Why a Doctor in Congress Has No Health Insurance
By: Jill Lawrence
August 5, 2009
Rep. Steve Kagen is a doctor, a Democrat and, as far as his office has been able to determine, the only member of Congress who does not have any kind of health insurance. The way he describes it, it happened as an afterthought. It was late 2006. He was finishing his new-member orientation in the basement of the Cannon House Office Building and hurrying to make a plane. A woman stopped him and said, "Hang on a minute — don’t you want to hear about the benefits?" Then, he recalls, she showed him "a whole cafeteria" of health insurance plans available to him and his family because he was now a federal employee.
"I told her, ‘I’ve got a plane to catch. If you can make that same offer to everybody I’m representing, then I’ll accept it.’ Then I turned to walk out," the Wisconsin allergist told me in one of two phone interviews this week. "It didn’t seem right. It didn’t feel right to me that I was being offered something that wasn’t being offered to the people I was representing."
Kagen, 59, practiced medicine around Green Bay for 30 years, treating allergies, asthma and immune disorders. Along the way he did groundbreaking research, established his own lab and consulted for CNN. He ran for Congress in 2006, he says, spurred by difficulties his patients were having. Some were being dropped by insurance carriers. Others were struggling to pay for medications. "They could not afford to breathe," he said.
As a member of Congress, Kagen has helped shape the debate over health care. Last year, for instance, he introduced a bill to end discrimination by health insurers. That’s been a central talking point this year for President Obama and other reform proponents.
This week Kagen fell victim to one of the unruly crowds confronting Democrats at their town meetings this month. "Shouting overwhelms Kagen forum on health care," the Green Bay Press Gazette headlined. "Angry crowd packs library." The loud, disruptive conduct brought police to the scene and caused some seniors, who merely wanted information, to cover their ears, according to the newspaper. You can see part of the meeting here.
"Some people came to talk and not to listen," Kagen told me Tuesday. "We call it the Wisconsin way, to be civilized and shake everybody’s hand even if you disagree with them. I think they had some different ideas." He added that "some were and some weren’t" from his district, but declined to discuss whether they were part of a national effort by conservatives to disrupt meetings and kill health reform.
Republicans call these events "recess roastings." Democrats call them "mob rule." Either way, they seem strangely removed from the realities of American households struggling to get coverage or pay for care, and from Capitol Hill, where members of Congress are toiling to fix big gaps in the system without plunging the country further into debt.
Kagen doesn’t fall into a gap. He’s eligible for health coverage under the Federal Employee Health Benefits Plan that’s often held up as a model for the choices everyone should have. Many employers only offer one plan. In Wisconsin, I count 15 different plans available to federal employees in the state.
But on principle, Kagen declined them and all other coverage. His oldest child, a 28-year-old nurse-practitioner in Miami, doesn’t have insurance either; she can’t afford it. Kagen’s wife and three college-age children are covered by a family policy, purchased by his wife, that does not include him. "I am literally naked, without coverage," Kagen said. "That gives me a lot of motivation to solve this problem. If everyone in Congress relinquished coverage, we’d get real progress in weeks."
Of course, he has a few advantages many people – including many members of Congress – don’t have. He’s in good shape, "healthy as a guy can be for almost 60." He’s also well off, so high costs won’t necessarily ruin him. Still, if catastrophic illness strikes, he said, "I’ve got a real problem."
Beyond money and good health, Kagen has the stature of being a doctor, first-hand knowledge of federal programs and a good sense of how much procedures really cost. Case in point: Kagen had knee surgery in January. He was going to be billed $1,400 for the MRI. "I said, ‘I don’t have insurance — what do you accept under Medicare?’ I negotiated a better price," he said. "Same for my surgeon. He couldn’t tell me the price because he didn’t know. I said, ‘This knee is pretty bad. Why don’t I try it before I buy it?’"
What he meant was, he would negotiate a price after he saw the results. How’d that work out? "Instead of $8,400, I paid $4,200," Kagen said. Would a civilian – not a doctor, not in Congress– be able to bargain with doctors and hospitals that way? "I don’t think people understand the power that they have in terms of bargaining for a price," Kagen said.
He added that everyone will benefit from competition when they are finally able to comparison shop in "a medical marketplace." The marketplace, or exchange, has broad support on Capitol Hill and most versions of health reform include a public plan to compete with offerings from private insurers.
Kagen comes from what’s considered a swing district. He beat Republican John Gard in 2006 by 51 percent to 49 percent, having spent $2 million of his own money and ridden that year’s Democratic wave. Two years later Kagen rode another wave to a 54 percent victory in a rematch with Gard. But the 2010 elections are shaping up as dicier for Democrats, given the national recession and Obama’s ambitious, expensive agenda.
Conservatives like to attack one element of that agenda, the public insurance plan, as socialized medicine and government control of health care. Kagen supports a competitive public plan on a level playing field with comparable private plans. I asked if he fears being attacked as a big-government socialist. He responded by describing his health advisory committee composed of "Republicans, Independents and Democrats, health care people, consumer advocates and United Way." The group came up with 10 essential elements of reform that he says are his "marching orders." Eight of them are in the landmark bill approved last week by the House Energy and Commerce Committee. Most forecasters predict Kagen will win a third term.
As Kagen was riding to Green Bay on Monday for what would turn out to be his "roasting," I asked him if he thought his colleagues should take more risks when it comes to health care legislation. "I would reassure my colleagues and my patients and my constituents that we are a nation of written laws, not jungle laws," he said. "We’re a nation that thinks things all the way through. We don’t shout in the movie house about a fire. And any member of Congress shouldn’t misrepresent the truth. We have to understand how important it is to listen to one another and be able to solve our problems with conversations, not confrontations."
That was exactly what didn’t happen in Green Bay. Reflecting on the experience later, Kagen said people were angry and "they fear somewhat reasonably that there’s a rush job going on." They don’t want unintended consequences, he said, and they do want explanations.
Kagen had a "much more cordial" town meeting Tuesday morning in Appleton, his hometown. On Wednesday, he had two more on tap in Oconto Falls and Marinette. At some point he’ll return to Green Bay. "This is not a scary movie," he said. "This is a constructive conversation about the most important thing we’re going to be talking about in Congress in this century."