Trading practice for political medicine

The New Physician – the magazine of the American Medical Student’s Student Association

Trading practice for political medicine

By Steve Woo

October 2008

After three decades as a practicing physician, Rep. Steve Kagen, M.D., (D-Wis.) knows the importance of having health insurance. So when the time came to sign up for the congressional health plan upon entering office two years ago, the answer was obvious.  

He said no.

With 47 million people uninsured in this country, the freshman congressman, up for re-election next month, had a strong feeling about declining that generous coverage.

"I didn’t run for public office to get a benefit," says Kagen. "It’s about public service. It’s about giving back. It just didn’t feel right to take a benefit that wasn’t offered to everyone else."

Granted, as a successful doctor whose family has coverage through work or school, Kagen may have an easier time paying for doctor visits than others do. But his decision drew at least a little attention to a health care system that needs a lot of fixing.

Kagen represents the 8th Congressional District in northern Wisconsin, an area that includes Appleton and Green Bay. In 1966, his dermatologist father ran unsuccessfully for the same congressional seat Kagen occupies now. That experience was a major factor in the younger Kagen’s political aspirations. For years, politics was a common dinner-table topic, and he spoke off and on about running for office, he recalls. Then, 40 years to the day of his father’s failed attempt, Kagen was elected.

A University of Wisconsin medical school grad, Kagen comes from a family with seven generations in health care. Continuing in the family vocation, his son is in medical school and his daughter is in nursing school.

In an interview with TNP, the allergist and immunologist who had owned a string of medical clinics spoke about his health care initiatives, medical education and other national concerns he supported during his past term.

The lawmaker had to give up practicing medicine upon entering Congress. "I miss it every day," he says. He is one of 11 physicians in the House, according to the Office of the House Historian. There are two in the Senate.

In Congress, Kagen has used his medical background to call for health care reform. As a first-term congressman, Kagen’s major health initiatives could be summed up in the No Discrimination in Health Care Act of 2008. Introduced by Kagen last February, the bill—H.R. 5449—focuses on improving health care based on Kagen’s "No Patient Left Behind" principles. It would require insurance companies to openly disclose health care prices; end health plan exclusions for pre-existing conditions; establish standard prices for health care products and services, regardless of the patient’s insurance coverage; set deductibles at 3 percent of household federal taxable income; and have the government cover overhead costs of providing health care to low-income people. The bill garnered 18 co-sponsors and was referred to the House Subcommittee on Health. It’s now up to the committee how the legislation proceeds, Kagen’s spokesman says.

The current health insurance model is discriminatory, especially denying coverage for pre-existing conditions, Kagen explains. His goal has been to make health insurance affordable and available for everyone. "Simply put, if you’re a citizen, you’re in."

He also emphasizes the importance of replacing varying state insurance regulations with a federal standard.

His advice to future physicians is simple: You don’t need to be a financial wizard to run a doctor’s office. "You shouldn’t be entering medical school thinking about an M.B.A.," he says.

Students must consider debt in a new way. Kagen says to "be a lumper," which means thinking about debts in the long-term—over years, rather than months. Focus on why you want to become a doctor, rather than the dollars it takes to become one, he says. "Over your career, you are going to do just fine."

Nonetheless, Kagen has supported legislation to reduce higher education costs. He voted for the College Cost Reduction and Access Act in 2007, which is now law. It increases college aid by $20 billion over five years by cutting some loan interest rates, increasing Pell Grant awards and other measures.

In 2008, Kagen voted for the Ensuring Continued Access to Student Loans Act, also now law, which was developed in response the housing crisis’ effect on student loans. He also supported the 21st Century GI Bill of Rights Act of 2007, which expands the education benefits veterans receive under the GI Bill to restore full, four-year college educations for veterans who served overseas after Sept. 11, including Iraq and Afghanistan. The bill was referred to the House Sub¬committee on Military Personnel.

In terms of the country’s health care shortages, the congressman says the number of student slots at medical schools must increase due to the shortage of physicians in coming years. In 2007, he co-sponsored H.R. 410, the United States Physician Shortage Elimination Act, which would increase the number of doctors entering primary care, especially in underserved rural and inner-city communities. The legislation would reauthorize the National Health Service Corps loan repayment and scholarship programs, increasing funding to $300 million per year through 2011. Ten percent of those funds would be set aside for medical school scholarships. The bill would also reauthorize the Centers of Excellence program and the Health Careers Opportunity Program. These programs increase minority and disadvantaged student representation in health professions through outreach to K-12 students and college students, mentoring and support for enrolled students, and expanded residency training programs and primary care services offered by community health centers. The legislation was referred to the House Sub¬committee on Health.

As a physician, Kagen has found himself legislating on changing medical technology and ethics. In 2007, Kagen joined a bipartisan group of lawmakers to advance stem cell therapy. Kagen voted for legislation to extend funding for stem cell research and institute strict ethical guidelines for stem cell work conducted under the National Insti¬tutes of Health.

In testimony for the bill on the House floor, he referred to himself as "Pro-Cure"—stating the efforts may assist in advancing treatment for Alzheimer’s disease, juvenile diabetes, spinal cord injuries and other conditions.

"Saying no to stem cell progress would be unkind to patients who will benefit from new treatments and potential cures," he told fellow lawmakers. "If one truly cares for life, then one should say yes to stem cell progress. Be not afraid to take this step forward."

Kagen has voted for bills to bring American troops home from Iraq, improve the economy and protect the environment. The legislation that may have had the most significant impact in his term was the Gas Price Relief for Consumers Act of 2008. The House approved Kagen’s act 324-84 in May. The bill allows the United States to sue any foreign country that limits oil production or engages in price fixing to affect competition.

For Kagen to continue to present his ideas for health care reform and other issues, he must first win re-election.

Supporters say the process will be bruising. His district has historically been conservative. The congressional seat was originally vacated in 2006 when Republican lawmaker Mark Green, after four terms, decided to run for governor. (Green lost to Democrat incumbent Jim Doyle.)

This election will feature a rematch between Kagen and his nemesis John Gard, whom he narrowly beat in 2006 to win the House seat. Gard, a Republican, served in the state assembly from 1987 to 2007, the last four years as assembly speaker. Kagen defeated Gard 51 percent to 49 percent, a margin of merely 6,000 votes.

Neither Kagen’s nor Gard’s offices would comment on the coming election for this story, but the race between the two is most likely to be as tight as it was the first time around, said Jeremy Levin, the Wisconsin Medical Society’s government relations specialist.

"It will be an interesting fall for sure."