Learning the landscape: medicine in the political arena

Abstract

We work in very controlled environments each day caring for our patients, using the best available tools to reach hidden areas of the gastrointestinal anatomy and to minimize incisions with the associated pain and suffering. We do this work in a scientific manner, bringing our experience and skill forward to solve an anatomic problem in a manner that can be replicated by ourselves and our colleagues over and over again. With the exception of the occasional surgical revelation, which really changes things, we can report and clearly pilot data that have meaning within our advancing profession. It is a very comfortable and comforting environment in which to work. Imagine working in a field that changes daily, a place in which we try to take steady steps on the shifting sands of an almost daily changing reality. This reality is not populated by our like-thinking colleagues but by politicians, lawyers, insurance companies, and business leaders. It is a world in which power and money are more important than the scientific method and, unfortunately, a world that in many ways controls our daily activities. Just consider that we are the only major segment of the American economy that is supposed to grow in service and shrink in compensation. We face regulation from all levels of government and are driven to police ourselves not on the basis of improving patient care but due to fear of lawsuit or fine. We are boxed in by reluctant payers and unhappy patients who feel pressured as more health care companies push them away from the doctors they have known all their lives. In short, as physicians trying to help resolve these great questions of health care, we are standing on the deck of a sinking ship looking into a void. Let us review the latest political and economic problems we face. We were looking at a possible 10.6% cutback in Medicare payments beginning this summer unless we were able to convince our legislators that this would be disastrous to our American health system, as fractured as it is. We believed that Congress would once again stop the July 1 cut in the nick of time. Senator Max Baucus had assured us that he was pushing for legislation to stop the cut for 18 months and give us a 1.1% raise. This would add $40 billion dollars to the cost of Medicare and still leave us facing a 20% cut in Medicare in 2010. This shortfall, we have come to understand will be financed by taking money from the Medicare Advantage programs, not a popular idea among the insurance companies who see these as a way to cut further back on our fees and make an additional profit as well. Also remember this became the enabling piece for the reversal of the fee reduction, with a few added details. The debate began in mid-May, and its outcome will affect us all. Other items that were attached to this bill include mandatory e-prescribing and extension of the Physician’s Quality Reporting Initiative (PQRI) program. Medicare Advantage programs also pose a veiled threat to us all. In Florida, the various carriers of the Advantage programs are able to meet and discuss fees. They have tried to force each physician who accepts one program to accept them all at their single lowest rate. They are supported by American Association of Retired People (AARP) and other patient advocates. These programs are essentially health maintenance organizations (HMOs) that get the usual Medicare funding plus 12%. They are financial ‘‘fat cows’’ buttressed by an extra 12% funding that they keep. All their clients are promised everything until they sign on the dotted line. In my opinion, this was an excellent place to seek funding for the required $40 billion to stave off the cut. E. Lerner (&) North Florida Surgeons, 836 Prudential Drive, #1107, Jacksonville, FL 32207, USA e-mail: vr-doc@comcast.net