With Friends Like These…

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By Bob Keaveney | August 31, 2011

In case you've been wondering how little influence physicians hold in Washington these days, consider how the triple-blow of health reform, deficit cutting, and ordinary Medicare spending adjustments will likely affect you.

For starters, wait until you get a load of Medicare's new Independent Payment Advisory Board. Very little notice has been given to this powerful new board created by the health reform act, but that will soon change. Its job is to help a spendthrift Medicare become fiscally sustainable. Unlike its predecessor — a board called MedPac, whose cost-cutting recommendations to Congress are just that — the new group's actions become law unless explicitly overturned by Congress, and its remedies will mostly be limited to cutting payments to doctors.

What's happening now to American physicians is the result of a long-term cultural shift in the way society views you and your role in public life. Physicians, America has demoted you. Previous generations saw you as vital experts offering crucial advice and service to individuals and families, mostly via the private sector. Today, doctors are viewed as anonymous "providers" in a healthcare system that is better understood as a quasi-public utility than as a private industry.

Many of you have noticed that shift for years now and have resented it (my inbox is proof of that), but the practical effects have been minor compared to what you'll see in the environment brought on by health reform, which represents, I think, the final piece in your transformation from vital professional to public utility employee.

Where were physicians' voices during the debate over how to shape reform? You were talking, but, alas, you weren't (and still aren't) speaking with one voice, and in any case our elected leaders weren't listening. Doctors again took it on the chin in August, when Congress at last resolved its protracted debate over the debt ceiling by creating yet another deficit-reduction commission. This one will be charged with finding $1.2 trillion worth of debt reduction (at minimum) by Thanksgiving. Failure triggers draconian cuts, including a 2 percent reduction in payments to hospitals and physicians, amounting to $130 billion over 10 years. Perhaps the commission can avoid the trigger by agreeing to an actual proposal, but any such agreement would surely include Medicare cuts. Eric Zimmerman, a hospital industry lobbyist, told the Boston Globe that his clients are trying to decide which is worse, the automatic cuts "or whatever the committee recommends."

And all of it is on top of the 30 percent payment cut that doctors face in January as part of Medicare's usual process of reconciling its sustainable growth rate formula with its actual costs. That threatened cut has always been overturned by Congress at the 11th hour, usually replaced by a token payment increase. It’s an annual Washington tradition as predictable as the presidential pardoning of a Thanksgiving turkey. But this could be the year that conservatives, infused with budget-cutting zeal, might force real reductions.

There was a time when American physicians had real influence in Washington. That time has passed.

Perry, Romney and Their Healthcare Stances - TIME TO PAY ATTENTION

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By Marisa Torrieri | September 9, 2011

Chances are, you caught (or at least heard about) the jabs between GOP candidates Mitt Romney, Massachusetts’s former governor, and Texas Gov. Rick Perry on healthcare reform, social security, and job creation at the most recent Republican presidential candidate debate.

One of the most memorable moments, Ponzi scheme-social security comparisons aside: Perry taking a dig at the Massachusetts mandate requiring people to buy health insurance, and Romney defending it.
Not even two days later, news pundits are speculating how the two assumed frontrunners, who joined six other candidates at Ronald Reagan Presidential Library for one of the first major political sparrings of the 2012 elections, would tackle healthcare reform.

And although it’s early in the 2012 presidential campaigns, physicians — especially those who aren’t fans of the Affordable Care Act, sometimes referred to as “Obamacare” — should take the time to familiarize themselves with the GOP candidates’ healthcare platforms. Or at least their evolving platforms.

A quick candidate healthcare platform guide published by Becker’s Hospital Review in the wake of the debates outlined the basics. As expected, there are some notable differences between the two frontrunners. Perry believes job creation can improve healthcare, as it would allow employed consumers to be covered by employer-sponsored health plans. He also is in favor of repealing the Affordable Care Act. Romney, meanwhile, reportedly supports a national version of his Massachusetts universal health program, but not at the expense of raising taxes.

But an editorial in the New Jersey Star-Ledger compared pinning down Republican presidential candidates on specifics to getting “a measles shot into the arm of a wriggling toddler.”

“Mitt Romney, the former Massachusetts governor whose plan was the model for the Affordable Care Act, now insists that what’s good for a state isn’t necessarily good for a nation,” Star-Ledger editors wrote. “To coax votes from conservatives, he is backpedaling from a sensible program that provides insurance for 96 percent of Massachusetts residents.”

Editors also noted that Perry, who supposedly finds healthcare mandates “repulsive,” signed an executive order that all teenage girls in his state receive the HPV vaccine to prevent cervical cancer. Perry was reminded of this stance by another GOP candidate, Texas Rep. Ron Paul — who is also a physician — during the debate. The order signed by Perry was never enacted into law and he has since backtracked his stance on the controversial initiative.

Furthermore, while Perry is critical of the Massachusetts plan, he also has stated that “the answer to healthcare issues in this country can be found in the states,” the editorial noted.

Like we said, it’s still early. Many of you are just getting to know these candidates.

Perhaps physicians should consider that the Affordable Care Act is still in its infancy: Some changes that went into law only recently revealed themselves. It may be too soon to weigh its effectiveness in favor of ideological healthcare changes envisioned by the likes of Perry or Romney.

Regardless of how they feel today, physicians should keep their eyes peeled and their ears tuned to what GOP frontrunners are saying today, as healthcare reform will definitely be a big-ticket issue for many years to come.