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"You have a lot of influence, but..."

By: Peter Pollack

By Peter Pollack

“I cannot emphasize enough the importance of involvement in the political process—for everybody, but particularly for physicians,” said James McCrery III, former Republican member of the U.S. House of Representatives, featured speaker at the Orthopaedic Political Action Committee luncheon yesterday. “Physicians generally are well thought of across the board. People love their doctors, so you have a lot of influence, but you don’t always use that influence to the utmost.”

Mr. McCrery discussed the healthcare bills currently under consideration in Washington as well as a number of related issues, but took time to emphasize the importance of physician involvement in the political process.

James McCrery urges surgeons to play a greater role in the political process.

“You work very hard, and I understand that,” he told the packed house, “but you work in an environment that is not totally controlled by you or your profession. Like it or not, government plays a role in shaping the environment in which you work. Unfortunately, because government has become so involved in health care in a number of ways, it not only affects the environment, it dictates what that environment is to some extent.”

Mr. McCrery explained that what physicians choose to do now will affect not only themselves, but those who may consider going into medical school in the future. If medicine becomes viewed as an undesirable occupation, the field will have difficulty attracting the best and the brightest in the future.

“My fear is that as the government gains more control and dictates more rules, regulations, restrictions on the healthcare profession and particularly on physicians,” he said, “that young people who are the best and brightest will shy away from the medical profession and all become lawyers or financiers.”

Learning the wrong lesson
Mr. McCrery also addressed the issue of bipartisan cooperation—or lack thereof—on healthcare reform. When President Obama took office, he promised a bipartisan solution, but the reality has fallen short. What happened? In the opinion of Mr. McCrery, the blame falls on the president.

“I’m not saying that [President Obama] designed it this way and intended it this way,” he said. “I’m saying that he didn’t have a whole lot of experience when he came to the White House. He didn’t have

a great understanding of how Washington works, and how the Senate and House and White House work together.

“In my opinion, if he really wanted a bipartisan effort, which he should have on healthcare reform, then he should have called the House and Senate leadership together, and said, ‘Guys … and lady … I want to do this. I want to hear all ideas. I want to find out why we can’t get Republicans and Democrats together on a plan to solve some of the problems in our healthcare system. So I want you all to come to the White House.’ And he should have done that in January of last year, not March of this year.”

Bright people have good ideas on both sides of the aisle, Mr. McCrery explained. Unfortunately, the president never heard some of those ideas. In trying not to repeat the mistakes made by President and Mrs. Clinton in the 1990s, President Obama learned the wrong lesson. Then, a White House task force wrote the legislation and handed it to Congress, but Congress failed to muster the votes needed for passage—at least in part due to resentment that the legislation was crafted without Congressional input. According to Mr. McCrery, the real lesson of the Clinton plan was that the task force tried to do too much.

“You can’t do one big, huge, giant healthcare reform bill on a partisan basis,” he said. “If you’re going to pass healthcare reform on a partisan basis, you better be a little smarter about it and do it piece by piece.

“If President Obama wanted to pass a big global bill like this, he should have brought in Republicans with Democrats from the get-go,” continued Mr. McCrery, “and he didn’t do that. So we now have this big giant bill that’s totally Demo¬≠cratic, and it should be no surprise that no Republicans voted for it.”

A 50/50 chance of passage
Mr. McCrery doesn’t think the odds are very good that a comprehensive healthcare bill will get passed during this Congressional session. Because Democrats in the Senate no longer have a filibuster-proof majority, the House would be forced to approve the Senate’s bill outright, followed by a reconciliation process designed to merge the House and Senate bills into something a majority of legislators in both houses can accept.

Shifts in the political environment, however, as evidenced by Republican gubernatorial wins in New Jersey and Virginia, as well as the loss of a Democratic Senate seat in Massachusetts, have caused some Democratic legislators to back away from healthcare legislation.

“I would say the odds of Speaker Pelosi getting the votes in the House are no better than 50/50 right now. That’s my view,” said Mr. McCrery, who was once a ranking member on the House Ways and Means Committee.

In addition, according to Mr. McCrery, there may be no legal way to reconcile some aspects of the House and Senate bills.

“Lots of tertiary issues are coming into play that are very difficult to deal with,” he said. “For an item to be in a reconciliation bill, it has to have some budgetary impact. But issues like abortion and some of the insurance reforms perhaps do not have a direct budgetary impact, but are included in the current bill. It remains to be seen how the Senate parliamentarian would rule on some of those issues.”

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaos.org

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