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Can Congress redeem its record of failure on health care?

From the November ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

By Robert B. Doherty

Rather than describing things as they really are, Washington excels at the art of equivocation. Because no one wants to risk alienating the powers that be, we make excuses (usually under the guise of "analysis") as to why Congress couldn't get a particular bill passed.

We blame problems on gridlock, partisanship or outside special interests when Congress fails to pass important and popular legislation. It sometimes seems that our elected lawmakers are powerless to change the course of events, even though it is they who determine the agenda and schedule the votes.

Very few will say it, but the sorry truth is that the 107th Congress adjourned in mid-October to campaign for re-election after miserably failing to enact a single piece of major health care legislation. The responsibility for this failure lies with both the House and the Senate, Republicans as well as Democrats. Individually and collectively, this Congress failed to act to halt devastating Medicare payments cuts, to expand coverage for the uninsured, to improve patient safety, to expand Medicare coverage to prescription drugs, to cut Medicare red tape, to reform an out-of-control medical liability system or to guarantee a patient bill of rights.

The 107th Congress has one last chance to partially redeem itself when it returns for a post-election "lame duck" session. Although little else is expected to be accomplished, Congress will be able to right one of the biggest wrongs of the past session: the failure to pass legislation to halt cuts in Medicare payments for physician services.

Broken promises

Congress has known since November 2001 that Medicare's flawed "sustainable growth rate" (SGR) formula will trigger deep and unintended cuts unless the law is changed. Two-thirds of the members of Congress co-sponsored legislation that would have averted an across-the-board cut of 5.4% cut on Jan. 1, 2002, yet Congress adjourned last December without acting on the bill.

Doctors were repeatedly assured that this year would be different. Members of Congress told their physician constituents that they understood the devastating consequences for patients if Medicare payments to doctors were cut again. They promised that if they accomplished nothing else this year, they would at least make sure that legislation was enacted to halt further physician payment cuts.

ACP-ASIM did not take legislators at their word, however. We did more lobbying, media relations and grassroots advocacy on this issue than on any other in the College's history. Our lobbyists were on the Hill every day explaining the devastating consequences if Congress didn't act to halt the Medicare payment cuts.

We placed op-ed pieces, letters to the editor and issue advertisements in newspapers read by members of Congress and voters nationwide, reaching tens of millions of people. We combined forces with a coalition of like-minded physician, nursing and group practice professional societies. Working with these groups, we were able to coordinate our legislative strategy and commission studies and surveys to show the impact that the cuts are having on access.

We repeatedly called upon our 2,000-strong network of Key Congressional Contacts to send increasingly urgent letters, phone calls and faxes to their members of Congress, demanding action before they adjourned for the election. And we met with key White House advisors to prevail upon them to use their influence to get Congress to act.

Legislative logjam

Our efforts did produce results. The House of Representatives passed provisions, as part of its prescription drug bill, that would have halted the Medicare cuts in payments for physician services and replace them with positive inflation updates for the next three years.

Unfortunately, the Senate was unable to agree on a prescription drug bill, so there was no companion bill and no progress on the issue. House Republicans blamed Senate Democrats for not getting anything done. Senate Democrats blamed House Republicans for including the physician payment provisions in a prescription drug bill that they knew would never be acceptable to the Senate.

In the end, all that the House and Senate could agree on before the election was a continuing resolution to keep the government funded for another month. ACP-ASIM made a last-ditch effort to persuade legislators to include relief from the physician payment cuts in the continuing resolution, but not enough members of Congress were willing to buck their leadership and the White House (which insisted on a "clean" continuing resolution) to make this happen.

There is enough blame to go around for Congress' failure to act. If the House and Senate leadership and the White House really wanted to get the job done, they could have found a way to pass a bill that halts Medicare physician payment cuts and sign it into law before the elections. Both chambers, both parties and the White House must therefore be held responsible for failing.

Last chance for redemption

Congress can partially redeem its dismal record by passing legislation during the lame-duck session and finally halt the cuts in Medicare payments to physicians.

Immediately after the election recess, ACP-ASIM President Sara Walker, MACP, sent out an urgent e-mail to all ACP-ASIM members. We are asking you to call, e-mail and fax your members of Congress to demand that they make a commitment—with no ifs, ands or buts about it—to halt the physician payment cuts when they return to Washington after the election.

The letter includes a link to an action kit that College members can use to pressure their members of Congress and to enlist their Medicare patients in the fight. (Copies of the letter and alert can be found online). The College firmly believes that if members of Congress—particularly those running for re-election—hear from enough internists and their patients, Congress can still act in time to avert another 4.4% cut in Medicare payments on Jan. 1, 2003.

No matter what Congress does before the end of the year, it won't be enough to overcome its legacy of failure on prescription drugs, patient rights or the uninsured. But it can do one final good thing for patients by passing legislation to halt Medicare cuts that will be devastating to the quality and availability of medical care for elderly and disabled patients.

Otherwise, they will unequivocally deserve to be remembered only as a "do-nothing" Congress that played politics as the health care system collapsed around it, even though very few in Washington will be willing to say so.

Robert B. Doherty is ACP-ASIM's Senior Vice President for Governmental Affairs and Public Policy.

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