On Saturday, we’ll get some data on how yet another Trump Tragedy will end. Recent polls put Bill Cassidy, the senator from Louisiana, in third place heading into the first round of the Republican primary here. It’s his first competitive race in a dozen years and the culmination of a zigzag of events that had him standing up President Trump, kissing up to Mr. Trump, being tossed aside by Mr. Trump, gaining no political advantage in any direction along the way, and undermining not just his positions as a politician but also — in what makes this tragedy more raw than most — his greatest accomplishments as a physician.
Mr. Cassidy may advance to a runoff in June, but few give him any chance of winning it. As James Carville summed up the events to me: “Bill Cassidy sold his soul to the devil, and he didn’t get anything for it.”
Mr. Cassidy has never had a high profile nationally or in Louisiana, despite being a senator for 11 years. He was a well-respected liver doctor at a charity hospital for about 25 years and set up a clinic in Baton Rouge to provide medical services to the uninsured. He began his political life to lobby on public health issues, first as a supporter of the Democratic governor Kathleen Blanco 22 years ago, before switching parties, citing the supposed demise of “conservative Democrats.” He won his first state seat in 2006 as a Republican.
Mr. Cassidy developed a reputation as a hard-working, smart, sometimes stiff policy wonk, which is about as natural in Louisiana as an igloo. We like big personalities, thick accents, backslapping and a bit of wicked fun. Mr. Cassidy doesn’t like to answer reporters’ questions about politics. He prefers discussing policies and programs, particularly those regarding health care; he has a pinnacle position as the chair of the Senate Health, Education, Labor and Pensions Committee. He still likes to be called Dr. Cassidy, not Senator Cassidy. Several New Orleanians reminded me of the most famous local assessment of Mr. Cassidy, from former Representative Cedric Richmond: “Dude is weird.”
Two votes have defined his career on the national stage. The first was as one of seven Republican senators to vote for the conviction of Donald Trump in the 2021 impeachment trial. Mr. Cassidy probably thought that in five years he would once again compete in a nonpartisan “jungle” primary against a divided field. In 2020, he had beaten his leading Democratic competitor by 40 points. And, anyway, Mr. Trump in 2021 seemed to be soon gone from public life.
But then the Louisiana Republican Party changed the rules such that only Republican (or “no party”) voters could vote in its Senate primary. And, of course, Mr. Trump did not disappear from public life. So Mr. Cassidy joined the long line of former Trump antagonists led by Marco Rubio and JD Vance in trying to ingratiate himself with Mr. Trump — most famously, with his vote last year to confirm Robert F. Kennedy Jr. as secretary of health and human services.
As recently as last November, Mr. Cassidy told the press, “It’s been communicated the president’s staying neutral” in his race. And then Mr. Trump did what Mr. Trump does and endorsed one of Mr. Cassidy’s challengers: Julia Letlow, who represents the Fifth Congressional District. (A third candidate, John Fleming, Louisiana’s conservative treasurer, has proved a surprisingly competitive dark horse).
Mr. Cassidy had raised more money than his opponents — the majority of it from contributors outside Louisiana. But close political observers have told me that the polls have consistently shown that Mr. Cassidy’s polling numbers have not risen enough for him to win, despite the millions spent and his incessant labeling of his Trump-endorsed competitor as “liberal Letlow,” which has the benefit of alliteration if not of logic.
Part of this may come down to Mr. Cassidy’s wonkish side. Shameless triangulation is practically a job requirement for a politician. But as Lionel Rainey III, a national Republican strategist based in Louisiana, also told me, “If you’re going to be successful in a closed primary in Louisiana after impeaching the president of said party, you better have a larger-than-life personality.”
It is the great irony of Mr. Cassidy’s life that his second moment in the national spotlight — the tiebreaking vote he cast to advance Mr. Kennedy’s nomination — would erode much of his life’s work. Mr. Cassidy has spoken often about his efforts to protect Louisianans from hepatitis B and how he started a program to vaccinate 36,000 children against it. He’s recounted being depressed after loading an 18-year-old patient into a medevac helicopter to get a liver transplant, knowing that a $50 vaccine could have saved her.
Mr. Cassidy was always clear about how much Mr. Kennedy’s opposition to vaccines bothered him. In the lead-up to the crucial Senate committee vote last year, Mr. Cassidy told Mr. Kennedy, “If there is any false note, any undermining of a mama’s trust in vaccines, another person will die from a vaccine-preventable disease.”
But Mr. Cassidy then was still trying to ingratiate himself with the Trump administration and prevent Mr. Trump from endorsing an opponent. Mr. Cassidy insisted that he could vote to confirm Mr. Kennedy with a clear conscience because he had extracted promises from the nominee, including that they would have an “unprecedentedly close collaborative working relationship.”
Mr. Kennedy quickly broke those agreements. He assembled what Mr. Cassidy calls a “totally discredited” advisory panel of vaccine critics who voted to remove the recommendation for a hepatitis B vaccine — the vaccine that played such a large role in Mr. Cassidy’s medical career — at birth. The Centers for Disease Control and Prevention website still includes an information page with the headline, “Vaccines Do Not Cause Autism,” but it is accompanied by a note that says the only reason the headline has not been removed is that a certain senator won’t allow it. The rest of webpage is filled with what the American Medical Association called “misleading claims” linking vaccines to autism. Mr. Kennedy’s allies in the MAHA PAC pledged a million dollars in support of Ms. Letlow.
In response, Mr. Cassidy has reiterated that vaccines are safe and effective and do not cause autism. He stalled-to-death the nomination of Casey Means as surgeon general.
But Mr. Kennedy’s campaign against vaccines has surely not ended — and has definitely not ended due to Mr. Cassidy.
In February, when The Dispatch asked Mr. Cassidy if he regretted his vote for Mr. Kennedy, he answered: “What do my emotions matter? It doesn’t matter.” Mr. Cassidy sounded like a seasoned gambler who knows you can’t win ’em all. And we don’t want our politicians to win ’em all: At points, they should subordinate their opinions — and even their expertise — to political realities. That’s how republican government works.
The tragedy of Bill Cassidy is not that he cast a vote he didn’t want to. It is not that he grossly miscalculated the certainty of Donald Trump’s vengeance. The tragedy of Bill Cassidy is that he is as close as we have to the nation’s most powerful doctor and the point he was willing to compromise on — the point at which many looked to him to first, do no harm — gave him no political benefit at all. It may even help cost him his national role.
Even if he loses, Mr. Cassidy will have the rest of his life to use his compromised voice in public and, for a few months, as a leader in the Senate. The nation is ever more confused by battling medical advice, of all types. It needs a ferocious champion of vaccines. We could use a doctor unencumbered from political gambles and the whims of Donald Trump.
Gary Sernovitz is a writer based in New Orleans. His most recent book is “The Counting House.”
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