Price has long opposed government role in health care

Tom Price – congressman, orthopedic surgeon, warrior against government intrusion into medical care – was three minutes into a speech condemning the Affordable Care Act when he asked his hotel ballroom audience of physicians whether they all were on the list to get emails from the federal agency overseeing Medicare and Medicaid.

“If you’re not, you ought to get on it,” Price said. “Because, you know, everyone needs a good dose of nausea every now and again.”

The Georgia Republican had already been a House member for a half-dozen years when he made the wisecrack at the 2011 annual meeting of a conservative fringe medical group to which he belongs. Now that he appears on the cusp of Senate confirmation as the Trump administration’s Health and Human Services secretary, such remarks and his affiliations over a long career in medicine and politics shed light on the intensity of his beliefs – and show that he would lead a department whose mission and bureaucrats he has repeatedly deplored.

The group, the Association of American Physicians and Surgeons (AAPS), holds positions that are at wide variance with basics of federal health policy. It opposes Medicare, the government’s health insurance for older Americans, and it offers extensive training to doctors on how to opt out of the program. It also opposes mandatory vaccination as “equivalent to human experimentation,” a stance contrary to requirements in every state and recommendations of major medical organizations and the federal Centers for Disease Control and Prevention.

Such positions are part of an underlying credo, which Price has long espoused, that doctors should be autonomous in treating their patients – free from government rules, medical quality standards, insurance coverage limits or certain kinds of legal punishment when they make mistakes. The congressman’s ardent hostility toward the Affordable Care Act, before its passage in 2010 and ever since, springs from that credo’s antigovernment aspect.

Elements could be heard when Price testified last month at his confirmation hearing before the Senate Finance Committee. “Anything that gets in the way of the patient … their families and physicians making the decisions about what kind of health care they desire,” he said, “we ought not go down that road.”

Such lexicon dovetails with the motto of the AAPS, three Latin words that translate into “all for the patient.”

While Price has long been explicit about his views, it is less clear how the sprawling Department of Health and Human Services would be affected if he is confirmed, as expected, in a Senate vote scheduled for early Friday morning.

“I’ve seen people with extreme views come into government and take the position very seriously, and I’ve seen people with extreme views come into government and pursue their specific interests,” said Dan Mendelson, president of Avalere Health, a Washington-based consulting firm. “So I don’t know which model will play out here.”

For now, Mendelson said, he is seeing an uptick in job applications to his firm from HHS employees. “A lot of the best and brightest in government are starting to look, because they are worried about their operating environment, whether they can do their jobs.”

Price was not available to comment for this story. Instead, a senior communications adviser at HHS offered: “The bottom line is that Dr. Price spent a career in medicine caring for Americans from all walks of life, including seniors and folks on Medicaid. It’s why he knows the challenges facing our system, and why he has a long, public record in Congress fighting for patient-centered health care solutions.”

A Michigan native, Price moved to Atlanta for a medical residency at Emory University and later set up what evolved into a large orthopedic surgery practice in a conservative, affluent community on the city’s north side. He practiced medicine for 20 years before winning a seat in the Georgia state Senate in 1996. By then, he already had become active in fighting for what he saw as good for doctors and the health-care system.

He has spoken publicly of having been part of the AAPS’s successful 1993 lawsuit, with other groups, against then-first lady Hillary Clinton over closed meetings of that White House’s task force to draft a health reform plan. And during his eight years as a state lawmaker, he fought to limit doctors’ exposure to malpractice lawsuits.

In 2003, when the legislature’s two chambers passed differing tort reform bills, Price objected to the absence of a cap to restrict jury awards for pain and suffering in malpractice cases to $250,000. According to news media accounts at the time, his insistence on those limits during a conference committee was one reason neither bill became law.

“He is a right-wing doctor first before he is a right-wing zealot on every other issue,” said Mark Taylor, who was Georgia’s Democratic lieutenant governor at the time. “Whether it be liability or any policy issues about how health care is delivered, how it is paid for, how it is accessed, it is doctors – all day, every day.”

The American Medical Association honored Price in 2001 as one of nine people to receive its highest award for public officials. The AMA cited him for working to improve home child care facilities and strengthen drunken driving laws and for sponsoring bills to “increase patient choice,” create health savings accounts and change the Georgia Medicaid system. To this day, Price is an AMA member and a delegate to its governing body – a position he has said he will relinquish if confirmed as HHS secretary. The AMA, with nearly 235,000 members, endorsed his nomination.

Other groups that have lauded Price are less mainstream. In 2009, Price received an award from a small conservative group called Doctors for Patient Freedom. The group was founded by a Florida neurosurgeon, David McKalip, who leads Florida’s chapter of the AAPS and is a past president of the Florida Neurosurgical Society. He gained brief notoriety that year after emailing to a tea party group an image depicting then-President Barack Obama in tribal dress with a bone through his nose. McKalip apologized.

A few months after the email flap, Doctors for Patient Freedom chose the congressman as one of three winners of an award named for a former AMA president who had fought Medicare’s creation in the 1960s. Earlier news accounts have suggested that Price and other recipients shied from the award. But in an interview this week, McKalip said Price could not attend the awards dinner at a Houston restaurant because the House was voting that Saturday night on its version of legislation that became the ACA.

McKalip said Price called in to the Nov. 7 dinner on his cellphone from outside the House floor. A member of the Medical Society of Georgia, who was accepting the glass trophy for him, put his own phone up to a microphone so the 80 doctors in the room could hear Price’s words. “We all cheered when he said he was going to vote against it,” McKalip recalled.

The previous month, AAPS had given him its Shining Scalpel Award and praised him for “outstanding service to the American people and the profession of medicine by ‘cutting’ through the political rhetoric regarding ‘healthcare reform,’ and fighting for patient- and physician-centered healthcare legislation.” The group’s executive director, Jane Orient, a Tucson internist who does not participate in any private insurance or government insurance programs, said this week that fewer than half a dozen people have received the award.

The AAPS was founded during World War II to oppose “socialized medicine” and “the government takeover of the practice of medicine,” according to its website. Today, it has a legal team that “defends doctors who have been mugged by Medicare or railroaded by hospitals using sham peer review.” It has 5,000 members, of whom 3,000 – including Price – pay dues. Its mascot was named in 2002 with a resolution that said: “The Newfoundland dog does not bite the hand that feeds it, unlike governments are wont to do.”

Orient is the editor of an AAPS quarterly journal. Its articles, which she said are peer-reviewed, do not necessarily reflect the group’s positions. Over the years, some have asserted that the “gay male lifestyle” shortens life expectancy and that disabled babies of illegal immigrants are “valuable” for generating welfare benefits for their families. In spring 2015, one contended that the research establishing that HIV causes AIDS “is providing to be a substantial fallacy of modern medicine.”

Asked whether Price shares all AAPS stances, the HHS communications adviser replied that doctors belonging to any organization “don’t all believe the same thing,” pointing out that the nominee for secretary is a longtime AMA member, even though that group has supported the ACA and he does not.

Price has, however, been active in the AAPS. He has spoken at two annual meetings in recent years and been on the agenda for AAPS virtual town hall meetings against the ACA.

At his Senate Finance Committee confirmation last month and a similar hearing before the Senate’s Health Education Labor and Pensions Committee, Price was pressed about some of his views. Asked by Sen. Charles E. Grassley, R-Iowa, whether he would adhere to recommended vaccine schedules, Price responded that vaccination is “a very important aspect of public health.”

He did not say whether he believes vaccines should be mandatory.