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College leaders take three key messages to legislators

Rare bipartisan atmosphere opens way for ACP members during ACP's Leadership Day on Capitol Hill

From the June 1997 ACP Observer, copyright 1997 by the American College of Physicians.

By Deborah Gesensway

WASHINGTON, D.C.—Reform Medicare in a way that assures quality was just one of the messages delivered by 100 ACP members from 32 states who descended on the 105th Congress one day last month to make sure the College's views are heard through the din of political debate.

This year's annual Leadership Day came just as Congressional leaders and the Clinton administration had agreed on the broad outlines of a budget plan. That meant, the internists were told, they had arrived on Capitol Hill during a rare few days of bipartisan cooperation.

"Will this budget deal open up other action?" asked political analyst Norman Ornstein of the American Enterprise Institute, speaking to the gathered internists. "It might, but it's going to be trench warfare."

Because nearly two-thirds of the legislators just arrived to Congress in the 1990s, he explained, the political dynamics in Washington are unique. "A Generation X Congress means an individualistic group. Most are not aligned with something larger than themselves," he said. "We don't have many followers, which makes it very hard to be a leader. If someone says, 'Follow me.' Everyone says, 'What's in it for me?' "

That meant the internists had their work cut out for them as they tried to convince legislators to compromise on dramatic policy initiatives such as Medicare reform and expanding children's health coverage.

The internists took these messages to the Hill:

  • Reform Medicare and assure quality. The Medicare program has had many successes over the years, but is financially unsustainable in its current form, said the College. The goal is to improve the quality of care while making the program more financially secure.

    ACP wants to convince legislators to stop delaying long-term restructuring of the program and begin now, starting with demonstration projects on a range of ideas including case management and disease management. The College also wants legislation authorizing physician sponsored organizations and changing the payment formula for Medicare managed care. "This doesn't mean that tomorrow everyone will be in a new system, because many reforms will take a long time to implement," explained Michael Werner, ACP's Senior Associate for Government Relations.

  • Insure children. Remembering that universal coverage has been a key issue for the College since before the Clintons' proposed health reform. Making sure the 10 million currently uninsured children get access to health coverage is an appropriate next step for the nation, said the College.

    "Recent research shows that the most needy age group for health insurance are those age 58 to 65," said Elizabeth Prewitt, ACP's Senior Associate for Government Relations, speaking to the internists at Leadership Day. But, she said, there is currently little political support for initiatives that specifically address this vulnerable population. Insuring children is less costly—estimated at about $16 billion over five years—and appears to have bipartisan support.

  • Prevent firearm injuries. Physicians are concerned about firearm injury prevention as a public health issue and there are many ways short of an outright ban on guns to reduce preventable firearm injuries, the College said.

    While this may not appear to be a priority issue for this Congress, there are currently about 30 different bills on the subject, such as those requiring child safety locks on all guns; internists told their representatives that physicians have broad support for these bills.

Before embarking on a day of meetings with their senators and representatives, the internists heard from Sen. John Breaux (D-La.), who is making a name for himself in promoting health care reform.

Sen. Breaux, a House centrist, champions a plan to reform Medicare into a defined contribution, rather than defined benefit, type of program. He said the Medicare provisions in this year's proposed Clinton budget are simply more of the "same-old, same old" changes—mostly cuts in provider fees.

"The current model is government-controlled price fixing, and it doesn't reflect today's realities," he said. "But having an agreement on the budget gives us the opportunity to try to do more." However, the senator told College leaders that he is not optimistic this Congress will overcome its polarization and make any headway on true Medicare reform.

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