Wednesday, June 23, 2010

Patients Held Hostage, Day 23

Remember when TV news broadcasts recorded the running total of each day that American diplomats were held hostage in Iran under the banner "America Held Hostage, Day [ ]?" Well, I wouldn't be surprised if America's seniors are feeling like they are being held hostage by a hostile government, as Congress' continued stalemate over the Medicare SGR physician payment cut enters the 23rd day since a 21% cut went into effect.

(Yes, I am engaging in a bit of hyperbole, because as bad as the SGR situation is for patients and their physicians, it doesn't rise to the terror inflicted by the Americans captured by a revolutionary Iranian government.)

Yesterday evening, ACP issued a statement blasting Congress for all of the excuses and finger-pointing offered by politicians to justify the impasse:

"It is past time for politicians from both political parties and both chambers to stop blaming someone else for the impasse. Physicians and patients don't want to hear that it is the Democrats' fault, or the Republicans', or the President's, or the Senate's, or the House's. They don't want to hear politicians claim that they are for repealing the SGR, as they withhold their vote from any practical plan to achieve repeal.

"They want to hear that they people they elected can work together to solve the problem.

"They want to hear that the House and Senate have resolved their differences and enacted legislation to immediately reverse the 21 percent cut and make physicians whole for the damage already done.

"They want to hear that members of Congress, on a bicameral and bipartisan basis, have agreed on a long-term solution to replace the unworkable SGR. Such a solution, at a minimum, would provide stable, reliable and positive payments for all services that covers physicians' costs, provides for higher updates for primary care visits and preventive services, and lead to repeal of the SGR.

"Absent such agreement, physicians and their patients will continue to lose faith in Medicare and TRICARE, causing potentially irreparable and permanent damage to both programs."

ACP also sent out a blast email alert to its 6,000 plus "key congressional contact" grass roots network urging them to call their legislators to demand action.

Many of have told us that they made the calls. Some, though, have said that they see no point, since they don't believe that Congress is listening.

I understand their frustration and sense of powerlessness. But I also know that if physicians don't hold their elected senators and representatives to task, they are essentially engaging in unilateral disarmament. The most powerful tool to influence Congress is grass roots engagement by the people whose votes they will be seeking for re-election. The reaction to an intransigent Congress should be to increase the pressure from voters, not to back off out of frustration.

Lastly, I continue to hear from some ACP members who argue that organized medicine should have "insisted" or "demanded" SGR repeal as the price for supporting health care reform. I addressed this issue in my post from Friday, so won't restate all of the reasons why the SGR is an inherited problem separate from health care reform, or all of the policy reasons (including getting all Americans covered) that ACP supported health care reform even without an SGR fix.

But let me address the fallacy behind the idea that organized medicine could have successfully "demanded" that Congress fix the SGR as part of health care reform. The fact is that a majority of the House of Representatives voted to repeal the SGR. But in the Senate, it would have required 60 votes. Every Republican member of the Senate had vowed to vote against health reform, even if it included an SGR fix. The only way that the SGR fix could have been included in health care reform, then, would have been if all 60 Democrats in the Senate (that is, before Scott Brown took the Senate seat previously held by Democrat Ted Kennedy) were willing to vote for the over $200 billion additional cost of including the SGR in health reform. The simple fact is that there were a half dozen or more Democrats who wouldn't agree to the added SGR cost, no matter how much organized medicine might have "insisted" that it be included. And the fact is that once the Democrats lost a filibuster-proof majority after Senator Brown's win, there was no way for SGR repeal to be included in the health reform bill without at least one GOP vote for the broader legislation. This isn’t to excuse Congress' inaction, or to blame one political party over the other, only to explain why "demanding" that the SGR be included in health reform was never a realistic strategy.

I hope that physicians can stop beating up on each other by second-guessing the decisions made by their professional organizations on the SGR, and direct their outrage where it can really do some good: holding their members of Congress accountable for the irreparable harm it is inflicting on Medicare.

Today's question: What changes are you making in your practice because of the SGR cut? And are you holding your members of Congress accountable?


marcsf said...

The best change a physician can make is to opt out of Medicare. In that way physicians are free to contract with their patients a fair reimbursement, free of Medicare audits, feee of Medicare price-fixing, and free of bureaucratic Medicare nightmares. Free! Free at last!!!!!

Arvind said...

As Marc said. Bob, I find the idea of "organized Medicine" to be a figment of your imagination. We wouldn't be in this mess if there was a true organized medicine.

While it is very convenient to say now that it was impractical to insist on an SGR repeal before the passage of the "reform" law, we as physicians could have simply refused to endorse such a flawed Bill. We did not have the spine to do that or perhaps the willingness.

Perhaps it would have been a much less expensive bill if there was less "pork" in it; and mabe some Republicans would have supported it in the Senate. Bob, you being a master at politics, should make it clear to your blog's readers, that the Senate Bill that was signed into Law, was not meant to be the final Law. It is a poorly written document; and had to be debated in "conference" and a compromize hammered out. None of this occured because the Speaker and President wanted to push through some legislation (any Bill) and show some "achievement". I cannot still believe that all you smart people just went with all this nonsense, knowing full well that only a fool believes a politician's promise.

As I have said before, it is not too late for the ACP to admit that it made a mistake and try to salvage something out of nothing. I doubt its going to happen, but as you can see, I am still an optimist. I will hold my elected representatives accountable in November, and try to bring balance to the Force!

Unknown said...

Dr. Arvind,

You are quite correct. Why don't we (ACP) just admit that we got "hornswoggled" by these folks? Or do we really want people to think that doctors are that dumb?

Instead, seems like ACP has been in "full spin" mode with regard to this SGR nightmare. First, it was "all the republicans fault" because even though SOMEHOW, Reid and Pelosi and Obama had the political muscle and will to ram through "healthcare reform," all of a sudden they are completely POWERLESS and "held hostage" by a small minority of Senate repubs when it comes to the SGR?? Gimme a break! That one doesn't pass the straight face test.

Now, when the Senate has actually done SOMETHING (albeit almost nothing, to be sure) to at least keep the wolf away from the SGR door for a few more months, Nancy Pelosi has thumbed her nose at the ACP, the AMA, and every doctor in the country by claiming this "fix" doesnt' have ENOUGH PORK in it for her pals. I think all the botox has fried her tiny brain.

Is ACP now going to urge all its members to write to Nancy and tell her what we think of her? (just as ACP excoriated the senate -primarily the "obstructionist republicans" - last week and urged its membership to call for SGR reform)

Well, I kinda doubt it - but we'll see . . .

Phil 314 said...

It will get "fixed" but only in the short run.

Physicians will need to be a part of a comprehensive, sustainable "cost" solution.

Not just a short-term "revenue" solution

Unknown said...

If your objective in life was to cause the collapse of Medicare, wouldn't opposition to 'docfix' be one of the tools you'd use?

Susan Greenberg said...

I did opt out effective 7/1/10. I have 90 days to change my mind. We all have the same option.
I went to the Hill yesterday to lobby for us. The fingerpointing is awful. However everyone in Congress with whom I met said virtually the same thing. "Where is your representation on the Hill?" and/or "Why are you putting up with this?" and several times " Getting doctors to cooperate if like herding cats." Congress is using all of those sentiments and facts to the utmost.
How about the ACS working with the ACP, AOA, ASH, ASCO, etc for this once.
How about we all take a vacation on the same day - just one day - to make a point that just may make the news.