Who’s Afraid of the Big Bad Wolf?

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Radiologist Milton Wolf's challenge to U.S. Senator Pat Roberts (R-Kan) is one factor that may have led the senior statesman to break with the House Republican leadership and announce that he will not vote for the bi-partisan budget deal worked out by Representative Paul Ryan (R-Wis) and Senator Patty Murray (D-Wash).

Senator Roberts, 77, is the senior Senator from Kansas and a ranking member of the United States Senate Committee on Agriculture — a politically important port for this rural state with many farms. He has already won his seat three times by comfortable percentages in his conservative home state. In 2002, he won 82% of the vote when the Democratic party did not even bother to run a candidate against him.

However, Dr. Wolf, 42, is mounting a serious challenge. According to the Roll Call Political Moneyline blog, Dr. Wolf disclosed that he has more than $1 million in income as a diagnostic radiologist and investor in an imaging center. His personal financial disclosure report as required by the Ethics in Government Act lists $916,034 in salary from Alliance Radiology; $157,379 in shareholder income from Johnson County Imaging Center; $7,200 in non-employee compensation from the Washington Times as a columnist. His investment in the Johnson County Imaging Center is listed at a value between $100,001 and $250,000.

In addition, Dr. Wolf has been able to generate some income from being both an outspoken Tea Party conservative and President Obama's cousin. He listed $2,800 from Premiere Speakers Bureau and $580 in royalties from Harper Collins for his e-book entitled, First, Do No Harm: The President’s Cousin Explains Why His Hippocratic Oath Requires Him To Oppose Obamacare.

Now add to this the endorsement of the Senate Conservatives Fund, a Virginia-based political action committee, that was founded to advocate for small-government, Tea Party affiliated Republicans, and it becomes clear why Senator Roberts may be worried. In the 2012 election cycle, The Senate Conservatives Fund spent about $16 million, and it has already given out more than $6 million in the 2014 cycle.

So why is this significant beyond just the cool factor of a radiologist potentially getting a key seat in Congress? Well, if the fear of challengers like Dr. Wolf is leading sitting Senators and Representatives to avoid voting in favor of any legislation that compromises with Democrats to ensure passage, the ability of Congress to pass budgets, new laws and fixes to old laws that didn't quite work out as intended (remember the sustainable growth rate or SGR formula?) is severely compromised.

Already, the current Congress is on track to become the least productive Congress in American history, as measured by bills passed into law. If it cannot pass even major legislation like the budget and the Farm Bill (normally, a political softball because of its broad public support), what becomes of smaller but very important issues like removing the excise tax on medical devices and the multiple procedure payment reduction (MPPR) on radiologists’ reads? Even the SGR fix, with its heavy lobbying by medical societies, seems in danger as Congress is adjourning with only a temporary 3-month fix instead of the permanent repeal that seemed possible back in the spring.

Who's afraid of the big bad wolf? If it is candidates like Dr. Wolf and the political action committees that fund them that are part of the reason Congress has been so unproductive, then I guess the answer would be, I am.