A country’s illnesses usually reach its parliament late, and by a roundabout route. They show up first in the waiting room and the pharmacy queue, then on the household bill, and only after that, slowly, as a line in a budget debate. This autumn in the United States a group of people who have spent years with the first stage of that journey are trying to cut straight to the last. They are doctors, they are Democrats, and on Tuesday, 3 November, their names will be on the ballot.
Their bet, as Adam Shanks reported for Al Jazeera, is that the backlash against President Donald Trump’s health policies can be turned into votes.
Who wears the white coat
For a long time the white coat in Washington has belonged mostly to one party. Most of the doctors now serving in Congress are Republicans, and so are all four physicians previously elected to the Senate.
That arrangement may be starting to crack. Senator Bill Cassidy of Louisiana, one of the best-known Republican doctors, is stepping down. Senator Roger Marshall of Kansas, another physician, faces uncertain odds of re-election. Coming up from below are at least five Democratic newcomers with medical degrees who want seats in the 120th Congress. Behind them are the nurses: at least 10 Democratic nurses are running for Congress this year, against four Republicans, according to the publication Nurse.org.
Read one way, the numbers are small. Read another, they are a profession deciding it no longer trusts others to write the diagnosis.
Two prescriptions
The doctors do not agree on the cure. In South Carolina, the pediatrician Annie Andrews is [challenging Senator Lindsey Graham](https://en.wikipedia.org/wiki/Annie_Andrews_(physician)) for a seat that would normally be safe for Republicans. She told NewsNation that “Medicare for All”, the proposal for universal public health coverage, is an “outdated, non-pragmatic policy”. Her own programme has a name that sounds more like a clinic than a manifesto: the “Patients and Prices Platform”. She took it around the state on a tour named in the same spirit.
In Michigan, Abdul El-Sayed is running for an open Senate seat and holds the opposite view. He co-wrote a book called Medicare for All: A Citizen’s Guide. There is a small historical footnote attached to his candidacy. Bloomberg Government noted that no Democrat who practised medicine has served in the Senate since 1938, and that El-Sayed would not end that streak even if he wins: he has a medical degree but is not licensed to practise.
What joins them is the bill. The United States has one of the most expensive health systems of any high-income country, and affordability runs through nearly every one of these campaigns. Whatever these candidates think of the hospital’s design, every one of them talks about what the visit costs.
Why we went to medical school
Ami Bera, a Democratic congressman from California and a doctor himself, is running for re-election. He argues that the country has reached a point where it must decide what its health system will become, and that the decision belongs with doctors and patients rather than with the accountants.
“Let’s not talk about reimbursement. Let’s talk about why we went to medical school — we want to care for our patient.”
“Doctors who have practised, have been in the exam room, in the OR [operating room] have a unique perspective on patient care,” Bera told Al Jazeera. “They bring that unique perspective to Congress.”
This year he helped found the Democratic Doctors PAC to push health care up the campaign agenda. Other groups have put in money of their own. The pro-science advocacy group 314 Action said in October that it had spent nearly $30m on the midterms. In its own announcement the group set that figure against MAHA Action, which it said had spent less than $1 million. The comparison was a deliberate jab at the movement built around Robert F. Kennedy Jr.’s “Make America Healthy Again” slogan.
Bera still hopes health care can stop being a battlefield between the parties. “Up until this moment in time, that is what the conversation’s been, right? Democrats defending the Affordable Care Act, Republicans attacking the ACA,” he said. “I think it’s such a crisis moment that it’s opened up the opportunity to think about the ‘what next’?”
Here is a reflection, offered as nothing more. Governments find it easier to talk about reimbursement than about patients, because reimbursement is a column of figures and a patient can talk back. A ballot gives the patient a voice. In the weeks before the vote the White House has been sending checks to Affordable Care Act enrollees, seniors and parents, which suggests it can hear the complaint too.
The health director
Eric Feigl-Ding, the founder of Vax PAC, sees the same opening, and he points to Ohio. There Amy Acton, who once ran the Ohio Department of Health, won the Democratic primary for governor. She now goes into Tuesday’s vote ahead of her Republican opponent, Vivek Ramaswamy. A Marist poll of Ohio voters, taken from 15 to 18 October, gave her 50 per cent among likely voters to his 43 per cent, with a margin of error of 4.5 percentage points. The same poll found that more likely voters, 49 per cent against 45, still expected Ramaswamy to win.
Feigl-Ding calls Acton’s position historic.
“If you think about it, how many times in history does a health director run for governor and win the primary, and is now slated to potentially win the governor’s race?” he asked.
The polls in Columbus close on Tuesday. So do the polls in Columbia, South Carolina, and across Michigan. A health director, a pediatrician, a public-health doctor without a licence and a congressman who still talks about the operating room are all waiting on the same result.