By Jane M. Orient, M.D.
A “Thousand Doctor March on Washington” or some such is a frequent activist plan. Let’s show up in force, make rounds on Capitol Hill and help our elected representatives understand our view.
Or let’s deluge them with letters, faxes and phone calls.
Been there, done that. But during my trip last week, I think I finally got the message.
While I was sitting in a congressional office, waiting for an important staffer to get free for a few minutes, the events on the floor were playing out on the television screen. There were a few short speeches, probably to a mostly empty House (you couldn’t really tell). Calls were presumably pouring into offices, if doctors were heeding the urgent pleas of an AMA action alert, asking for a “no” vote. Then there was a voice vote, an announcement – “The ‘ayes’ have it,” and the potentially most important piece of health-care legislation since the Affordable Care Act (Obamacare) was off to the Senate.
The number of people who voted: about 15. How did your representative vote, if he did? Nobody will ever know. Was there a quorum? A quorum is assumed if nobody stands to object.
This process involves the suspension calendar, where the rules are suspended to expedite routine things like naming buildings. It’s supposed to be unusual to put important matters on this calendar. When the Democrats controlled the House, the Republicans used to post a sentry – send a member to be on the floor at all times – to be ready to demand a quorum call.
Who controls the suspension calendar? I assume that would be Speaker John Boehner, R-Ohio. He must have had the cooperation of House Minority Leader Nancy Pelosi, D-Calif., and Senate Majority Leader Harry Reid, D-Nev., who routinely kills bills passed by a solid, recorded majority of the House by refusing to bring them to a vote.
What is in the 121-page bill? Nobody had time to read it. It delays, for the 17th time, the Clinton-Gingrich fee cuts to doctors (the “Sustained Growth Rate” or SGR formula), which by now amounts to about 25 percent. It delays (but does not repeal) the enormously expensive, absurdly complicated ICD-10 diagnostic coding system that doctors will have to use if they want to get paid, though the Centers for Medicare and Medicaid Services (CMS) swore there would be no more delays, that this October was IT. Then there are delays in various provisions related to hospital billing.
The SGR seems to be the AMA’s main lobbying concern. It doesn’t want SGR to go into effect, but opposed this bill because it seemed to displace a bill to get rid of SGR – and replace it with something even worse. The Association of American Physicians and Surgeons (AAPS) says let the SGR happen, encourage doctors to opt out and get rid of the cause of the problem: price controls and the AMA’s relative value scale (RVS). But does Congress care what its constituents think?
I have been to D.C. many times. It reminds me of the planet Trantor, the capital of the galactic empire in Isaac Asimov’s “Foundation” trilogy. Huge forbidding gray buildings, housing a bureaucracy with tentacles reaching everywhere. Traffic snarls from security-related re-routing. Tank barriers and metal detectors. Restricted access – no entry without an escort. (Our Rulers are afraid.)
I have met with senators, representatives and staffers. I have testified at hearings and done briefings. I have attended forums and fundraisers. I have written countless letters. My diagnosis: The political elite, with few exceptions, listens only to those who bring millions (of dollars or votes). Staffers are young, earnest and intelligent but bereft of understanding of life in the real world. “Political reality” is their mantra. Meaningful change will be blocked by the bipartisan establishment. And anyway, Congress has already abdicated much of its power to the bureaucracy.
The current regime created our problems and will not, indeed cannot, solve them.
We need to fire the lot of them. We need automatic term limits by electing only those who have already had a successful career and are too old to become a career politician.
We all need to recognize that D.C. is totally corrupt, untrustworthy and bankrupt, and strive to become as independent of its favors as possible.
Jane M. Orient, M.D., executive director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of “Sapira’s Art and Science of Bedside Diagnosis”; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored “YOUR Doctor Is Not In: Healthy Skepticism about National Health Care,” published by Crown.
