Rand Paul's Political Views Make Perfect Sense When You Look At His Medical Background

The doctor is in. The senator is out.

Rand Paul, the ophthalmologist and Republican senator from Kentucky, officially launched his presidential campaign on Tuesday, complete with a little rebranding. Paul's Twitter handle had previously been “@SenRandPaul.” That old profile is gone. Now, his handle is “@RandPaul” and the official name on the account is “Dr. Rand Paul.” Paul’s campaign website refers to him throughout as Dr. Paul and the official campaign biography focuses on his work as a physician -- including a history of performing surgery at deep discounts, or at no charge, for people without the ability to pay for it.

Playing up Paul’s medical background has several benefits. As my colleague Scott Conroy has observed, it burnishes Paul’s image as an outsider -- somebody who's not a politician at heart, who will challenge the Washington establishment and the way it normally conducts business. Paul often refers to himself as a "country doctor," as a way to sand down whatever sheen of elitism the title might convey -- and, perhaps, to conjure up nostalgic images of the bygone America that ignites conservative enthusiasm.

But the “doctor” honorific has one other purpose as well. It lends Paul an aura of compassion, something that most physicians have and that Paul, a libertarian who has advocated reducing government spending on the poor and elderly, could desperately use. It’s no coincidence that the campaign bio notes, in bold, near the end, “A large part of Rand’s daily work as an ophthalmologist was dedicated to preserving the vision of our seniors.”

Paul’s charitable work seems to be genuine and, for the people who benefit from it, of real life-changing value. But if you’re looking for insights into Paul’s policy priorities -- and what his presidency would actually mean for people in need -- you need to be careful about how you interpret his professional history.

The fact that he’s a doctor tells you something. The fact that he’s an ophthalmologist tells you more.

That’s because the medical profession has a well-known, well-documented divide when it comes to politics. On one end are specialists. Think orthopedists, anesthesiologists, plastic surgeons, radiologists and, yes, ophthalmologists. They tend to be conservative and support Republicans, whether you measure this by self-described political affiliation or by campaign contributions.

On the other end of the spectrum are general practitioners -- pediatricians, family doctors and internists. Psychiatrists usually fall into this category, as do many oncologists and obstetricians. They tend to be liberal and support Democrats. (Greg Dworkin, a pediatrician who writes for Daily Kos, had a great write-up on this recently.)

The split makes sense if you understand the very different work these doctors perform -- and the money they get paid for it. Specialists' clinical interactions tend to be episodic: A surgeon called in to remove a gall bladder, repair a ligament or install a stent is probably meeting his or her patient for the first time -- and may have little contact, or even none at all, with that patient once the procedure and rehabilitation are over. Such encounters may reinforce a more individualistic, atomistic view of one's relationship with patients and one's role in society.

Among physicians, specialists and surgeons have the highest incomes and, according to a Rand Corp. study, are the most likely to face a malpractice claim. Not surprisingly, they gravitate to the party that puts a high priority on lowering taxes for the wealthy, reducing malpractice liability and generally pushing the government out of health care.

Ophthalmologists in particular are also fond of talking
about LASIK surgery, something they perform on a cash-only basis, as proof that health care would be cheaper without government interference.

Generalists, on the other hand, don’t deal with body parts. They deal with whole bodies. And inevitably, that approach forces them to consider how patients live. It’s the generalists who end up asking about conditions at home, who see connections between lifestyle and health, and who think about the ways in which economic insecurity affects long-term health. (Pediatricians are frequently the first ones to pick up signs of developmental delays and mental health problems, both of which can be products of struggles at home.)

Overall, these doctors have lower incomes than specialists and surgeons -- and are less likely to face malpractice claims. Their kindred spirits are the politicians who put a high priority on making health insurance more easily available and helping people pay for basic needs like food and shelter -- even if that means higher taxes and, yes, bigger government.

These trends probably reflect a great deal of self-selection. Medical students who care more about making money and operating free of government interference are more likely to pursue surgical training. Those who care more about improving general health, particularly among the poor, gravitate to fields like pediatrics. Choices about medical careers tend to go hand in hand with other variables that correlate with political affiliation, such as gender. Men (who are more likely to vote Republican) still dominate the surgical fields, while women (who are more likely to vote Democratic) make up the majority of primary care doctors.

You’ll find plenty of exceptions to these crude categories. But Rand Paul is not one of them. His medical profile lines up perfectly with his ideological profile -- not to mention with the policies he’s proposed. As Dylan Matthews has noted at Vox, the budget proposals that Paul has endorsed are more extreme than anything else you’ll see in this presidential campaign. They would effectively dismantle Medicaid, Medicare and the Affordable Care Act, among others -- forcing literally millions to lose health insurance and endure economic hardship. The vast majority of these people would be elderly or poor or both.

As a surgeon doing charity work, Paul could help a few of these people. The rest would be on their own.

Rand Paul