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Leadership Day focuses on modest reform

From the April 1996 ACP Observer, copyright © 1996 by the American College of Physicians.

By Deborah Gesensway

Washington, D.C.--ACP leaders from Maine to California one blustery day last month blanketed House and Senate offices, urging legislators to come together across the aisles during this most political of seasons to enact modest health insurance reform as a small step toward universal coverage.

The College's fourth annual Leadership Day drew more than 80 internists--Governors, residents and Regents--to Capitol Hill for meetings with more than 150 senators, congressmen and their legislative aides. The message was three-fold:

  • Enact the limited, bipartisan health insurance reform bill promoted by Sens. Edward Kennedy (D-Mass.) and Nancy Kassebaum (R-Kan.)as a first step toward universal access (see "Making hard choices in health policy").
  • Oppose the National Governors' Association's proposed compromise on Medicaid reform because it could "substantially weaken the safety net" by allowing states to severely restrict the amount, duration and scope of health benefits provided to poor and disabled Americans.
  • Consider legislation that could help curb some of the HMO practices most intrusive to the doctor-patient relationship and that would preserve the financial infrastructure of graduate medical education.

"In this volatile economy, when people are scared of losing their jobs, we think the issue of health insurance portability is very important," said Paul F. Speckart, FACP, the College's Governor for Southern California Region III, during his 20-minute meeting with Rep. David Dreier (R-Calif.) and his health policy aide. "We are very concerned about legislation that concerns our patients."

ACP's leaders couldn't have come to the Hill on a better day. Health insurance reform bills, after months of sitting in shelves, were finally being dusted off and fought over by congressional leadership. On one side of the Hill, a House committee was marking up its insurance portability bill; on the other, Rep. Marge Roukema (R. N.J.) was personally urging ACP members to convince their representatives to sign on to her bill.

Interestingly, it was also the day Senate Majority Leader Robert Dole (R-Kan.) clinched the presidential nomination by sweeping the Midwest primaries and the day President Bill Clinton submitted his $1.64 trillion budget proposal for 1997, which, the Washington Post reported, "effectively opens the Washington phase of the 1996 presidential contest."

With debate on a bill to limit immigration blaring on C-SPAN terminals in each office, Bernard P. Shagan, FACP, Governor-elect for New Jersey, found the opportunity to raise his concerns with an aide to Rep. Robert Torricelli (D-N.J.) that a national policy to suddenly limit opportunities for international medical graduates could have a dramatic impact on patients' access to health care in the Garden State. These doctors are the ones providing care in New Jersey, Dr. Shagan said.

Meanwhile, Robert Winn, MD, a third-year resident from Chicago, was telling Sen. Carol Mosely-Braun (D-Ill.) of his worries about the future of medicine--his future--if funding for medical education and research are drastically cut back. "we are learning how to be more frugal in how we practice," Dr. Winn said. "but it's frustrating to me that [HMOs] don't have the obligation" to help contribute to medical education costs.

The internists heard different responses from different legislators. A staffer to House Majority Leader Newt Gingrich (R-Ga.) expressed astonishment that doctors would be willing to put their profession's self-interests aside that day--in this particular case, to urge Congress not to jeopardize passage of an insurance law that could be taken as a first step toward universal access by adding malpractice reform an other issues that do not have bipartisan support.
"If the next generation of doctors is not just going to become health insurance employee, it is vitally important for doctors to advocate on issues relating to health care," Sen. Mosley-Braun told Dr. Winn and the three other Chicago internists who visited her office. "Once the insurance issues dominate [all discussion about health care], then important topics like GME and long-term care all fall off the face of the earth."

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