Friday, March 28, 2014

A (Not) Funny Thing Happened on the Way to the Quorum

Yesterday, the House of Representative voted for the 17th Medicare SGR patch over 11 years, an embarrassing record of futility in addressing real Medicare physician payment reform.  Even more embarrassing—and troubling to anyone who believes in the Founding Fathers’ vision of a good and transparent democracy—is the way that the House leadership orchestrated a secret voice vote to get the patch enacted when they knew that they didn’t have the votes.

Here is what happened.  The patch was opposed by ACP, AMA, the American College of Surgeons, and just about everyone else in organized medicine (More later on why).  Debate on the House floor started yesterday morning, and it quickly became apparent that the House leadership did not have the 2/3 voting super-majority needed to pass the patch (two-thirds was needed because the House had suspended the rules to allow for a quick vote).  Lacking a quorum, the House temporarily put off the issue.  Most members of the House expected to be called back later in the day, with a recorded vote for or against.

Instead, as Roll Call reports, “it was clear that a bill to avert a pay hike for doctors was short on support, so Republican leaders struck a closed-door agreement with Democrats to pass the bill by voice vote while members were not yet in the chamber, according to members and aides from both parties.”

The article continues, “The bipartisan power move to hold a voice vote allowed members to avoid a tough roll call, which would have forced them either to vote for a bill they do not support or allow doctors who treat Medicare patients to take a pay cut, incensing powerful outside interests. The tactic flies in the face of Speaker John A. Boehner’s pledge to be a transparent and rule-abiding Congress, members and aides said.  ‘I’ve seen a lot of dumb things, but I’ve never seen anything quite as comical as this,’ Rep. John D. Dingell, D-Mich., the longest serving member in the history of Congress, told CQ Roll Call.”

In my 35 years advocating for doctors in Washington, I also have never seen such a blatant and secret power-play, blessed by the leaders of both political parties, to win a vote they knew they had lost with zero individual member accountability.  But I don’t find it to be comical at all. 

As ACP President Molly Cooke said in a statement following the vote:

“Physicians and their patients need to know that today, by a voice vote—with no recorded votes and therefore no individual member accountability for their votes—the House of Representatives voted for the 17th short-term Medicare SGR patch over the past eleven years. By voting for the patch, the House failed to heed the unified call, of physicians who believe that now is the time for the House and Senate to reach agreement on the bipartisan reforms that were agreed to by the leaders of the Medicare committees of jurisdiction.”

“[This] would be the 17th patch enacted over 11 years to temporarily halt impending SGR cuts, at a budget cost of over $150 billion. Each time, physicians and patients were told that, this time, things will be different, that the temporary patch would give Congress the time it needs to achieve agreement on permanent reform. Why should physicians and patients believe that passing another patch now would result in permanent SGR repeal?

This one-year patch, if passed by the Senate, will likely give Congress the out it wants to push the entire issue of permanent SGR repeal and Medicare payment reform to the 114th Congress. The new Congress would then have to start over on crafting a permanent SGR repeal and Medicare payment reform bill that could clear the authorizing committees, pass both chambers, and be signed into law by the President—before this latest proposed patch expires on March 31, 2015. It is more probable that this would result in the enactment of patch #18 at an additional budget cost of tens of billions of taxpayers' dollars and further destabilization of Medicare.”

Notwithstanding the House vote, the College is not giving up on permanent SGR repeal.  In a letter sent today to all Senators, the College argued that the, “Senate can—and must—do better, by voting down the patch and passing the bicameral, bipartisan permanent SGR repeal legislation that was agreed to by the leadership of the authorizing committees.”  The Senate vote is expected to take place on Monday, April 1, at 5 p.m.  I encourage ACP members, and other readers of this blog, to call your Senators today and Monday to urge them to vote down the patch and pass real SGR repeal.  Click here for more information on how you can help.

I know that some of you may be worried that with a 24% SGR cut looming on Monday, that a patch may be the only way of stopping the cut. Consider this, though: every time that Congress has come up against the deadline for a scheduled cut, it has made the same old tired excuse, that a patch is the only option to stop it.  We have heard this from them 16 times over 11 years.  Each time they promise to do better, but they don’t and they won’t.  Congress has a choice other than to allow the 24% cut to take place or another patch, which is to pass the bipartisan, bicameral SGR repeal bill.

As we approach the Senate’s vote—which, ironically is supposed to take place the evening before April Fools Day—it would be good to remember the idiom, “Fool me once, shame on you; fool me twice, shame on me.”  Will we wake up on April 1, having been played the fool for the 17th time in 11 years?

Instead, it would be better to remember the classic rock anthem penned by The Who’s Pete Townsend and sung by Roger Daltrey, “We Won’t Be Fooled Again.”   Don’t be fooled into thinking that a patch is the only way to stop the 24% cut.  And remember, it is Congress, not organized medicine,  that’s  acting like the “Fools on the Hill” (Beatles).

Today’s questions: What do you think of the House’s secret vote to pass SGR patch #17?  What are you going to do to hold your House members and Senators accountable to enact permanent SGR repeal? 


PCP said...

What do I think of the SGR patch voice vote?

They like us exactly where they have us! These are power hungry people and they get their way with a powerful and respected profession and loathe to change the status quo they have carefully crafted since the start of medicare.

ryanjo said...

Doesn't it bother you that the very politicians who pulled this recent heist are the very same who will be responsible for creating public policy governing physicians and patients? I would have been much more confident in our profession's future if ACP President Cooke had simply stated that this latest slap in the face is the last, and the medical organizations will encourage and assist their membership in avoiding participation in any federal programs until physician integrity and independence is respected.