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“Can’t Anyone Here Play This Game?” How our broken politics is hurting health care (and what physicians can do about it). Bob Doherty Senior Vice President, Governmental Affairs and Public Policy Nevada Chapter Meeting January 14, 2012.
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Senior Vice President, Governmental Affairs and Public Policy
Nevada Chapter Meeting
January 14, 2012
“It may be best, at this point, to simply quote Casey Stengel's infamous yelp of frustration about the 1962 Mets: ‘Can't anybody here play this game?’
If the '62 Mets were the worst team in major league history, it's also fair to wonder whether any Congress has ever been more dysfunctional, with less cause, than this one.”
Michael Hirsch, The Atlantic, November 21, 2011 www.theatlantic.com/politics/archive/2011/11/the-supercommittee-and-a-neverending-cycle-of- dysfunction/248800/
“The level of dysfunction that has characterized the 112th Congress may be unparalleled,” wrote Roll Call, Capitol Hill’s hometown newspaper.Worst ever?
Roll Call, Capitol Hill’s hometown newspaper
Revenues and Financing
Total Outlays = $3.629 Trillion
Total Revenues = $2.230 Trillion
Total Financing = $3.629 Trillion
(Percent of GDP)
Avg. Historical Spending (1970-2010): 20.8%
Avg. Historical Revenues (1970-2010): 18.0%
Note: Estimates based on CRFB Realistic Baseline.
Drivers of Entitlement Spending Growth (Percent of GDP)
Source: CBO Long-term Budget Outlook, 2010.
How the Automatic Cuts Will Work
DETERMINE THE SIZE OF CUTS
Evenly split each year’s cut
between defense and
E Evenly among FY 2013-21
percent in debt
ALLOCATE CUTS ACROSS DEFENSE AND NON-DEFENSEACCOUNTS
Mandatory Accounts all years
After exempting certain programs,
percentage cuts to all
accounts to achieve
the required savings.
apply a uniform percentage cut to
all accounts to achieve the required
savings. Medicare cuts cannot
exceed 2 percent.
Lower the statutory
cap on total discretion-
ary spending by the
amount necessary to achieve the required savings
Exemptions include: •SocialSecurity•Medicaid •Civilian and military retirement
` CBO, Director’s blog, September 12, 2011, http://cboblog.cbo.gov/?p=2719
“ In the past year, 40 states and Washington, D.C. have cut funds to public health, 30 states cut their budgets for the second year in a row and 15 of those have cut their budget three years in a row. Since 2008, 49,310 state and local public health department jobs have been lost. Federal funds for state and local preparedness declined by 38 percent from fiscal year (FY) 2005 to 2012 (adjusted for inflation) — and additional cuts are expected under budget sequestration.”
Ready or Not? Protecting The Public’s Health From Diseases, Disasters, And Bioterrorism, 2011, The Trust for America’s Health, www.healthyamericans.org/assets/files/TFAH2011ReadyorNot_09.pdf
“Left in the wreckage of the ‘Super Committee’ process are plans to automatically impose unprecedented cuts in health care programs—cuts that will within weeks endanger Medicare beneficiaries’ and military families’ access to care, and later, cause unsustainable cuts to many other critical programs to reduce disease, protect public health and safety, and ensure that patients have access to doctors.”
Virginia L. Hood, MBBS, MPH, FACP , President, American College of Physicians, November 21, 2011, www.acponline.org/pressroom/no_agreement_deficit_plan.htm?hp
“Unless we begin the process of developing a long-term solution, we will once again be faced with the unwanted choice of extending a fundamentally broken payment system or jeopardizing access to care for Medicare beneficiaries. We cannot let either happen.”
House Energy and Commerce Committee, March 28, 2011 letter to physician membership organizations, including ACP
“Instead of replaying the tired old script of arguing over whether the cut should be delayed for two months or two years, Congress must do the right thing and enact a permanent solution. At Congress’ request, ACP put forward concrete proposals to eliminate the SGR . . . and transition to new . . . delivery models, and ACP even gave Congress proposals to help pay for it. When will Congress do its part and join with us to develop a bipartisan plan to end the recurring SGR nightmare?”
Dr. Virginia Hood, ACP President, December 19, 2011, www.acponline.org/pressroom/srg_medicare_cut.htm
23% or more
7% or less
Data: U.S. Census Bureau, 2009–10 Current Population Survey ASEC Supplement; estimates for 2019 by Jonathan Gruber and Ian Perry of MIT using the Gruber Microsimulation Model for The Commonwealth Fund.
Source: Commonwealth Fund State Scorecard on Child Health System Performance, forthcoming 2011.
“Physicians should help the community and policymakers recognize and address the social and environmental causes of disease, including human rights concerns, discrimination, poverty, and violence. They should work toward ensuring access to health care for all persons . . .”
“Physicians, patient advocates, insurers, and payers should participate together in decisions at the policy level; should emphasize the value of health to society; should promote justice in the health care system; and should base allocations on medical need, efficacy, cost-effectiveness, and proper distribution of benefits and burdens in society.”
“Physicians should not engage in strikes, work stoppages, slowdowns, boycotts, or other organized actions that are designed, implicitly or explicitly, to limit or deny services to patients that would otherwise be available. In general, physicians should individually and collectively find advocacy alternatives, such as lobbying lawmakers and working to educate the public, patient groups, and policymakers about their concerns.”
ACP Ethics Manual: American College of Physicians Ethics Manual: Sixth Edition Lois Snyder, for the American College of Physicians Ethics, Professionalism, and Human Rights Committee, Ann Intern Med January 3, 2012 156:73-104; http://www.annals.org/content/156/1_Part_2/73.full#fn-group-1
“ ‘I say! You are blocking my path. You are right in my way. I’m a North-Going Zax and I always go north. Get out of my way, now, and let me go forth!’
‘Who’s in whose way?’ snapped the South-Going Zax. ‘I always go south, making south-going tracks. So you’re in MY way! And I ask you to move and let me go south in my south-going groove.’
Then the North-Going Zax puffed his chest up with pride. ‘I never,” he said, ‘take a step to one side. And I’ll prove to you that I won’t change my ways if I have to keep standing here fifty-nine days!”’
‘And I’ll prove to YOU,’ yelled the South-Going Zax, ‘That I can stand here in the prairie of Prax for fifty-nine years! For I live by a rule That I learned as a boy back in South-Going School. Never budge! That’s my rule. Never budge in the least! Not an inch to the west! Not an inch to the east! I’ll stay here, not budging! I can and I will if it makes you and me and the whole world stand still!’”
“But the World Didn’t Stand Still!”
From Dr. Seuss, The Sneetches and other Stories, 1961