AAOS Endorses Manish K. (Manny) Sethi, M.D. – “Repeal and Replace”

Manny Sethi M.D., an orthopedist who announced June 2 that he’s running for the open U.S. Senate seat of Tennessee Republican Lamar Alexander, was quickly endorsed by the political action committee of the American Association of Orthopaedic Surgeons (AAOS).

“We are always working to increase the number of physicians in Congress, on both sides of the aisle, and couldn’t have asked for a better candidate to represent our organization,” said AAOS President Kristy L. Weber, M.D. “Dr. Sethi has dedicated his life’s work to helping his community and embodies the truest form of public service. We are proud to support him in his pursuit for Congress.”

Here’s a Portrait of the Candidate

He’s an orthopedic trauma surgeon and director of the Vanderbilt Orthopaedic Institute Center for Health Policy at Vanderbilt University Medical Center. He graduated from Brown University (cum laude) and Harvard Medical School and served a Fulbright Fellowship providing medical services in Tunisia.

He was co-editor, with former U.S. Senate Majority Leader William H. Frist, M.D. (also of Tennessee and worked at Vanderbilt), of a 2013 book, “An Introduction to Health Policy – A Primer for Physicians and Medical Students” (available from Springer, $64.95 in e-book version, $84.95 paperback).

He founded and continues to run Healthy Tennessee, an organization which provides free health screenings and promotes healthy living at fairs around the state.

He is married (wife’s name is Maya) with two beautiful children. They attend McKendree United Methodist Church in Nashville. The family has a dog—a pug, it looks like, in a photo online, with a face so pugly you can’t help but love it.

He’s self-described as “very conservative” and a strong supporter of President Trump. He wants to “repeal and replace” the Patient Protection and Affordable Care Act (ACA). His campaign is planning to issue a document on what he’d replace it with, but meanwhile, he discussed many of his views on health care policy in an interview for this article and in other public statements.

He makes a point of the fact that he is the son of two immigrant physician parents, describing himself as “a product of the American dream.” He makes a distinction between “legal” immigration, as he uses the term, and the current wave of Mexican-border refugees seeking asylum (which is also legal).

He describes himself as an “outsider” to politics. You can find that well-worn political slogan about running against “a government that is out of touch with its own citizens” at his website.

However, he comes across as a natural politician, combining policy-oriented thinking with the charm of a campaigner and views which are in the mainstream of Tennessee politics, which tends to be conservative (President Trump won there by 26 points in 2016, and in 2018, the U.S. Senate seat vacated by retired Lamar Alexander was won by Republican Marsha Blackburn over Democrat Phil Bredesen, 1,227,483 – 985,450).

In public political comments, he emphasizes his small-town roots, offering a “political outsider/man-of-the-people” image of himself, spinning homespun tales about his childhood. For example: “I learned my first lessons about health in our state as a boy, sitting shot-gun in my dad’s blue 1980 Oldsmobile as he made house calls,” he said in prepared testimony for a U.S. Senate committee hearing in 2017.

On his campaign website, he says, “I grew up next to a corn field in Hillsboro.” The Tennessean story on his announcement of candidacy said he “recalled a story of when his father drove a man who had a heart attack to the hospital and the man offered money. Sethi’s father refused the money, drawing a question from his son. ‘He said, ‘son, it doesn’t matter what’s in your bank account. What matters is the difference that you make.’”

Another: In that 2017 Senate testimony, he told another tale about “the trucker we met in Hawkins County” with a body mass index of 50, blood pressure of 200/100, “a very proud and hardworking Tennessean, whose income was too high for a subsidy on the individual market (the upper limit for a subsidy was $46,680 in 2015, $48,560 in 2019) and he just simply couldn’t afford the insurance, or a basic blood pressure pill for that matter.”

Some high points in our interview with Dr. Sethi:

On the opioid epidemic:

Boiled down to main points, he advocates for:

• Mental health intercession with traumatized children before addiction might capture them (“the Department of Education is spending billions of dollars on these programs, like cultural competency education, and instead I think we could flip that money and invest it in our schools for mental health stuff…a mental health counselor in every school”);
• Local rather than national control of opioid health care and law enforcement resources, with local political leaders and faith-based groups taking the lead to deal with the crisis (“For example, the MAT [resources are] is in West Tennessee, whereas in East Tennessee is where the major problem is”);
• And securing the Mexican border, which he sees as a main pathway for illegal drugs.

On the health care insurance system:

“The essential health benefits of Obamacare are a problem…I think you should be able to tailor health insurance the way that, you know, you want to basically create competitive packages, to create a competitive market.” He says allowing insurers to compete across state lines would increase competition and reduce insurance costs. He favors a wider array of plans without strict government standards for coverage: [T]he hand of government will never work, I believe, in the insurance market. What you’ve seen is, the premiums rise.” He advocates for health savings accounts to cover deductibles and gaps.

On Medicaid:

“I believe that block granting is a better option” than the Medicaid expansion under President Obama’s ACA. “In Healthy Tennessee, I have taken care of lots of Medicaid patients across the state. We do these screening health events where we take care of patients, and I’m telling you what works in West Tennessee, if you did it the same event or the same style in East Tennessee, it won’t work…I just think that block granting, I believe, will allow more flexibility. I believe it would bring down the cost of Medicaid, we ultimately will be able to provide cheaper care and it will be more effective.”

Because Tennessee is one of the states whose legislature didn’t choose to take federal funding to expand Medicaid under the Affordable Care Act, a federal block grant would likely be a significant addition to the resources the state currently allocates to low-income patients.

He also favors a work requirement for Medicaid participation.

On the National Institutes of Health (NIH) budget:

We asked whether he supports President Trump’s proposed $49 billion cut in the NIH budget. He didn’t specifically answer it, saying, “We’ve got to cut our discretionary spending, but I believe that we can do that in smart ways if we cut our healthcare costs, because we’re spending so much on the back end treating disease and not promoting wellness…I think the National Institutes of Health has done some incredible work, and they changed the way that we deliver care. So, I believe that if we were to dramatically reduce the waste, fraud, abuse, I don’t think this will be a problem.”