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March 3, 2014 by Thomas Hauber

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It’s pretty clear the Republican Party is pinning its hopes on regaining control of the US Senate on a successful criticism and hopeful repeal of the Affordable Care Act (ACA). An interesting part of that strategy is coming from within the medical profession itself, doctors running for Congress, thirty of them in all, 24 Republicans.

There are already three medical doctors in the US Senate, the most since 1925, Tom Coburn (R-OK), John Barrasso (R-WY) and Rand Paul (R-KY) an opthalmologist. In at least three states, Louisiana, North Carolina and Oregon, medical doctors are posing a serious challenge to Democrat-held Senate seats. In those three races, all incumbents were strong ACA supporters, their physician opponents are uniformly calling for its repeal.

There is an implicit assumption here that doctors, due to their unique experience, are best qualified to criticize, assess and fashion a cure for what ails healthcare in America. We should seriously listen to what doctors think, though privately be suspicious that the profession is self-serving and predictably protective of any threat to its livelihood.

Opinions from doctor friends vary greatly on the ACA, from full-blown advocates for single-payer national health insurance to ardent opponents of any meddling with the pre-ACA status quo. The stance of Republican candidates, doctor or not, is strongly anti ACA. Take Oregon for example.

The current Democrat incumbent, Jeff Merkely, was elected to the US Senate in 2008, clearly an Obama year, but Oregon is hardly solid Blue, historically more like Purple. Merkely defeated two-term Republican senator Gordon Smith by a relatively slim margin, 49% to 46%, with 5% of the vote going to the ultra-right, pre-Tea Party Oregon Constitutional Party. In modern times, Oregon’s senators were Republican: Smith’s two terms, Mark Hatfield (5 terms), Bob Packwood (41/2 terms), and Wayne Morse (4 terms, despite his party switch in 1955). 

Merkely has amassed a solid liberal voting record, has out fund-raised all the Republicans combined and remains the early favorite, but is seen as vulnerable as an outspoken supporter of the ACA, and the even more disastrous rollout of the “Cover Oregon” exchange. Two major candidates are vying for his seat and Republican nomination, main-line Conservative and State Congressman Jason Conger and the somewhat more moderate Portland neurosurgeon Monica Wehby. 

Smith in defeat was clearly not Conservative enough for the party in ’08. His support dropped suddenly near election day as he opposed increasing troop levels in Iraq and cozied up to Obama with partial support for certain gay rights and immigration issues. The problem in ’08 is the same problem facing Republican moderates like Wehby. Until recently her position on the ACA was essentially that of the AMA, where she held State and National offices, i.e. the ACA is law but needs reform by market-based solutions, the system-increased efficiencies, medical liability (tort) reform, tax breaks and use of HSAs. Under pressure from Conger, she has recently called for the ACA’s repeal. Where Wehby is seen as the ACA waffler, Conger is the Crow.

Conger is a Conservative state legislator whose main support comes from Central Oregon  (Bend) with its rural red-state perspective. Conger sees Wehby as a RINO, whose pro-choice stance and softer appeal is incompatible with traditional Conservative issues, strong defense, limited Government, balanced budget amendment, gun rights, pro-life and strong initial opposition to the ACA. Conger is clearly the attacker, challenging Wehby’s every statement and calling for one-on-one debates. What is becoming apparent in the fund-raising department is Wehby’s potential national support. 

Wehby had out-raised Conger better than 2-1, with half of her money coming from out of state, including the AMA and Senators Dr. Tom Coburn (R-OK) and pro-choice Susan Collins (R-MA). Is this indicative of support from the National Republican Senatorial Committee (NRSC), who above all wants a win?  Or will the NRSC let them fight it out?  Wehby’s candidacy begs obvious questions about the future of the Republican Party and whether there is a future at all for pro-choice candidates. Of the twenty female US Senators, only four are Republican. After the retirement of Olympia Snowe (R-MA) only Collins and Lisa Murkowski (R-AK) will be pro-choice. With Gallup reporting Oregon as the 5th least religious state, Wehby’s pro-choice position could be a positive in the general election, but with Oregon’s closed primary, a negative with the party faithful in the upcoming primary election.

In the end it’s all a numbers game. Nowhere is the urban-rural divide more apparent than in Oregon unless it is nearby Washington State. where it is said all the votes Democrats need for national office are visible from the Space Needle. So it is in Oregon. Multnomah Co. (Portland) and Lane Co. (Eugene), Oregon’s most liberal and urban counties, provided 40% of all votes cast for Merkely, tromping Smith by a 68-32% margin.

This is a problem Conger must recognize intrinsically. But Merkely’s narrow 2008 victory gives pause as does the real voter effect of the poor ACA and “Cover Oregon” rollouts – media hype or true voter dissatisfaction. Note: of West Coast states, Washington and California have female senators. Can an accomplished pro-choice Republican female with a moderate streak be a contender in Oregon? First she must win the closed Republican primary. More later.

There are other important issues this November beside the ACA and the right-to-life: foreign wars, tax and immigration reform, and the future of Medicare and Social Security. One hopes the race for the US Senate would focus on a broad view of the public interest, but don’t count on it.

 

 

 

 

 

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