Minnesota anesthesiologist Mark A. Warner freely admits he doesn't know who represents Eastern Maryland in Congress. But he knows who he wants for the job: Andy Harris, the Republican challenger to Frank Kratovil, the district's Democratic incumbent.
In his second run at the seat he missed narrowly two years ago, Harris has worked hard to raise money from fellow doctors around the country. Anesthesiologists from at least 39 states and the District of Columbia have responded by pumping more than $250,000 into his campaign, according to Federal Election Commission records, making them far and away the largest single interest fueling Maryland's most competitive House race.
About one in five dollars donated by individuals to Harris' 2010 candidacy has come from medical professionals, according to the nonpartisan Center for Responsive Politics, which tracks money in campaigns. Virtually all of that was given by anesthesiologists, one of the most politically active medical specialties.
Health care is likely to be back on the agenda in Washington next year, regardless of who controls Congress. And anesthesiologists are under growing pressure in an emerging debate about slowing the rising cost of care.
"It's important that we have somebody there [in Congress] who can be sitting at the table, not to represent the views of any particular group, but who understands how health care is delivered," said Warner, president-elect of the American Society of Anesthesiologists.
Harris, an obstetric anesthesiologist at the Johns Hopkins Hospital, has attracted more campaign cash from health professionals than any other House challenger in the country — a field of hundreds, including 17 other physicians — according to a CRP analysis of FEC data.
The veteran state legislator from Baltimore County says he's grateful for the anesthesiologists' support, but says he would not put their interests above those of his district. Still, he added, that "whenever a physician goes to Congress, they represent the interests of their patients as well as their constituents."
Harris said he solicited campaign contributions at anesthesiology conferences in Louisiana, Georgia, Florida and Tennessee. He networked with members of the Texas Society of Anesthesiologists at a San Antonio resort last September; since then, he's received more than $31,000 from Texas anesthesiologists.
In Nashville, he addressed a Tennessee Society of Anesthesiologists meeting on "emerging issues in the practice and regulation of anesthesiology." Before leaving town, he had raised at least $13,500 for his campaign from members of the doctors' group.
Harris also received valuable help from the national anesthesiologists association. Its political arm, which prides itself on being the largest medical-specialty PAC on Capitol Hill, spent $64,150 for ads promoting his candidacy during the Republican primary, FEC records show.
The simplest explanation for all this activity by anesthesiologists is that Harris is one of their own. If elected, it is believed that he'd become the first anesthesiologist to serve in Congress.
"As a doctor, Andy Harris knows better than most what we need for real health care reform," said the anesthesiologists' 60-second radio ad, which, by law, had to be produced independently of the Harris campaign.
It is the only campaign commercial the anesthesiologists' PAC has sponsored anywhere in the country this year. The PAC also gave $10,000 to Harris, the maximum allowed by law.
At the same time, a long-running feud between anesthesiologists and the specialized nurses they often supervise in administering anesthetics has spilled over into the Harris-Kratovil race.
On one professional forum online, a writer, who described himself as an attending physician and personal friend of Harris', solicited campaign contributions as a way of fighting what he termed "infringement" by the nurses on anesthesiologists' business.
Harris "is an anesthesiologist who will fight for our cause!" wrote the poster, identified only as IN2B8R. "He is a guy who can tremendously help our specialty, I hope he wins this time around!"
Kratovil has also sought to cash in on the medical industry turf war. His campaign set up a separate web page for nurse anesthetists — who often use the acronym CRNA, for certified registered nurse anesthetist — to contribute to his candidacy. Campaign manager Jessica Klonsky said it had attracted "a smattering" of $25 and $50 donations.
A nurse anesthetist in Arizona linked to the Kratovil site on a Facebook page for the nurses.
"CRNAs from around the country need to help Frank Kratovil stay in Congress to ensure that CRNAs continue to have a friend, as opposed to an enemy, on Capitol Hill," wrote Mike MacKinnon of Glendale, Ariz.
The political arm of the American Association of Nurse Anesthetists has given Kratovil $10,000, a donation that didn't escape Harris' notice.
"We did find it a little interesting that, at one point, Mr. Kratovil's campaign was the only campaign that they had contributed the maximum to," Harris said.
A Washington lobbyist for the nurse anesthetists, Frank Purcell, denied that the Kratovil-Harris contest is a proxy for the conflict between his group and the anesthesiologists. He said the nurses' PAC contributed to the incumbent because Kratovil is "a strong independent voice for rural Maryland communities."
Nurse anesthetists want greater professional autonomy in part because they are sometimes the only ones available to administer anesthesia in rural hospitals. But that has not been an issue in Maryland, according to officials of the state nurse anesthetists association.
It's unclear whether health care issues will influence the outcome of the election. Republicans, who are expected to gain House seats in November, set a goal last week of repealing the recently enacted health care overhaul. Harris, who has represented the suburbs north of Baltimore in the Maryland Senate for the past 12 years, has been campaigning for repeal. Kratovil voted against the measure in the first place.
Regardless of what happens with the health care law, controlling medical costs is considered vital to restraining long-term government spending, which both parties say they want. The fight over anesthesia care is becoming part of that debate because it involves money.
Anesthesiologists make at least twice as much annually as nurse anesthetists — averaging roughly $350,000 to about $150,000 for the nurses — a difference that results in part from government regulation.
The nurses argue that they can give anesthetics at a lower cost without sacrificing safety, and cite research studies to back up the claim. Anesthesiologists contend their additional training as physicians offers patients an extra margin of security in case something goes wrong. They say physicians should continue to supervise nurses at hospitals and other surgical centers in treatment that involves reimbursement from Medicare and Medicaid.
In 2001, the Baltimore-based Centers for Medicare and Medicaid Services began letting states opt out of government rules requiring physician supervision of nurse anesthetists. To date, 15 states have done so; Maryland has not.
Nurse anesthetists say if they were free to work without physician supervision everywhere, it would help bring health care costs under control.
Those with experience in the field believe any decision to ease federal regulation of anesthesiology would likely come not from lawmakers, but from officials of the Medicare-Medicaid agency. Thomas A. Scully, who worked out the current compromise over anesthesia supervision when he headed the agency from 2001 to 2003, said there was "not much" likelihood that Congress would act to change the rules.
Paradoxically, the steady flow of campaign funds from both camps might be an incentive for lawmakers to stay out of the fight. As long as the battle continues, the politicians can continue to collect contributions every two years.
The anesthesiologists, who put more than $2 million into their national election fund in 2008, have been urged to keep giving as the midterm election approaches so their PAC can remain in first place among medical specialties.
An anesthesiologists' association official, in a presentation used to raise money for the 2010 election, warned that rival medical lobbies were "fully engaged" in the political arms race and took note of the $704,000 the Nurse Anesthetists PAC had already gathered to pass along to candidates.
"You can be assured that the nurse anesthetists will continue to raise vast amounts of money. We cannot afford to rest," advised the anesthesiologists political unit.
Doctor in the House?
Republican congressional candidate Andy Harris is trying to become the first anesthesiologist elected to Congress. Members of his medical specialty have opened their wallets and made him the nation's top House challenger in donations from health professionals. One in five dollars raised by Harris from individual contributors has come from fellow doctors.
Incumbent Democrat Frank Kratovil has received a much smaller amount from certified registered nurse anesthetists, who are in a long-running battle with anesthesiologists over practice issues.
Health Professional contributions (includes anesthesiologists)
Contributions from other medical interests (employees of hospitals, nursing homes, HMOs, health service, pharmaceutical and health product companies)
Source: Center for Responsive Politics