This is the dilemma currently facing House Speaker Nancy Pelosi. You have to be sympathetic to her plight. As we described in our last post, Ms. Pelosi “saw no reason” for the House of Representatives to vote on a Senate measure that would have prevented Medicare doctors from having the net income that they receive from Medicare and TRICARE cut by 43%. (TRICARE takes care of the families of our military servicemen and women, and bases its own rates on Medicare. However it pays even less than Medicare in most cases.)
Her clearly stated rationale was that, by threatening to bankrupt doctors taking care of the elderly, she could force the Senate to vote for additional unfunded billions of dollars in unemployment benefits:
“The inadequate legislation on physicians’ fees that Senate Republicans allowed to pass today is a great disappointment. The House has approved long-term reform that ensures that Medicare patients will have access to quality physicians’ services.
“The bill Senate Republicans allowed to pass is not only inadequate with respect to physician fees, but it ignores urgent sections of the House bill to provide jobs. The House has repeatedly sent jobs-creating bills to the Senate since December — Build America Bonds, small business hiring incentives, and importantly, summer jobs — and yet Republicans continue to block approval of jobs legislation.
“What is it that Republicans in the Senate and House don’t understand about the need for jobs in America?
“I see no reason to pass this inadequate bill until we see jobs legislation coming out of the Senate. House Democrats are saying to Republicans in the Senate: Show us the jobs!”
It’s clear from this letter that Ms. Pelosi is adamant about treating doctors who care for the elderly fairly and not allowing them to suffer financially. So much so that she must destroy the small businesses and livelihoods of many of them, (remember, doctors are small businesspersons too), so that the Senate might send her a bill to fund temporary summer jobs.
Now that’s tough love.
But a funny thing happened on the way to the ransom. No one seems to care about the hostage. Poor Speaker Pelosi must not know whether to cry or rub her hands with glee.
On one hand, a 21.5% cut in Medicare payments to doctors means that the Federal government is saving millions of dollars each day, all the way back to the first of June. Dollars that our elected leaders can spend on things like a fraud-ridden home buyer tax credit, that has paid $8,000 each to illegal immigrants, minors, enterprising convicts serving life sentences, and even people who never actually bothered to buy a house. More than half a billion dollars of taxpayer money may have been fraudulently disbursed.
On the other hand, Ms. Pelosi figuratively sent her colleagues in the Senate a healthcare worker’s bloody ear, and no one cared. The AMA and AARP managed no more than a pathetic squeak, in which they urged Congress “not to forget about” the financial ruin being heaped upon physician practices. Nobody in the Senate complained. And President Obama didn’t say anything at all.
What’s a self-respecting hostage-taker to do? In Speaker Pelosi’s case, she now wants to dump the body in an alley and try to take the same hostage again another day. The Associated Press is reporting that:
“House Speaker Nancy Pelosi says the House may pass a bill as early as Thursday evening [June 24, 2010] that would spare doctors from cuts in Medicare payments.
The Medicare money is part of a much larger bill to provide continued unemployment checks to millions of people and provide states Pelosi said it is “clear” the Senate will be unable to pass the larger bill, so the House is considering passing a much smaller bill that deals only with Medicare payment for doctors.”
But the real question in all of this is whether doctors, Medicare and TRICARE recipients themselves have learned anything about the motivations and priorities of their political Leaders, and how to respond to them? By now it’s pretty clear that the only things that our elected representative understand with respect to the healthcare system in America are ill-conceived and poorly managed mandates, covert rationing, the expansion of administrative overhead and the language of lobbying dollars. If American physicians fail to hang together at the grass-roots level, they will surely all hang separately as Benjamin Franklin would say.
The reality is that doctors in 2010 don’t really have an effective voice in American politics. They have now become too poor (and the wealthy AMA has too much conflict of business interest) to lobby effectively. The Obama administration has seen to it that doctors can’t band together for commercial purposes without going head to head with the police power of the Department of Justice. The only thing that doctors really have of any value to our elected representatives is their relationship with their only real partners: patients. If patients and providers are going to look after their own self-interests, they are going to have to do it together, and at the grass roots level. Every patient that is directly or indirectly affected by government policies needs to hear about it when they visit their doctors’ offices. At least through newsletters, leaflets, fliers and signs posted on the doors. (Providing these is the one useful service America’s physician organizations should be able to accomplish.)
God knows there’s not enough time to speak with every patient individually, but the message has to get across. The death-by-a-thousand-cuts efforts of our political Leaders to undermine American healthcare does not bode well for any of us. If doctors can no longer afford to see or schedule patients, patients need to know why. In the long run, only patients have the numbers and political clout to do anything about it.
For all of their efforts, the only thing that our elected representatives are going to understand is to receive some tough love in return.