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Washington's new agenda as the nation braces for war

From the October ACP-ASIM Observer, copyright © 2001 by the American College of Physicians-American Society of Internal Medicine.

By Robert B. Doherty

When I first sat down to write this column, I was prepared to give a recap of what to expect from Congress as it returned from the August recess. The big story was going to be how the sudden evaporation of the federal budget surplus would affect Congress' ability to deliver Medicare prescription drug coverage and increase spending for the uninsured.

The next day, however, was Tuesday, Sept. 11, 2001. I knew then that the story could not be the same. When terrorists hijacked U.S. airliners and used them to destroy the World Trade Center and attack the Pentagon-killing thousands of Americans in the process-they forever altered the ways of Washington.

The immediate-and most painful-impact was the lives lost. Washington is in many respects still a small town, so almost everyone had a connection to someone who died or lost loved ones in the Pentagon attack.

The attack also had an awful impact on Washington's sense of self. Residents here have long taken solace in the belief that we would be spared the terrorism that regularly took lives in other countries' capital cities. After all, we live and work in the "most powerful city in the most powerful nation in the world," as billboards for a local bank once proudly proclaimed.

Newfound vulnerability

On Sept. 11, we learned otherwise. From the roof of ACP-ASIM's Washington headquarters, which is located five blocks from the White House, I could see the smoke billowing from the damaged Pentagon building. We later learned that the White House itself was the original target of the plane that hit the Pentagon. The televised images from New York showed that as bad as things were in Washington, the tragedy was even greater elsewhere.

As I write this column two days after the attack, I can look out my office window and see the oddly comforting, yet unsettling, image of a Humvee and a military police officer patrolling the intersection of 20th Street and Pennsylvania Avenue.

It isn't possible to understand how the state of war in which we now live has affected the nation's health care agenda until you appreciate how profoundly it has affected the ways of Washington. Put simply, Washington is now the capital of a country at war. It is a capital where the priorities are protecting our citizens and eliminating our enemies. It is a capital that has lost its sense of invulnerability and perhaps some of its hubris.

No other issue, no matter how important it is to the College or any other organization, will command the same degree of attention. Washingtonians now know that they are at risk, and nothing alters a government's priorities faster than discovering that it is the target.

Impact on health care

Before the attack, the patient bill of rights was expected to be one of the first issues that Congress would address this fall. The College was prepared to use its influence to try to get the House and Senate conferees-the group appointed to reconcile differences between the House and Senate bills-to reach a compromise on liability that would result in agreement on a bill that President Bush could support. Now, the word is that consideration of the patient bill of rights has been postponed, possibly until next year.

The budget was also expected to be a top issue. The budget resolution that Congress passed last spring called for an infusion of $28 billion to expand coverage for the uninsured and $300 billion for Medicare prescription drug coverage. With the Congressional Budget Office reporting in August that the non-Social Security budget surplus had basically disappeared, the debate in Washington was expected to focus on "who lost the surplus"--and how or if Congress could still meet its commitments to the uninsured and Medicare patients.

Now the top budget issue is making sufficient money available to fight terrorists and rebuild the areas destroyed by terrorist attacks. All other claims will take a back seat.

The new war on terrorism will clearly redirect the attention and resources of the federal government to other concerns, as it should. The issues that the College has championed, however, will not go away. Uninsured people need health care, even--and perhaps especially--in a time of war. People still need to know that the quality of health care is as good as possible. We must still change Medicare to make it more responsive to the needs of physicians and patients.

ACP-ASIM's agenda

The College will have to re-assess its public policy priorities and advocacy activities to take into account the new priorities of a country at war. We will need to address the health care consequences of a nation at war, including preparing physicians and health care facilities to treat potential biologic and chemical attacks.

We know that it will be much harder now to get policy-makers to seriously consider proposals to help the 43 million uninsured, to protect patient rights, to improve health care quality and reduce errors, to cut hassles and red tape, and to reform Medicare. But as long as such needs exist, ACP-ASIM must continue to find a way to make lawmakers and the president remember that these issues too must be priorities, even as we support our government's efforts to defend our country from our enemies.

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