New Hampshire doctors say the nation’s health care system is in desperate need of attention. But they don’t necessarily agree on who has the best prescription.

Both Dr. John Grobman, an orthopedic surgeon who practices in Laconia and Franklin, and Dr. Albee Budnitz, a pulmonary specialist from Nashua, want a president who will champion medical malpractice liability reform.

But they’re not voting for the same candidate.

“I have a lot of trouble voting for a ticket that includes a trial lawyer,” said Grobman, a Republican who plans to vote for President Bush next week.

“The environment, health care and education are my three big issues, and they haven’t done a good job with that,” said Budnitz, an independent who’s voting for Sen. John Kerry.

Interviews with more than a dozen New Hampshire doctors last week found no unanimity among them on the presidential race -partly because the factors shaping their votes were complex, and not limited to health care.
Many doctors said that neither candidate offers a revolutionary remedy for what they described as the nation’s “broken” health care system. At the same time, most doctors interviewed were listening carefully to what Bush and Kerry have said about health care. And many had strong views on the candidates’ starkly different approaches to expanding coverage for the uninsured and underinsured.

Though doctors of every political stripe desperately wanted tort reform, they disagreed about whether and how it could be done. Meanwhile, other matters - especially Iraq and the war on terror -have displaced health care as the most powerful drivers of many doctors’ votes this year.

‘Doctors want something done’

All the doctors interviewed expressed deep disillusionment about the effect they said malpractice lawsuits have had on their profession. They expressed an almost desperate desire for tort reform, legal changes that would limit such lawsuits.

“Doctors want something done,“said Dr. Gary Sobelson, a Concord family practice physician and the president-elect of the New Hampshire Medical Society. “By and large, doctors feel this is our crisis point . . . and the public doesn’t get it and Congress doesn’t get it.”

Many doctors said the fear of lawsuits had depleted New Hampshire’s supply of obstetricians and neurosurgeons. They said they were sick of ordering unnecessary, expensive tests to protect themselves from liability and of spending more time documenting what they’re doing than treating patients. And they were exhausted by the stress of worrying about being financially ruined. Just last month, Dr. Clifford Levy, a Concord surgeon, lost a $2.5 million case in trial court (the case is on appeal), which rattled many doctors in the area.

“Cliff Levy is an excellent physician who happened to have operated on me,” Grobman said. “You shake your head and you say, is this really trial by jury? It’s worse than the toss of a coin.”

Bush supports capping non-economic damages to plaintiffs. Kerry doesn’t, but he has proposed several strategies for eliminating frivolous lawsuits, such as requiring all lawsuits to go before a screening panel and punishing lawyers who bring frivolous claims to court.

But John Edwards, the Democratic vice presidential nominee, is the trial lawyer poster boy, and Democrats have opposed Republican tort reform bills in the U.S. Senate for years.

“Those guys are bought and sold by the trial bar,” said Dr. Doug Black, an obstetrician/gynecologist from Concord who is supporting Bush.

Dr. David Charlesworth, a cardiologist at Catholic Medical Center in Manchester, had this unique perspective: Edwards, he said, may be the only person who can make meaningful tort reform happen.

“It doesn’t matter who the president is unless someone who represents the trial attorneys, such as John Edwards, steps forward and says, ‘We’ve had enough,’” said Charlesworth, a Republican who is voting for Kerry, likening this scenario to President Nixon’s watershed trip to China.

For most doctors backing Kerry, though, tort reform is not among their reasons for doing so. Sobelson ticked off the issues that were important to him this year: foreign policy, the national budget, the economy, reproductive choice.

“I just can’t have (tort reform) be the primary issue for me in this election,” he said.

‘The best presidentwe’ve had in years’

Dr. Georgia Tuttle, a dermatologist from Lebanon and a delegate to the American Medical Association, was among the few doctors who said health care policy alone would determine her vote. She’s for Bush, who she said was “the best president we’ve had (on health care) in years.”

Tuttle, an independent, called the health savings accounts authorized under the Medicare reform bill Bush signed last year “one small piece of health care reform that is absolutely essential.”

Health savings accounts let people save money tax-free for their own health care. People can pair them with low-premium, high-deductible health insurance, so they have the money sitting in the bank when they need to go to the doctor, get eyeglasses or have a tooth filled. Bush wants to expand the program by offering low-income people and small businesses tax credits toward high-deductible insurance premiums.

“People decide what is important to them and they spend their premium dollars on what they think is important,” she said. “And they have catastrophic insurance to protect them if bad things occur.”

Other doctors, however, argued that health savings accounts mainly benefit upper-middle-class and wealthy people. Bush has proposed offering up to $2,000 a year in tax credits to low-income families for high-deductible health insurance, but many doctors said that wouldn’t suffice.

And some said they worried about providing a financial incentive to put off medical care. Budnitz said he already sees patients who have health savings accounts delaying checkups and skipping their medicine.

“I agree with Bush that patients need to take more responsibility, and a medical savings account is good because it shows them what things cost,” he said. “But if they’re not willing to do it, we need a different way to educate them.”

Kerry would attempt to lower insurance premiums by having the federal government pick up 75 percent of catastrophic costs. He would allow anyone to buy into the health plans offered to members of Congress, and he would offer tax credits to small businesses, low- and middle-income workers and people between the ages of 55 and 64. He has also proposed allowing the federal government to negotiate directly with the pharmaceutical companies for lower prices, something the Medicare bill Bush signed last year specifically prohibits.

Dr. B.J. Entwhisle, a geriatrician who teaches at the New Hampshire Dartmouth Family Practice Residency at Concord Hospital, noted that Canadians pay less for prescription drugs because their government negotiates with the pharmaceutical companies, which the Medicare prescription drug law Bush signed last year specifically prohibits.

“I take care of people who choose food or drugs,” she said. “This really happens in our country.”

Tuttle, though, said Kerry’s plan won’t work.

“He’s just shifting more people into the public sector,” she said. “He’s putting 50- to 64-year-olds into Medicare - and it’s a bankrupt system already,” she said.

Dr. Gary Woods, who practices in Concord and is the president of the New Hampshire Medical Society, also said that both candidates had avoided talking about the fundamental problem: Health care costs keep rising, he said, and Americans want a free ride.

“Both are going to be expensive, and neither one has addressed the fact that costs are going to continue to go up as technology rapidly accelerates and the public wants more and more,” he said. “To hide behind, ‘I can get health care for everybody for the same dollars’ is a little bit of a specious argument.”

‘Lesser of two evils’

So health care isn’t steering Woods’s vote this year. He’s supporting Kerry -“the lesser of two evils,“he said - for other reasons. Kerry did better in the debates, he said. Bush “pulled the trigger a little too quick” in Iraq. With Bush’s deficits, “my kids won’t have money to put in a parking meter.”

Charlesworth said he considers himself a moderate Republican but plans to vote for Kerry. “I think isolationism and unilateralism is a dangerous way to go in a dangerous world,” he said.

Dr. Thomas Johnson, an allergy specialist from Salem who served in the Air Force during the Vietnam War, is volunteering for Bush.

“The most important issue to me in the presidential race is our personal security as Americans,” he said. “I am a Vietnam-era veteran, and the specter of someone sitting in the Congress of the United States saying the things Senator Kerry did, throwing his medals away and casting aspersions on his colleagues and producing painful results for our POWs constitutes a reason for me to doubt whether he would ever be an effective commander-in-chief for the United States of America.”

Dr. Nicole Varasteh, a Concord obstetrician/gynecologist who was born in Iran, is voting for Bush, even though she usually supports Democrats, because of his handling of the war on terror.

Pointing to Libyan president Moammar Gadhafi’s renunciation of terrorism and weapons of mass destruction, which she said was a result of the U.S. invasion of Iraq, Varasteh said Bush was right to play hardball with dictators in the Middle East.

“I think it hasn’t worked the other way,” she said. “It’s increased hatred there because the people are ruled by these terrible dictators, and people are mostly illiterate, they’re constantly being bombarded with messages of hatred.”

As for Kerry, she said, “I still don’t have a clear answer as to what Kerry is really going to do besides the summits and the ‘global test.’”

Grobman said he isn’t crazy about how Bush has handled Iraq, but “I don’t think Kerry is a decisive enough individual on that front.”

Kerry was the choice, though, among doctors who said they were concerned about the environment.

“‘Clear Skies’ actually creates more air pollution,” said Dr. Kathryn Schat, a Laconia family practice physician, referring to Bush’s proposed air pollution regulations. “Everyone in the country sees an epidemic of asthma, and it’s been shown time and time again through the 1990s to be related to air pollution. Many of my pediatric population that I deal with have asthma -and my adults.”

Dr. Barbara Walters, the senior medical director for Dartmouth-Hitchcock, said she is “stuck in the middle.” She opposes the restrictions the Bush administration has placed on the federal funding of embryonic stem cell research, but she prefers the Republican approach to tort reform. Neither candidate has explained sufficiently how he will pay for his health care programs, and neither is talking about insurance parity for mental health, the issue that is most important to her.

“I’ll probably make up my mind when I walk in there,” she said. “I’m really struggling.”