Predictions on how Congress
will handle three issues in 2000
Washington Perspective From the January 2000 ACP-ASIM
Observer, copyright © 1999 by the American College of
Physicians-American Society of Internal Medicine.
By Robert B.
Doherty
Political forecasting is much like long-range weather forecasting:
notoriously untrustworthy. Predicting how Congress will act on an issue is
difficult enough when the vote is only a few days away, let alone months
in the future.
But that difficulty doesn't stop people from asking for predictions,
and it doesn't stop those of us who work with Congress from taking our
best shot. So with the caveat that the following may be no more accurate
than forecasting when the next snowstorm will hit Washington, here are my
predictions on what to expect from Congress in 2000 on three key issues:
access to care, patient rights and collective bargaining.
The year of the uninsured?
Last October, ACP-ASIM invited House Majority Leader Dick Armey
(R-Texas) to brief reporters on the prospect that Congress would act to
reduce the number of Americans without health insurance. During his
remarks, Mr. Armey boldly predicted that 2000 would become the year of the
uninsured in Congress.
He speculated that Congress and the president will be highly motivated
to agree on reforms, in part because voters in the upcoming elections are
likely to judge Congress on how well it addresses the uninsured problem.
Mr. Armey suggested several approaches that might command bipartisan
support, including refundable tax credits that would help subsidize the
cost of buying coverage.
In reality, however, the president would likely veto many of the
solutions preferred by Republican leaders, such as medical savings
accounts. And refundable tax credits may cost more than the current
Congress and administration are willing to spend. The promise by the
president and Congress to not raid the Social Security trust fund to
support other governmental spending will greatly limit the amount of money
available to fund measures to help the uninsured.
Mr. Armey certainly deserves credit for exercising his leadership to
make 2000 the year of the uninsured. It is more than likely, however, that
substantial progress will not be made until after the voters have spoken
in the November elections—by electing a president and Congress committed
to working together to reduce the number of uninsured Americans.
Patient rights
On Oct. 7, the House of Representatives passed the Norwood-Dingell
patient bill of rights by a solid margin of 275 to151. Sixty-eight
Republicans bucked their own party's leadership to vote for the bill.
Any celebration by ACP-ASIM and other supporters of the bill was
quickly dampened, however, by Speaker of the House Dennis Hastert
(R-Ill.), who put opponents of the bill on the team that will represent
the House in negotiations with the Senate. While conferees are supposed to
support the bill originally passed by the House, only one of the members
picked by Mr. Hastert voted for the Norwood-Dingell bill.
Nonetheless, the conferees will face tremendous pressure from their
colleagues and voters to push for a strong bill. National polls have put
patient bill of rights legislation at the top of the list of voters'
concerns, and many independent analysts believe that the Republicans risk
losing control of the House if they fail to agree on a strong measure that
includes the key provisions established in Norwood-Dingell. My guess is
that enlightened self-interest will ultimately rule the day, and Congress
will agree on a patient rights bill that is closer to Norwood-Dingell than
the weak Senate bill passed last spring.
Collective bargaining
In a Dec. 7 speech to the AMA's House of Delegates, Rep. Tom Campbell
(R-Calif.) announced that Mr. Hastert had promised an early vote on his
bill to allow physicians in independent practice to engage in joint
negotiations with payers. He confidently predicted that the bill would get
through the House Judiciary Committee and then be approved by the entire
House.
Despite the applause that Mr. Campbell's remarks elicited from the
AMA's physician-delegates, it is far too early to declare victory. First,
there is no guarantee that the bill will even pass the House. Many members
of Congress have reservations about any legislation that could encourage
physicians to unionize. The recent ruling by the National Labor Relations
Board that residents are employees, not students, and thus can unionize,
is adding to some lawmakers' nervousness about physician unions.
It is important to note that the Campbell bill does not advocate for
traditional labor unions. Rather, it seeks to ease anti-trust restrictions
and allow physicians in independent practices to negotiate with health
plans on issues affecting quality and access. Mr. Campbell has explained
that such negotiations could take place outside of a physician union.
Even if the bill passes in the House, it will still have to make its
way through the Senate. So far, the Senate has shown no inclination to
take up the bill, and the rules of the Senate make it easy for any
individual senator to block the bill unless it commands a super-majority
of votes (60% or more) in the chamber.
My prediction? The bill will most likely be passed by the House but
will then stall in the Senate. The next Congress will be left to start the
process all over again.
Taking action
I could be wrong about all of these outcomes, but there is one lesson
to be learned either way: Whatever Congress does or doesn't do, we need to
remember that we can be more than passive bystanders. Effective advocacy
by national organizations like ACP-ASIM, backed up by grassroots advocacy
from internists at the local level, can move Congress to do the right
thing on access, patient rights, joint negotiations and other critical
issues. And it sure beats the alternative of sitting back and complaining
when things don't turn out right.
Robert B. Doherty is ACP-ASIM's Senior Vice President for
Governmental Affairs and Public Policy.
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