As I've mentioned previously on this blog, tomorrow I'm participating in the special session at ACC.10 about health system reform. The event features House Republican leader Paul Ryan, Democratic strategist and former Clinton White House adviser Chris Jennings, CEO of the Doctors Company Richard Anderson, MD, along with ACC President Fred Bove, M.D., F.A.C.C., ACC SVP of Advocacy Jim Fasules, M.D., F.A.C.C., and the events’ moderator, Scott Wright, M.D., F.A.C.C., of Mayo.

The event, tomorrow from 12:15 to 1:45 p.m. in Hall B100, promises to be a lively discussion on the promise and dilemma’s related to health care reform. I hope to see you there! Meanwhile, if you missed it in the last post, check out our ad that ran in major Washington, D.C., newspapers this week. I think it outlines the College’s positions quite well.

http://www.flickr.com/photos/wallyg/ / CC BY-NC-ND 2.0

Take a look at this nonpartisan, patient-centric ad that ACC is running in all of the news venues in front of Congress, the administration and the whole array of consumer and business lobbying entities in Washington, D.C., the rest of this week. Note that the ad does not take sides with either side of the aisle; it does not mention the Senate bill or reconciliation or any specific legislation; it emphasizes that the only real cost containment will come by getting physicians engaged in meaningful payment reform, including tort reform; and it asks that Medicare, Medicaid and the Secretary receive sufficient funding to hire the expertise to meaningfully engage in such new payment systems (given the truly outdated culture that is currently theirs).  Take a look — this lets all those constituencies know we still care about making sure that every American has access to quality care in a timely fashion!

 

 

 

 

 

 

 

 

 

Click on the ad to view it larger.

OK, we’ve had the Obama Health Care Reform Summit. Enough key members of both parties showed, and everybody got a chance to express their view. The president remains a brilliant articulator and a cool head. One has to be impressed with these abilities. He makes clear there are a lot of needed and good things on the Senate bill. But, for a lot of viewers, Republicans will have struck a note about 2,700 pages of legislation in the Senate bill, and a trillion dollars in spending, and an awful lot of unanswered questions. The bottom line of this event is that nothing really changed.

This is a cause for concern. As physicians, we tend to forget that there’s more than $200 billion of new funding for physician services embedded in that Senate bill, which is sorely needed to stabilize the profession and medicine, and most of it is not the Medicaid expansion, but rather a very significant expansion of private coverage for currently uninsured and underinsured individuals and employees of small businesses and their families. A lot of EMTALA write-offs would get reimbursed here, and we tend to forget that there are billions of dollars of new funding for chronic disease management, prevention and new services for which we have long advocated. And then there’s the $10 billion to fund pilots for real payment reform to get us out of the current dead-end circumstance of endless certain reimbursement cuts if the status quo continues. 

The bill also has a lot of good insurance reforms. Republicans are right that there will be no real cost containment in the current insurance model until we create a competitive and large risk pool and across-state-boundary competitive insurance bidding for the individual and small business marketplace. The bill does contain this innovation, along with a lot of administrative simplifications that are long overdue.

But the bill also contains a lot of things that should have been dropped out, like the independent payment advisory board (IPAB), prohibitions on physician-owned hospitals, and a disregard for the need for tort reform. The excise tax issue with respect to “Cadillac coverage” was in essence horse-traded off the table by the president as a ‘gimme’ to the unions when he set the threshold at $27,000 for family coverage and put off implementation until 2018. So, funding a modified bill will thus require taxes on high-income families and on some high-income individuals’ investment portfolios.

The two parties came into this from very different positions. The Dems need a bill to be passed. Republicans need for that not to happen. The Summit, while promoted by both sides as offering some fresh ideas about how bipartisan progress could be made, offered little hope it will. There is no bipartisan spirit here. That’s what the Summit made clear.

What will happen now? Personally, I believe we can’t trust anyone who thinks they know what will happen. Unlikely as it is, the Dems may still try to pressure a reconciliation, even though I think it’s unlikely without a lot more work, but we’ll see. Pelosi said on Saturday that she thinks a bill will be ready by their Easter (spring) break. I don’t know.

 

 

Not to be outdone by the White House and their televised summit on health care reform (which I'll talk about further over the next couple of days), the ACC is holding a similar meeting of the party minds at ACC.10. I hope many of you will be there in Atlanta and able to attend this special session. “ACC.10 Health System Reform: Where Are We Headed?” takes place on Sunday, March 14, from 12:15 to 1:45 p.m. in Hall B100 of the Georgia World Congress Center. The session will bring together a policy leader on health care from each party. House Republican leader Paul Ryan and Democratic strategist and former Clinton White House advisor Chris Jennings will define and debate the issues and give us the latest update on health care reform. Then, we’ll have the unique opportunity to advocate on behalf of our patients and the entire cardiovascular specialty as we share our ideas with them.

President Fred Bove, Jim Fasules, ACC member Douglas Wood and I will offer our input on the importance of patient access to care and discuss ACC quality initiatives, our perspective on health care reform and physician payment reform. Plus, Richard Anderson, MD, CEO of the Doctors Company, will offer his perspective on the need for tort reform as part of health care reform. Be there. I think this will be a very compelling session, and one that should demystify the health policy issues for you. Of course, ACC.10 is also the premier scientific and clinical care venue in cardiovascular care anywhere worldwide. Don't miss it.

The president has at long last put out his own official health care reform proposal. I must admit I’m somewhat surprised that Obama didn’t propose a slimmed down and more simplified proposal that might have more acceptance with moderate Republicans and Blue Dog Democrats. He actually adds additional costs and more provisions to what the Senate has proposed, which I think bodes poorly for getting this passed by the House of Representatives. They only passed HR 3962 by five votes as it was, and there are a lot of things in the Senate bill that House Democrats don’t like, and a number of them still are there.

I’m hoping that the president has a strategy of being willing to appease some of the irritated constituencies in this first go-around, and that he might be willing to really horse trade on TV with moderate Democrats and Republicans in attendance to get to a slimmed down version capable of passage by both chambers.

From ACC’s point of view, a proposal should have a means of involving physicians and other professionals in helping to design means of improved quality and care coordination through a payment system that incentivizes such results. And, some kind of assurance to businesses and working families that health care will not bankrupt the nation. I think all of us in medicine know there is a pathway to success in these regards.

So, the summit of 36 to 40 bipartisan members of Congress who will gather at the White House Thursday to take us to the next step should be a thing of interest to behold. I won’t “beholding” my breath.

** Official Obama portait. **

The Senate is not seemingly getting closer to an SGRrrr fix. Not even a one- or two-month postponement. It is conceivable the cuts could go into effect March 1 unless they come to their senses. The House is ready to do a long term fix by just writing it off, but the Senate insisting it be largely ‘paid for’ (they agreed to write off only $82 Billion of the $210 debt) -- where’s the money? There are some members of the Senate who want to see if doctors will really stop seeing Medicare patients if the cut proceeds we suspect. This is a risky game.

AMA has led the advocacy campaign on trying to get this solved, and we’ve been working closely with them, but this is getting crazy at this point. ACC's CardioAdvocacy Alliance sent out the following action alert last night -- I urge you to take action:

Congress returns from its President's Day District Work Period this week, with only a few days left to intervene to stop a 21.5 percent Medicare physician payment cut from taking effect on March 1. In just seven days, the current temporary freeze in Medicare physician payments will expire. Although the House of Representatives passed a bill to eliminate the cuts (H.R. 3961) this past November, the Senate has been unsuccessful in passing similar legislation (S. 1776). Please call your lawmakers this week, even if you already have, and urge them to work with their colleagues to enact a permanent replacement of the flawed sustainable growth rate (SGR) formula.

Act now! Call your members of Congress at (800) 210-7193 or contact your Representatives by clicking here and your Senators by clicking here.

The entire House of Medicine is urging Congress to provide a permanent solution to the ongoing physician payment dilemma. This is even more important cardiovascular professionals given the recent 2010 Medicare cuts to cardiology. Contact your members of Congress today!

Thank you for taking the time to speak on behalf of your patients and your profession.

Remember when it seemed like reform was a sure thing to pass the Congress? Well, now it’s far from certain to pass. Something dramatic is surely needed to address the impending unsustainable rise in health care costs. The Fed raised the base bank borrowing rate by ¼%, meaning the recession is really over, even if hiring hasn’t bounced back. But rising health care costs represent our dirty little problem -- Wellpoint put off their proposed 39% increase in individual rates under political duress (for only 2 months), and while Republicans are switching to tea parties, Democrats are going to need some powerful triple espressos to get through the next phase of health reform. 

While the upcoming (this week!) Obama ‘bipartisan’ health summit proposes to assemble the surly parties to compromise on a reform strategy, and, believe me, I’d love to see it happen, I’m not holding my breath. Nonetheless, Obama’s team was ordered to come up with a unique, simpler compromise bill -- and they say they have it. Supposedly it will cull the best elements of the House and Senate bills, and will be released Monday. 

But, given that Democrats have lost their filibuster-proof majority in the Senate, Harry Reid, Nancy Pelosi, and White House chief of staff Rahm Emanuel met quietly yesterday to review the President’s ideas, AND to discuss how to use ‘budget reconciliation’ to pass a reform bill if Republicans will agree to nothing. Reconciliation can be used to speed the approval of legislation calling for tax cuts or increases or funding changes in programs like Medicare. A reconciliation bill needs only 51 votes to pass, and filibusters are limited. (The Alliance for Health Reform has a new toolkit on budget reconciliation if you are interested). Of course, some Republican leaders are saying they will boycott the summit unless the Dems will start over on reform -- meaning the President’s new bill may be a non-starter. The 'summit' is likely to be more a 'circus.' 

President Obama has been telling everybody that he would be willing to compromise with Republicans on their health priorities, including tort reform. The trial attorneys (American Association for Justice) are cautioning him against any hasty decisions on tort reform, or the 'party’s over' on their hefty funding of Dem campaigns. The Dems feel they must pass a reform bill, and the Republicans will do anything to block that. This looks to be tragically entertaining. This week will be interesting!

*** Image from Flickr (Suviko). *** 

The SGR fix remains a top priority in Congress, with the House still wanting a long-term fix and the Senate unwilling to pay for that. As a result, Thursday of last week Senate Finance Committee chair Max Baucus (D-MT) and ranking member Chuck Grassley (R-IA) proposed a bipartisan jobs bill, known as the Hiring Incentives to Restore Employment (HIRE) Act (pdf), in which they would extending current Medicare physician payment rates for seven more months, through Sept. 30, 2010, once again postponing the 21.2 percent cut that was scheduled to take effect on Jan. 1. 

We hear this 7-month reprieve represents a compromise between Senators who wanted a one-year payment fix through Jan. 1, 2011, and others who were seeking an even shorter bridge period to supposedly give Congress time to pass a permanent repeal of the Medicare sustainable growth rate (SGR). 

The HIRE Act is getting trashed as a real jobs creation bill. Majority Leader Harry Reid (D-NV) wants the health aspects out of any Senate jobs bill. HIRE includes extensions of unemployment insurance benefits and COBRA premium assistance for terminated workers, and would extend a number of health care provisions that expired at the end of 2009, including GPCI geographic payments to rural doctors. These provisions are hardly what ‘jobs’ advocacy has been all about, and so this will likely not end up as an SGR vehicle after all.

Along with the AMA, the ACC wants Congress to permanently repeal the formula once and for all.  The short-term, band-aid approaches used in the past to stop imminent cuts only made future cuts steeper and increased the cost of a permanent solution. If Congress had fixed the problem in 2005, when physicians faced cuts of  3.3 percent, the cost would have been $49 billion.  5 years later we face a 21% cut at a cost of $210 billion.

Here’s AMA’s statement of yesterday -- I’d say we’re right with them on this:

”Congress has passed legislation to reinstate statutory pay-as-you-go (PAYGO) rules, which require bills that would increase federal spending to include provisions that offset those costs through spending reductions or revenue increases.  That legislation would also exempt from PAYGO requirements $82 billion of the currently estimated $210 billion cost of a permanent SGR repeal.  The AMA is continuing its advocacy efforts to secure permanent Medicare physician payment reform, and will continue to oppose further short-term fixes.”

Let me translate that -- a much better solution to the HIRE bill idea is to pay it all off at once, with a discount write off of $82 billion, meaning they would have to come up with about $128 billion to get rid of it. They should.

Is it unpatriotic to support continuity of the U.S. health system’s status quo, as many physicians and citizens seem to be comfortable advocating?  In answering this question, we need to consider how much health care is contributing to the debt, which itself threatens our economic vitality and national security. The accumulated national debt is currently well over $12 trillion, about 53% of the U.S. GDP for 2009. It’s about $4,000 per citizen.

As currently projected, it would grow to over 300% of GDP by 2050, and the vast majority of that growth will be the result of rising health care and Medicare costs, government economists estimate. The deficit number for this year will be $1.8 Trillion, and for the year 2011 the deficit would be $1.3 Trillion. If the SGR was to be eliminated, the number would likely be at least a half-trillion more. The dramatic growth of the deficit puts the nation’s future stability and security at great risk if not addressed. Deficit growth will be mainly related to unfunded health care costs to cover the 40 years it will take for the boomers to retire, vote en masse to demand the best health care, and die off, presumably after becoming part bionic and genetically-engineered beings. 

Tough Choices
The current partisan environment and resultant difficulty we will have to make the tough political choices needed to stabilize Medicare, health care, and Social Security represent a recipe for disaster. Without new thinking about health delivery system and payment reforms, for example, we will surely face accelerated price fixing and price cuts for doctors annually, like we have seen this and previous years for cardiology. The current SGR dilemma we face may look like a cake walk in the face of future pressures for cost containment. And doctors seem to be the easiest political victims for achieving such cuts.

Finally, it will be increasingly essential that patients bear a much larger share of their own health care costs in this future, potentially motivating more informed shopping. But, there is a finite amount of out-of-pocket spending that middle class and lower income families will be able to contribute, so political pressure for a bigger social support infrastructure for health costs will be demanded by aging boomers. Where will it come from? Probably from more cuts to health care providers. My crystal ball indicates we’re headed for a decade of tough fights like we are experiencing this year, unless we figure out how to ferret out the extensive waste in the current system to protect health care and the vitality of the profession.

There are ways this story could unfold in a more positive fashion. It would be nice if we as a species and a nation could dispense with war, for example, although this would seem to require ‘human nature’ transplants, or miracles, or both. We could tax the living heck out of everybody making more than minimum wage. But unfortunately that would kill off economic growth. 

Or, we could get engaged in preserving the profession and the patient-physician relationship, while still promoting continued innovation and scientific progress in health care. To accomplish this, we would need to figure out and refine ways to reduce health care spending increases to no more than a percent or two greater than the GDP. Could we accomplish this without killing off innovation and the vitality of the profession? I happen to think we could. I know some of you reading this are skeptical. That’s understandable. But what are the options here, folks? Leaving things to ‘evolve’ on their own in the political environment looks awfully risky.  Ironically, even if not yet realized, the nation needs for us to take these challenges on or solutions won’t likely be forthcoming. If we all allow the debt to explode, the entire economy -- including medicine -- will suffer greatly.

So, back to my original question: Is it unpatriotic to support continuity of the U.S. health system’s status quo, as many physicians and citizens seem to be comfortable advocating?   An informed answer is yes.

*** Image from morgueFile (jdurham). ***

Congress has still not figured out what they’re doing about the SGR, with the two-month extension ending in just three weeks. Chairmen Waxman, Stark and Rangel have assured us they still want to see a 10-year fix, as the House has recommended. They however note that the Senate remains unwilling to support them. There have been rumors that some physician organizations are asking for another two-month extension to have more time to convince the Senate to produce a longer term solution. Baaaad strategy.

This would be extremely dangerous, since the CBO (Congressional Budget Office) is preparing its next ten-year budgetary estimates, and speculation is that they will revalue the SGR debt much higher at between $300 and $400 billion! It would be very risky to have this projection come out while Congress is negotiating whether to give us a two-year, five-year or longer remedy, so we believe we need to move this month on negotiating as long an extension of SGR funding as possible.

My frustrated bet: They will kick the can down the road once again for a two-year fix, leaving us at risk of a half-trillion dollar funding cliff in 2012! What a mess.

The ACC this morning held a press conference on health care reform as part of the National Coalition on Health Care, of which the ACC and a number of other specialty societies and consumer groups are members. Ralph G. Neas of NCHC, Ron Pollack of Families USA, Mary Andrus of the Consortium for Citizens With Disabilities, Terry Gardiner of the Small Business Majority, Mary Wilson of the League of Women Voters, and Richard Kirsch of Health Care for America Now and I were the featured speakers. From today's Advocate:

The press conference was in keeping with the College's ongoing efforts to work with multiple stakeholders to enact health care reform that protects patient access, addresses tort reform, improves quality/coordination and reduces disparities in care. The ACC had the opportunity to highlight the cardiology community's concerns with the current legislation and urge the elimination of provisions that have reduced public trust and increased partisan rancor.

Even more importantly, it also placed us front and center with key consumer groups who have the ability to help us not only with crucial elements of reform, but with mitigating the impacts of the 2010 Medicare cuts. ACC leadership was also able to individually educate the media in attendance on the impacts of the CMS Medicare cuts on the practice of cardiovascular medicine and patient access to quality care.

Your ACC continues to navigate a critical path through the reform quagmire that truly meets the needs and goals of the cardiology community, while also protecting the patient-physician relationship. Click here to read the ACC's recent letter from ACC President Alfred Bove to House and Senate leaders outlining both the College's areas of support and areas of concern.

In other news, efforts continue to fight the cardiology payment cuts included in the Rule. Please take a few minutes to call or write your representatives and urge them to cosponsor legislation (H.R. 4371) introduced by Rep. Gonzalez (D-TX). We've set a goal of 100 more cosponsors -- contact your member today (so far we're at 77 -- but we'll need a lot more to force some action). To see if your member is already one of the 77 cosponsors and to say thank you, click here. ACC staff is working on generating similar legislation in the Senate. For more on ACC's efforts related to Medicare payment reform, go to http://www.campaignforpatientaccess.org.

We’re about to take another slap if the recent deliberations of MedPAC become real. They’re bound and determined to kill off in-office imaging for all specialties, not just cardiology. To force by public policy all imaging to hospital sites is going to cause quite a problem for patients, both in inconvenience and in increased overall cost. (ACC President Fred Bove has a great President’s Page on the democratization of imaging in the next issue of JACC; watch for it.) Nonetheless, our current version of the IPAB (Independent Payment Advisory Board) is MedPAC, and here’s what they’re doing:

MedPAC staff recently made a presentation to the MedPAC commissioners regarding the “in-office ancillary services” exception (commonly known as the “group practice” exception) to the Stark Law (see the MedPAC slides).  It is this exception that enables private practice cardiologists to provide echocardiography services to their patients.

At the meeting, MedPAC staff suggested that the Commissioners consider three options for addressing the increased utilization that ostensibly results from this exception, especially in the area of clinical lab services, radiation therapy services and diagnostic imaging:

1. Excluding certain services from the group practice exception, such as outpatient therapy and radiation therapy and diagnostic tests that are not usually provided at the time of the office visit.  (According to data presented by MedPAC staff, ultrasound is provided on the same date as the office visit less than 30 percent of the time, so echo likely could not be provided by group practices if this test were adopted.)
   
   
2. Payment tools such as reducing payments for self-referring physicians, packaging services and bundling services.
   
   
3. Establishing a prior authorization program for physicians who self-refer.

In case you’re not watching closely, I need to alert you to the fact that the entire payment system — in both the public and private sector — is in severe disarray. If most doctors are working for hospitals in order to remain viable in the near future, which might be administratively simpler for Medicare and the insurers, the need for payment reform and for physician involvement in it will become even more pressing, because hospital-based costs are going to drive health care costs up. And then, next year, the thrust will be to slash hospital reimbursements. The status quo of the current payment systems, as exemplified by this entry, needs to be changed. Price controls don’t work. When do we wake up here? This is a bad dream.

Notwithstanding Harry Reid’s plethora of public statement snafus, Ben Nelson’s being booed out of a popular restaurant in his hometown on his health reform behaviors, and despite the fact that Republican Scott Brown won the “Kennedy” Senate seat over Democrat Martha Coakley in Massachusetts (wiping out the 60^th Dem vote needed for reform in the Senate), I remain optimistic about health reform.Mr. Reid and Ms. Pelosi seem to have a very shaky but barely sufficient majority of votes needed to move a compromise bill through both houses and on to the President in time for the State of the Union. Who would have thought this to be possible a month ago? Of course, lots of things could derail it, but it seems to be moving forward.

The ACC, along with most of medicine, is extremely concerned about the proposed IPAB (Independent Payment Advisory Board), which is an outgrowth and evolution of the IMAC (Independent Medicare Advisory Commission), itself a version of ‘MedPAC-on- steroids.’ The Senate has of late proposed the IPAB consist of 15 physicians that would oversee (guess what?) physician spending. Hospitals, long-term care and pharmacy costs would seem to be excluded.

What? First we have the SGR as a volume-based expenditure target for doctors only, and now we are going to have a second process to limit physician spending? At the same time, hospitals will continue to have their “market basket” formula, which gives them a tidy 2 to 4 percent increase every year, without expenditure targets. Until we physicians decide to increase our investment in our future (and the future of our patients) by getting more involved in the political action and PAC activities, the hospitals, health plans will continue to have much more leverage than we do.  It looks now like the SGRrrr will get only a short 2-3 year fix in the talks this weekend. No good.

The ACC is also pushing still for tort reform, including certificates of merit, health courts and other provisions that a fairly large number of Democrats will support. Of course, we could get support for tort reform from almost the entire contingent of Republicans in both the House and Senate, except they won’t help now because they don’t want to give the Democrats any credit for something they believe is their domain. Some progress on tort reform looks possible. The ACC signed on to a multi-society letter drafted by the Health Coalition on Liability and Access (HCLA). We are a member. HCLA lobbied for the kind of tort reform language that the ACC has long supported directly with Harry Reid and Nancy Pelosi this week.

Health reform may be imminent. Hold your breath. Whether you want to see this proceed or are adamantly opposed, the nation could be doing something as significant as occurred in 1965 with the establishment of Medicare and Medicaid soon.

As our attorneys, ACC's witnesses, staff, and I were about to board our flights to Florida for the scheduled hearing on our preliminary injunction and expedited discovery motions related to the Medicare 2010 Payment Rule, Judge William Dimitrouleas of the US District Court Southern District of Florida denied our motions. Basically, he refused to hear our case.

We are deeply disappointed in the judge’s decision not to hear our case based on his opinion that the federal courts do not  have jurisdiction to review Medicare physician payment determinations.  Nevertheless, we continue to believe in the well-documented merits of our case.  The ACC will continue advocating for real payment solutions based on quality outcomes and patient care.

What is deeply troubling about today’s ruling is that it sets the precedent that CMS has complete and unchecked control over physician reimbursement for patient care even where its determinations are based on faulty data.  This only begs the question: Who's next?  Today’s ruling should be a warning to all physicians that anyone is susceptible to falling into CMS’s crosshairs unfairly and without recourse.

Ironically, this rule will increase Medicare costs by shifting cardiologists and their patients to more expensive hospital settings. These cuts are a perverse ‘reward’ for the amazing work cardiologists have done over the past decade in reducing heart disease deaths by thirty percent.

Today’s decision is counted as a loss; however, we stand behind our position that the system erred. The practice expense data used to determine this rule was inaccurate and incomplete.  Reliance on this data will negatively impact patients' access to care.

We have introduced legislation and we remain hopeful that Congress will get the message that these cuts represent bad public policy.

Our ongoing campaign for patient access is about making quality cardiovascular care accessible to the millions of Americans who are battling our country’s number one killer, heart disease. We will continue to fight on behalf of our patients to protect their access to quality care. I encourage you to visit CampaignforPatientAccess.org for more.

It’s time for 2010! Let’s turn the corner here, and not look back too long. 2009 started with George Bush as President -- doesn’t that seem a long time back at this point? And, it’s been a slog all the way through the year for the new Administration on many fronts. That said, the stock market has regained much of what was lost last year; and let’s hope the worst of 2009 is behind us. Our resolution for 2010 needs to be to apply all means to turn around this 2010 Payment Rule, and then also to design and implement a new and better payment philosophy and methodology based on improving payment and quality and effectiveness.

Think how well cardiology would do in such a reinvented system if it were real: we’ve helped America experience a 30+% reduction in morbidity and mortality in cardiovascular disease in the past decade. A reformed payment system should provide that level of reward -- the overall savings and ROI societal benefits would dwarf any reward to cardiology for these documented improvements. I know a lot of you are skeptical that something this logical and positive could even be realized; but don’t give up -- there is a lot of creative space in the health system reform arena to maneuver in. That said, instead of diving into that creative space when opportunities present, I have been increasingly concerned that we are getting caught up ourselves in partisan rhetoric that will impede our progress to promote our best future and protect our membership and their patients. (Drucker: “The best way to predict the future is to create it.”).  Let’s leave a lot of the cynicism and understandable frustration we’ve all been sharing in 2009 as part of the certain-to-be-damned legacy of the ugly “aughts,” a decade which started with a raging Wall Street, NASDAQ, and housing market, and with unwarranted optimism. 

On Partisanship
A lot of this recent history gets filtered through partisan perspectives. How partisan is health care; and how partisan is the ACC itself? In the public’s mind doctors are mostly Republicans, but is that so? I personally think we’re divided in a partisan fashion as much as the public is. Of course, I guess I should disclose in fairness to you that I am a registered Democrat, although my mostly liberal wife accuses me of being too often on the right side of the great divide. In truth, I reject both party platforms, and the far left and far right extremes that define them. I consider myself a fiscal conservative, and a social liberal. There are more people out there for me to relate to in these regards with each passing year.  Basically, like most Americans, I consider myself to be mostly in the political ‘common sense’ middle -- and in fact most voters now consider themselves to be ‘independents.’ I think that is a good trend. But we need to take heed of it.

Why? Because health care is largely non-partisan, and ACC needs to focus on the merits of each issue, not on a party platform or deliberated slanted party rhetoric, either left or right. If we can do that, we’ll be staying close to our patients and the public in the mainstream -- where we need to be to survive. From a partisan perspective, health care reform is evil for Republicans and good for Dems -- depending on who is in the majority. When Richard Nixon was the champion of reform (he favored the employer mandate that only Hawaii implemented), reform was then “good” for Republicans and evil for Democrats. Partisan politics is gridlock -- and we don’t do well in that future, colleagues.

The challenge of making positive change requires a more discerning, “bi-partisan” course -- we must exert leadership to influence folks on both sides of the aisle. Congress has forgotten completely how to do that; but we shouldn’t fall into the same trap. The vast majority of Americans are concerned about access, and are terrified about the effects of rising costs on families and business -- people mainly want some prudent reform to protect their ongoing access to good and affordable health care.

People are underwhelmed about health reform right now because the left media suggests the current bills lack a public option or single payer; and the right media suggests that we are moving toward communism and a totalitarian state. The bills may be full of screwy provisions in their 2000 pages, but there are sorely needed provisions in there too.

Staying the Same is Irresponsible
As I’ve said in previous blogs (to the praise of some and the consternation of others), the status quo in health care is unsustainable and a certain fiscal nightmare. Doing nothing is not a responsible course real leaders in health care should recommend. Our last 3 ACC  Presidents Jim Dove, Doug Weaver and now Fred Bove have been bold -- and have tried to find a critical path through the reform quagmire that truly reflects the membership’s goals and desires, along with what will protect the patient-physician relationship.  To just say no; or to take a purely partisan stance is not responsible.

Finding a balance is what we need to do together. 2010 will demand a lot of us in the policy arena, and everybody needs to try to be involved---the best way for most folks to do that will be through your feedback on issues to the BOT via the BOG (the Board of Governors) and our state chapters.

But please don’t get your policy perspective exclusively from the NY Times or the Wall Street Journal, or from MSNBC or Fox News -- your colleagues and your patients will be better sources of what is needed. Some kind of bill is almost certain to be passed. We need to make sure it is less toxic than it might otherwise while we’re simultaneously suing the government on the Rule. But considering the Medicare Payment Rule we have faced for the past 6 months, 2010 has got to be better, doesn’t it? (Or, let’s be sure we make it so anyway?)

I’m an inveterate optimist I must admit; although I am somewhat envious of pessimists -- they they are never disappointed. I admit the year is not starting off swimmingly, but there have to be some blue skies ahead out there…