I am writing to inform you about where we are right now in the rapidly changing arena of health care reform. The debate continues to intensify. Key House and Senate committees have released draft health care reform legislation, with other individual proposals added to the mix. Committees are holding markups and hearings, talking to stakeholders, and discussing ever-ambitious timelines for passage of the most sweeping health care reform bill this country has ever seen.
While the momentum is very real, we are still in the early stages of debate. As White House Chief of Staff Rahm Emanuel said in a June 19 Washington Post article, “Since it’s the first inning, I wouldn’t call the game.” This was in response to critics indicating that the whole process was on hold due to concerns about the ever increasing estimate of the cost for proposed health care reform.
To be key players in the game, it’s essential that we recognize the policy and political realities surrounding health care reform discussions. Further, each of us needs to understand how the various proposals currently under consideration will potentially affect the medical specialty of anesthesiology.
Currently in Congress, we are monitoring three moving parts of an increasingly complex debate on comprehensive health care reform. While all of these bills are just drafts, they will likely evolve into the final legislation that Congress ultimately considers:
- The Senate Health, Education, Labor and Pensions (HELP) Committee, which has released a draft health reform bill that has been characterized as the most liberal of all proposals. Since Chairman Edward Kennedy (D-MA) has been largely absent due to health issues, Sen. Chris Dodd (D-CT) has been leading the committee. The HELP Committee is in the process of marking up the legislation.
- The Senate Finance Committee, which has not yet released its draft reform bill and will likely not do so until after the Fourth of July recess. The committee is chaired by Sen. Max Baucus (D-MT), who has said he is committed to a bipartisan approach to reform with his Republican counterpart, ranking member Charles Grassley (R-IA). It is important that this committee and the Senate hear ASA members voice their concerns over any plan tying payment for anesthesia services to Medicare rates. An ASA grassroots letter writing campaign has generated over 11,000 contacts in the Senate over the past few weeks.
- The House “Tri-Committee,” which released the most recent draft health care reform bill on June 19. The Tri-Committee is comprised of the three House committees with jurisdiction over health care matters: Energy and Commerce, chaired by Rep. Henry Waxman (D-CA); Ways and Means, chaired by Rep. Charles Rangel (D-NY); and Education and Workforce, chaired by Rep. George Miller (D-CA). The proposal ties anesthesia payment to Medicare rates, and we need ASA membership voices to be heard that such a proposal is unacceptable. The grassroots campaign to House members was launched last week.
Proposals by these committees represent thousands of pages of complicated bill language with a plethora of health-related issues. Many of the provisions in theses bill will go a long way toward bringing needed reforms to our health care system – a goal endorsed by ASA. However, there are also many provisions that could directly harm the medical specialty of anesthesiology. And there are many important issues, such as liability reform and personal accountability, that are not included or not sufficiently addressed in these bills.
After reviewing these bills, spending two meetings on Health Care Reform at the White House, attending a closed session meeting with nine Republican Senators, meeting with multiple House and Senate key legislators and their staffs, and evaluating the political landscape, I believe that the gravest threat to our specialty, and therefore where we should keep our focus, is that a public plan option based on Medicare’s unsustainably low payment rates is unacceptable.
ASA has been a leader in the medical community on this issue and intends to direct its energy and resources thusly. Accordingly, I would ask that each and every ASA member communicate to his/her U.S. Senators and Member of Congress their strong opposition to any public plan option based upon Medicare rates.
Please recall that there is no other organization involved in the reform debate that is speaking for anesthesiology. Our shared voice is the only way to ensure that the important concerns of our specialty, our practices and our patients are heard in the halls of Congress. In politics, silence means acquiescence. Let’s be certain that we are heard.
Let me also take this opportunity to address recent communications I have received from ASA membership.
I am well aware that many thoughtful, dedicated members of this society are supporters of a public plan option, even if based upon Medicare rates, and even of a Medicare-based single payer system for health care. Some have even suggested that ASA is aligning itself too closely with the commercial insurance industry.
Let me reply by stating that I simply do not believe that any system based upon Medicare’s underfunded payments can sustain a strong and vital anesthesiology medical specialty in this country. Even the investigatory arm of the U.S. Congress has concluded that Medicare pays only 33 percent of commercial insurance rates – a massive and unfair payment disparity. Moreover, after watching year after year as Congress has waited until the last minute to pull physician payment s back from the brink of massive reductions, ASA simply cannot endorse Medicare pay levels as worthy of replication. Recall that there is a whopping 21 percent payment reduction currently scheduled to take effect on January 1, 2010!
I would also add that I and my colleagues in the ASA leadership are well aware of the abusive practices of commercial insurance, whether it be their patient care denials, the administrative burdens they foist upon physicians and even their excessive executive compensation. The interests ASA represents are those only of its members and of the patients we serve. There are hundreds of industries and organizations engaged in the reform debate, and to the degree that their interests intersect with the interests of our specialty and our patients, we welcome them to the debate.
I am also aware that many active ASA members flatly oppose any public plan option, regardless of whether it is based on Medicare payment rates or not. At this moment, ASA leadership has chosen to be neither for nor against the concept of a “public option.”
There are currently a number of proposals under consideration under the name of “public option.” Some of these proposals, at least in concept, appear to represent reasonable reform alternatives that would not disrupt the insurance marketplace or physician practices. However, we understand the fear that many hold that ANY “public option” will eventually lead to a single payer system – of which ASA is opposed. Be assured that ASA will carefully review any new public option proposal and withhold support from any proposal that could reasonably be determined to harm our practices, whether academic or private.
Our specialty faces a very significant challenge at this time. To maintain the sustainability of anesthesiology and to remain relevant in the current debate, we must stick to the issues that affect our practice directly and specifically. As I stated before, Medicare severely underpays for anesthesia and pain services—33 percent of what private insurers pay, according to the Government Accountability Office (GAO). On the other hand, Medicare pays other specialties an average of 80 percent of private pay. Some draft legislation extends this unsustainably low Medicare payment mechanism to a larger segment of the population—to the detriment of our specialty.
In the coming weeks, additional details will emerge regarding these proposals, and ASA will continue its involvement in the health care debate. Please be assured that ASA is committed to seeking comprehensive health care reform that strengthens our specialty so we can continue providing the lifeline of modern medicine for America’s patients. In addition, I am personally committed to keeping ASA membership informed as to ASA leadership’s understanding and thinking about health care proposals when they solidify, and as we move forward with changes that will affect our future practices as anesthesiologists. Please call on our ASA Washington office if you have concerns, questions or ideas. We stand ready to assist, and to work together to achieve success in the legislative arena. You can reach the office at (202) 289-2222.
Roger A. Moore MD