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Politics and Your Practice: The GOP Challenge


President Bush is running out of time. Lame-duck status awaits him after November's midterm elections, giving him a year - at most - to pass his healthcare agenda. Here are some policy predictions.

President Bush's aggressive plan for changing healthcare and the private practice environment is in trouble.

Why? The Republicans' firm control of both the House and Senate may be weakened in the November 2006 midterm Congressional elections.

Although only 12 of the 435 House seats and just a handful of Senate seats are likely to be competitive, and Democrats - needing 15 pickups in the House and six in the Senate - are unlikely to gain control of either body, they do stand a good chance of trimming the GOP's margins. That alone will make governing more difficult, especially in the Senate, where parliamentary tactics can keep legislation bottled up interminably.

Historically, the sixth year of a reelected president's time in office can be disquieting politically, with major losses of seats in Congress for the ruling party.

In any case, Washington will become obsessed with the 2008 presidential election by the end of 2007, giving Bush a year, at most, to get his healthcare agenda passed.

With that timetable and the political landscape affecting decision-making in mind, here's some speculation on what will happen over the next six months regarding several issues important to physicians:

Medicare physician payment: This is looking like a fraternity food fight. Physicians want to be paid more; senior citizens want to be assured of getting treated by a physician they trust; the government wants to save money by reducing physician payments. Most solutions will cost money, which the government does not have. On top of that, Medicare chief Mark McClellan, MD, has told the American Medical Association that physicians might have to show improvements in the care they provide - through pay-for-performance or other measurements - before seeing any improvement in compensation.

Prediction: Republicans will find some way to make it appear they're helping everyone while actually doing nothing. In the long term, I expect some of this year's newly elected legislators will arrive in Washington ready to work with innovators to develop new ways of compensating physicians. A new Congress and president will propose a comprehensive solution in 2009.

Electronic health records (EHRs): Presidential aspirants as disparate as Sen. Hillary Rodham Clinton (D-N.Y.) and former House Speaker Newt Gingrich have embraced EHRs. Physicians continue to implement EHRs into their practices even without federal financial support. But federal mandates on standards and use by small practices are problematic.

Prediction: Some small financial incentives for a limited number of practices will make it through Congress.

Medical liability reform: Senate Majority Leader Bill Frist (R-Tenn.) has only six months to realize his goal of federal caps on noneconomic damages in liability suits. Frist hopes tort reform will be a winning issue for him in his likely run for president in 2008. Clinton also plans to make use of the issue.

Prediction: Nothing happens. With caps in place in 30 states, there's not as much pressure for a federal solution.

The 2006 campaign is a warm-up for 2008 - which will be the first presidential campaign since 1928 without a sitting president or vice president running for the nation's top office. This could make it the most hotly contested campaign in many years - no small feat considering our two most recent presidential elections. With so much at stake, most politicians are afraid to take on issues that could hurt them at the polls. Of course, your job as physicians and voters is to force politicians to be responsible.

Hold their toes to the fire.

What do you think? Write me at kkarpay@physicianspractice.com. The views expressed here are my own, and do not necessarily reflect those of Physicians Practice.

This article originally appeared in the April 2006 issue of Physicians Practice.

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