A New Year, a New Resolve?
Ronald Szabat, J.D., L.L.M., Director
Governmental and Legal Affairs
third of the U.S. Senate is up for re-election in
2006. The entire House of Representatives will face
the voters. Polls indicate that the president’s
popularity is woefully low. Sobering economic forecasts
continue, driven by ballooning energy costs. Federal
deficit spending remains out of control. Uncertainty
fills the air. These disparate but related realities
are converging this year, setting the stage for the
continuing drama surrounding the future financing
of our nation’s health care, especially for
those patients treated under Medicare.
Same old Washington? Not really. A surprising dynamic
or struggle continues to play out in the halls of
Congress and to some extent within the Administration,
exacerbated by high-profile investigations into alleged
wrongdoing. What is at stake is the ability of a majority
party to govern, both from within Congress and nationally.
The key players are emerging blocks of conservative
and moderate Republicans in the House who have decided
there will be little in the way of “party discipline”
until their side is accommodated. The unexpected defeat
of a FY 2006 House Labor-Health and Human Services
Appropriations bill late last November, as well as
the difficulty that the GOP has had in setting a true
course on deficit spending reduction, exemplifies
the current governance problems. Democrats see their
prospects improving.
Strange? Perhaps. Unusual? No, except that no clear
winners have yet been declared. History, as always,
is instructive: Throughout the 1970s and 1980s, and
until roughly 1995 when former Representative Newt
Gingrich’s “Contract with America”
catapulted the GOP and him to power, Democrats had
long ruled the House by regular compromise with their
Southern “Blue Dog” members and other
loose coalitions to ensure that votes went their way.
Now, with a transformed southern Republican base and
10 years of near lockstep uniformity, the present
House majority is experiencing adolescent growing
pains that will determine if it retains its grip on
power beyond this decade or not.
Politically involved anesthesiologists — as
you all should be — please take note. Times
of change provide wonderful opportunities to cement
old relationships, win new allies and advance agendas.
Despite the many friends that ASA has made on both
sides of the aisle in Congress, the White House and
state capitals across the land, physicians in general,
many of whom have voted and supported Republicans,
cannot take for granted that one party sees the world
as they do. A few large health plans have established
a major foothold with the advent of new Medicare Advantage
plans this year, and employers continue to demand
more accountability of the growing health care insurance
premium dollars that they pay. All this makes for
a continued squeeze on payments to physicians, especially
under Medicare where artificially contrived conversion
factors fail to reflect market costs by larger and
larger margins annually. Particularly for anesthesiology,
the Medicare reimbursement system is broken.
What lies ahead? Much depends on you. Throughout 2006
there will be new opportunities to educate and work
to re-elect or elect legislators at the state and
federal levels who need better to understand anesthesia
medical care; anesthesiology research and its financing;
the importance of scope-of-practice laws that tie
licensure to education, skills and training; and the
need to provide greater funding to educate future
generations of anesthesiologists as perioperative,
pain medicine and critical care specialists. At the
same time, an informed electorate needs to challenge
those whose views are antithetical to good patient
care and medical practice.
ASA is committed to keeping its members informed of
legislative and regulatory events on the national
level. We also continue to lend strong support, as
requested, to our state component societies when the
need arises for more localized action. But organizational
involvement can only take us so far. Grassroots opportunities
abound. All of us working together must take the time
to become and stay involved so that the issues of
today and the future are decided based on facts and
a clear vision of the road ahead. To do less is to
abandon the call to serve patients to the best of
one’s ability.
Please make it your New Year’s resolution to
reach out to a state or federal legislator on a regular
basis, to stay involved in at least one major public
policy issue facing anesthesiology and to open your
wallet to help finance good government. These are
not only civic responsibilities, they are professional
duties. By answering the call to active involvement,
you can and will set the course of future patient
care with sound financing.
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