ASA March 2007 Newsletter

On Staying Focused

Ronald Szabat, J.D., L.L.M., Director
Governmental and Legal Affairs

t began as a trickle. Then it became a more constant flow. Very soon our chief full-time inside ASA lobbyist and ASA Political Action Committee Director Manuel Bonilla was devoting 30-minute segments to calls from worried ASA members. At about the same time, one of our ASA listserves began circulating alarming notes of concern.

Was it the needed reform for the Medicare anesthesiology teaching rule that excited our members? Was it the need to address the looming 10-percent cut in 2008 to the Medicare conversion factor because of the sustainable growth rate (SGR) formula? Or the collapsing anesthesia conversion factor as a result of recent Medicare Five-Year cuts? Was it the hope for Congress to extend Medicare’s anesthesia rural “pass-through” to anesthesiologists? Or was it the long-sought need for physician antitrust relief? A threat, real or imagined? Sadly, mostly the latter!

So what was it that had our members so concerned? Well, as of the end of February, when this article was being finalized, it was just talk. Talk of a “Medicare-for-All” bill when one had not yet been introduced. Talk that Senator Edward M. Kennedy (D-MA), Chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee, was poised to make this a priority for the 110th Congress — just as he has said would be the case for numerous years. Talk that this would be the end of organized medicine, especially anesthesiology, even as the purported sponsor talked reassuringly about the need to provide insurance to the health uninsured. And never mind that Sen. Kennedy has long led the charge against the evils of managed care and recently helped ASA advance our teaching rule agenda.

So, am I overly concerned? Not really, and I ask that you take a deep breath and share my perspective.

First, calls for expanding Medicare to all American citizens or some sort of national health insurance are not new, especially from Sen. Kennedy and the Democrat party. But the last time I checked, organized medicine, with appropriate and important qualifications, still supports the goal of universal access.

Second, among the many difficult issues facing Congress, there remains no consensus on a plan for addressing the needs of the uninsured, any more than there was when now-Senator Hillary Clinton (D-NY) was our nation’s First Lady and tried to tackle the problem comprehensively or throughout the recent Republican-controlled years in Congress. After all, do you really hear Senate Majority Leader Harry Reid (D-NV) or House Speaker Nancy Pelosi (D-CA) seriously talking about advancing Senator Kennedy’s plan? And did we ever see former Senate Majority Leader Bill Frist or House Speaker Dennis Hastert (R-IL) successfully move lesser bills?

Third, as I am reminded on a daily basis, because of longstanding cloture rules, our Democrat-controlled U.S. Senate generally cannot act unless at least nine of the 49 Republicans cross over to help a solid majority. In other words, 41 Republicans can stop practically anything, which is real power.

And finally, fiscal realities being what they are, not to mention the $1.7 trillion price tag for the ongoing war in Iraq, there exists a severe limitation on massive expansions of federal health programs. In fact, there could be a firestorm this year over efforts to spend some $50 billion to reauthorize and expand the State Children’s Health Insurance Program (SCHIP) to provide better health care insurance for our nation’s poor children well before we see any multitrillion-dollar expansion for the nation’s uninsured.

In short, as a leading national specialty organization, ASA needs to stay focused. There is no shortage of policy opposition to the notion of expanding Medicare-to-all from the American Medical Association (AMA), to our state medical societies, to other well-positioned specialties. If this bill or proposal were to move, all manner of well-respected people and organizations would chime in and rally the troops. Why then are we preparing to gear up for a battle that might never occur? Beware of urban legends and cleverly disguised fundraising schemes!

At about the same time that our ASA members started calling and e-mailing us about the “threat” of the looming Kennedy bill, I happened to be sitting next to a well-respected and good congressional friend from a major committee who happens to be a Republican. He, too, in his remarks to our group mentioned the Kennedy “Medicare-for-All” proposal. Coincidence? I doubt it! Debate in Washington takes predictable paths and twists. And, sadly, having failed physicians miserably in late 2006 on reform of the Medicare SGR and other high-profile medical issues such as reform of our Medicare anesthesiology teaching rule, the GOP might just be looking for something to market. Nothing plays like fear. Fear of big government. Fear of further unworkable price controls on Medicare reimbursement. And the fear that those who have lost power just might need something to market to help win back lost seats in the House and Senate. Let’s be smarter than that and hold out for real reform.

ASA is putting in place a strong legislative agenda for 2007 and 2008 that needs every member’s attention and involvement. Together we got S. 2990, the bill to restore full Medicare funding to our teaching programs to the one yard line last December. In fact, for a while it looked like we had gotten a touchdown, until a penalty based on misinformation from the nurses forced us back. We can and must advance and win this issue this year. Along with work before the Relative Value Update Committee (RUC) by ASA’s advisors, we can and must begin to explain and reverse anesthesiology’s disproportionately low Medicare conversion factor. Legislation to provide greater access to rural anesthesiologists through the Medicare rural pass-through also must be a priority. And, of course, with the AMA we can and must find a long-term solution to the Medicare SGR formula.

In short, please consider first that your ASA officers and governmental affairs staff are working daily in Washington to advance and defend anesthesiology. There is little that happens here relating to anesthesiology that we do not make happen, temper or soon know. At the same time, we need strong grassroots help, staying on message and advancing our goals. If spare time remains, we can always tilt at windmills, too!