| |
April 2000
Volume 64 |
Number 4
|
| |
|
|
Write to your legislator in the U.S. House of Representatives,
Washington, D.C. 20515, or U.S. Senate, Washington, D.C.
20510, or call the Capitol switchboard at (202) 224-3121.
Politics: Who Gets What, Where, When
and Why -- A Brief Guide to Getting Your Representative's
Ear
|
John David Y. Cabral,
M.D.
Resident Delegate to American Medical Association Resident
Physicians Section
While getting involved in national and state health care policy
is great, one must be prepared. Before effective policy is created,
one has to go through politics. Politics, in its most basic form,
reflects who gets what, where, when and why.
While the notion in America is to write your congressman if
you want to be heard, this does not always happen the way our
forefathers had planned. Members of Congress receive thousands
of letters, e-mails and telephone calls each day that raise concerns
about issues for everything from money to Martians. It would be
impossible for each member of Congress to read every letter that
is presented to them. Based on my previous experience as a Senate
intern after my first year in medical school, I saw many letters
end up in the trash after being read by some college or high school
intern. (My first job was going through the mail and trashing
letters that I felt inappropriate for attention.) So how can you
effectively reach your representative's ear? The first step in
getting the ear of a member of Congress is to first do a little
research.
Who Are They?
A majority of Americans do not know who their representatives
or senators are. A great place to start is the Yellow Pages, or
ask your friends or neighbors. Such Internet sites as <www.senate.gov>,
<www.house.gov>, <www.ask.com>
and the ASA Web site are other
great resources. Does your representative have a legislative aide
who deals primarily with health care issues? If so, in addition
to writing your senators, or congressman, you should also write
to their health care legislative aides directly. They will be
very helpful in the process since their primary duty is health
care. However, some of these health care legislative aides are
economists, physicians or lawyers; some may be inexperienced personnel
who are not knowledgeable in the health care arena. One health
care aide to a congressman I met was only an undergraduate political
science major whose only health care experience was a semester
in biology class. Rapid responses and subsequent actions depend
upon the political platform of the individual representative and
where health care falls on that spectrum. While your two U.S senators
in each state probably have a staff member who deals directly
with health care, talking and writing to your representatives
who are not up to date with current health care policy is also
of vital importance. They may not be as vociferous in a field
that is not comfortable to them (such as health care), but their
vote still counts. The goal is to enlighten the uninformed and
confirm the informed.
What Do I Write?
A good rule is to write both senators in your state and at least
two representatives. When mailing correspondence to members of
Congress, be formal and focused, or your letter may be ignored.
Include your title and ground mail address in the body of the
letter because most Congress members only respond to their constituency.
Your letter should be no longer than one page. Two brief paragraphs
are best. You should identify your affiliation and your major
concern in the first paragraph. The American Society of Anesthesiologists
Political Action Committee has a list of various topics concerning
anesthesiologists and can tell you where current policy is being
debated. You should describe why the concern is important and
worthwhile in the second paragraph.
Another great idea is to complement your ideas with scientific,
clinical or economic studies rather than just hearsay. Include
copies of the articles with your letter and summarize them in
layperson's terms. This makes research easier for the staff, and
they will appreciate it.
Always make copies of your letters before sending them. If your
representative has not written or called within six weeks, write
him or her again including your original letter. Always give ample
time for a response. Form letters signed by an automatic pen from
the senator always come before the true letter. (Signing form
letters with an automatic pen was my second job.) Unfortunately,
waiting for a response from your representative can truly be an
exercise in patience.
How Should You Contact Them?
There is no rule saying that one form of communication is better
than any other for contacting members of Congress. However, the
overall impression is that e-mail is taken less seriously than
ground mail or a telephone call. If you plan on visiting your
state capital or Washington, D.C. in the next year, include those
dates in your letter so that you can schedule some time to meet
with your representative or their legislative aide.
While writing letters is a great start, meeting and talking
with your representative further strengthens your position. A
face along with a letter is much better remembered than either
one alone. Any meaningful relationship also begins with open communication,
persistence and perseverance. It is the same way with politicians.
You should follow up your letter with telephone calls, town meetings
and possibly fund-raisers.
Another idea that has become popular with senior anesthesiologists
is inviting representatives to spend some time in the operating
room during special occasions such as Doctors Day. It is not only
a great opportunity for you to show them your world (about which
they know very little), but it is also a great opportunity for
them to be seen in public participating in real life health care
situations. These methods are highly effective in forming a lasting
relationship with your representative.
Why Should I Write My Representative?
When I was a medical student working as a Senate intern, many
leaders asked why I was going into anesthesiology since they were
under the erroneous assumption that nurse anesthetists provide
the same care for a fraction of an anesthesiologist's cost. While
many people on "the Hill" do not know what goes on in real medicine,
they know even less about anesthesiology. From Health Care Financing
Administration reports, they know that anesthesiologists are among
the top 10 income earners in medicine. They believe that many
rural communities survive without an anesthesiologist on their
surgical team. They also believe that nurse anesthetists have
been used as an "economic substitute" in many parts of America.
What they do not know is how hard we work as physicians to provide
top quality medical care to the sickest of patients undergoing
surgery. They do not know the differences in training between
anesthesiologists and nurse anesthetists. Among government officials,
there is a glaring misconception that must be corrected concerning
the role of anesthesiologists in patient care.
In summary, I encourage you all to become involved in policy-making
on the local, state and national level. It is a long and slow
process, but a necessary one for us. It is not only beneficial
to our individual practices, but it benefits our profession as
a whole to get involved in politics and policy-making. From the
senior anesthesiologist, legislators need to hear about your experience.
From junior anesthesiologists and residents, representatives want
to know that patients are receiving the best quality care at the
lowest cost. So if you do not have time to contact your representative
concerning our profession, continue to provide top quality care
to our patients so that there is no question as to our importance
in the medical field. Give them no reason to substitute us.
While we all strive for good and effective policy, we all have
to deal with politics. Thus, we must stand united for what we
believe through these proper political channels.
Acknowledgements:
Special thanks to Alan Harvey, M.D., and Jaime Gilkerson.
NOW is the time for all residents to get involved
-- for the first time or the 20th time -- in the onerous issue
involving Medicare's abdication of its responsibility to provide
the safest possible care to seniors in this country. See page
3 for information about how to contact your members of Congress.
John David Y. Cabral, M.D., is an anesthesiology
resident at Brigham and Women's Hospital, Boston, Massachusetts.
return to top
|