Friday, July 31, 2009

Congress to recess without finishing health reform (me too!)

Congress today effectively wrapped up action on health reform until September. The House leaves town today, the Senate at the end of next week.

The Hill reports that the Energy and Commerce Committee has reached an agreement to win the support of dissident conservatives and liberal Democrats. As a concession to conservative "Blue Dog" Democrats, the Energy and Commerce agreement reportedly will require that a public plan negotiate rates with physicians and hospitals, up to the prevailing rates of private insurers in the market, instead of using Medicare rates. As a concession to liberal members, who have sharply criticized what they view as a "weakening" of the public plan option, the bill will allow the federal government to negotiate drug discounts under Medicare Part D. ACP supported both of these changes.

In the Senate, the HELP committee has done its part, but Senator Max Baucus (D-MT), chair of the Senate Finance Committee, announced that he needs the August recess to complete an agreement that he expects will win some GOP support.

Even so, health reform legislation has advanced further in Congress than it ever did when Bill Clinton was president.

During the next few weeks, voters will be subjected to an onslaught of advocacy advertising, robo-calls, town hall meetings, and presidential speeches, all designed to swing voters to support or oppose the legislation. Polls show a public conflicted by two impulses: large majorities still support major reform or even a complete rebuilding of the health care system, but there is rising anxiety about the cost and the impact on their own care. The battle being waged is over which sentiment will prevail.

I continue to believe that physicians' views will be critical in shaping public opinion, yet as long as the profession remains sharply divided, it will have less influence than if there was a sense of common purpose.

ACP, for its part, continues to believe that health reform is essential. Not any reform, but reform that delivers on ACP's priorities.

- Affordable coverage that builds upon and creates incentives for employers to provide coverage and for individuals to buy it;
- Subsidies to help people buy qualified coverage through a large group purchasing pool, giving them access to the best rates;
- Insurance market reforms so that health plans compete on improving patient care, not cherry-picking healthy patients;
- Increased Medicare payments, scholarships and loan forgiveness to retain and recruit more primary care internists;
- Putting an end to the annual cycle of Medicare doctor payment cuts due to the flawed Sustainable Growth Rate (SGR) formula;
- Reducing the enormous costs associated with frivolous malpractice lawsuits and defensive medicine.

I know that internists don't agree on some aspects of health reform, but these are "common ground" priorities that came from ACP members, long before the current administration and Congress were elected. Except for the inexplicable unwillingness of Congress and the President to deal with the medical liability problem, the bills pending in Congress have policies that advance each of our priorities, but none of them will be passed "as is" and they all need work. As they are revised, internists need to remain engaged to shape the final outcome, and I hope you will support us as we work to ensure that any final bill includes the above priorities.

As Congress recesses, so will I. Next week, my family and I are traveling to the United Kingdom to spend a few weeks with my sister, a career foreign service officer who works at the American embassy and lives in London. We also planned a side trip to Paris. You won't be hearing much from me until I return in a few weeks. (No, I won't be blogging about the U.K and French health care system, unless our vacation takes an unfortunate turn of events!) But this blog will remain active: several of my ACP colleagues have graciously agreed to post "guest blogs" and I will be leaving a few to be posted in my absence.

Cheers and au revoir!