he witness list and prepared testimony for the July 2006 House Energy and Commerce Subcommittee on Health hearing, “Medicare Physician Payment: How to Build a Payment System That Provides Quality, Efficient Care for Medicare Beneficiaries,” appeared much the same as the previous year’s hearing. The Medicare Payment Advisory Commission testimony indicated that there was no documentation that reduced payment to physicians resulted in reduced access to services for Medicare beneficiaries. The American Medical Association and other stakeholders provided testimony predicting future reduction in access and services unless payment to physicians increased. The testimony of Mark McClellan, M.D., Ph.D., Administrator of the Centers for Medicare & Medicaid Services (CMS), focused on questionably necessary increases in utilization of services and his perception of the need to tie physician payment to performance measures.

Thirty minutes after the previous year’s 2005 Subcommittee on Health hearing began, I was flattered, as a new Congressional Fellow, when my boss, Congressman John B. Shadegg (R-AZ), a subcommittee member, asked me to redraft his opening statement to the committee. This year he scheduled other meetings and did not plan to attend the hearing.

In the minutes preceding this year’s hearing, I chatted with the committee’s counsel and exchanged morning salutations with Congressman Nathan Deal (R-GA), the subcommittee chairman. I then took my place among the other staffers seated behind the members. From this perspective, I could view the witness table and also hear the off-the-record commentary exchanged between the members.

The opening statements of the members attending this year’s hearing echoed their statements from the previous year. The testimony of the witnesses also reiterated the previous year’s testimony. Members of both parties addressed pointed questions to Dr. McClellan, expressing what appeared as their general lack of confidence in his perspectives.

As I listened to the discussion, it sounded like a grade-B movie, and I increasingly had the feeling that this was where I had come in the year before. Nothing new was being proposed.

“As the August congressional recess began, I felt that the atmosphere on the Hill was very much like I had often felt standing in a small skiff at low slack tide, feeling the shifting of a coming sea change.”

As the August congressional recess began, I felt that the atmosphere on the Hill was very much like I had often felt standing in a small skiff at low slack tide, feeling the shifting of a coming sea change. Polls indicated that public confidence in the Congress had fallen to an all-time low. Dr. McClellan announced his resignation as administrator of CMS, and other agency appointees of the current administration were being replaced by career agency staff. Mid-term elections were two months away and would determine the magnitude of the sea change.

As I traveled across the country this fall and paused in airport news stands, I noted the many local publications featuring lists of the communities’ “Best Doctors.” The ratings were based on evaluations by other physicians and also civic involvement. It was curious to note the cities in which no anesthesiologists were listed. I was pleased to return home where the cover of Seattle Magazine featured Shelley Agicola, M.D., a cardiac anesthesiologist, medical center leader and respected golfer <www.seattlemag.com/bestdoctors06.asp>. Dr. Agricola creates social capital in her hospital and on the golf course.

During the ASA 2006 Annual Meeting, Resident Component President Benjamin D. Unger, M.D., made a presentation titled “Why Civic Engagement Matters.” He based his presentation on the observations of Robert Putnam, published in Bowling Alone: The Collapse and Revival of American Communities.

Dr. Unger chronicled the decline in community involvement, professional association participation and individual participation in political involvement over the past 20 years. He stressed the need to rebuild social capital to mend the political process as suggested by Mr. Putnam in his “Better Together” initiative <www.bettertogether.org>.

From my perspective, as I sense the coming sea change, it is clear to me that it will be increasingly important to elect individuals who are truly interested in serving the communities they represent, including the physicians who serve those communities.

In order to elect good candidates, we need to begin at the grassroots, become involved in our communities and build necessary social capital.
Many candidates and elected representatives understand the generic problems with Medicare and our health care system. They frequently lack, however, firsthand experience with these problems. As physicians we serve our patients, our communities and their constituents. If we become personally known to our representatives, we can provide them with valuable firsthand information about health care issues that affect the constituents they represent.

Take the time to get to know your representatives, and let them get to know you. I guarantee it will be rewarding.

William G. Horton, M.D., is Clinical Professor of Anesthesiology, University of Washington and Emeritus Physician, Virginia Mason Clinic, Seattle, Washington.