Dr. Robert Hertzka's wife knew he had turned into a political junkie when she came home from church one Sunday and he was watching "This Week With David Brinkley" instead of a football game.
"She said, 'You're not the man I married,' " Hertzka recalls with a laugh.
The politics that Hertzka lives as well as teaches is a variety not seen often: grass-roots political organizing by a well-to-do group, physicians.
Appropriately, he is starting at the bottom, with one of the first medical school courses in the country on medical politics. Labeled Anesthesia 223, "Introduction to the Politics of Medicine," the course has tried to persuade about 50 first-year medical students at UC San Diego to become activist doctors.
"I tell them there's this big powerful process that can do anything," says the 34-year-old Poway anesthesiologist, his words coming faster with enthusiasm. "But, if you're willing to work at it, you can do something about it."
Indeed, the fall 1989 class did do something.
"I got together with the students, and we killed a bill in the Legislature. Us. I thought that was pretty good," Hertzka said.
The bill they take responsibility for defeating would have made it impossible for residents to earn money as doctors after completing four years of medical school and an internship. It would have denied them them medical licenses until after one to two years of additional post-graduate training.
After surveying UCSD graduates to show the change would have meant severe financial hardship for some of them, the class lobbied the California Medical Assn. The survey persuaded delegates at the annual meeting to overturn the governing council's support of the bill. The bill was withdrawn in the Legislature.
Hertzka concedes that doctors as a group have a tradition of influence over social and medical policy through groups such as the American and California medical associations.
But, at a local and very personal level, the average physician is content to cry in his Chablis rather than act to solve some of medicine's political problems, he says. And he sees medical school faculties as not much better.
"I felt it was a disservice to me to not present this stuff to me as a student," said Hertzka, who graduated from UCSD's medical school in 1982. "Faculty are just generally toeing the party line--saying, 'It's all over. Medicine is going to be all socialized.' Those are the only people you have to listen to, and actually they don't really know what they're talking about when they say that."
As a medical student at UCSD, and then during an internship and residencies in Baltimore and San Francisco, Hertzka said he first became aware of politics' influence over medicine when he learned of proposals to let nurse practitioners prescribe drugs.
"You can argue that issue and yell 'turf battle' and all that, but just genuinely I thought this was the stupidest thing I'd ever heard of. To just turn these nurses loose to set up shop next to the chiropractor in the mini-mall?
"And it passed the state Assembly in California. It just blew me away. Anything can happen, I was thinking."
The proposal eventually died in California, but Hertzka remained politically galvanized.
As chairman of the San Diego County Medical Society's legislative committee, he leads a delegation of doctors every spring to the Legislature. He also is active in the state medical society and attends as many political open houses and fund-raisers as he can.
This has made Hertzka a familiar face to San Diego's delegation to Sacramento, Assemblywoman Tricia Hunter (R-Bonita) told the students at a class meeting in late November.
"There's not a legislator in town that doesn't know Robert. He's someone who's been very, very visible in the legislative process," Hunter said.
Hertzka's friendly but blunt style also gives him the reputation as someone who can be trusted to tell the truth about a bill's impact when a lobbyist wouldn't, she said.
"We've disagreed on pieces of legislation, but, if I call Robert about a bill--even if he knows that by telling me that I won't vote for it--he'll tell me. And I know that. That relationship is there."
How can a doctor who runs a busy surgical center and has a physician wife, Dr. Jean Olson, and young sons, Andy and Daniel, find time to stay current on medical politics?
"Personally, I need about four hours sleep a night. And most nights, once the kids are in bed at 9, from about 9 to 1 I'm doing something related to all this," Hertzka said. "I read mostly the standard things that a lot of doctors read--but I really read them, particularly the health policy articles."
The medical politics course Hertzka teaches is an elective, so must fit into the 20 total elective course units that medical students take.
Held at night in the fall term, it consists largely of presentations by people involved in the medical politics process, such as legislators, health-care lobbyists and political consultants. The only tests students take are of the consciousness-raising variety--like a true-false quiz on proposals they are surprised to learn have already become law.
But attending a course at night, when they could be studying for more basic courses, is a sacrifice for first-year students, he said.
"So to the students who do politics rather than a simpler elective that meets at a convenient time--it's a big deal," he said. "The kind of people who take this class are the kind who think they're going to graduate and go to Nicaragua and run free clinics or something."
Hertzka clearly has viewpoints about health care and what should be done to improve it. He supports the California Medical Assn.'s proposal to solve the problem of uninsured Californians with mandatory employer-based health insurance, rather than a government-run program paid for through payroll taxes. The latter is being advocated by a consumer group called Health Access.
But Hertzka goes out of his way to give both sides their due, because he says the process is the most important thing.
"Apathy is the worst thing," he said. "I'll take being out-argued by sincere people all the time over that."