ORGANIZED MEDICINE

From the trenches to the Hill

Physicians attending an AMA conference in Washington, D.C., last month hit Capitol Hill to try and influence legislators' votes on the Patients' Bill of Rights.

By Bonnie Booth, AMNews staff. Oct. 25, 1999.

Washington D.C. -- It's just after lunch, and Kenneth J. Edwards, MD, is huddling in the lobby of the Mayflower Hotel with the rest of the members of the Michigan delegation to the AMA Grassroots Conference.

The 21 representatives of the Michigan State Medical Society and its alliance are holding one last strategy session with Kevin A. Kelly, MSMS managing director, before heading to Capitol Hill. After a quick snapshot, the group divides up and hails several taxis. For the next four hours they will crisscross Capitol Hill, visiting the offices of the state's two senators and 11 of its 17 congressmen.

Top on their agenda was the Patients' Bill of Rights, which was at the forefront of every legislators' consciousness as the AMA conference commenced last month. Also on the doctors' lobbying agenda were a bill sponsored by Rep. Tom Campbell (R, Calif.) to provide antitrust relief for physicians and problems with the Health Care Financing Administration's implementation of a "sustainable growth rate" factor in computing Medicare reimbursements.

"The main goal was to really strongly portray our desire to get this [Patients' Bill of Rights] legislation done and to express our feeling that this is really the last good shot that we have for this type of legislation," said Dr. Edwards, an orthopedic surgeon from St. Joseph, Mich. "I think we were successful in demonstrating the importance that we place on this issue. It wasn't a complete success in that we changed a lot of people's minds, but in several offices we got people thinking about ways to get this done."

Participants at this year's conference were treated to the usual speeches from politicians and a variety of seminars, but it's the chance to rub elbows with -- and twist the arms of -- their legislators that most see as the highlight of the two-day conference.

"We see and hear so much of the hype that is Washington," said Alice T. Epitropoulos, MD, an ophthalmologist from Columbus, Ohio, attending her first grassroots conference. "It was neat to actually experience some of it."

Dr. Epitropoulos' exuberance was shared by Dr. Edwards, a second-time grassroots conference participant.

"I think it's an exciting process," he said. "I like this kind of interaction. I like working with my colleagues, and this is important work.

"I enjoy a good level of trust in my congressman's office, and my opinion is well-regarded. That doesn't mean they will agree with every position I take, but I think they view me as one of many resources that they will use on issues."

On a mission to sway key votes

Dr. Edwards' influence with Rep. Fred Upton, a moderate Republican, was key to Michigan's strategy for lining up backers for the AMA-endorsed Norwood-Dingell patients' rights legislation. Upton had not yet decided which of the bills he would support when Dr. Edwards and the Michigan delegation came calling.

"One of our goals is to get very deeply into Upton's office to discuss the fine points of the legislation with them," Kelly said.

Upton was chairing a house subcommittee during the time set aside for his meeting with Dr. Edwards, so the group took up their cause with his senior policy adviser, Jane Williams.

They got straight to the point.

"You and I know Coburn [competing patient protection legislation from Rep. Tom Coburn (R, Okla.)] is dead," Dr. Edwards said. "Fred is safe in his district in voting for this; he won't be viewed with anything but respect."

Williams and Dr. Edwards had differing interpretations of the Norwood-Dingell bill's provision for health plan liability, but Dr. Edwards held firm in his interpretation and Williams eventually agreed to take a second look at the bill's language.

And while it may seem gutsy to question a seasoned policy analyst on her interpretation of a bill, Dr. Edwards firmly believed he had been briefed by the best.

"The AMA has a tremendous legislative division that looks at these bills and interprets them," he said. "Our medical society has a phenomenal legislative arm. Kevin Kelly is articulate, accurate and really passionate about these things. He provides us with a lot of literature."

He said that while members of the group may have differing opinions about the merits of some pieces of legislation, they need to make sure they all interpret them the same way.

"One thing that really causes you to immediately lose credibility is not really understanding what you are talking about," he said. "I think you have to have a really good handle on the facts of the legislation before you can even discuss the nuances of the politics that we encountered."

Just as the group is getting ready to move on to another office, Upton comes racing down the hall and wonders aloud to the staff in his reception area whether he missed Dr. Edwards. The group returns to Upton's office, reiterating their case to him.

This scene is repeated dozens of times across the Hill by the more than 300 grassroots conference participants.

Awestruck, but not naive

For some it is old hat, butfor others it's their first trip to Capitol Hill as someone with a message for a congressman.

"They surround themselves with monuments to the institution they serve, the offices are filled with activity, it's very impressive," said Charles Rothberg, MD, a Long Island, N.Y., ophthalmologist attending the conference for the first time.

But a first-timer's awe at the surroundings should in no way be mistaken for political naiveté. Most of these people have had some previous contact with their legislators -- albeit when they are home during a weekend or a recess or running for reelection.

"I know my legislators and have worked in several campaigns," said MSMS Alliance member Sue Anne Addy. "The best part of this for me is having the opportunity to see them in their offices and to be a part of a delegation that is talking about issues of real concern for patients."

The Michigan delegation saved for last their visit to Rep. John D. Dingell, the Michigan Democrat who is a co-sponsor of the Patients' Bill of Rights backed by the AMA.

It was a different sort of experience for the group -- no longer advocating for the legislation but telling Dingell and his staff what they had learned and offering suggestions for strategy in the coming debate.

"That was really unique," Dr. Edwards said. "Dingell is the primary sponsor of this, he wants it passed. He's looking for ways he can work through his Republican colleagues, what kinds of things he needs to get done to get this bill passed."

Dr. Edwards believes that traversing Capitol Hill in support of patient protection legislation is as much a part of being a responsible physician as seeing patients.

"Physicians as a group are very silent when it comes to their concerns," he said. "This is a process that needs to be proactive not reactive. Physicians have felt that getting involved in the political end of things was in some way unprofessional. To me it's not only part of our professional responsibility, its essential."

That's a sentiment echoed over and over by physicians who have embraced the political process.

"I've always believed that physicians need to be unified," Dr. Epitropoulos said. "There is strength in numbers, whether it be at a local, state or national level. I think it's also important to get to know your legislators in order to effect change. It's kind of exciting to go to Capitol Hill and talk to our legislators about different health care issues."

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