By Melanie Zanona
This article appeared on CQ Roll Call on March 17, 2016.
Just like doctors listen to their patients, diagnose an illness and provide treatment, lawmakers listen to their constituents, identify a problem and offer a legislative solution.
Former physicians and Louisiana Reps. Charles Boustany Jr. and John Fleming each hope the skills they learned as doctors will help propel them to the Senate next year.
The pair are among eight candidates vying to fill retiring Republican David Vitter’sopen seat this November. With one of the few physicians in the Senate—Republican Bill Cassidy — already serving in Louisiana, the race involving Boustany and Fleming increases the odds that two senators in the same state next year will both be former doctors.
That scenario has only occurred three times, but never in modern history: The last time was in 1837 when physicians John Shelby Spence and Joseph Kent both represented Maryland as Anti-Jacksonians in the U.S. Senate.
For all the traits shared between physicians and politicians, doctors represent a surprisingly small slice of the representation in Congress compared to their outsized role in shaping health policy.
Currently only three doctors are in the Senate and 15 in the House, according to a CQ Roll Call tally that excludes optometrists. By comparison, there are 204 attorneys in Congress.
“There are very few doctors in Senate right now,” Boustany said in a recent interview with CQ Roll Call. “When I first ran for Congress and I met (former Rep. Phil Gingrey, R-Ga., and Michael C. Burgess, R-Texas) we talked about if I got elected, there were so few of us that we ought to form a Doctors Caucus. And we did.”
Fleming and Boustany are competing against GOP State Treasurer John Kennedy, tea party favorite Rob Maness, former Republican Rep. Joseph Cao, and Democrats Caroline Fayard and Foster Campbell. Former state Sen. Troy Hebert also is running as an independent.
Louisiana’s top-two system means that a candidate must clear 50 percent of the vote on Election Day, or else the top two candidates — regardless of party affiliation — face off in a runoff election.
Although Fleming and Boustany share the goal of repealing and replacing the 2010 health care law (PL 111-148, PL 111-152) and draw heavily on their medical experience, their legislative styles couldn’t be more different.
Boustany, who is more closely aligned with leadership, touts his role bringing lawmakers together on historic doc-fix legislation. Fleming, who often bucks leadership, prides himself on being an outsider and founding member of the hard-line conservative House Freedom Caucus.
“We are tremendously different. He is much more moderate in his voting record, and I have the most conservative voting record of anyone in our delegation,” Fleming told CQ Roll Call in an interview. “I’m someone who has defied our leadership, and the American people feel like there needs to be a lot more people like me.”
Fleming came to Congress in 2009, just in time to become one of the most vocal opponents of the health care overhaul. The lawmaker says his small-government mindset was shaped by his experiences as both a physician and a businessman.
The Meridian, Miss., native said he had wanted to become a doctor since age 11, when he was inspired by his grandmother who was a nurse. Fleming served six years in the Navy Medical Corps practicing family medicine before setting up his own practice in Minden, La.
He also opened up the first Subway sandwich franchise in the state.
“Nobody had ever heard of it,” Fleming recalls. He now owns 40 shops, and also is a sub-franchiser of The UPS Store.
“I found myself not only delivering health care, but also providing coverage to them as employees,” Fleming says. “And that gave me a very unique perspective on health care and health care reform.”
Fleming advocates for a private insurance system in which people would have health savings accounts. He is a co-sponsor of the Republican Study Committee’s health care plan (HR 2653), which would entirely repeal President Barack Obama’s signature domestic policy achievement and replace the law’s tax credits to help people pay premiums with tax deductions for purchasing insurance.
The RSC blueprint also would use high-risk pools for individuals with pre-existing conditions, overhaul medical malpractice laws, and increase the contribution levels allowed in flexible saving accounts and HSAs, among other things.
“If you make it more affordable and more attractive, people will voluntarily purchase it,” Fleming says. “You don’t have a law that says people have to buy cars.”
Fleming has sponsored bills to dismantle the health care overhaul (HR 370) and opposed the deal that ended the government shutdown in 2013 because he said it didn’t do enough to curtail the health law. He also led the charge to oppose any government spending bill that funds Planned Parenthood after sting videos about the family planning plan group were released in summer 2015.
Fleming is encouraged, however, that Congress for the first time sent a repeal measure (HR 3762) to Obama’s desk this year through the process of budget reconciliation. Even though it was vetoed, he hopes to repeat the process next year.
Fleming, a self-professed “ideas” man, says he is interested in allowing veterans to seek certain health services from local physicians and hospitals; enhancing research for cystic fibrosis, a condition that his grandson has; and promoting telemedicine and other innovative delivery methods, or what he like to calls the “uberization” of health care.
Workhorse With a Track Record
But Boustany is quick to point out that unlike some of his opponents in the Louisiana Senate race, Boustany has a track record of successfully passing legislation.
“One of the key distinguishing factors for me, especially with regard to health care, is the fact that in my time here in the House I’ve actually gotten legislation passed," he says.
Boustany, the oldest of 10 children and son of a doctor, grew up in Lafayette, La. After medical school, he completed residencies in both general surgery and cardiothoracic surgery — another factor he says separates him from the pack. He then opened a medical practice in his hometown.
“Many of the doctors who have come into Congress represent primary care fields. I dealt with complex cardio and pulmonary conditions,” Boustany says. “So I have a good handle on how to get costs under control that some of the others may not have.”
Boustany served on nonprofit boards and the local chamber of commerce, which helped him transition to Congress in 2005. Like Fleming, Boustany says he got into policy because he was “increasingly concerned about all the problems in our health care system.”
Perhaps one of Boustany’s biggest legislative achievements was helping overhaul Medicare’s oft-criticized physician payment formula, an issue known as the doc fix.
The effort was years in the making — Boustany recalls working right after Christmas one year — but Congress finally passed a permanent fix (PL 114-10) in spring 2015.
“Even at times when the whole effort was getting ready to fall apart, I’m proud I was able to provide some glue to keep everybody together,” he says.
Boustany continues to call for repealing the health care law, saying he favors health savings accounts and more competition among insurers and providers.
As a member of the Ways and Means Committee, Boustany has focused his attack on the taxes in the law, as well as advocated for Medicare changes that emphasizequality over quantity. The tax-writing panel is involved in ongoing GOP efforts to propose a health care replacement plan this year.
He has sponsored a stack of bills (HR 4689, HR 3320, HR 1863) on veterans’ health care issues, with a focus on reducing waste and increasing transparency within the Department of Veterans’ Affairs, and says he was instrumental in gettingtwo VA clinics opened in Louisiana.
After he gave the Republican response to Obama’s joint session to Congress in 2009, Boustany says he started receiving calls from physicians all around the country seeking advice about running for office.
He says he helped several colleagues become lawmakers —including Fleming and Cassidy.
“A medical background is very helpful,” Boustany says. “We’re very good at listening, then using that information to diagnose a problem.”