AMSA Convention 2016 Logo

On the Road in Iowa


The New Physician September 2004
One day in mid-January, as news coverage of Iowa’s upcoming Democratic Presidential Caucus reached a fever pitch, I decided to take a road trip. After a year and a half of studying at the University of Minnesota Medical School, I realized if I was going to be effective at promoting patients’ health, I needed to help improve the climate in which they lived their lives. This was my chance to grill the top Democratic candidates on their policies, learn what Iowans thought about health care and promote the health-care issue to the international media. I was going to Iowa! And I wasn’t sure if I could accomplish anything.

I woke up on Saturday, Jan. 17, at 4:30 a.m., showered, shaved, packed, threw my things in the car and ate breakfast on the fly. For the next three days I was going to be on the campaign trail, racing from town to town, talking to every candidate, voter, reporter and volunteer I could find.


Former Gov. Howard Dean (D-Vt.) was about to cook pancakes before an adoring crowd. I asked a veteran Iowa journalist, a Tokyo film crew and a cable TV reporter how to get in and question the physician-turned-politician. The consensus was: “Don’t even try. These guys stick to the script and don’t like interruptions.” This was a nice way of saying, “Stay out of our way.”
With this in mind, I moved to the front of the crowd. As Dean flipped his first flapjack into the air and onto a voter’s plate, I shouted, “Hey, Dr. Dean, can you do that with our foreign policy?”
“I better!” he replied. He flipped another pancake higher into the air.
“How about the health-care system?”
“The health-care system, too,” he said.
When he was done, he removed his apron and hung it on a chair a few feet away from me. I leaned over a press barrier, introduced myself and asked Dean why his universal health-care plan would work when the Clinton plan hadn’t. He said his plan was successful in Vermont, and he knew he could pass it in Congress. Next, I asked if this was his ultimate vision for health care or just a step toward a single-payer system. He said single payer was a nice idea, but it couldn’t get past Congress. Our conversation ended when he was called to the stage.


Sen. John Edwards (D-N.C.) was first in a lineup at Dubuque’s Grand River Center that included Rep. Dennis Kucinich (D-Ohio) and Sen. John Kerry (D-Mass.). As a rock-’n’-roll guitar solo played, Edwards entered the arena from a loading dock door, a giant “John Edwards for President” banner hanging behind him. He headed for the stage through a tunnel of cheering supporters.

An excellent orator, Edwards rallied the crowd using his well-known “Two Americas” speech, and afterward, as supporters and reporters swarmed around him in the lobby, I called out: “Could I get you to weigh in on global AIDS, Sen. Edwards?”

“Oh, yeah, huge issue! But can we do it outside? I just don’t want to keep people waiting,” he said.

I followed his instructions, exiting the lobby to where his bus was parked. I waited patiently, but when he and his people reached the exit doors, they ran—trailed by throngs of fans—across the sidewalk, past me and jumped into the bus. The fans screamed. Edwards waved. His rock-’n’-roll soundtrack blared. The bus drove away. I was lost in the crowd.

Next up—Kucinich. Although the media portrayed him as uncharismatic, Kucinich was a dynamic speaker. He spoke in paragraphs, outlining concise criticisms of the current administration and returning periodically to such underlying themes as “the truth shall set you free.”

After his speech, I asked him if his plan for a single-payer health-care system was a viable option for the 45 million uninsured. He said he’d talk to me in the lobby. Wary of being blown off again, I stuck close until a reporter shoved her microphone in my face and pushed past me, almost knocking over an Iowan waiting patiently for Kucinich’s autograph.

Stunned, I stumbled backward, losing my place in the international press swarm. Then, Kucinich’s campaign manager said they had to go, and the candidate apologized and left. Watching the Iowan glare at the journalist, I realized I wasn’t rude enough to compete with campaign reporters.

Kerry had canceled his appearance in Dubuque, so I hit the road to catch him at his next stop.


Two men stood in the median of the main drag holding large “Kerry for President” signs and shouting at passing traffic. They directed me to an intimate theater-in-the-round-style venue where Kerry was expected to hold a question-and-answer session.

It was past 9:15 p.m. Kerry was late, but according to his Des Moines headquarters, he was not going to cancel. His daughters, Vanessa and Alexandra, took the stage after a comedian and a Kerry biographer had run out of things to say. When their talk reached a lull, I thought I’d help. “Hi! I was wondering if you would take questions,” I shouted. They both said they would.

“You were talking about growing up with John Kerry,” I said, “and most of us growing up kind of thought our parents were a little weird.” The crowd laughed. “I’m pretty much grown up, and I still think my parents are weird. Is your dad weird?”

The sisters smiled and told of a time their dad wore a bathing suit on the outside of a full wetsuit and how he used to make pancakes in animal and alphabet shapes. This provoked more questions from the audience, which finally ended with someone suggesting they debate the Bush girls. Later I apologized for putting them on the spot, but they said it was fun.

When Kerry finally arrived, he had an unexpected guest—registered Republican Jim Rassman, the former Army Green Beret Kerry rescued under enemy fire nearly 35 years ago and hadn’t seen since Vietnam. Rassman had recently contacted the Kerry campaign and offered to do anything he could to help. The Kerry–Rassman reunion event earlier in the day was a public relations dream come true. I suspected this was the reason Kerry had canceled his Dubuque appearance.

After Rassman said a few candid words about the candidate’s courage and selflessness, Kerry took center stage, and the question-and-answer period began. I asked if he really had a plan to address the AIDS epidemic or if he were just blindly pledging money and making declarations like everyone else seemed to be doing. He fired back that he had written comprehensive HIV/ AIDS legislation in the Senate and then called on all Americans to redouble their efforts to battle the virus.

Kerry answered questions until well past 11 p.m. when campaign managers tried to drag him away. The senator refused, telling the crowd that if any undecided voters had unanswered questions preventing them from caucusing for him, he would not leave without giving them an answer.

An older gentleman took this as an opportunity to leave. As he made his way to the exit, Kerry thanked him for his time and asked if he could count on the man’s vote. The man said he favored retired Army Gen. Wes Clark, but if Clark wasn’t a “viable” option on caucus day, he’d vote for Kerry. Kerry smiled, shook his hand and said, “Thank you for your vote, sir.”


The gravel parking lot of the local union hall was packed with U.S.-made cars. Flanked by Teamsters President James Hoffa and other union leaders, Rep. Richard Gephardt (D-Mo.) addressed a standing-room-only crowd, blasting the North American Free Trade Agreement and calling for new jobs. On the topic of health care, his eyes welled with tears as he spoke about his son who almost died of cancer as a child.

Afterward, he shook hands with and talked to every union member who approached. He paused for a brief interview via satellite and for one last photo opportunity with the local union boss’s family, then bid farewell to the crowd. I followed the candidate out the door, inquiring, “Why employer-based health care?”

He was about to answer when a reporter and cameraman asked Gephardt his policy toward Europe. Incredibly frustrated, I walked away. After responding to the reporter, Gephardt glanced across the parking lot, gave me a puzzled look, climbed into his sport utility vehicle and sped away. He probably thought I was a reporter, and I bet he’d never seen one give up before.

But I hadn’t. I jumped into my car, put the gas pedal to the floor and roared out of the parking lot, hell bent for Pella, Gephardt’s next campaign stop.


I left for home the same time Iowans filed into their respective caucus sites. Driving through the night, past the dusky outlines of pole barns and silos, I listened to the results. Kerry and Edwards had surged with 38 percent and 32 percent of the votes, respectively. Dean came in third with 18 percent. Gephardt was left with 11 percent, and Kucinich’s first showing was 1 percent.

As I reflected on my weekend trip, I decided my success at accessing the candidates had exceeded my expectations. Yet I felt I had learned the most from the people of Iowa.

On the whole, they thought it was nice I was promoting health care, but most Democratic Iowans didn’t separate the issues the way I did. They made me realize that advocating for health care was tied to a lot of other things. They had a profound sense of the peril of their own well-being. They looked at the yearly increases in insurance premiums and shrinking coverage, the astronomical costs of medications, the lucrative profits of insurance and pharmaceutical companies, the bank foreclosures of their family farms, the local jobs lost to foreign competition, and the billions of dollars Congress sent to Iraq as one issue in the same: Their way of life was vanishing.

They weren’t concerned with the finer distinctions among the candidates’ policies. They were focused on getting a Democrat—any Democrat—into office. A democracy of people voting against what they were afraid of instead of voting for what they believed in was not the kind of idealistic democracy I had learned about in high-school civics class.

As those last precincts reported in, it became clear that these Iowans, in their polite, understated way, were sending a simple message to the rest of America’s voters: Quit fighting over the details, band together and hold the line.

I wondered how different physicians are from them. What if we gave up on turf wars and infighting, and united as a profession? What if we joined our scalpels and prescription pads, and presented a united front against the lobbyists, the insurers, the health-plan bosses and the TV ads? What message would this send to the rest of the nation? Could we hold the line? Could we preserve our way of life?

Earlier that day, a campaign volunteer asked me if I should have been studying for school instead of driving around Iowa. A good point, I thought, then said, “This is medical school.”

The volunteer smiled, and we watched as the press pool of another candidate poured into the building like storm troopers, frantically fighting for another vantage point in anticipation of another dramatic entrance and another stump speech at another stop on the long haul toward the White House.
Will Nicholson is a third-year at the University of Minnesota Medical School. Direct comments about this article to