DBR: It’s important to differentiate between legislative advocacy and political advocacy. Supporting specific pieces of legislation is not political, for the most part. You might have to play some party politics to get things passed, but it’s not supporting candidates. When I got involved at the state level, I jumped in with both feet both on the board of the Medical Society Alliance as legislation chair, and on the PAC board. That line has to be very clear because the Pennsylvania Medical Society and the Pennsylvania Medical Society Alliance are not permitted to endorse candidates, while they are permitted to get involved in legislative activities. The bottom line is that, in order for legislative initiatives that are important to medicine to pass, there have to be legislators in place who support those issues and to support what physicians feel is important. What starts out as pure legislative advocacy morphs into political advocacy as the legislators who are helping you need to be reelected so they can continue to do so. It’s an ongoing process and requires physician advocate support at both levels.

DBR: I’m way busier now than in past election cycles. I was peripherally involved in the Mike Eakin for Pa. Supreme Court campaign, passing out brochures to physician offices in my area. That was actually the beginning in Pa. of an upsurge of physicians being willing to get involved with political activity. It was easy to persuade physicians to get involved because we knew that, in order to maintain any kind of tort reform that we were going to be able to get passed, we needed to change the composition of the Pennsylvania Supreme Court so that there was a Republican majority which supported liability reforms. Then, two years later, the Joan Orie Melvin race came up and I worked on that. Judge Orie Melvin came and spoke to a convention of the Medical Society Alliance and we assisted in getting materials out across the state. It’s a very important function because, while physicians often are too busy themselves to run yard signs around their neighborhood, their spouses – and not all of them are wives – tend to have a little bit more leeway to do those kind of things. We rely on that pretty heavily, both when we’re doing legislative issues and some political issues. I also got involved two years ago in the reelection campaign of a local senator who has been a very good friend to medicine, Charles Dent. My husband and I hosted a fundraiser for him in our home, which over 100 physicians attended. We raised $10,000. We had a nice surprise that day as well. Senator Dent told the Mike Fisher for Governor campaign that he was coming to our house and asked if they would like to join him. So, during our fundraiser here at our house the Mike Fisher for Governor bus pulled into our driveway and the attorney general had a beer with us and talked about medical liability reform, and unfortunately is not our governor today.

DBR: I never really intended to get this involved. I always thought legislation was interesting and thought I had the skills to get the membership of the Alliance a little bit more engaged in it because of my background as a journalist. When the medical liability crisis worsened, I started digging in a little bit further because it needed to be done. As a journalist, I was able to put together newsletters to the members, which has now grown to be a much bigger thing: my Liability Updates now go to about 7,000 people every time I email one.

DBR: Right now I’m almost entirely involved in political activity. There’s not much legislative activity going on in Pa. right now because everybody’s out campaigning. The death of the caps bill means that we need to gear that machine back up again next year. In the interim there’s very little else to do at the legislative level, so I’ve focused all of my attention on political campaigns. There are two doctors running for office in Pa. Dr. John Bulger from Montour County, who’s an internist at Geisinger, is running for state legislature against a long-term incumbent, Rep. Robert Belfanti (D-107), who frankly has not been as hardcore against medicine as some other Democratic legislators have been but, as you look at the composition of the state legislature in Pennsylvania, we don’t have any doctors. Most other states at least have a couple of doctors serving in some position in their state legislatures. Much of Dr. Bulger’s support is coming from his fellow physicians. The other physician candidate is Dr. Melissa Brown, who’s a Montgomery Country ophthalmologist. She was a congressional candidate in her district a few years ago and lost narrowly to Joe Hoeffel. She now has the full support of the Republican Party in that area, which she did not have last time, and she has full support of the American Medical Association PAC (while PAMPAC only supports candidates at the state level).

DBR: Largely, I’m getting out the word to other physicians. The Liability Update is an e-mail newsletter that I put out on a fairly regular basis. Because it is not affiliated with any particular advocacy organization, it is not restricted as to whether there’s political activity in them. I’m getting out the word for them on some fundraisers in their areas, and I also work on getting information to them about the medical liability crisis. Dr. Brown often calls me before she has a speaking engagement to get an update on the Disappearing Doctors List, and to make sure she has her facts straight about various issues because she knows I have extensive computer files and can pretty much put my fingers on a lot of information very quickly for her. I’ve also made some financial contributions to the two campaigns.

DBR: Yes, I’m also supporting the candidacy of Joe Peters who is running for Pennsylvania Auditor General. He is a former Scranton cop, has been with the U.S. Attorney’s office, and has promised to audit the MCARE Fund if elected. We have long looked at the billions of dollars expended by the Fund and wondered where it’s gone. Mr. Peters has agreed to look into that and make sure that it’s being run as efficiently as possible. When there’s a huge unfunded liability and spiraling awards being paid out by the Fund, it makes a lot of sense to look at it and make sure that everything is on the up and up. I’m in the process of organizing a physician-based fundraiser for him in the Lehigh Valley and am using the Liability Update to get the word out about his candidacy.

Pa. Senator Dent is now running for the Congressional seat in the 15^th district in Pennsylvania, the open House seat of Pat Toomey, who is vacating after self-limiting to three terms. I will be holding a fundraiser for him at our home. I stood at the Allentown fair and stuck "Dent for Congress" stickers on people coming to the fair. Charlie Dent has always been very open to the physician’s points of view, especially on medical liability reform – he was one of only six Pa. Senators who voted against a watered-down version of Act 13, and he supported the caps bill. I’m also pulling together a fundraiser for the Pa. state legislative campaign of Allentown’s state Rep. Jennifer Mann, a Democratic incumbent who supports caps against the wishes of her party leadership. Jennifer used to be a small businesswoman and is very aware of the way that spiraling insurance costs not only affect the medical profession but affect small business as well.

Because we had worked very hard to get caps passed at the state level and were thwarted, a lot of the focus of Pa. physicians has moved to the national stage. Obviously, we were always aware that liability reform was an issue at the national level – it’s actually a Pennsylvania congressman who proposed the Health Act, which passed the House twice but which has been filibustered to death in the U.S. Senate. With the death of caps in Pa. for at least three years, I think physicians have gotten a little bit more enthusiastic about it happening at the national level.

Because we’ve seen failures to achieve cloture three times now in the U.S. Senate, there are several things that need to fall into place. There are eight key U.S. Senate races this year where it might be possible for Republicans to pick up a couple of extra seats. In order to end a filibuster and achieve cloture in the U.S. Senate, you have to have 60 votes to bring a bill to the floor for debate, and then you need a majority for passage. We don’t have enough votes to get cloture. What we’re hoping can happen in several of the states where there are open Senate seats is that the Republicans will pick up a larger majority in the Senate, which will make it more possible to achieve cloture and pass a medical liability bill at the national level. However, we’re very aware that both John Kerry and John Edwards, during their careers in the Senate, voted against every medical liability bill or every tort reform bill in general. They are opposed to capping awards. They’re opposed to capping attorneys fees. They’re opposed to stopping class action lawsuits. Even if the state medical societies and the other supporters of medical liability reform in the states that have these pivotal seats are able to get Republican senators elected who will support medical liability reform, if John Kerry is in the White House, those measures will get vetoed. And so, many physicians in Pa. have gotten involved with the Bush campaign because President Bush has from the beginning of his administration been very supportive of medical liability reform at the national level, came to Scranton in January 2003 to announce the introduction of Congressman Greenwood’s Health Act and has continued to talk everywhere he goes about how we need medical liability reform so that doctors can keep treating patients.

We created a Pennsylvania chapter of Doctors for Bush and have the participation of physicians across the state who are disseminating information to their colleagues and patients, and who are making sure that physicians are registered to vote. We’re also planning to do a push on absentee balloting for physicians because a surgeon may very well have every intention of voting and gets tied up in the OR.

DBR: The most important thing doctors can do is talk to their patients. Patients do respect them and do like to listen to what they have to say, and we seem to be overcoming physicians’ reluctance to bring that into their offices. We got some materials into physicians’ offices during the Eakin campaign. There were more during the Orie Melvin campaign. People are far more likely to let their political opinions be known now than they used to be. There are still some doctors who don’t want to put materials in their office and don’t believe it has a place there. Certainly, we respect that. But those who have begun to discuss the issues with their patients are very gratified and amazed at how receptive patients are to listening.

Politically, what we have found over the years is that sometimes it’s Democrats who support physicians on health care issues and sometimes it’s Republicans. Right now, because the number one priority to most medically-oriented organizations across the country is medical liability reform, doctors tend to be leaning a little more toward the Republicans. When it comes to political contributions, physicians have never been quite as one-sided as lawyers have been. Physician contributions to political candidates, both through PACs and as individuals, tend to be 60 percent going to Republicans and 40 percent going to Democrats – that’s a national average. I believe in the last election cycle at the national level lawyers had contributed maybe 10 times what physicians did and about 85 percent of trial lawyer money goes to Democrats. So, physicians try to be a little more bipartisan about their approach to political activism. That works in their favor sometimes and sometimes it works against them.

Over the past several years in Pennsylvania, because the Republicans support medical liability reform, physicians have supported Republican candidates. That made it doubly galling for Pa. physicians and others who worked on the issue to watch Senate Bill 9 – the caps bill – go down in flames because Republican chairmen of both the Senate and the House judiciary committees refused to allow the bill to come to a floor vote. Senate Judiciary Committee Chairman Stewart Greenleaf is not up for reelection until 2006, although I do know many physicians in his district who just can’t wait to campaign against him the next time around. Rep. Dennis O’Brien, the chairman of the House Judiciary Committee, is up for reelection but it’s my understanding that he doesn’t have a Democratic opponent in this election, so the physicians in his district can’t even have the satisfaction of going out and campaigning against him.

Helping to support those who support you, and trying to oppose those who don’t support you – doctors frankly don’t have a really good track record of making that happen. But they’re still learning. You have to work hard to get like-minded candidates elected and that’s what the trial lawyers did in the district where Senator Greenleaf and Representative O’Brien served and, even though they were Republicans, those ties and those ideologies were still there. And yet, when you look at how many resources were brought to bear by the trial lawyers association and those who oppose medical liability reform, and if you look at the amount of money that was spent to assure that certain candidates were in office, the doctors probably kicked in less than 10 percent of what the trial lawyers did and yet we almost got a bill passed. What that says to me is that there are legislators in Harrisburg who are doing things not for political support and not to keep a special interest happy, but just because they think it’s right. While the whole experience frustrated me at many levels it also gave me hope that there really are legislators out there who are doing a good job and trying to do what’s right just because it’s right.

DBR: We always need more physician involvement at every level. As much as physicians might not want to get involved in the political and legislative arena, they have to. It’s simply a cost of doing business. The government has been chipping away at physicians’ rights and their ability to impact the way medicine is practiced for many years, and in a lot of cases the doctors who ought to be spelling out those policies and telling the legislators what they need to do, have simply not been engaged.

DBR: I’ve heard from physicians who have said, "I’m sick of it. We worked our tails off. We got nothing. I don’t want to hear about it. I’m talking to a headhunter." The week that Senate Bill 9 was tabled, I got a lot of e-mails from doctors all over the state that said, "I was sticking around just for this; I’m looking now." So, a lot of people have thrown up their hands in disgust and will simply just not be involved, and I believe that those people will eventually not be here. On the other side of the coin are the ones who are angry enough that they’re working harder. I know that there are physicians who have signed up to work with Doctors for Bush who have never been involved in a political campaign before, who have never gone out and done anything like this. We had doctors in white coats standing at the Bush/Cheney Lehigh County Republican booth at the Allentown Fair over the weekend, doing voter registration and doing things that doctors have not in the past been willing to do.