Doctor, my eyes

From a Filipino independence leader to Syrian dictator and libertarian US senator, Sally Tyler takes a look at the political visions and impacts of eye doctors who’ve swapped patients for politics.

I recently found myself in Manila on the annual holiday commemorating Jose Rizal, so I decided to learn more about the Filipino national hero. A physician who turned to fiction to ignite the patriotic passions of the Filipino people, his novel, El filibusterismo (or The Reign of Greed in English), is required reading for all schoolchildren there. What caught my eye (so to speak) was Rizal’s chosen medical specialty – ophthalmology, which focuses on the eye and its diseases.

The eye is a wondrous chamber, and, for most of us, the gateway to our perception of the world. The skill necessary to preserve or restore the gift of sight is special, and I wonder if those ophthalmologists who have entered the political fray bring any unique insight.

The effect of such insight may manifest itself in vastly different ways. Case in point: Bashar al-Assad practiced as an ophthalmologist before inheriting his father’s mantle as Syria’s dictator. Whereas, Rizal used his vision of Filipino self-determination to inspire an independent nation, Assad has turned a blind eye to the suffering of his people, particularly in Aleppo.

In the US, the most prominent ophthalmologist-turned-politician is Republican Senator Rand Paul. His self-proclaimed libertarian principles lead him to occasionally buck his party’s leadership on issues such as drones and Syria. But, he frequently allows any independent vision to be subsumed in favour of the party line, and is a reliably partisan Republican vote.

Last week, however, Paul became the first Republican member of Congress to officially break rank to say that he will not vote for repeal of the Affordable Care Act (Obama’s health reform law) without first establishing a legislative replacement. With 52 Republicans in the Senate, it will only take two others to join him to hand Democrats a win in the first skirmish of what will be a multi-year resistance to the Trump agenda.

Yet, the incoming president has made it clear to party leaders that the initial repeal (couched awkwardly in a budget resolution projected to add $9.7 trillion to the federal debt) will be a blind loyalty vote, setting the tone for his congressional interaction. Accordingly, Senate Leader Mitch McConnell is under enormous pressure to keep his people in line.

A small number of other Republican senators have now begun to publicly question the wisdom of overturning the law without a replacement, though none have yet joined Paul in actual refusal. These senators are primarily from rural states, where many of the 20 million individuals receiving health care coverage under the law reside; and where blowback to repeal, even among Trump voters, is building. Members of Congress will soon find out that once access to health care has been extended to millions of people who have not experienced it in their adult lives, a rollback is difficult.

A parallel can be found in Thailand, where several iterations of Thaksin opponents were unsuccessful in dismantling the former prime minister’s 30-baht health scheme. Try though they might to denigrate the program by linking it to the exiled former leader (much as US Republicans have always called our law by the “Obamacare”perjorative), the program proved so popular with those who benefitted from it that the notion of access to health care for all became firmly established within the Thai populace. So much so that the scheme’s minimal co-pay was eventually abolished to make way for free health care for most low-income Thais.

In the US, this upcoming blind loyalty vote has enormous stakes, threatening to make 20 million Americans worse off than they were when the law was passed in 2010, when medical debt was the nation’s second leading cause of bankruptcy. Additionally, the Commonwealth Fund projects that the law’s repeal will cause the loss of 2.6 million jobs by 2019.

Over the weekend, Trump personally called Paul to pressure him to return to the fold, and the senator emerged from the conversation with statements that an effort to repeal and replace would be made simultaneously this week. This indicates that shell replacement language may be tacked on to the budget, yet the law’s scope and complexity will require months of careful legislative drafting to effectively replace. If Republicans vote for such a sham replacement, they will be goose-stepping off a cliff, not knowing whether a lake or concrete slab will break their fall.

Whether Paul maintains his independent vision in opposing repeal without replacement, or whether he will acquiesce to the demand for party unity in the new administration’s first turn at bat is a major question. Certainly, as a physician, he should be guided by the principles of the Hippocratic Oath. Perhaps, now is the time for all members of Congress to look to its first tenet for wisdom in this vote; First, Do No Harm.

Sally Tyler is an attorney and policy analyst, based in Washington, DC. She holds degrees from Emory University, and from Harvard’s Kennedy School of Government.