10 July 2008


Kevin's Medicare Roundup includes the following from Joe Paduda (with whom I usually agree):

"It will also serve notice that the physician lobby and the AMA remains a very powerful force, a lesson that will be heeded when the health care reform process gets serious next year."
He couldn't be more wrong. The physician lobby is pathetically weak and not well regarded on Capitol Hill. Iconic Chicago newspaperman Mike Royko famously defined "Clout" as political influence, as evidenced by results (in Chicago, usually patronage). We don't got any clout.

There's an urge for all of us politically aware policy wonks to slap ourselves on the back and say "Boy we really muscled that one through! Boo-yah!" But no. Seriously, Medicare is the second most popular program in the history of the federal government, and everybody knows it was facing absolute implosion (again) and there was bipartisan, nearly unanimous consensus that a fix was needed to avert catastrophe (again), and all we were able to get was an eleventh-hour stay (again). And only barely.

That ain't clout.

Look at the other national legislative priorities the physician lobby has favored. How'd that "Patient's bill of rights" turn out? How about tort reform? (hint: the trial lawyers' lobby has clout.) Did we ever get EMTALA funded? Balance billing? For that matter, can you name a single major piece of legislation the physicians' lobby has gotten passed at all, let alone over major opposition? And I hasten to point out that Congress was for 12 years in the iron fist of our ostensible "allies" in the GOP. How'd we do?

Compare that to, say, the insurance or energy or farm lobbies. They write their own bills, and they almost always pass. Let's not delude ourselves into thinking that this "win" indicates a powerful lobby on our behalf. We'll have a seat at the table for health reform in 2009, but we'll have a lot of work to do to make our actual voices heard.

It's a win, so I'll take it. It's better than losing. But I have to (much as it pains me) agree with Catron: all we really won was another stay of execution.


  1. I think the medical lobby has a long road ahead of it if it expects to have anywhere near the political clout that the energy and farm lobby enjoy.

    The farmer's lobby and energy lobby have spent decades to get where they are.

    The only way that the AMA will enjoy any clout on capital hill is MONEY and a whole boatload of it. If they don't have money they need to show a united front, where the AMA can go to Capital Hill and say, see here all the doctor's are a powerful voting lobby, we need some changes. This is how politicians live in fear of angering the AARP.

    What makes this a very sad topic is that medical reform is as important as Social Security reform, but politicians by their very nature are a cowardly lot and they will keep putting this off unless they are forced to do otherwise.

  2. There is a game being played right now that our beloved organizations don't get.

    The game is called, "Keep the Doctors Busy by Every Few Months Having Them Send URGENT Messages to Congress to Stop the Next Medicare Cut."

    Thus we acknowledge our subservience to the politicians in ever-so-charming boot-licking rituals.

    I say let the cuts happen. Make it ever harder for those on Medicare to find care, then have THEM call Congress to fix this.

  3. Hey S-fax - well, I've been wrong a few times before, but I'm thinking this isn't one of them.

    The GOP Senators were "what's for dinner" at Fourth of July Barbecues, and their local physicians were doing the cooking. There are a couple observations that point to the power of the physician lobby.

    First, the fact that the vote was close to start with indicates a number of GOPers were only too happy to vote for the docs.

    Second, as soon as Ted walked in, even the tough ones (Cornyn, Specter, Hutchinson...) melted like a sand castle under a tsunami.

    Third, this was a battle between health plans and docs - the money for docs was going to come out of health plan revenues.

    And it did.

    Docs won. They may be disorganized, fractious, confused and occasionally hypocritical, but they're also damn effective when they want to be.

    Joe Paduda


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