Seven Questions for Joe Heck

The doctor/congressman on the similarities between practicing medicine and politics, the troubles with Obamacare and the unhealthy side effects of campaigning

One of 17 medical doctors in the 113th Congress, Republican Joe Heck is suddenly Nevada’s senior representative after withstanding John Oceguera’s challenge for only a second term last fall.

Born in Jamaica, New York, Heck completed his undergraduate studies at Penn State University and received a doctorate in osteopathy in 1988 at the Philadelphia College of Osteopathic Medicine. Heck moved to Nevada in 1992 and completed his residency in emergency medicine. A colonel in the U.S. Army, the 51-year-old has been called to active duty three times, including a deployment to Iraq in support of Operation Iraqi Freedom. Heck also operated a small business, Specialized Medical Operations, which provided medical training, consulting and support to law enforcement, emergency medical services and military special-operations teams.

To change how Medicare pays doctors, Heck—who served one term in the state Senate in 2004—and Rep. Allyson Schwartz, D-Pa., earlier this month introduced a bill to scrap the Sustainable Growth Rate formula and create a new payment model. The “doc fix” bill, Heck says, “phases in over 10 years, provides some predictability and stability to clinicians, and helps curtail the spiraling cost of health care.”

How does your experience as a doctor inform your views as a congressman?

The training as a doctor really sets you up for success in what you need to do when you get elected to office. Throughout medical school, you’ve got to consume large quantities of information in a relatively short period of time, process it and come to an informed decision. Everything you do as a physician is driven by data and fact, and not so much by emotion. So you’re able to assess things from a different perspective. I look for data points when I’m assessing legislation and looking for whether what the legislation intends to do is going to be supported. Being an emergency-department physician, you’ve got to be able to multitask, whether you’re handling six to 10 patients at a time or multiple committees and multiple bills.

So do you find yourself rolling the ball uphill when you’re trying to assess facts and others are playing politics?

Most physicians are type-A personalities, and it’s difficult to be a type-A personality in Washington, D.C., because things tend to move at glacial speeds. You’re very used to identifying the problem, coming up with a solution and implementing it in a very compressed time frame. In Washington, even if you identify the solution, it could be years before it gets implemented.

What qualities in a doctor translate to politics?

Just like you want a doctor with a good bedside matter—meaning they’ve got good interpersonal skills and are able to explain what they’re doing and what they think is wrong—that’s helpful in being a congressperson, too. You want somebody with good interpersonal skills to build relationships within your party, across party lines, and be able to explain your viewpoint to reach a consensus.

Perform triage on Obamacare. What needs fixing or tweaking now?

Obviously it’s the law of the land, based on the Supreme Court decision and the November elections. … Now it’s about going in with a more surgical manner and looking for those things that I think fundamentally change the way we provide health care—not necessarily for the better: The repeal of the Independent Payment Advisory Board, unelected bureaucrats who basically dictate what services would be paid for and at what levels; tort-reform legislation to minimize frivolous lawsuits; a whole host of tax-related issues—the additional .9 percent Medicare tax, the 3.8 percent passive-income tax or 10 percent tanning tax; and the part of the bill that tries to phase out and diminish the role of Medicare Advantage plans, a type of Medicare plan that’s very successful and that a lot of seniors in Southern Nevada participate in.

As the Nevada Legislature takes up the Medicaid issue, what advice do you offer?

Nevada has always had one of the most restrictive Medicaid enrollment criteria. If Medicaid is supposed to be for the poor, then you should have people who are at the poverty level or below eligible for Medicaid, which we haven’t. The idea of this expansion at 133 percent of the poverty level for the newly eligible—with the federal government paying the cost for the first few years but then that cost starts to shift back to the state—is the concern.

We didn’t have enough money in our state budget to fully fund the Medicaid program as it was—now we’re going to have a few years of 100 percent funding from the federal government, but eventually we’re going to have to start absorbing those costs as well. There’s a way to do it, but it’s still too restrictive on the federal government’s side.

Saying you have to cover everybody to 133 percent is a little too dictatorial. I’d much rather see the federal government say to the states, “You’ve got to cover everybody to 100 percent—that’s the poverty level.” You may want to do carve-outs like we have in Nevada for other populations like pregnant women and children. But you really need some flexibility in how you’re going to structure the program to meet the needs of your population.

What can Nevada do to attract more doctors?

We have to increase our residency-training opportunities here in Nevada. Research shows 70 percent of residents will stay in the location where they did their residency to do their practice. Only about 30 percent of medical students will stay where they did medical school. … We don’t have enough residency slots to meet the needs of our local graduates plus the ability to recruit graduates from other schools who want to come to Nevada.

We [also] have to address issues having to do with licensing here. It takes an awfully long time to get a medical license in Nevada—sometimes six to eight months. Nevada does not offer reciprocity, with the exception of very limited situations. There are very stringent licensing requirements; some would say that’s probably a good thing … but there’s always a balance.

Is campaigning bad for your health?

It is, because you don’t sleep enough, you don’t eat right and it was a challenge to stay on my exercise regimen. I try to run at least 2-3 miles a day and get to the gym at least two to three times a week. But pistachio ice cream and kettle-cooked sea-salt-and-vinegar potato chips are my weaknesses.