Political Apathy en masse in Massachusetts

Writing this letter makes me feel queasy; I was brought up never to discuss money or religion at the dinner table, but when I read the article by James L. Becker, M.D. (December 2006) about the numbers of donors to ASA Political Action Committee (ASAPAC), I was compelled to write.

I have been a member of the Massachusetts Society of Anesthesiologists for 41 years, and proud of it — until now. Only 6 percent of our members donate to ASAPAC. We are at the bottom together with Washington, D.C., Puerto Rico, Missouri, Mississippi, Vermont and the State of Other.

Even worse, the few colleagues who do donate give the least amount of all the states except Puerto Rico and Other.
I wondered if this is related to the large number of residents in Massachusetts, 390 out of a total of 1,212. Maybe. Or the relatively large number of teaching programs, which, if so, perhaps suggests that academic faculty feel isolated and insulated from the slings and arrows of outrageous governments and insurance companies?

As I always do when I have worries about the future of anesthesiology, I drove yesterday to William Morton’s monument in the Mount Auburn Cemetery and put my ear to the inscription for a chat. When I told him this dismal news, he groaned, “Penny wise, pound foolish.” After that, all I heard were creaking noises. He was turning in his grave.

Gerald L. Zeitlin, M.D.
Chestnut Hill, Massachusetts

Editor’s Note: Dr. Zeitlin’s words are meant to be provocative, and they speak to the need for every anesthesiologist to be politically active in some manner. In point of fact, many of the leaders in organized anesthesiology hail from the states he mentioned, giving tirelessly of their time, talent and expertise in addition to monetary resources. Dr. Zeitlin never meant to disparage those who have contributed — rather he wants those who haven't contributed to begin, and those who are able to increase their commitment to our specialty's future. William Thomas Green Morton, whose public demonstration of ether anesthesia at the Massachusetts General Hospital created a revolution in surgery, would no doubt understand Dr. Zeitlin's frustrations, as he spent years lobbying Congress to receive financial compensation for his unenforceable patent on ether anesthesia. As an historian, Dr. Zeitlin is no doubt aware of these parallels to Morton and hopes to have his fellow anesthesiologists in Massachusetts and across the United States support political action in favor of the specialty. May our outcome be better than Morton's, largely because our positions rest on what is best for the patient, and not our own pockets.

— D.R.B.

Who Is the Real Scrooge?

In an unfortunate attempt to be seasonally correct, the editor likens some anesthesiologists to Scrooge: “There are those in anesthesiology who resemble Scrooge” (ASA NEWSLETTER, December 2006). The editor’s theory is that somehow the message of Scrooge in Charles Dicken’s A Christmas Carol can be applied to the reluctance of some anesthesiologists to give up the use of anesthesia time in the equation used to determine payment by the Centers for Medicare & Medicaid Services (CMS).

Perhaps Dr. Bacon should review A Christmas Carol again, because the message of the predicament Scrooge finds himself in (and the ensuing redemption) is one of greed, selfishness and a complete disregard for the disadvantaged in the world that surrounds him. In that respect, a more accurate analogy would be that, at least in the world I live in where Medicare cases result in a payment that is pitiful, CMS is the Scrooge, and the anesthesiologist is Bob Cratchit. The net effect of this poorly thought-out analogy is that the editor’s message, though likely unintended, comes across as offensive.

As far as the subject of the anesthesia time issue is concerned, the editor’s message (and a letter to the editor in that same issue) implies that if we were to give up anesthesia time, CMS would somehow treat us so much better. What behavior in CMS’ past has given any indication that any concession on our part would result in a substantial increase in payment on its part? At least the use of anesthesia time gives us some control over the great disparity in the time taken by surgeons in performing the same procedure.

Actually, I’m not totally against giving up anesthesia time, but let CMS first come up with some flat fees that will substantially increase the payments that we are presently receiving — and then let’s talk!

David M. Dolan, M.D.
Rancho Mirage, California

Editor’s Note: Dr. Dolan raises an excellent point — as in any negotiation, both parties have to understand that the outcome may not be exactly as either desires. CMS, however, does not seem to comprehend how its rules are strangling both private and academic anesthesiology. It would be wonderful if CMS spontaneously increased our fee structure; however, it is highly unlikely. CMS does not yet see that action as being in its best interests — despite a long and valiant effort by the leaders of organized anesthesiology at all levels to educate it on this very idea. It is my belief that we as a specialty need to come to the table with a new, innovative proposal that captures the imagination of the leaders of CMS and brings them back to the discussion in good faith.

As for my analogy, Dr. Dolan, do you believe that CMS’ attitude can be redeemed by three ghosts?

— D.R.B.

The views and opinions expressed in the “Letters to the Editor” are those of the authors and do not necessarily reflect the views of ASA or the NEWSLETTER Editorial Board. Letters submitted for consideration should not exceed 300 words in length. The Editor has the authority to accept or reject any letter submitted for publication. Personal correspondence to the Editor by letter or e-mail must be clearly indicated as “Not for Publication” by the sender. Letters must be signed (although name may be withheld on request) and are subject to editing and abridgment.