WASHINGTON — When newly elected Congressman Ralph Abraham, a doctor with a family practice in Mangham, takes his seat in the U.S. House in January, he’s confident his medical background will help him tackle a range of problems in government.
“We are taught to listen, diagnose and treat,” Abraham said. “Really, in Congress, it doesn’t have to be any different than that.”
U.S. Rep. Charles Boustany agrees. He’s a doctor, too, giving up a career as a heart and lung surgeon in Lafayette to win election to Congress in 2004.
“I believe as physicians, we bring very special skills to the table,” Boustany said. “We’re highly educated and we’re able to deal with complex subject matter. We’re very solutions-oriented: We’re very used to taking complex problems, breaking them down into parts and coming up with useful solutions.
“We deal with communications skills that we can use in the political arena, and put things in terms that people can understand.
“We’re very good listeners,” he said. “Physicians learn from the beginning that to understand the problem, you have to listen to the patient.”
If Abraham and Boustany are right, then Louisiana’s interests figure to be in good hands in Washington. When the new Congress opens in January, the state’s eight-member delegation will include four doctors: Abraham, Boustany and John Fleming, of Minden, in the House, and Bill Cassidy — now finishing his third term as a House Member from Baton Rouge — in the Senate. No other state rivals Louisiana in either the number or proportion of doctors in its delegation.
Overall, the number of physicians in Congress, while still a small percentage of the 535 total members of the House and Senate, doubled from 10 to 20 between 2000 and 2014, although the 2014 elections resulted in a net loss of two physicians. The upward trend may be connected to the emergence of health care as a dominant national political issue, epitomized by the 2010 enactment of Democratic President Barack Obama’s signature legislation, the Affordable Care Act, also known as Obamacare.
The four Louisiana doctors are all conservative Republicans, and they share a deep antipathy for the Affordable Care Act — and for what they regard as undesirable government intervention in the health care system, going back well before the law passed. Fleming says his apprehensions played a major role in prompting him to run for Congress in 2008.
“I was able to see that the opportunity for physicians to deliver the best of health care was being increasingly diminished over the years because of federal government intrusion into health care, and also the same applying to business as a whole,” he said. “And unfortunately, it only got worse when I got to Washington.”
The doctors rail against what they claim are inadequate reimbursement rates for doctors under Medicare and Medicaid and the programs’ onerous coverage restrictions that affect treatment.
“The pressure on doctors — the downward pressure on their income and their reimbursements, and the upward pressure on their overhead and their costs — is getting to a crisis point,” Fleming said.
Fleming would like to see doctors freed under the government programs to negotiate for higher payments from better-heeled patients — and he favors a tactic often associated with a liberal agenda: means testing.
“The average taxpayer is subsidizing Warren Buffet’s Medicare,” he said. “That’s insane.”
Cassidy, too, cites his experience working for 20 years in the Louisiana charity hospital system as motivation for his run for Congress in 2008.
“I would see politicians pass laws which they felt were great laws and which I would realize were not necessarily good for patients or patient care,” he said. “At some point, you’re frustrated about that, and you make a decision to try to change it.”
While in the state Senate in 2007, Cassidy introduced a bill to promote a broader exchange of information about insurance options for patients who enrolled in the program, and it called for the state to study various ways to provide universal health care. In his Senate campaign this year against Democratic incumbent Mary Landrieu, a pro-Landrieu group attacked the proposal as out-Obamacaring Obamacare — though media fact-checkers ridiculed the claims.
Cassidy also drew fire from Landrieu for his arrangement with the LSU health care system to continue to work on the medical faculty part-time after he was elected to Congress, as she suggested his time sheets indicated he received pay for work he didn’t do. Cassidy defended his record.
House rules severely restrict outside employment, and Cassidy had to negotiate with the House Ethics Committee for approval of his deal with LSU. He said recently he hopes to continue to be involved with LSU as he moves to the Senate, subject to ethics clearance. He is one of only two doctors in Congress to continue practicing at any level; he has more than once used the word “love” to describe his affection for diseases of the liver.
In the Senate, Cassidy will serve on the Committee on Health, Education, Labor and Pensions, which should position him for hands-on work developing Republican alternatives to Obamacare. Fleming helped craft an ACA alternative advanced by the Republican Study Committee, a right-leaning caucus that includes a majority of House Republicans.
Boustany was charged by the Republican House and Senate leadership in 2009 to deliver the party’s televised response to Obama’s health care address before a joint session of Congress. He also won House passage of his bill to repeal the only section of the Affordable Care Act that’s been set aside by law, although it was incorporated in other legislation in clearing Congress: a long-term care program that even the White House acknowledged was unworkable.
Boustany comes from a medical family: His father was a family doctor, his sister is a dermatologist and some of his uncles and cousins are medical doctors.
“I saw how rapidly medicine was being changed by these outside forces taking away the very personal nature of medicine,” he said.
With Republicans adding control of the Senate to their existing House majority in the next Congress, Boustany hopes to see a thoroughgoing proposal to fix what’s wrong with the health care law.
“I’m prepared to look at a way that we can completely overhaul the program and bring it back to a private-sector model that puts a premium on the doctor-patient relationship,” he said.
“It needs to be a good plan. It has to bring down cost, it has to improve quality and it has to expand coverage.”