Sunday, February 22, 2009

Yes They Can

Oh how we forget.

It was under a year ago that physicians were faced with a proposed 10.1% Medicare fee cut. Fortunately, that cut was thwarted after both the House and Senate overrode a Presidential veto of H.R. 6331, the “Medicare Improvements for Patients and Providers Act of 2008.”

But the threat of physician cuts with upcoming legislation persists, especially as Congress looks for ways to save Medicare's unsustainable costs:
Under the current formula, doctors would still face cuts of more than 5 percent a year from 2010 to 2012.
But a little over a week ago, we witnessed a new and concerning ploy from our legislature eager to pass a pressing agenda: the fear-mongering tactic of "approve it or else." The recent passage of the colossal 1073-page economic "Stimulus Package" representing some $787 billion was never read by a single member of Congress, yet approved. We do not have to think too hard to consider how this same tactic will be deployed with the even larger fiscal crisis of health care reform.

But doctors are experts at naval-gazing. We're just too busy. Our independent subspecialty bodies will protect us, really they will. After all, we pay our dues!

But who's really at the table making policy decisions these days?

Is it the Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, American College of Cardiology or even the larger American College of Physicians?


It's America's "voice" for doctors: lobbyists for the American Medical Association.

Yep, the AMA - a body whose members represent only 15% of practicing doctors in America and has resorted to all kinds of questionable ways to stay afloat despite the mass exodus of doctors from their membership.

But as we've recently seen, the AMA has access to secret, closed-door meetings with influential left-leaning senators regarding health policy when all other physician advocacy groups do not. Do we honestly think that our individual subspecialty societies for cardiologists, internists, surgeons, hospitalists or even newer, heavily-promoted doctors' internet sites will hold a policy-making candle to the AMA's lobbying stature on the Hill?

No way.

And like it or not, "change" is coming.

In thinking about this and although I'd like to say otherwise, our best bet to advocate for our interests might just be via the American Medical Association. If we're going to have a collective voice concerning upcoming policy decisions as they affect physicians, be it specialist or generalist, MD or DO, hospitalist or primary practice doctor, it just might be time to swallow our collective egos and consider working with the AMA.


Because like never before, doctors need to collectively advocate for their interests in Washington before the next "Stimulus Bill for Health Care Reform" contains mandated physician pay cuts within it that none of our representatives will even bother to read.

Oh, you think they'd never do this?

Well, as we've now seen ...

... yes they can.



Anonymous said...

"Because like never before, doctors need to collectively advocate for their interests in Washington"

sounds like you think Physicians needs a labor union to do 'collective' bargaining?

DrWes said...

Anony 12:26-

Tell me: who's at the table in the current discussions? Who's representing the doctors and patients' interests at the moment?

My point is that by our own specialization and subspecialzations societies and segmented advocacy interests, doctors have lost any unified voice in the debate.

But perhaps actions will have to speak louder than words. Once th epolicy wonks cut payments sufficiently so doctors refuse to see Medicare patients, real health care finance reform will occur. But in case they piecemeal it (more likely) it certainly would be nice to have a more robust voice in the current debate.

shadowfax said...

You do know it's a load of bullshit that "nobody read the bill" before it was passed, right?

You are half-right, which is where crazy-ass half-truths like this gain their potency, in that the final conference bill was only available for review for a few hours before the final vote. But the changes in the conference bill from the bills as passed in the House and Senate were limited and easily checked, and the compromises made were well-publicized. In short, about 1050 pages of the 1073 page bill were unaltered. And the drafts had been very very well circulated prior to the conference committee.

In short, any legislator who wanted to was able to read the bill prior to passage -- both the drafts and the updates. Yes, that does assume a certain amount of good faith that nothing was slipped in at the last minute (and that has happened in the past). The true shame may be how few members of congress bother to read legislation at all prior to voting on it.

Besides, it doesn't really matter whether they read it, because in the end, nobody had any say into the bill except Pelosi and Collins, and everybody else just voted the way their leaders told them to...

DrWes said...


Besides, it doesn't really matter whether they read it, because in the end, nobody had any say into the bill except Pelosi and Collins, and everybody else just voted the way their leaders told them to...

Gotta agree with you there.

But drafts, even if circulated time and time again, are never the final bill - they are works in progress. The enormity of the costs respresented by this bill are worth noting. If one were to divide the bill by tax dollars per page, each page of the final bill represented about $733 million dollars each. Using similar logic, those "only 23 pages" of changes would potentially add up to about $16.8 billion in "changes."

Sorry, in my mind with that much money at stake, America deserved a careful review. Such was not the case.

And so it became law.

Now, (getting back on topic) could a similar tactic be planned for our new health care reform package?

Anonymous said...

Wes, from what I can tell, Nancy Nielsen is all we've got. She was the only doc at the White House for the Fiscal Responsibility healthcare work group... and she and I were the only docs at the Medicare Policy Summit. Pete Stark and others express open disdain for docs and former HHS secretaries fully believe that the physician shortage can be easily solved with nurses. The lack of MD presence in Washington policy meetings is quite shocking... how many lawyers would be involved in high level policy discussions if we were trying to reform our legal system? When it comes to reforming healthcare, doctors have been shut out. Either by indifference, clinical exhaustion, or active exclusion by politicians. We are well and truly screwed. Besides the AMA (whose power pales in comparison to the AARP for example), all we've got are our blogs. Seriously.