Photography By: Tracey Brown
Maryland Physician recently interviewed Congressman Andy Harris, M.D., (R), a practicing anesthesiologist committed to healthcare issues.
When in your career did you decide to become proactively involved in politics?
I’ve always been interested in politics because my parents are both refugees. My father spent several years in the Soviet Gulag for being anticommunist and experienced a political system out of control, so they understood the importance of being involved. In 1998, I was on the faculty at Hopkins and involved with my state anesthesiology association and realized that an opportunity existed to get into elected office. I ran, and served for 12 years in the Maryland State Senate.
What are your priorities as a physician in Congress?
As government becomes more involved in the process, we actually have a decline in quality and access to healthcare. As Medicare policy becomes more cumbersome, access is decreasing… because the government’s response to a budget crisis is always to decrease payments to providers. It’s what I call back-door rationing. You can see a physician, but you have to wait in line long enough. We know that Medicaid is in the same situation, that only 42% of specialists will see a Medicaid patient. That’s not a system we ought to promote and progress to.
What are your suggestions to get Maryland physicians to take a more active role?
They just have to get involved. We don’t go to medical school to learn how to advocate in the legislature. But because the legislature has gotten so involved, part of taking care of patients now is making your views heard in the legislature. Along with being involved in specialty societies, take time off to make your views known to the people whose policies will have incredible effects on your practice.
Have you seen an increase in activism by physicians?
Overall, nationally, more physicians are ‘getting it’ – that you really do have to be involved. Medical schools now frequently include courses in advocacy. The system is kind of stacked against patients because they don’t have time to go and express their opinions to legislators. Insurers or legislators can’t be their advocates because balancing a budget is almost diametrically opposed to guaranteeing access. When I was in the legislature, every year when the budget was deficient, they would pick a provider class and decrease payments to them. The end result is that, if you have a Medicaid card in Maryland, you almost can’t go to the physician of your choice and you’ll end up in a managed care panel. We should do better.
How do you stay in touch with physicians and what they need?
I’m still active in the national anesthesiology society and still maintain my license. Ten days a year, I’m in a hospital with my colleagues. I’m also invited to societies around the country to address the issues, so I’m frequently in touch with physicians. Recently, I was in Texas addressing and listening to the concerns of their medical society. They have huge drug shortages that are really beginning to impact care.
One of the causes of the shortages is that the regulatory environment is so unfavorable for drug manufacturers. When the new FDA ratcheted up the regulatory warnings, and there were three to four times as many warnings in its first year, companies decided to stop production. We effectively restrict what companies can charge, through a variety of schemes that include what the federal government will pay.
When you make it economically unfavorable to make a drug, usually generic drugs, companies stop making them. Take epinephrine, we have shortages of this very inexpensive drug because companies don’t think they can make enough money on it. As government has gotten more involved, and not being willing to restrict tort, you have the logical conclusion that the company decides to make something else.
I think there’s a bright future for biomedical research and pharmaceutical innovation. But we have to be mindful of the fact that when you place a 2% tax on medical technology, you get less medical technology. That’s one of things that the ACA [Affordable Care Act] taxed. It’s an interesting policy judgment.
Maryland is actively involved in stem cell research, with support from the 2006 Maryland Stem Cell Research Act. What’s your opinion of this?
The moral question is whether we should do stem cell research with your own cells or with embryonic cells from someone else. Since, in the long run, the solution is going to be using your own cells … are we losing opportunities if we look at [using embryonic cells]?
Embryonic cells are totipotent because they can become any organ… We need to get other cells back to the stage where we can turn their genes on and off. I’m convinced we’ll be able to do that. So to me, that’s where the focus should have been because there’s so much controversy the other way… We’re just not smart enough to figure it out how to do it yet.
Are there any aspects of the ACA that you support?
I’ve long supported healthcare reform. There are two aspects of the ACA I do support, [though not on a federal level]. One is coverage for people with pre-existing conditions – everyone has or will have a pre-existing condition at some point. In Maryland, we’ve solved this. If you have a pre-existing condition, you’re guaranteed health insurance. You have to go to the Maryland Insurance Commission site. I supported that concept when I was in the state legislature, because insurance fails when someone is uninsurable. I think that 35 states already have high-risk pools; we just need to incentivize the other ones.
The other thing is, I think we should require all insurers to offer a policy for children up to age 25. However, I believe that, in general, state solutions work better than a centrally imposed federal solution…If a state is not doing a good job, the federal government can incentivize them to. We can do it through the states without a single, one-size-fits-all mandate. In Massachusetts, for example, they decided they want universal coverage and that’s fine. But to impose their system on another state where people don’t feel quite the same, that’s not the way the country should be set up.
Do you support H.R. 5707 (Medicare Physician Payment Innovation Act of 2102) to repeal the SGR and reform Medicare?
The problem is that, whenever you put healthcare in the federal government and they have a budget problem, they cut payments to providers. This is what happened with SGR. When they ran out of money, they decided to automatically cut payments to providers and it’s accumulated over time…
It’s a real quandary. We will never cut that reimbursement rate and we shouldn’t. Seniors understand what the result of that will be – that their physician will no longer be able to afford to see them. Congress did what it’s famous for – kick the can down the road and the cliff gets steeper and steeper.
The 10-year cost of fixing SGR is over $300 billion. We have many competing demands for that money. The best we’re going to get right now is a solution one year at a time. H.R. 5707 proposes to use the savings we get by not spending money in Iraq and Afghanistan… but it’s not real dollars, so this bill doesn’t get to the core of the problem. As a society, we have to decide what level of care we’re going to provide to our seniors and how to make it solvent. The current Medicare system is not going to guarantee access for seniors. We have an aging population and we’re not tremendously expanding the number of physicians. 10 to 15 years from now, it’s likely that most primary care will be delivered by mid-level providers.
If there’s a push to train more primary care physicians, we’ll have a shortage of specialty physicians. As people age, they require more specialty care, so we shouldn’t pretend that that shortage is not going to exist. From the government’s view, that shortage controls costs – you end up waiting longer to see a physician. We should have a discussion – do we want to control costs by controlling access?….
What are your views on tort reform?
I was an obstetric anesthesiologist who finished my training in 1984. At that time, a solo practice obstetrician who was covered every other weekend was treating my wife. When it’s time for my daughters to go to obstetricians, they will be in large groups and if they’re lucky, they might see the same person twice. That’s because obstetricians are worried about getting sued and can’t afford the insurance. The answer? You have to go to systems. In the Maryland legislature, I proposed a bill that took cerebral palsy off the litigation table by forming a fund that would pay for care for that child without assigning blame. But until we can overcome advocacy by the trial bar, the problem will continue.
These are bipartisan issues. Neurosurgeons face the same problem. My first idea to solve this is to take litigation off the table for government patients (Medicare or Medicaid). The other thing is we have to put common-sense limits on non-economic damages. We should probably start with ER, obstetrics and neurosurgery. We have changed the way healthcare is delivered as a result of tort liability, and it’s not been for the good.
Andy Harris, M.D., is an anesthesiologist and the Congressman for the 1st Congressional district of Maryland. He previously served as a Maryland State Senator. He serves on the Transportation and Infrastructure, Natural Resources and Science, Space and Technology committees.