gingrich suggested only small cuts
in doctors' fees when he proposed cutting Medicare by $270 billion over
five years. He was rewarded by an AMA endorsement of his plan.
Overall, doctors identify themselves as Republicans by two-to-one
margins.
But in the past few years, the growing power of managed care has
scrambled the political equation. Doctors who had for years been afraid of
government interference now were much more upset about what they saw
as the excesses of the free market and began clamoring for government
protection. Employers and health plans countered that the doctors
themselves were largely to blame for surging health costs and that managed
care was the only way to get costs under control.
Whether all this will lead to a permanent political realignment, of the sort
that led black voters to the Democratic party in the 1930s, is still hard to
say. Many physicians remain strong supporters of GOP state lawmakers,
some of whom have pushed anti-HMO bills through the legislatures.
Ampac's Support
But the ground clearly is shifting. For years, Ampac has funneled
three-quarters of its contributions to Republicans; now it is likely to
decrease the GOP's portion for the 1999-2000 election cycle. AMA
President Thomas Reardon says that physicians around the country have
asked him: "Why isn't Ampac supporting the Democrats more?" He notes
that Ampac operates independently of the AMA.
Other medical groups are steering money and support toward the
Democrats, too. Just last week at the Mayflower Hotel in Washington, a
bipartisan group of psychiatrists and other doctors feted House Minority
Leader Richard Gephardt of Missouri to raise money for the Democratic
Congressional Campaign Committee. Gephardt aides say the event, which
raised $100,000, was a "breakthrough" -- the first fund-raiser in memory
for the Democratic committee by a group representing organized medicine.
Several conservative Republicans helped organize the Mayflower
fund-raiser, including Richard Epstein, a Bethesda, Md., psychiatrist who
has raised thousands of dollars for GOP candidates. He recently wrote
GOP Party Chairman Jim Nicholson, decrying the party's "irresponsible"
position on managed-care reform and medical-records privacy, but hasn't
yet gotten a reply.
Mike Collins, a spokesman for Mr. Nicholson, defended the Senate's
approach to HMO reform as "a careful, considered approach that doctors
and patients will find satisfactory." He said that Dr. Epstein will soon
receive a reply to his letter.
For their part, irked Republican leaders say doctors are on a mission to
destroy managed care -- which will only drive up health costs and the
ranks of the uninsured.
They grouse that the AMA, long an advocate of
minimal government intervention, has betrayed its conservative principles
by pressing for stepped-up government controls on health plans. "They
have suddenly taken a hard left, while I'm still riding the same old train,"
says Texas GOP Sen. Phil Gramm.
In Bed With Lawyers?
He and other Republicans also worry that doctors, who have long
bemoaned medical-malpractice suits as a scourge, are pushing for injured
patients' right to sue HMOs if wrongly denied care. This liability provision
is a top priority for trial lawyers, staunch allies of the Democrats. "When
you have doctors in bed with the trial lawyers, it's a relationship that
Republicans look suspiciously at," says Republican Sen. Bill Frist, a
Tennessee transplant surgeon. and brother of Thomas Frist, head of
Columbia/HCA Healthcare Corp., the hospital chain based in Nashville,
Tenn. He worries that the AMA will hinder enactment of a limited patients'
protection bill, such as the one that passed the Senate in July. The senator
says the legislation, which lacks a right to sue, would be a "good step
forward." The AMA and its consumer-group allies have denounced it as a
sham.
For many doctors, the patients' bill of rights is the ultimate litmus test, rising
above all other issues. And while their numbers are small -- there are only
750,000 doctors in the U.S. -- they carry a lot of influence with patients.
They could affect the races that decide who ends up controlling the House,
Prof. Blendon says. "The biggest influence of physicians isn't their votes,
but their influence on patients and others in the community," he says. If the
GOP leadership blocks tough HMO reform, he says, it will bolster
Democratic arguments that the Republicans have presided over a
"do-nothing Congress." That grassroots power -- much more than
lobbying prowess or political contributions -- is the foundation of the
AMA's influence.
One congressional district to watch is that of GOP Rep. Ernie Fletcher, a
Lexington, Ky., family physician elected two years ago, who faces a tough
re-election fight. The AMA doled out $350,000 in independent spending
to help elect Dr. Fletcher, then watched in amazement as the lawmaker
voted with the GOP leadership, and against the AMA, in a series of crucial
subcommittee votes last June on patient protection.
Target of 'Blast Fax'
Dr. Fletcher has expressed opposition to what he fears could be a vast
expansion of lawsuits in the health-care field under some of the proposals
pending in Congress. His comments prompted the AMA this summer to
urge the doctors in Dr. Fletcher's district to "blast fax" him with complaints.
Irate about what he considered an unfair attack from the AMA, he sent
local doctors a letter assuring them that he shares their health-care goals.
The AMA has declared a truce, at least for the moment.
More doctor hardball is on the way. At a recent meeting in Monterey,
Calif., Bill Thorne, a top Ampac official and longtime Republican, exhorted
the state medical associations to stop recommending Republicans who
were opposing the sweeping HMO-overhaul legislation, according to
people at the meeting.
Republicans are quick to note that the AMA doesn't represent all the
nation's doctors -- only about 290,000 doctors belong, or 38%, down
from 70% of doctors three decades ago. Moreover, embarrassing
missteps, including the organization's aborted marketing pact with
Sunbeam Corp., have hurt its credibility. In addition, they note, some
doctors oppose expanding liability for HMOs, on the grounds that
additional litigation would snare doctors as well as health plans.
The war of once-close allies has created migraines for the GOP, and led to
a House rebellion among Republican doctors and a dentist in the House.
The upshot: GOP Rep. Charlie Norwood, a Georgia Republican and
dentist, has joined forces with Democratic Rep. John Dingell of Michigan
on a bill that gives injured patients the right to sue their health plans and
gives doctors a much greater say in medical decisions. It's backed by the
White House, all the Democrats and, at the moment, about 21
Republicans. The debate is scheduled to begin next week.
One of Many Issues
In the meantime, Democrats are cheered by physicians' support. Rep.
Martin Frost, a Texas Democrat, says he went to the annual dinner of the
Dallas County Medical Society last year and listened to doctors rail
repeatedly at insurance companies. "I came away from that saying, 'This
sounds like I have been to a Democratic rally,' " he says. And Democratic
Rep. Harold Ford of Tennessee, who is considering a Senate bid against
Dr. Frist next year, recently had a cordial meeting with the Tennessee
Medical Association in which the doctors spent much of the time
complaining about Dr. Frist's stand on patients' rights. Sen. Frist says that
he keeps in close contact with the state medical association members, and
that the patients' rights legislation is just "one of many issues" they discuss.
In Texas, especially, the issue resonates powerfully among doctors
because the state has the nation's most far-reaching patient-protection law,
including the right to sue. And, so far at least, the law hasn't led to huge
premium increases or a flood of lawsuits. But opponents note that it has
been in effect only two years, too short time to know its long-term effects.
The doctors are furious with the Republican leadership. The Texas
Medical Association's political action committee recently decided against
giving Republican Sen. Kay Bailey Hutchison any more campaign
contributions for now, according to Dr. Duffner, the chairman of the
committee. She, along with Sen. Gramm, voted for the modest Senate
rights bill that is opposed by the AMA. Replies Sen. Hutchison, "I support
issues based on what I believe is the right solution for a given problem.
Sen. Kennedy's bill will not improve the quality of health care for the
American people, and that's really the issue here."
Neverthless, rank-and-file Republicans are uncomfortable about frayed
relations with physicians. One Republican lobbyist who is working to
defeat a comprehensive HMO-overhaul says GOP members are so upset
about the conflict that several have endorsed a bill by Rep. Tom Campbell
(R., Calif.) that would allow self-employed doctors to band together to
negotiate rates and other issues with managed-care companies. The bill is
another AMA priority. Republicans know the legislation isn't going
anywhere, he says, but they just want to do something for the doctors. |
