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- ↵*Reprint requests and correspondence: George Beller, MD, FACC, Cardiovascular Division, Department of Internal Medicine, Health System, University of Virginia, P.O. Box 800158, Health Sciences Center, Charlottesville, Virginia 22908-0158
Politically charged pace requires vigilance
As is typical during an election year, the congressional session begins with a whirlwind of ideas, both parties posturing to “one up” the other in a battle of innovation. The party in control is motivated by the need to prove its principled leadership on issues of concern to Americans. The minority party wants to show that the party in control is incapable of creating and passing sound policy. Despite this phenomenon, there is generally room for substantive compromise as long as some bipartisan combination and the administration believe it is in their best interests to produce policy. An example of this occurred in 1996 when President Clinton made a series of accommodations with the Republicans that produced sweeping welfare reform and the health insurance reform legislation commonly known as HIPAA (the Health Insurance Portability and Accountability Act).
Unfortunately, this Congress was marked from the beginning of its term in 1998 by serious partisan divisions stemming from two not-so-typical events: 1) the impeachment controversy that ultimately led to President Clinton’s strong and reciprocated embrace of the congressional Democrats and 2) the election results that put the Democrats within striking distance of regaining the House majority. The reality of this scenario is that Congress is sharply divided in a way that leaves prospects for any serious lawmaking in the dust. This has not, however, stifled debate on a number of crucial health, education, and other issues. Already, the House has passed (well ahead of its usual timeframe) most of the 13 appropriations measures—a Medicare prescription drug benefit, physician collective negotiation legislation, and a Medicare surplus “lockbox” provision, to name but a few. Also, the Senate has passed a patients’ bill of rights; but this flurry of activity begets merely what Rep. James P. Moran, Jr. (D-Va.), calls “the appearance of motion without the substance of action.”
Perhaps the most poignant example of this scenario is the battle to enact a Medicare prescription drug benefit this year. There is little dissension surrounding whether Medicare beneficiaries should be able to afford needed drugs and whether the government should provide some relief, particularly for the poorest and sickest beneficiaries. Indeed, there are common elements among the administration’s, the Congressional Democrats’, and the Republicans’ plans. All three major alternatives, and numerous other proposals, would provide a prescription drug benefit that is voluntary, that contains a stop-loss provision, and that acknowledges that the private sector must be involved in administering the benefit. In addition, there is clear consensus that something needs to be done to address the disparities and skyrocketing costs of pharmaceuticals. The differences are found largely in the scope and, hence, the cost of providing the benefit. Yet, despite the similarities, it is not clear that any consensus will be reached in the few remaining days of the session, because of the politically charged nature of the issue. Each party struggles to maintain control over the issue to ensure that it can either claim victory or at least prevent much credit from being afforded the opposition. In the end, it is President Clinton who has the control. Already he has indicated he will veto the Republican plan should it pass both houses of Congress.
The effort to secure a patients’ bill of rights is another prime example of perceived motion without real action. Patients’ rights legislation stalled in an unproductive Senate-House conference committee. Faced with growing criticism about the nature of the conference and an apparent inability to reach compromise on key provisions, and perceiving the need to demonstrate action, Senator Don Nickles (R-Okla., chair of the conference committee) attached a patients’ rights amendment to the Labor-HHS-Education Appropriations measure. The amendment is essentially a reworked version of the 1999 Senate-passed patients’ bill of rights, with a limited health maintenance organization liability provision added. Nonetheless, Senate Republicans hope to claim credit for passing a bill, legislation dismissed by Democrats as merely political cover for the elections.
As to physician-specific legislation, the House passed by a 276–136 margin the “Quality Healthcare Coalition Act,” sponsored by Reps. Tom Campbell (R-Calif.) and John Conyers (D-Mich.). This victory for physicians is huge, but it may be largely symbolic. No Senate bill has been introduced; thus, final enactment is unlikely. Again, motion without action.
Opportunity for action
So, where does this leave the American College of Cardiology? The frustrating fact is that, substantively, the parties are not far apart on many issues, but the political overlay plagues Congress’ ability to reach consensus on crucial issues of concern to the American public. Yet, it is in this same muscle-bound environment that every spoken word and every action are important; nothing can be taken for granted, for so much is at stake. Hence, this particular election year presents a prime opportunity for cardiovascular specialists and the College to increase our visibility and to have our views heard.
The House of Representatives is split down party lines by a mere five-member margin, thereby intensifying the relevance of every registered vote. Therefore, there is great incentive to listen to constituents—to voters—and to deliver. Know your congressional representatives. Know your senators. Most important, communicate with them on a regular basis in some way. We need to convey to our legislators the College’s positions on issues of importance to our patients and our profession.
When this session ends and the dust settles, the College will be in the final stages of creating a new entity to enable our staff and leadership to advocate more effectively on your behalf. These efforts must and will be greatly enhanced by your participation in the political process. There are myriad ways in which you as a physician can have influence even without great knowledge of the political process. It may be as simple as sending a letter or an e-mail message, making a phone call, or writing a check—whatever you are comfortable with. Make yourself known and available as an expert in your field to federal and state policymakers. Another approach involves participation in the College’s grassroots “key contact” program, through which you are asked to respond to the College’s calls to action.
Legislators and regulators at both the federal and state levels will continue to make decisions affecting your ability to treat patients, practice medicine, teach, and conduct research—to remain a physician. Let’s ensure that cardiovascular specialists are in the forefront as these policy decisions aremade.
- American College of Cardiology