David Nagel, MD, Begins Term in New Hampshire House of Representatives
Longtime AAMA member, David Nagel, MD, ran for election to the New Hampshire House of Representatives to represent Belknap 6. He won in the general election in November and assumed office on December 7, 2022. His current term will end on December 4, 2024. We asked Dr. Nagel to share his thoughts about the intersection of public service and medicine. Here are his comments:
AAMA: Why did you decide to run for office? Do you have any prior public service experience?
Nagel: Years ago, my mom, who is my hero, was functionally bullied by an able-bodied person who verbally pushed her out of the way. My mom had severe RA and was very limited. I was so angered by this stigmatization that I felt a need to stand up for her and others like her. My mom always stood up for those in need. She couldn’t walk well, but she had a finger and a phone, and she created a model of what I call “kitchen-table advocacy.” The world did not treat her well, but she did her best to not let that happen to others. She has always been my inspiration.
I joke that I am a middle child born on a Wednesday; I get in the middle of everything. I have always felt a need to stand up for the marginalized. That led me to be involved in advocacy at a young age. I started merely by standing up for someone who was being bullied when I was in fourth grade.
I have been involved in advocacy and public policy for those with chronic and end of life pain for more than 30 years. My book, Needless Suffering, How Society Fails Those with Chronic Pain (2016), is a policy/advocacy book that aims to change the way those in pain are perceived, judged and treated. The book changed my life by giving me opportunities beyond my wildest dreams, and, to quote others, all I did was say what needed to be said.
I am amazed at the power of the letters “MD” that allow me to advocate for others — both in my practice and in the broader social realm. In an un-friendly medical world, dominated by a medical-industrial complex that burns out health care providers, I have found that this work allows me to retain the special needs and feelings that made me what to become a doctor in the first place.
In short, I chose to run for office because I believe that I can have greater power to make social change as in insider than I can as an outsider. I fully accept that may be an illusion, but one I feel compelled to follow.
AAMA: Not everyone is as comfortable engaging in policy and advocacy activities as you are. Do you have counsel for those who are involved with AAMA who may need a nudge to get more involved?
Nagel: I learned a long time ago, if you are not involved they won’t hear you. It is very easy to whine about how things are, or how they should be, but whining accomplishes nothing. I also learned how hard decision-making gets in the political arena, and, dare I say, I have developed a respect for those who struggle to make fair decisions. There all sorts of ways of getting involved. My mom used the phone. My own model is what I call “John the Baptist Advocacy” — a voice crying in the wilderness. You need to find a model that suits who you are. Never try to be someone you are not. Mother Teresa understood this intuitively. In her Mission, she found a place for everyone who had a desire to help, no matter their physical, spiritual, intellectual, or social limitations.
AAMA: Are there any specific health care issues you hope to address/change while in office?
Nagel: My priority is to eliminate barriers to health care for those disparaged: those in pain; those suffering from mental health problems; those with addiction; those of color or other ethnicities; women, veterans, children, and other vulnerable populations. We are trying to create a world of inclusion. I am very interested in Native American rights here in New Hampshire. I am very interested in challenging insurers on policies that create unnecessary barriers to care, such as excessive co-pays, deductibles, and premiums, as well as the practice of prior authorizations. Related, I want to upend the medical pyramid and change the way we fund care from fragmented, bio-medical proceduralization to management, including primary care and management of complex physical and mental conditions.
Already I have a number of bills before our legislature that focus on patients’ rights and access to care. NH HB 303, for example, deals specifically with increased access to alternative therapies. I believe in working with broad coalitions of people to make change, and HB 303 started with the creation of a broad coalition of diverse people, always including patients, who came together to achieve a goal. We wrote this bill together.
AAMA: What strengths do you think physicians bring to the table as policy-makers and legislators?
Nagel: I have always struggled with concepts of ego and pecking order. I believe all individuals are important, and our place on an artificial hierarchy does not determine who we are, how important our voice is, or who should be listened to. At the same time, I am a realist. For good or bad, the degree “MD” allows us to occupy a higher rung. We are respected, and greater value is placed on our voices. With that reality come increased responsibilities and opportunities, which can be used for the greater good.
I have come to understand that legislators are lacking in knowledge and desperate for direction. Physician legislators can provide that knowledge and, frequently, our voices and our knowledge can change the entire direction of policy dialogue. That is a powerful attribute, one that needs to be respected.