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Feature Story | Sep 2014

Ruminations for the Voting Booth

Ophthalmologists need to research candidates running for office before voting in the 2014 midterm elections.

Voters tend to label candidates according to their stances on certain issues; in turn, these labels are often deciding factors in how voters cast their ballots. However, the dynamics of modern politics and the 24-hour news cycle have made it difficult for voters to accurately label candidates. In the modern political arena, super political action committees— or super PACs—spend large sums of money to pigeonhole candidates, and the cacophony of political rhetoric transforms some candidates’ public images at the whim of shifting political winds.

The race for Oregon’s US Senate seat is one example of the confusing consequences of reductive labeling. During a Republication primary debate, Monica Wehby, MD, a pediatric neurosurgeon, was characterized as a leftist moderate by one of her opponents, and thus unworthy of the party’s nomination. Yet, since securing the Republican nomination, her opponent in the general election, incumbent Senator Jeff Merkley (D-OR), has cast Dr. Wehby as a far-right-wing conservative. Sen. Merkley’s television advertisements have attempted to tie his opponent to national conservative figures by featuring her image alongside those of Karl Rove and Newt Gingrich in an apparent attempt to scare liberal voters. Obviously, Dr. Wehby cannot simultaneously be a leftist moderate and a right-wing conservative. Nevertheless, the consequence is obvious: Oregon voters relying only on campaign rhetoric might find it difficult to determine what policy stances this candidate holds. With this type of confusing rhetoric commonly swirling for months before Election Day, one wonders how the everyday voter—or ophthalmologist, for that matter—can keep it all straight.


Despite the chaos that frequently envelops campaign messaging, there are ways for voters to solicit information to help them make decisions on Election Day. Candidates’ official web pages likely have position statements on hot-button issues. These sites can quickly inform voters about a candidate’s views or, at least, a candidate’s desired public image. For incumbent candidates, sites such as votesmart.org help voters examine a current member of Congress’ voting record, providing the dedicated voter with the information needed to show where a candidate actually (as opposed to publically) stands on certain issues.

Attending small campaign events where attendees may ask a candidate about his or her stance on particular issues gives citizens the opportunity to get a feel for that candidate’s sincerity. Attendees should listen for caveats in candidates’ responses; candidates may use qualifying statements to give themselves wiggle room on certain issues. Such provisos do not necessarily indicate a weak candidate. Savvy voters seeking to glean exactly where on the political spectrum a candidate falls understand that equivocation can indicate either an open mind or an unwillingness to engage with a particularly divisive topic. Absolute answers often indicate that candidates are in ideological wings, whereas open-ended responses indicate that candidates likely fall closer to the political center, allowing specific circumstances to inform their final opinions on an issue.

Citizens analyzing the track record of a current public official at the federal or state level who is seeking a higher office should remember that official’s political circumstances. Was that official’s party in the majority during his or her previous term in office? Did he or she have an executive working with or against his or her policy objectives? How did his or her state or district fare during that time? The answers to these questions help voters understand how effective those candidates have been during their term holding a prior office.

Freshman federal politicians who hail from state governments that were nonpartisan may find that the national political dynamic of partisanship impedes their ability to deliver results to constituents.

Voters wishing to be informed about a candidate who has never held public office must look at the candidate’s professional background. A candidate’s particular expertise or vocation often informs citizens on how that candidate might act as a member of Congress. For example, a successful entrepreneur likely faced difficult decisions while running a business. Some voters will see the experience of running a business and making difficult decisions as analogous to the role that lawmakers play in Congress. Members of Congress make pressure-filled decisions on a daily basis, so someone familiar with that professional lifestyle may make an effective congressional leader. However, voters should remember that, while having deep expertise in one area helps legislators craft laws regarding that specialty, members of Congress are required to legislate on a plethora of topics, many of which they will have little or no expert opinion on. Candidates who reliably incorporate information into policies about which they have little knowledge are likely to be more effective legislators.


Ultimately, voters must weigh the policies, experience, and on-the-record history of a candidate to craft a holistic image. Regardless of their caucus, most voters agree on the substance of the problems facing the United States; they differ (and often greatly) on how to solve those problems. For ophthalmologists in particular, there are a few areas to which they should pay particular attention: the economy, small business, and health care.

The economy affects physicians and their patients, and a strong economy is crucial to a strong practice. Individuals are more likely to seek health care encounters in a strong economy, and elective procedures to treat problems such as macular pucker are even more correlated to the health of the economy. Thus, when analyzing a candidate’s economic policy, voters should pay particular attention to any specific examples he or she may give that can help bring jobs or economic activity to their city, town, or region. Relying solely on national party platforms to formulate an economic policy does not indicate a poor candidate, but given the dynamics of a 535-member Congress, those policies may never come to fruition. A candidate with comprehensive plans to strengthen the local economy has a more practical approach to economic policy than a candidate who relies on generic, party-platform economic talking points.

Many ophthalmologists operate in private practice and are thus familiar with the challenges of owning and supporting a small business. Some candidates will campaign on the grounds of removing regulations that burden small businesses, and others may spell out ways the government can help small businesses through grants or other financing. Most candidates have views on tax policy, and, if they are elected, that policy could have an effect on medical practices in many ways. Ophthalmologist-voters should review candidates’ tax policies to see how those policies might affect their practices.

Ophthalmologists in private practice who are primarily concerned about the relationship their practice has with government vis-à-vis small business development may wish to vote for a candidate who has experience running a small business, has a record of supporting policies that grow small businesses, or prioritizes the concerns of small businesses.

A candidate’s views on health care are of vital importance to ophthalmologists. The Patient Protection and Affordable Care Act (PPACA) continues to be a significant campaign issue and may serve as a barometer for candidates’ views on improving the US health care system. Ophthalmologist-voters should review candidates’ views on specific PPACA provisions to understand how those revisions may affect their practices. The PPACA is germane to many areas that affect ophthalmology, such as Accountable Care Organizations, health savings accounts, coverage for services where ophthalmology and optometry intersect, and Sunshine Act disclosure requirements. Voters who know a candidate’s stance on one or more of those issues can likely determine how that candidate feels about the PPACA in general, and his or her willingness to modify, defend, or eliminate the law.

Other health care issues aside from the PPACA might have an impact on a physician’s vote. Voters should understand candidates’ stances on issues such as malpractice reform, funding for continuing medical education, Medicare physician reimbursement, and hospital acquisition of ambulatory surgical centers. Because ophthalmologists rely heavily on new medical technologies, they should also be mindful of a candidate’s posture toward the life science industry and try to gauge his or her stance on the balance between innovation and patients’ safety.


Political candidates are elected to represent the views of their constituents. Voters who try to find candidates whose views resemble their own practice an imperfect science: No candidate will ever fully match a voter’s ideology, and voters must understand that even their perfect candidate will likely differ with them on some issues. Still, research is crucial in determining which candidate will best represent a voter, and gauging levels of trust in a candidate is vital for those who wish to place a reliable representative in Congress. Investigating a candidate’s stances on issues unique to the medical field will help ophthalmologist-voters make informed election decisions this election cycle.

Many people underestimate the power of voting, but voters should remember that, if members of Congress respond to anything, it is voting patterns. Ophthalmologist-voters who decline to vote never get their voices heard and have little room to complain when policy changes affect their practices.

This article is reprinted with permission from Retina Today’s September 2014 issue.

Jeffrey J. Kimbell is the founder and president of Jeffrey J. Kimbell and Associates, a Washington-based consulting firm focused on the executive and legislative branches of the US federal government and specializing in providing strategic solutions to a select group of health care sector clients seeking creation, modification, or proper implementation of public law. Mr. Kimbell may be reached at (202) 735-2590; jkimbell@kimbell-associates.com.

Kenneth L. Hodge is an associate director of government affairs and legislative policy with Jeffrey J. Kimbell and Associates, where he has worked for 4 years.

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